Complete Continence Rate Research Articles

Five-year Results from the Prospective, Multicenter, Observational SOUNDS Study of Patients with Overactive Bladder Treated with the InterStim System for Sacral Neuromodulation

BackgroundAlthough sacral neuromodulation (SNM) for overactive bladder (OAB) is an established therapy, there is a lack of high-quality, long-term data on real-life practice. ObjectiveTo report on real-life therapeutic effectiveness, quality of life (QoL), disease severity, and safety as well as patient-reported symptom bother after approximately 5 yr of follow-up. Design, setting, and participantsA total of 291 OAB patients were enrolled at 25 French sites according to local standard of care. Sacral neuromOdUlation with InterStim therapy for intractable lower uriNary tract DySfunctions (SOUNDS) enrolled both de novo and replacement patients, and a total of 229 patients were permanently implanted. Outcome measurements and statistical analysisOver the course of the study, patients were followed up six times with two follow-ups in the year after implantation and annually thereafter. Of the patients, 154 completed the final follow-up after a mean of 57.7 ± 3.9 mo. Results and limitationsThe mean number of daily leaks in urinary urge incontinence (UI) patients was reduced from 4.4 ± 3.3 at baseline to 1.8 ± 2.6 after 5 yr in de novo and from 5.4 ± 4.9 to 2.2 ± 3.0 in replacement patients (both p < 0.001). Likewise, the number of voids in urinary frequency patients was reduced compared with baseline (de novo: reduced from 12.6 ± 4.0 [baseline] to 9.6 ± 4.3 [5 yr]; replacements: reduced from 11.5 ± 4.3 [baseline] to 9.2 ± 3.1 [5 yr]; both p < 0.05). Complete continence rates after 5 yr were 44% (25/57) in de novo and 33% (5/15) in replacement UI patients, and 68% (39/57) and 67% (10/15) of UI patients were categorized as therapy responders by showing a >50% improvement in leaks. Disease severity (Urinary Symptom Profile domain 2), Numeric Rating Scale–based symptom bother, and disease-specific QoL (Ditrovie) improved significantly in both groups at all visits (p < 0.001). Adverse events related to device or procedure occurred in 51% (140/274) of patients, with 66% (152/229) of the events being classified as minor (Clavien-Dindo grade I and II). Surgical revisions were reported in 39% (89/229), which include permanent explants in 15% (34/229) of patients. ConclusionsSOUNDS demonstrates the sustained effectiveness and QoL improvements of SNM in OAB patients after 5 yr in real-world conditions while maintaining an acceptable safety profile consistent with literature. Patient summaryThis study confirmed that French overactive bladder patients had a sustained symptom and bother reduction, and improvements in quality of life up to 5 yr after sacral neuromodulation device implantation.

MP71-09 WHICH REVISION STRATEGY IS THE BEST FOR NON-MECHANICAL FAILURE OF MALE ARTIFICIAL URINARY SPHINCTER?

MP71-09 WHICH REVISION STRATEGY IS THE BEST FOR NON-MECHANICAL FAILURE OF MALE ARTIFICIAL URINARY SPHINCTER?

Open Radical Cystectomy versus Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Early Outcomes of a Single-Center Randomized Controlled Trial.

Radical cystectomy (RC) with urinary diversion (UD) is still considered a complex surgery associated with significant morbidity. Open RC (ORC) remains the reference option of treatment, even if adoption of robot-assisted RC (RARC) is rapidly increasing. To date, all the available randomized controlled trials were characterized by an extracorporeal approach in performing UD, undermining potential benefits of a totally minimally invasive procedure. In this study, we aimed to report perioperative and 6-month outcomes from the first RCT comparing ORC and RARC with totally intracorporeal UD. Patients were eligible for randomization if they had a diagnostic transurethral resection of bladder tumor with cT2-4, cN0, cM0 or recurrent high-grade nonmuscle-invasive bladder cancer and no anesthesiological contraindications to robotic surgery. Patients were enrolled with a covariate adaptive randomization process based on the following variables: body mass index, American Society of Anesthesiologists® score, baseline hemoglobin, planned UD, neoadjuvant chemotherapy and cT stage. The primary end point was to demonstrate the superiority of RARC with intracorporeal UD in terms of a 50% transfusion rate reduction. Overall, 116 consecutive patients (58 RARC, 58 ORC) were enrolled. Among primary endpoint, overall perioperative transfusion rates were significantly lower in the RARC cohort (RARC: 22% vs ORC: 41%; p=0.046). This prospective randomized trial observed 22% and 41% overall perioperative transfusion rates in patients treated by RARC and ORC, respectively, confirming a significant benefit in favor of RARC with intracorporeal UD. However, perioperative complications, hospital stay and 6-month health-related quality of life were largely comparable between groups. Oncologic and functional outcomes will be assessed at longer followup to observe potential differences between arms.

Prostatectomía radical asistida por robot en el Centro Médico Naval. Experiencia inicial

Introducción: La prostatectomía radical asistida por robot (RARP) es cada vez más utilizada alrededor del mundo. En México existen 13 hospitales que cuentan con equipo de cirugía robótica. En otros países ha demostrado disminuir la morbilidad quirúrgica con la misma efectividad en resultados oncológicos y funcionales.&#x0D; Objetivo: Reportar los resultados de experiencia inicial y seguimiento a corto plazo de RARP en el Centro Médico Naval.&#x0D; Material y métodos: Se realizó una revisión retrospectiva de los pacientes sometidos a RARP en nuestra unidad del 19 marzo 2016 al 30 abril 2018 que cumplieran con al menos 6 meses de seguimiento postquirúrgico.&#x0D; Resultados: Se realizaron 48 RARP, con una media de edad de 64,7 años, APE preoperatorio medio de 10,4ng/dl, con clasificación de riesgo bajo, intermedio y alto de 19, 29 y 52%. El tiempo quirúrgico medio fue de 240 minutos, sangrado medio 223 ml, 3 días de estancia hospitalaria. Se realizó neuropreservación al 56.3%, y se realizó linfadenectomía estándar a 68.8 y extendida a 31.2%. Tasa de bordes positivos del 45.8%. Se reportó falla bioquímica en el 14.6%. Un 12.5% recibieron radioterapia externa postquirúrgica. El tiempo medio de seguimiento fue de 9 meses. Documentamos una tasa de continencia completa en 91,3% de los pacientes y función eréctil suficiente para sexo en el 53,5% de los pacientes.&#x0D; Conclusiones: Reportamos resultados similares a los de la literatura mundial en morbilidad funcional y perioperatoria, en el inicio de nuestra curva de aprendizaje a pesar de tener una población con características de alto riesgo.

AMS-800 Artificial urinary sphincter in female patients with stress urinary incontinence: A systematic review.

To perform a systematic review of studies reporting the outcomes of AMS-800 artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency (ISD). A systematic literature search of the Medline and Embase databases was performed in June 2018 in accordance with the PRISMA statement. No time limit was used. The protocol was registered in PROSPERO (CRD42018099612). Study selection and data extraction were performed by two independent reviewers. Of 886 records screened, 17 were included. All were retrospective or prospective non-comparative case series. One study reported on vaginal AUS implantation, 11 on open AUS implantation, two on laparoscopic AUS implantation, two on robot-assisted AUS implantation and one compared open and robot-assisted implantations. The vast majority of patients had undergone at least one anti-incontinence surgical procedure prior to AUS implantation (69.1-100%). The intraoperative bladder neck injury rates ranged from 0% to 43.8% and the intraoperative vaginal injury rates ranged from 0 to 25%. After mean follow-up periods ranging from 5 to 204 months, the complete continence rates ranged from 61.1% to 100%. The rates of explantation, erosion and mechanical failure varied from 0% to 45.3%, 0% to 22.2% and 0% to 44.1%, respectively. AMS-800 AUS can provide excellent functional outcomes in female patients with SUI resulting from ISD but at the cost of a relatively high morbidity. High level of evidence studies are needed to help better define the role of AUS in the female SUI armamentarium.

Radiotherapy is associated with reduced continence outcomes following implantation of the artificial urinary sphincter in men with post-radical prostatectomy incontinence.

Objectives:The objective of this study is to present the outcomes of men undergoing implantation of artificial urinary sphincter, after treatment for prostate cancer and also to determine the effect of radiotherapy on continence outcomes after artificial urinary sphincter (AUS) implantation.Materials and Methods:A prospectively acquired database of all 184 patients having AUS insertion between 2002 and 2012 was reviewed, and demographic data, mode of prostate cancer treatment(s) before implantation, and outcome in terms of complete continence (pad free, leak free) were assessed. Statistical analysis was performed by Chi-squared and Fisher's exact tests.Results:A total of 58 (32%) men had bulbar AUS for urodynamically proven stress urinary incontinence consequent to treatment for prostate cancer in this period. Median follow-up post-AUS activation was 19 months (1–119). Forty-eight (83%) men had primary AUS insertion. Twenty-one (36%) men had radiotherapy as part of or as their sole treatment. Success rates were significantly higher in nonirradiated men having primary sphincter (89%) than in irradiated men (56%). Success rates were worse for men having revision AUS (40%), especially in irradiated men (33%).Conclusion:Radiotherapy as a treatment for prostate cancer was associated with significantly lower complete continence rates following AUS implantation.

Orthotopic Detaenial Sigmoid Neobladder after Radical Cystectomy: Technical Considerations, Complications and Functional Outcomes

In recent years the orthotopic neobladder has gained increasing popularity in patients who undergo radical cystectomy. However, there are only a few reports of orthotopic neobladders reconstructed from the sigmoid without detubularization. We investigated the complications and functional outcomes of the orthotopic sigmoid neobladder reconstructed using our detaenial technique. We performed a retrospective study of the detaenial sigmoid neobladder in 210 consecutive patients who underwent radical cystectomy at our institution from January 2003 to March 2010. ANOVA was used to investigate urodynamic finding differentials with time. Univariable and multivariable analyses were done to determine factors influencing continence. Median followup was 48 months. Early complications (90 days or less) were observed in 65 patients (31%). Late complications (greater than 90 days) were observed in 45 patients (21.5%). Five-year daytime and nighttime complete continence rates were 74.6% and 57.1%, respectively. Younger age was the only independent factor associated with complete continence during the day (OR 2.342, 95% CI 1.803-3.041, p <0.001) and night (OR 1.193, 95% CI 1.087-1.310, p <0.001). Mean maximal capacity and post-void residual urine were 328.8 and 22.2 ml, respectively. The mean maximal flow rate was 18.5 ml per second. The mean end filling pressure, pressure at maximal capacity and maximal intravesical pressure were 35.8, 55 and 60.6 cm H2O, respectively. These parameters remained stable with time (each p >0.05). This study confirms that detaenial sigmoid neobladder is a safe, feasible alternative for urinary diversion.

Stuhlverhalten und lokale Schmerzen nach perinealer und retroperitonealer radikaler Prostatektomie

One of the main therapeutic targets of a radical prostatectomy (RP) as a treatment for -localised prostate cancer is the maintenance of quality of life after surgery besides the known oncological and functional effects. This prospective study compared the quality of life after surgery of patients treated with two different surgical methods (perineal RP, RPP; retropubic RP, RRP). The aim of this study was to compare perineal and retropubic RP with regard to stool behaviour and local pain symptoms. 257 radical prostatectomies (169 RPP, 88 RRP) were performed between July 2003 and December 2004. 208 (151 RPP, 57 RRP) prospectively evaluated patients replied to a physician-independent validated questionnaire (QLQ-C30 with prostate modul, IIEF 75, stool behaviour) followed by a phone survey regarding the continence of all 257 patients. One year after surgery, the complete continence rate (no pads) was 75 % for the RPP group and 61 % for the RRP group. 22 % of the patients reported involuntary stool leakage in the RPP group and 19 % in the RRP group (not significantly different). 29 % of the patients in the RPP group complained of local pain after 12 months, one third of them while sitting. In the RRP group, 28 % of the patients complained of local pain after 12 months, 15 % of them while sitting.17 % in the RPP and 27 % in the RRP group who suffered of stool leakage had these symptoms preoperatively. One year after surgery, 52 % of preoperatively potent patients were still potent after nerve-sparing RPP and 40 % were potent after nerve-sparing RRP. 78 % of patients in the RPP group and 67 % in the RRP group had an overall satisfactory quality of life. The application of different surgical methods did not differ with regard to postoperative local pain, stool behaviour, or general health items of quality of life. Stool leakage and perineal pain while sitting were not limited to RPP only and about a quarter of these patients had suffered from stool leakage already be-fore surgery.

Efficacy and Tolerability of Botulinum Toxin Type A in Patients with Neurogenic Detrusor Overactivity and Without Concomitant Anticholinergic Therapy: Comparison of Two Doses

BackgroundBotulinum toxin type A (BoNTA) has been reported to be effective for treatment of patients with neurogenic detrusor overactivity (NDO) refractory to anticholinergic agents. However, in most of the studies, the efficacy was associated with concomitant use of anticholinergics. ObjectiveTo evaluate the efficacy and tolerability of BoNTA and compare two different doses in patients with NDO without concomitant anticholinergics. Design, setting, and participantsBetween 2004 and 2006, adults with NDO refractory to anticholinergics or discontinued anticholinergics due to adverse events or contraindications from four different French clinical centres were included in a prospective, randomised, double-blind, comparative trial. Inclusion criteria were urinary incontinence (UI) resulting from NDO that could not be managed with anticholinergics. Patients with bladder cancer, lithiasis, or urinary infection were excluded. InterventionPatients were randomised to receive an intradetrusor injection of 500 U or 750 U of BoNTA. MeasurementsThe initial evaluation (ie, clinical and urodynamic variables and quality of life [QoL]) was repeated at days 30, 90, 180, and 360. Primary outcome was complete continence rate at day 30. Secondary outcomes were cumulative incontinence rate, reappearance of leakages, pad usage, urodynamics, and QoL. Results and limitationsSeventy-seven patients received 500 U (n=39) or 750 U (n=38) of BoNTA and were included in the full analysis set for efficacy analysis. Complete continence at day 30 was observed in 22 patients (56.4%) and 28 patients (73.7%) receiving 500 U or 750 U of BoNTA, respectively (p=0.056; one-sided χ2 test to compare to α=0.025). The median delay in the reappearance of leakages was 168 d. Monotherapy of BoNTA significantly improved UI in patients with NDO. Although there was a trend towards a greater improvement with 750 U of BoNTA, no statistically significant differences in terms of clinical and urodynamic variables and QoL were found between the treatment groups. Tolerability was excellent and equivalent for both doses. ConclusionsMonotherapy of BoNTA at Dysport (Ipsen, Brisbane, CA, USA) doses of 500 U or 750 U seems to be effective and well tolerated in patients with NDO.

Sacral Neuromodulation Outcomes in Patients With Urge Urinary Incontinence and Concomitant Urge Fecal Incontinence

: To study the efficacy and safety of sacral neuromodulation (SNM) in women with dual urge incontinence (DUI). : Women with simultaneous urge urinary and urge fecal incontinence (FI) were prospectively identified and tested to determine eligibility for SNM. Those who experienced at least 50% improvement in their urinary symptoms were offered a full implant. Changes in FI were not considered. Validated questionnaires were administered at baseline and during follow-up. Preimplant urodynamic data were collected. Adverse events were recorded. : A total of 11 women had DUI. All had greater than 50% improvement in their urinary symptoms and underwent full implantation. Average age was 76 years. Median follow-up was 14 months. There were statistically significant improvements in validated questionnaire scores. No women were able to achieve complete simultaneous urinary and fecal continence. Six women (54%) were able to achieve at least a 50% improvement simultaneously in both their urinary and fecal symptoms. Two women (18%) only experienced a significant improvement in their urinary symptoms. One (9%) only experienced significant improvement in her FI. Two (18%) experienced no significant improvement in either their urinary or fecal symptoms. The urodynamic findings did not correlate with outcome. Two patients had transient implant pain. One implant was removed due to lack of efficacy at patient's request. : SNM is a safe and effective treatment for DUI. In patients with DUI, complete continence rates may be lower than with either type of incontinence alone. DUI may be the end-organ manifestations of a common neurologic pathway-overactive stimulation or underactive inhibition.

Complete Continence after Botulinum Neurotoxin Type A Injections for Refractory Idiopathic Detrusor Overactivity Incontinence: Patient-Reported Outcome at 4 Weeks

BackgroundObjective improvement following intradetrusor injections of botulinum neurotoxin type A (BoNTA) is well documented. Although patient-related outcome measures are highly recommended for monitoring overactive bladder symptoms, no study before has dealt with the question of patient-reported complete continence after BoNTA treatment using validated questionnaires. ObjectiveTo investigate the change in patient-reported continence rate after intradetrusor injections of BoNTA for treatment of refractory idiopathic detrusor overactivity (IDO) incontinence. Design, setting, and participantsSeventy-four patients (51 women, 23 men) with refractory IDO incontinence treated for the first time with intradetrusor injections of 200 U BoNTA were evaluated in this nonrandomised, open-label, cohort study. MeasurementsChanges in patient-reported urinary frequency, urgency incontinence, and stress incontinence were assessed using the condition-specific validated short form of the Urogenital Distress Inventory (UDI 6) before and 4 wk after BoNTA treatment. Results and limitationsThe patient-reported outcome of complete continence (defined as a score of 0 in both the urgency and stress incontinence subscales of the UDI 6) was 51% (38 of 74) 4 wk after intradetrusor injections of BoNTA. In patients who were not completely continent, median urgency incontinence scores reduced significantly from 100 to 0 (p<0.001), stress incontinence scores from 33 to 0 (p<0.001), and median urinary frequency scores from 100 to 33 (p<0.001), respectively. The inclusion of patients with mixed incontinence may have resulted in underestimation of the complete continence rate. ConclusionsAn excellent response with >50% of patients reporting complete continence 4 wk after BoNTA treatment reveals the efficacy of this emerging treatment for patients with refractory IDO incontinence. Furthermore, in those in whom complete continence was not achieved, there was a notable and significant reduction in reported urgency incontinence, stress incontinence, and urinary frequency.

Morbidity and Quality of Life in Elderly Patients Receiving Ileal Conduit or Orthotopic Neobladder After Radical Cystectomy for Invasive Bladder Cancer

The objectives of the study were to evaluate morbidity, survival, and quality of life (QoL) in elderly patients with invasive bladder cancer who received an orthotopic neobladder or an ileal conduit. The charts of 85 patients, aged 75 or older (median age 78), who had received an ileal conduit (n = 53) or an orthotopic neobladder (n = 32) after radical cystectomy at 3 Italian institutions in the period January 2000 to September 2004 were retrospectively reviewed. Perioperative and postoperative complications were recorded, as well as survival data at last follow-up. QoL was evaluated in 34 of 37 patients who were alive at the time of analysis by using the European Organisation for Research and Treatment of Cancer (EORTC) instruments quality of life questionnaire C30 (QLQ-C30) and QLQ-muscle-invasive bladder cancer module (QLQ-BLM). Multiple regression analysis showed that stage significantly affected survival whereas the type of urinary diversion did not. Global Health Status (GHS) scores in the neobladder group were higher than in the ileal conduit group but the difference was not statistically significant. The scores of all the QLQ multi-item scales and single-item measures were comparable in the 2 groups. Overall, 56% and 25% daytime and nighttime complete continence rates were observed in patients with an orthotopic neobladder. The results of our retrospective analysis suggest that an orthotopic neobladder can be suitable for elderly patients with no additional morbidity compared with an ileal conduit. Both types of diversion seem to result in acceptable scores for most aspects of QoL, including urinary symptoms and continence rate. These figures may be helpful in the preoperative counselling of elderly patients with bladder cancer.

前立腺全摘除術における尖部処理の改良と術後尿禁制

To evaluate urinary continence after modified radical retropubic prostatectomy. From March 1999 to May 2004, 110 patients with prostate cancer underwent radical retropubic prostatectomy. In all patients, the fascia of the levator ani was preserved, and the plane between the prostate and rectum was dissected prior to cutting the urethra. A modification to the technique of apical dissection was introduced in May 2002. The modified method included cutting the urethra along a precise line between the prostate and urethra following the shape of the prostatic apex. The grade of early urinary incontinence was analyzed by using the incontinence rate (urinary incontinence volume (ml)/total urinary volume x 100 (%)). The incontinence rate was compared between the conventional and modified surgical techniques. Several other risk factors were also examined in these patients. Continence rates were analyzed among the patients over a one-year postoperative course. The incontinence rate on the day, the next day and 5-7 days after the removal of the urethral catheter were 18.1%, 11.2%, 6.0% in the modified group, and 36.6%, 22.5%, 12.6% in the conventional group, respectively. With the introduction of this modified method, the incontinence rate was significantly decreased (P<0.005). Complete continence rates 3 and 12 months after the operation were 81.3% and 98.3% in the modified and 60.0% and 97.8% in the conventional group. The time to regain complete continence in the modified was earlier than that in the conventional. After one-year, the rate of complete continence was similar and a satisfactory average in each group. Except for surgical techniques, no other factors were associated with a risk of incontinence statistically. We recommend modified apical dissection to preserve the urethral striated sphincter, which can be useful in improving the early incontinence rate and the recovery of continence.

Rectus Fascial Sling Suspension of the Vesicourethral Anastomosis After Radical Prostatectomy

A study was performed to ascertain if fascial sling suspension of the anastomosis after radical retropubic prostatectomy would enhance postoperative continence rates. A fascial sling suspension with a strip harvested from the fascia of the rectus muscle was performed at the time of radical retropubic prostatectomy in 30 patients (group 2). Postoperative continence was compared to that of 30 previous patients (group 1) operated on by the same surgeon. Complete continence rates (no protection needed at any time) were 18 of 30 men (60%) in group 2 and 10 of 30 (33%) in group 1 (p = 0.069) at 1 month, 28 of 30 men (93%) in group 2 and 21 of 30 (70%) in group 1 (p = 0.042) at 3 months, 30 of 30 in group 2 (100%) and 27 of 30 (90%) in group 1 at 6 months, and 30 of 30 in group 2 (100%) and 28 of 30 (93%) in group 1 at 9 and 12 months. Fascial sling suspension resulted in an earlier return and more complete recovery of urinary continence in men undergoing radical prostatectomy.

Post-Prostatectomy incontinence and the Artificial Urinary Sphincter: A Long-Term Study of Patient Satisfaction and Criteria for Success

Purpose We investigated patient satisfaction with the artificial urinary sphincter and established criteria for a successful outcome by inquiring about patient perceived satisfaction, continence achieved and comparison with the surgeon office records. Materials and Methods During 9 years 65 patients with post-prostatectomy incontinence underwent placement of the AMS800 * * American Medical Systems, Minnetonka, Minnesota. artificial urinary sphincter. Review of charts and a telephone questionnaire were conducted to determine patient perceived satisfaction. Results A total of 50 patients participated in the survey. Median followup was 23.4 months. Preoperative incontinence was severe. Of the patients 90 percent reported continuous leakage, and 70 percent wore an average of 6 diapers and 24 percent wore an average of 7.4 pads daily. The long-term complete continence rate was 20 percent. Of the patients with wetness 55 percent had leakage of a few drops daily and 22 percent had leakage of less than a teaspoon. Of all patients 50 percent had leakage daily, 24 percent had leakage 1 or more times a week and wore an average of 1.5 pads per day, and 6 percent reported changing clothes due to wetness. A total of 90 percent of the patients reported satisfaction with the artificial urinary sphincter and 96 percent stated that they would recommend or had recommended the artificial urinary sphincter to a friend. In retrospect, 92 percent of the patients would have the artificial urinary sphincter placed again, 90 percent of those undergoing revision reported no change in satisfaction and 14 percent reported improved sexual activity. Conclusions Patient satisfaction with the artificial urinary sphincter for post-prostatectomy incontinence is uniformly high. Although postoperative continence was not 100 percent, relative improvement in continence was the most significant factor affecting patient perceived outcome. Using these parameters criteria for a successful outcome can be established, and patient concerns regarding the artificial urinary sphincter can be dispelled.

The risks outweigh the benefits of radical prostatectomy in localised prostate cancer: the argument against.

The value of early detection, via screening and/or treatment of localised prostate cancer has not been established in well-designed clinical trials. However, radical prostatectomy in localised disease can be justified for a number of reasons. Cure of localised prostate cancer is necessary: 3% of men over 50 years of age will die of prostate cancer. Cure is possible: prostate tumours take 10-15 years to grow from 0.5 cm3 to, for example, 8 cm3--the window where cure is possible by radical prostatectomy. Large series of studies show that the probability of remaining progression free, as determined by prostate specific antigen, can be up to 90% for pT2 tumours and 60-75% for pT3a/b tumours. A radical, anatomic technique is necessary with a low positive margin rate (zero in pT2 tumours) to achieve such results. Radical prostatectomy has a low morbidity: perioperative mortality is far below 1%, complete continence rate is 80-90%, complete incontinence rate 4%, stricture rate 6%, and relaparotomy rate <5%. To conclude, in suitable patients (for example, younger than 70 years of age) with tumours at suitable stages, cure is necessary, possible, and safe using the right technique of radical prostatectomy.

Continent urinary diversion in childhood: European experience.

Continence and a positive body image are important, especially to the adolescent patient. Since 1964 we have used ureterosigmoidostomy and have achieved a complete continence rate of 92.3%. The creation of a low-pressure reservoir by antimesenteric splitting of the recto-sigmoid eliminated many of the shortcomings of ureterosigmoidostomy. This procedure is termed the sigma-rectum pouch and has been applied in six children to date. Mainz-pouch bladder augmentation or substitution has been performed in 20 children, 17 of whom are completely continent. The results of the modified Young Dees procedure were disappointing. In three children, conversion into a continent diversion was necessary. All of the 41 children who underwent continent diversion using the Mainz pouch procedure are continent. The overall rate of late complications following the Mainz pouch procedure was 19.6%.

Ureterosigmoidostomy: An Outdated Approach to Bladder Exstrophy?

Long-term results among 46 children with ureterosigmoidostomy are presented. The indication for ureterosigmoidostomy had been bladder exstrophy in 40 patients, incontinent epispadias in 5 and neurogenic bladder dysfunction in 1. Of the 40 patients with bladder exstrophy 8 had undergone ureterosigmoidostomy after failure of other types of urinary tract reconstruction (6 had upper tract dilatation before ureterosigmoidostomy).Three patients with previously damaged upper urinary tracts required early postoperative conversion because of severely increasing kidney dilatation. Three other patients required conversion after a mean of 10 years to preserve kidney function. One patient died after 16 years of a cause not related to ureterosigmoidostomy. The remaining 39 patients were alive with a functioning ureterosigmoidostomy after a mean followup of 14.7 years. The daytime continence rate was 97.4% (38 of 39 patients) and the complete continence rate was 92.3% (36 of 39). Except for 1 tubular adenoma that was removed successfully during routine colonoscopy, no bowel neoplasia has been observed. None of the 45 living patients has renal insufficiency.