Abstract
Introduction: Despite improved surgical techniques, exist an increasing number of patients suffering post-prostatectomy stress urinary incontinence (SUI). Some 2-5% of the patients with incontinence after radical prostatectomy exhibit a persistent incontinence for >1 yr postoperatively despite conservative therapy attempts. For these patients surgical treatment is recommended and the artificial urinary sphincter is still the gold standard. The retro-urethral transobturator sling (AdVance®) represents a non-obstructive, functional therapeutic approach. Methods: A 64-year-old male had an elevated PSA level of 6 ng/ml. The DRE findings were negative for palpable nodules and subsequent TRUS-guided needle biopsy of the prostate showed right-sided prostatic adenocarcinoma, Gleason score 7(3+4). The patient underwent a transperitoneal LRP, the tumor was confined to the prostate with negative surgical margins (stage T1cNxMx). The follow-up PSA level was undetectable and 14 months later presented moderate SUI (3-4 pads/daily), despite conservative therapy. A previous urethrocystoscopy was performed to evaluate the sphincter function and the mobility of the posterior urethra (changes achieved by perineal pressure). The AdVance® sling (American Medical Systems) was placed for the treatment of SUI according to the Rehder and Gozzi method, with a total operative time of 40 min and estimated blood loss of 70 mL. The hospital course was uneventful and the patient was discharged on the first post-interventional day. This video demonstrates the surgical technique (step-by-step). Results: After 1 year, complete continence (no pads) was achieved and quality-of-life score improved significantly. Conclusions: The AdVance® represents an effective, safe and minimally invasive treatment option for mildto-moderate SUI post-radical prostatectomy. Int Braz J Urol. 2010; 36 (Video #7): 518_9 Available at: www.brazjurol.com.br/videos/july_august_2010/Rijo_518_519video.htm Correspondence address: Dr. Enrique Rijo Universitat Autonoma de Barcelona Department of Urology. Hospital del Mar Passeig Maritim 25-29 Email: rijo_enrique@yahoo.es doi: 10.1590/S1677-55382010000400030
Highlights
Intravesical chemotherapy and bacillus Calmette-Guérin (BCG) reduce the recurrence rate in patients with stage Ta T1 urothelial bladder cancer; the benefit of BCG relative to chemotherapy for long-term end points is controversial, especially in intermediate-risk patients
Design, Setting, and Participants: From January 1992 to February 1997, 957 patients with intermediate- or high-risk stage Ta T1 urothelial bladder cancer were randomized after transurethral resection to one of three treatment groups in the European Organization for Research and Treatment of Cancer Genito-Urinary Group phase 3 trial 30911
With 837 eligible patients and a median follow-up of 9.2 yr, time to first recurrence (p
Summary
The objective of this study was to determine if later toilet training is associated with urge incontinence in children. Results: Initiation of toilet training after 32 months of age was associated with urge incontinence (P=0.02). Conclusion: For children who display signs of toilet-training readiness, training should be initiated prior to 32 months of age to reduce the risk for urge incontinence. Patients with urge incontinence were trained at a mean age of almost 32 months whereas the control group was trained at just under 29 months. The study shows an association between urge incontinence and potty training at a later age. Each child and family must be looked at individually; we have more evidence to suggest that there may be an “ideal time” to initiate potty training
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