Level Of Bladder Neck Research Articles

Modified three-layer vesicourethral reconstruction in robot-assisted radical prostatectomy can change cystography pattern and improve early recovery of continence.

To determine early continence outcomes after three-layer vesicourethral reconstruction during robot-assisted radical prostatectomy (RARP) and the role of postoperative cystography pattern. Between May 2015 and January 2019, a total of 170 consecutive patients with localized prostate cancer who underwent RARP, were divided into one- and three-layer groups based on the method of vesicourethral reconstruction. Continent status, preoperative, intraoperative, postoperative, clinicopathological variables, and cystography parameters were analyzed. The patients were followed up for at least 12 months. Of the 170 consecutive patients, 85 with one-layer vesicourethral anastomosis, and 85 with three-layer reconstruction. The continence rates immediately after catheter removal, 4, 12, and 24 weeks after RARP were 47.1%, 75.3%, 92.9%, and 98.8% in the three-layer group; compared to 15.3%, 60%, 78.8%, and 90.6% in the one-layer group, respectively. In the multivariate analysis, three-layer reconstruction was the only independent variable with a 42% risk reduction of postprostatectomy incontinence (hazard ratio (HR): 0.58, 95% confidence interval (CI) = 0.42-0.80, p = 0.001). Cystography in the three-layer group revealed less anastomotic leakage, less sharp bladder neck angle, and higher bladder neck level category. Three-layer anatomical reconstruction demonstrated promising early continence outcomes, and postoperative cystography revealed a specific pattern more associated with continence.

T-L technique for HoLEP: perioperative outcomes of a large single-centre series.

IntroductionThe aim of this article was to describe, step-by-step, an original technique (T-L technique) in a single centre series of patients who underwent holmium laser enucleation of the prostate (HoLEP) for symptomatic benign prostatic hyperplasia and analyze perioperative outcomes.Material and methodsWe retrospectively analyzed data of 567 patients who underwent HoLEP. The T-L technique consists of a series of incisions used as landmarks, performed at the beginning of the procedure before enucleation. Two T-shape incisions are performed at the level of bladder neck (at the 5-7 and 12 o’clock positions); two L-shape incisions are performed at the level of verumontanum, bilaterally, to mark the apex and to limit the sphincter. Another T-shape incision is performed on the bladder neck at the 12 o’clock position posterior to the level of verumontanum.ResultsThe median operative time (OT) was 80 minutes (IQR 64–105); 50 minutes (IQR 35–70) and 15 minutes (IQR 10–20) for enucleation and the morcellation phase, respectively. Conversion to transurethral resection of the prostate (TURP) was necessary in 3/567 (0.6%) patients. Intraoperative complications occurred in 3.4% of cases, capsule perforation occurred in 12/567 (2%) of cases, while bladder perforation during morcellation occurred in 8/567 (1.4%) of cases. Postoperative complications were observed in 20/567 (3.5%) of patients. Specifically, grade 1–2 occurred in 19/567 (3.3%) and grade 3 was recorded in 1/567 (0.2%).ConclusionsThe T-L technique for HoLEP is safe and reproducible with a low rate of perioperative complications. The positioning of some landmarks before enucleation allows for the better orientation during enucleation and could be very useful in case of large prostates.

Is "extreme" bladder neck preservation in robot-assisted radical prostatectomy a safe procedure?

The aim was to investigate the surgical and pathological outcomes of an "extreme" bladder neck preservation in prostate cancer patients treated with robotic radical prostatectomy. The greatest concern about the "extreme" bladder neck preservation is the potential risk of creating a positive surgical margin at the level of bladder neck. We prospectively collected data from 88 patients with diagnosed prostate cancer who underwent robotic radical prostatectomy with "'extreme' bladder neck preservation." All surgical procedures were performed by the same expert surgeon (F.D.M.). In this study, "'extreme' bladder neck preservation" was considered when the length of the spared intraprostatic segment of bladder neck was ⩾1 cm. We compared the histopathologic data with those of a homogeneous similar cohort of 88 consecutive patients who underwent robotic radical prostatectomy without bladder neck preservation. The two groups analyzed were comparable according to clinical and pathological characteristics. A positive surgical margin at the level of bladder neck was found in five (5.7%) cases in the "extreme" bladder neck preservation group and in six cases (6.8%) in the no-bladder neck preservation group. The prostatic base was involved by neoplasia in 14 and 19 patients (15.9% and 21.6%, respectively); of these, five (35.7%) and six (31.6%) had positive surgical margin at the level of bladder neck, respectively. The pathological staging in positive surgical margin at the level of bladder neck patients was pT3 in five (100%) cases in the "extreme" bladder neck preservation group and in four (66.7%) cases when we decided not to preserve the bladder neck. We demonstrated that "extreme" bladder neck preservation is a safe oncological procedure with similar pathologic findings of a comparable no-bladder neck preservation series. Positive surgical margins at the level of bladder neck are linked to neoplasia with adverse pathological features, rather than the "extreme" bladder neck preservation procedure.

Sacrospinous hysteropexy with a low weight transvaginal polypropylene mesh for treatment of complete uterovaginal eversion.

ABSTRACTIntroduction Pelvic Organ Prolapse (POP) is a common condition in elderly resulting from the weakening of the organ suspension elements of multifactorial origin. It compromises significantly the quality of life and can affect more than 50% of multiparous women. Stage IV prolapse or complete uterovaginal eversion corresponds to 10% of the cases and the only form of curative treatment is the surgical correction. The aim of this video is to demonstrate our technique of sacrospinous hysteropexy with a low weight transvaginal polypropylene mesh for treatment of this challenge condition, focusing on technical details in order to prevent mesh related complications. Major, but rare complications, include: infection, prolapse recurrence, abscess formation, bladder perforation and urinary fistula. These situations are related mostly to low volume centers.Materials and Methods A 70 years old female with a stage IV POP had obstructive lower urinary tract symptoms. Only after reducing prolapse, it was possible to urinate, but without stress urinary incontinence. No topic estrogen was prescribed before the surgery and she also didn´t take any kind of hormone replacement therapy. Transvaginal ultrasound and the Pap smear screening were done with normal results. Cystoscopy wasn´t employed at anytime of this procedure. Hydrodissection of vaginal wall was followed by longitudinal incision from the level of bladder neck to the cervix. Notice that the ideal dissection should maintain the vaginal thickness, and address the plane of the connective tissue between the bladder and the vagina. Bladder base is then released from the anterior aspect of the cervix in order to create a site to pericervical ring repair and to fix the apex of the Calistar Soft® with polypropylene 3.0 stitches. A blunt dissection extended downwards through the lateral aspect of the levator ani fascia till the identification of the ischial spine and sacrospinous ligaments bilaterally. Two polypropilene 2.0 threads mounted on a specially designed tissue anchor system (TAS) are then fixed into each sacrospinous ligament 1.5 to 2 cm away from the ischial spine and repaired for further prosthesis anchoring. Then, a longitudinal incision is done at the posterior vaginal wall and the recto-vaginal fascia detachment from the posterior aspect of the pericervical ring is identified and corrected with interrupted polypropylene 2.0 stitches to the cervix and to the pericervical aspect of elongated uterosacrus ligaments bilaterally. The Calistar Soft A (anterior) and P (posterior)® prosthesis were fixed at the anterior and posterior aspects of the cervix, respectively, with interrupted polypropylene 3.0 stitches and meshes’ arms are fixed to the sacrospinous ligament using the previously implanted TAS. Then, the distal Calistar Soft A® arms were bilaterally fixed into the internal obturator muscles using its fish spine–like multipoint fix device in order to prevent mesh folding. Finally, perineal body repair was done and vaginal wall was closed with individual absorbable interrupted polyglactin 2.0 sutures and a 16 Fr Foley catheter as well as a vaginal pack embedded on neomicin-bacitracin cream were kept overnight.Results A high satisfaction rate has been computed with synthetic mesh to POP surgery correction. Approximately 10% of cases of mesh exposure may occur, most of them oligosymptomatic and easy handed by excision or with topic estrogen preparations. After 1 year follow-up, our patient is still satisfied without any complain and no relapse. Conclusion: We described a successful treatment of stage IV POP in an old female patient. This technique can be used for advanced end stage POP patients, especially those with some contraindication to sacropromontopexy, but who want to keep vaginal length and uterus. Anatomical knowledge, obedience to technical care, and intensive training are the keys for minimizing the risk of complications. Although we had success with this technique, more studies with proper randomization are necessary to compare success and complications of sacrospinous hysteropexy with a low weight transvaginal polypropylene mesh to sacropromontopexy.

Long-term renal outcome in infants with congenital lower urinary tract obstruction

Congenital Lower Urinary Tract Obstructions (LUTO) is a heterogeneous group of diseases in which urine elimination is obstructed at the level of bladder neck or urethra. The aim of the study is to evaluate the long-term renal outcome of patients suffering of congenital LUTO. We retrospectively reviewed patients with congenital LUTO. All patients had at least 1 year follow-up. Data on surgery, renal imaging and Schwartz estimate creatinine clearance were collected. Incidence of Chronic Renal Disease (CRD) is presented with Kaplan-Meier method. 40 patients were included, 23 patients with Posterior Urethral Valve (PUVs) and 17 patients with other aetiologies: anterior urethral valve (2), urethral atresia (2), urethral stenosis (2), cloacal malformations (2), obstructive ureterocele (1), bladder trigone malformation (1) and neonatal bladder-sphincter dysfunction without neurological abnormalities (7). Incidence of CRD at age 10 years was 37% in congenital LUTO, 42% in PUVs and 30% in other aetiologies, and was significantly higher in PUVs (P=0.032). Renal prognosis was significantly worsened by discover of retentional bladder wall changes in initial cystoscopy, and by loss of parenchymal differentiation or cortical microcysts in first ultrasonography. The use of urinary diversion was significantly higher in LUTO of other aetiologies. A high incidence of CRD is observed in patients with congenital LUTO, significantly higher in patients with PUV. LUTO of other aetiologies require step by step surgical management and higher use of urinary diversion. Precise initial evaluation in cystoscopy and ultrasonography is required and participate to evaluate future renal outcome. 4.

Possible predictor of early recovery on urinary continence after laparoscopic radical prostatectomy - Bladder neck level and urodynamic parameters.

To investigate the relationship between post-operative bladder neck levels and urodynamic parameters and their effect on urinary incontinence after laparoscopic radical prostatectomy (LRP). Forty-eight consecutive patients undergoing LRP were retrospectively reviewed. All patients were assessed using retrograde cystography after LRP and were grouped according to their bladder neck position: Level 0: at or above the superior margin of the symphysis pubis (SMSP); Level -1: at <2cm below SMSP; and Level -2: at >2cm below SMSP. Urodynamic studies were conducted at baseline as well as at 1 and 3 months post-operatively. Early recovery of urinary continence was defined as no urine leakage or only one pad/day used within 3 months after surgery. Demographic characteristics, changes in urodynamic parameters, and continence outcomes were analyzed. Overall rate of early recovery of urinary continence was 33.3%. Patients with higher bladder neck levels experienced a significantly earlier recovery of urinary continence in univariate analysis (77.8%, 29.2%, and 13.3% for bladder neck levels 0, -1, and -2, respectively, p=0.004). Patients with early recovery of urinary continence had significantly longer functional profile lengths (FPLs) 1 month post-surgery (21.0mm vs 14.8mm, p=0.019). Higher bladder neck levels were significantly associated with longer FPLs at 1 month (p=0.032). Bladder neck level is associated with FPLs at 1 month post-surgery, which is the possible predictor of early recovery of urinary continence after LRP. Patients with longer FPL at 1 month after LRP have a higher rate of early recovery of urine continence.

PD01-03 VIDEOURODYNAMIC CHANGES AND THE PREDICTORS OF EARLY RECOVERY ON URINARY CONTINENCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2016PD01-03 VIDEOURODYNAMIC CHANGES AND THE PREDICTORS OF EARLY RECOVERY ON URINARY CONTINENCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY Hsu-Che Huang, Yuan-Hong Jiang, and Hann-Chorng Kuo Hsu-Che HuangHsu-Che Huang More articles by this author , Yuan-Hong JiangYuan-Hong Jiang More articles by this author , and Hann-Chorng KuoHann-Chorng Kuo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2023AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although laparoscopic radical prostatectomy (LRP) is effective in treatment of localized prostate cancer, patients might suffer from stress urinary incontinence (SUI) after LRP. This study investigated the changes of videourodynamic parameters after LRP and impact on urinary incontinence METHODS A total of 48 male patients underwent LRP received videourodynamic study (VUDS) at baseline, 3 months and 6 months after operation. The changes of urodynamic parameters including detrusor pressure (Pdet), voided volume, cystometric bladder capacity (CBC), maximum flow rate (Qmax), postvoid residual (PVR), maximal urethral closure pressure (MUCP) and functional profile length (FPL) were measured at 3 and 6 months after opeation. The bladder neck (BN) level to the superior margin of the symphysis pubis (SMSP) after LRP was also measured 7 to 10 days after opeartion by retrigrade cystography. The BN level at or above SMSP was defined as 0, and BN level below SMSP more than 2 cm was defined as -2, otherwise, the BN level was -1. The SUI condition was evaluated by questionare during out-patient clinic follow up. RESULTS The overall SUI rate was 66.7%,47.9%, and 16.7% at 3,6,12 months after LRP, respectively. MUCP, FPL and Pdet significantly declined from 62.6cmH2O, 48.7mm and 41.8cmH2O, which was measured at baseline, to 46.4cmH2O,16.8mm and 25.4cmH2O at 6 months, respectively. Among patients with SUI at 3 months and 6 months after operation, the MUCP level at 3 months and bladder neck level were significantly lower than patients without SUI. For patients with prolonged SUI (12 months postoperatively), the MUCP at 3 months showed significant association. (Table.1 and Table. 2) CONCLUSIONS BN level and MUCP can strongly predict the early continence recovery after LRP. The BN level not below the symphysis pubis and higher MUCP level at 3 months after operation are associated with an early recovery of SUI after LRP © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e46 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Hsu-Che Huang More articles by this author Yuan-Hong Jiang More articles by this author Hann-Chorng Kuo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Management of Urinary Incontinence in Complete Bladder Duplication by Injection of Bulking Agent at Bladder Neck Level into the Proximal Urethra.

Bladder duplication is a rare entity in children. The term encompasses a wide spectrum of anomalies from isolated bladder duplication in coronal or sagittal planes to duplicated bladder exstrophy and associated musculoskeletal and visceral anomalies. Given this wide variability, the treatment of these patients is not standardized. We hereby present a female patient with chief complaint of long-standing urinary incontinence who had complete bladder and urethral duplication and pubic diastasis. The patient was treated with bulking agent injection at the incompetent bladder neck and proximal urethra with resolution of incontinence, obviating the need for extensive surgeries.

A Specific Cystography Pattern Can Predict Postprostatectomy Incontinence.

Postprostatectomy incontinence (PPI) is one of the most bothersome complications of radical prostatectomy. A postoperative image survey may better predict PPI than a preoperative survey. The aim of this study was to determine whether postoperative cystography bladder patterns can predict PPI at short- and long-term follow-up. In total, 180 patients who underwent robot-assisted radical prostatectomy (RARP) from September 2008 to September 2014, and who were followed for at least 6 months, were enrolled in this study. All patients underwent cystography within 2 weeks after RARP before Foley catheter removal, and all parameters were analyzed to evaluate the relationship with PPI at 1, 6, 12, and 24 months post-RARP. Patients were also divided into four bladder neck level groups, according to the relative position of the bladder neck to the pubic symphysis. A total of 119 patients were followed for at least 48 months after RARP. Cystography patterns were analyzed, including the downward bladder neck, bladder height, bladder width, height to width ratio, and bladder neck angle. A more downward bladder neck and a sharper bladder neck angle were significant predictors of PPI at 1, 6, 12, and 24 months after RARP. Patients with a larger bladder height or height to width ratio (prolate bladder shape) tended to have poor outcomes regarding PPI. Clinicians can also use a bladder neck level classification to rapidly predict the outcome of PPI. Postoperative cystography is a reliable and cost-effective tool for predicting PPI. A more downward bladder neck and a sharper bladder neck angle have the greatest predictive power for short- and long-term PPI.

V1024 STEP BY STEP TECHNIQUE OF PHOTOSELECTIVE VAPORIZATION WITH THE GREENLIGHT XPS 180 W LASER FOR PROSTATIC ADENOMAS > 80 CC

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence) & Infection1 Apr 2012V1024 STEP BY STEP TECHNIQUE OF PHOTOSELECTIVE VAPORIZATION WITH THE GREENLIGHT XPS 180 W LASER FOR PROSTATIC ADENOMAS > 80 CC Marie Aimee Perrouin Verbe, Maxime Thoulouzan, Francky Delage, and Georges Fournier Marie Aimee Perrouin VerbeMarie Aimee Perrouin Verbe Brest, France More articles by this author , Maxime ThoulouzanMaxime Thoulouzan Brest, France More articles by this author , Francky DelageFrancky Delage Brest, France More articles by this author , and Georges FournierGeorges Fournier Brest, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1128AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Greenlight XPS 180W laser and the MoXy liquid-cooled fiber provide up to 180W lasing energy and increase the surface of tissue treated with the laser beam. When compared with the Greenlight HPS 120W laser, this device increases the vaporization speed and allows the management of prostatic adenomas larger than 80 cc. METHODS For all procedures we used real time transrectal ultrasonography navigation, and a 23 Fr cystoscope with a 30° lens. Vaporization starts at the bladder neck. The first step is the creation of a central channel at the lower power of 120W to create a working space and improve irrigation, then the power can be increased up to 180W and the lateral lobes are lasered from the bladder neck to the veru montanum. Maximal efficiency of vaporization, assessed by bubbles generation, is obtained with a working distance of the laser from the tissue between 1 and 3 mm. At the end of the procedure, lasing energy must be decreased under 100W at the level of bladder neck and near the prostate capsule. RESULTS The Greenlight 180W XPS laser provides a faster vaporization when compared with the Greenlight 120W HPS laser. CONCLUSIONS This device allows the management of patients with prostatic adenomas larger than 80cc, which usually undergo open prostatectomy, in a safe manner and with an acceptable operative time. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e417 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marie Aimee Perrouin Verbe Brest, France More articles by this author Maxime Thoulouzan Brest, France More articles by this author Francky Delage Brest, France More articles by this author Georges Fournier Brest, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

T05-O-16 Cystoscopically and laparoscopically bipolar approach for the extraction of an endovesical electric cable inserted for sexual stimulation

A large variety of foreign body was described at the level of bladder. Even the diagnostic is no difficult, especially with the radiological methods, the treatment can be a challenging problem for the urologist for safely and minimalinvasive removal of this foreign body. A 22-year-old male was reffered to our emergency room for a acute urinary retention due to the presence of a foreign body at the level of uretra. Clinical exam and pelvis radiography present an opac structure with a knot at the bladder neck level makeing extraction of the cable impossible. Cystoscopic exam confirm the radiological image. A 10 mm laparoscopic trocar was introduced suprapubically and a 10 mm scissor cut the electric cable and his knot under a cystoscopic control. The electric cable was extract via laparoscopic trocar with the 10 mm laparoscopic forceps. An 18 ch urethro-vezical catheter and a Retzius drainage tube at the percutaneous approach point was inserted. Operative time was 30 minutes. No major analgesic therapy was required. The Retzius drainage tube was extracted the next day and the patient was released the second postoperative day. A prophylactic antibiotic treatment was maintained 10 postoperatory days. Urethro-vesical drainage tube was extracted 7 after the surgical intervention. Bladder foreign body extraction-an electric cable in this case-can be performed by a bipolar approach transurethral and suprapubic, combaining the laparoscopy and cystoscopy advantages.

Comparison of two experimental models of urodynamic evaluation in female rats

Urodynamic studies in small animals can be performed through urethral sounding or cystostomy. To compare the two methods of urodynamic evaluation in female rats. Ten female rats weighing on average 250 g, under anesthesia with urethane (1.25 mg/kg) were submitted in three repeats to an urethal catheter of 0,64 mm in external diameter for cystometric measurements of vesicle pressure(VP1) and contraction time (CT1). The catheter was extracted at a constant velocity of 0.05 cm/minute until complete exteriorization and determinations of maximal urethral pressure (UP1) and functional urethral length (FUL1). This was followed by a cystostomy with catheter PE50 and a new determination of the vesical pressure (VP2). After bladder denervation, a new cystometric record indirectly infered the maximum urethral closure pressure (UP2). The peak urethal pressure (UP3) and the functional urethral length (FUL2) were determined in another urethral sounding. The pressure registration system consisted of a continuous infusion pump regulated to a flow of 0.1 ml/minute connected both to the cystostomy catheter (PE-50) or the urethal catheter (0.64 mm) and the polygraph Narco-Biosystem. Statistical analysis employed the Wilcoxon non-parametric test Mean VP1= 48.2 mmHg (11,8 SD); Mean VP2 = 38.2 mmHg (9.0 SD) "p" (VP1 X VP2) = 0.0039. Mean CT1=30.2 s (21.5 SD); Mean CT2=20.0 s(7 SD) p (CT1 X CT2) = 1.28. Mean UP1 = 47.2 mmHg (6.5 SD); Mean UP2 = 21.3 mmHg (6.6 SD), mean UP3 = 40.7 mmHg(13.3 SD) p (UP1 X UP2) = 0.002; "p" (UP1 X UP3) = 0.084; p (UP2 X UP3) = 0.002. Mean FUL1=14.2 mm (1.9 SD); Mean FUL2= 14.1 mm (1.9 SD); p (FUL1 X FUL2) = 0.64. The methods employed to evaluate vesical and urethral pressures are different. The presence of the urethral catheter may be an obstructive factor. Surgical denervation up to the bladder neck level does not compromise urethral function.

Bladder Outflow Obstruction: An Unusual Presentation Of Mucocele Of The Appendix

Bladder outflow obstruction in elderly males usually results from an intrinsic narrowing at the level of bladder neck, prostate or the urethra. We report a case where obstruction to the bladder outflow resulted from an extrinsic compression by an appendicular mucocele, an unusual mode of presentation of this pathological entity.

88 The adjustable continence therapy (PROACT™) for the treatment of post‐prostatectomy stress urinary incontinence: a comparison of two techniques

Introduction: The Adjustable Continence Therapy (ProACT™) consists of two postoperatively adjustable balloons placed either at the level of bladder neck in postradical prostatectomy patients or, more recently, at the level of the apex in patients with residual prostate tissue. We compared the efficacy of ProACT in post radical and benign surgery patients.Materials and Methods: Thirty postradical prostatectomy (RP) and seven postbenign surgery have been evaluated beyond 6 months follow up. Three of the RP and one in the benign group had also undergone radiation therapy. Baseline assessment of pad usage; Quality of Life questionaries and assessment of adverse events were repeated at 6, 12, 24 and 36 months.Results: Mean follow‐up was 18.9 months in the RP group and 27.8 months in the benign group. Pad usage in the RP and postbenign group decreased from 2.6 and 3.8 at baseline to 0.7 and 1.2 at 6 months; 0.5 and 1 at 12 months; 0.6 and 1 at 24 months and 0.4 and 0.7 at 36 months respectively. Quality of Life increased in the RP and benign group from 49.6 and 49.7 at baseline to 71.7 and 77.9 at 6 months; 74.9 and 78.6 at 12 months; 70.6 and 76.1 at 24 months and 88 and 86.5 at 36 months respectively. Adverse events including balloon migration (two) and infection (three) were managed by outpatient removal and further re‐implantation.Conclusions: The results appear similar in both groups, though different techniques are required.

FEMALE EPISPADIAS REPAIR: A NEW 1-STAGE TECHNIQUE

No AccessJournal of UrologyPEDIATRIC UROLOGY1 Aug 2000FEMALE EPISPADIAS REPAIR: A NEW 1-STAGE TECHNIQUE TOM P.V.M. DE JONG, PIETER DIK, and AART J. KLIJN TOM P.V.M. DE JONGTOM P.V.M. DE JONG More articles by this author , PIETER DIKPIETER DIK More articles by this author , and AART J. KLIJNAART J. KLIJN More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67409-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Female epispadias is a rare anomaly. According to the literature it is usually treated with staged procedures, including bladder neck reconstruction, to achieve continence. We developed a 1-stage surgical technique that offers the possibility of achieving continence and a cosmetically normal appearance of the vulva. Materials and Methods: We treated 4 patients 4 months to 8 years old. The main point of the technique is to free completely the urethral plate and bladder neck from surrounding tissue. After tubularizing the urethral plate into a urethra modified needle suspension brings the bladder neck and proximal urethra into the intra-abdominal position. The pelvic floor is then reconstructed between the anterior vaginal wall and urethra. Thus, continence may be attained by intra-abdominal positioning of the bladder neck and proximal urethra as well as by pelvic floor reconstruction. Results: Of our 4 consecutive cases of primary untreated epispadias the technique proved successful in 3, while followup is too short in 1. One patient is completely dry and voids without a further procedure. Postoperatively 2 patients with 5 years or more of followup required injection of a bulking agent at the bladder neck level to achieve continence, including 1 who is damp during the day without the need to change clothes and 1 on clean intermittent catheterization twice daily because post-void residual urine volume causes recurrent urinary tract infection. Conclusions: The described technique is promising for treating this disabling anomaly. References 1 : Congenital epispadias with incontinence. J Urol1949; 62: 513. Link, Google Scholar 2 : Bladder prolapse in a female infant with complete epispadias. J Urol1997; 157: 1438. Link, Google Scholar 3 : Epispadias. In: . Chicago: Year Book Medical Publishers1979: 1377. chapt. 123. Google Scholar 4 : Surgical correction of female epispadias. Eur Urol1982; 8: 321. Google Scholar 5 : Congenital female epispadias with incontinence. J Urol1981; 125: 558. Link, Google Scholar 6 : Complete genitourinary reconstruction in female epispadias. J Urol1993; 149: 1110. Link, Google Scholar 7 : Female epispadias. J Urol1997; 158: 1543. Link, Google Scholar From the Pediatric Renal Center, University Medical Center Utrecht, Children’s Hospital, Utrecht, The Netherlands© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByCheikhelard A, Aigrain Y, Lottmann H and Lortat-Jacob S (2009) Female Epispadias Management: Perineal Urethrocervicoplasty Versus Classical Young-Dees ProcedureJournal of Urology, VOL. 182, NO. 4S, (1807-1812), Online publication date: 1-Oct-2009. Volume 164Issue 2August 2000Page: 492-494 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.KeywordsvulvaurethraabnormalitiesepispadiasMetricsAuthor Information TOM P.V.M. DE JONG More articles by this author PIETER DIK More articles by this author AART J. KLIJN More articles by this author Expand All Advertisement PDF DownloadLoading ...

Female epispadias repair: a new 1-stage technique.

Female epispadias is a rare anomaly. According to the literature it is usually treated with staged procedures, including bladder neck reconstruction, to achieve continence. We developed a 1-stage surgical technique that offers the possibility of achieving continence and a cosmetically normal appearance of the vulva. We treated 4 patients 4 months to 8 years old. The main point of the technique is to free completely the urethral plate and bladder neck from surrounding tissue. After tubularizing the urethral plate into a urethra modified needle suspension brings the bladder neck and proximal urethra into the intra-abdominal position. The pelvic floor is then reconstructed between the anterior vaginal wall and urethra. Thus, continence may be attained by intra-abdominal positioning of the bladder neck and proximal urethra as well as by pelvic floor reconstruction. Of our 4 consecutive cases of primary untreated epispadias the technique proved successful in 3, while followup is too short in 1. One patient is completely dry and voids without a further procedure. Postoperatively 2 patients with 5 years or more of followup required injection of a bulking agent at the bladder neck level to achieve continence, including 1 who is damp during the day without the need to change clothes and 1 on clean intermittent catheterization twice daily because post-void residual urine volume causes recurrent urinary tract infection. The described technique is promising for treating this disabling anomaly.

The nature of detrusor bladder neck dyssynergia in non-neurogenic bladder dysfunction

There have been two major opinions on the pathology or nature of the bladder neck contracture. One is an organic fibrosis, and the other is an accentuated sympathetic nervous function, or detrusor bladder neck dyssynergia. The existence of active detrusor bladder neck dyssynergia in neurogenic bladder was reported in a urodynamical manner using microtip transducer catheters. However, it has not been confirmed whether or not detrusor bladder neck dyssynergia is responsible for bladder neck contracture in patient without neurogenic bladder. The present study was designed to determine by means of video urodynamic study whether or not bladder neck contracture would be of the same nature as detrusor bladder neck dyssynergia in non-neurogenic bladder subjects. The study included 32 male subjects of 16–84 years old (average 52.3): 17 bladder neck contracture subjects including 7 subjects associated with minimum complications (4 with trapped benign prostatic hyperplasia and 3 with incomplete neurological lesion) and 15 non-bladder neck contracture subjects (10 healthy volunteers, 2 chronic prostatitis, 3 prostatodynia). A 5-microtip transducer catheter was used to measure the pressure in the bladder and at the bladder neck, the external urethral sphincter and the bulbous urethra during voiding. Proper localization of the transducers was done with an image intensifier. Bladder outlet obstruction localized at the bladder neck (diameters smaller than 0.75 cm) on voiding cystourethrogram was defined as bladder neck contracture. Detrusor bladder neck dyssynergia was defined where pressures were higher at the level of bladder neck than in the bladder during detrusor contraction. An alpha-blocker, terazosin hydrochloride (0.5 mg, b.i.d., two weeks), was orally administered to subjects judged to have detrusor bladder neck dyssynergia by the above methods for the purpose of confirming whether detrusor bladder neck dyssynergia was really due to accentuated sympathetic nervous function. Detrusor bladder neck dyssynergia was found in seven cases with bladder neck contracture: 6 cases with bladder neck contracture with minimum complications and only 1 case with bladder neck contracture without complications ( p<0.01). Detrusor bladder neck dyssynergia was found at the beginning and ending of micturition, but not at maximum flow. In six cases with detrusor bladder neck dyssynergia, the condition disappeared after terazosin. In conclusion, detrusor bladder neck dyssynergia was not thought to be a major factor of voiding dysfunction in bladder neck contracture in non-neurogenic bladder. In the presence of sympathetic hyperactivity or in cases with increased number of alphareceptors, detrusor bladder neck dyssynergia occurs, being predominantly noted in trapped benign prostatic hyperplasia and neurological disorder patients.

Innervation of the human vaginal mucosa as revealed by PGP 9.5 immunohistochemistry.

In order to obtain a description of the innervation of the vaginal wall we employed an antiserum against the general neuronal marker, protein gene product 9.5, on normal human vaginal mucosa. Specimens were taken from the anterior and posterior fornices, from the anterior vaginal wall at the bladder neck level and from the introitus vaginae region, and then processed for indirect immunohistochemistry. All regions studied revealed a profound innervation, although regional differences were noted. The more distal areas of the vaginal wall had more nerve fibers compared to the more proximal parts. Also, biopsies from the anterior wall generally were more densely innervated than the posterior wall. Some large nerve coils were observed in lamina propria of the anterior wall as well as gatherings of thick-walled medium-sized blood vessels. Free intraepithelial nerve endings were only detected in the introitus vaginae region. These fibers were very thin, always varicose and could be observed just a few cell layers from the surface. In this part of the vagina, protein gene product 9.5 antibodies also stained cells within the basal parts of the epithelium. These cells were also neurone-specific enolase positive and resembled, from a morphological point of view, Merkel cells.

Urethral Pressure Measurement by Microtransducer

Summary. Urethral pressure measurements were recorded at rest and during stress by a microtransducer technique in 20 women without urinary symptoms and 120 women with urodynamically proven genuine stress in-continence. In the symptom-free women the resting profile values were largely maintained during stress, as a consequence of 100% transmission of intra-abdominal pressure rises to the proximal three-quarters of the functional urethral length. Whilst the majority maintained continence at the bladder neck level, 25% of these controls showed evidence of bladder neck opening during stress. The stress-incontinent patients showed a deficiency of pressure transmission ratios which appeared to have an ‘all or none’ character in the determination of symptoms. The amplitude and stability of the maximum urethral closure pressure at rest, the extent of urethral closure pressure lost in response to stress, and the extent of intra-abdominal pressure rises interact to determine the severity of symptoms or ‘margin to continence’.

Urethral pressure measurement by microtransducer: the results in symptom-free women and in those with genuine stress incontinence.

Urethral pressure measurements were recorded at rest and during stress by a microtransducer technique in 20 women without urinary symptoms and 120 women with urodynamically proven genuine stress incontinence. In the symptom-free women the resting profile values were largely maintained during stress, as a consequence of 100% transmission of intra-abdominal pressure rises to the proximal three-quarters of the functional urethral length. Whilst the majority maintained continence at the bladder neck level, 25% of these controls showed evidence of bladder neck opening during stress. The stress-incontinent patients showed a deficiency of pressure transmission ratios which appeared to have an 'all or none' character in the determination of symptoms. The amplitude and stability of the maximum urethral closure pressure at rest, the extent of urethral closure pressure lost in response to stress, and the extent of intrabdominal pressure rises interact to determine the severity of symptoms or 'margin to continence'.