Complete Continence Research Articles

Pure robotic-assisted radical cystectomy with orthotopic U-shape ileal neobladder: surgical technique

Objective To investigate the surgical skills of pure robotic-assisted radical cystectomy with orthotopic U-shape ileal neobladder. Methods From October 2014 to September 2016, 37 patients with locally advanced bladder cancer(cT2-3N0-2M0)were diagnosed, including 29 males and 8 females, Their age ranged from 52 to 71 years old. According to preoperative cystoscopy, pathological diagnosis and bladder enhanced CT and other examination, 25 patients were staged as cT2, 12 cases were staged as cT3. 25 cases of them were primary tumors, who underwent pure robotic-assisted radical cystectomy and Endo-GIA assisted orthotopic U-shape ileal neobladder reconstruction. First, bilateral lymph nodes were dissected. And the ureter was explored and dissected to the outer wall of the bladder. Then, we ligated the superior artery of bladder and expose the seminal vesicle, vas deferent duct. The DV fascia was opened to expose the posterior wall of prostate. Incise was performed along the both sides of the bladder and prostate fascia to maintain the vascular nerve bundle until the tip of prostate. The urethra was cut off and then the bladder was remove. We used Endo-GIA to cut 30-35 cm ileum and construct U-shaped bladder. The anastomosis between ureter and neo-bladder and the anastomosis between urethra and neo-bladder were performed. Perioperative and follow-up data were collected. Results The surgeries were successful in all 37 cases. The operation time ranged from 245 to 335 min , mean (285±37)min. The mean intraoperative blood loss was(187±56) ml(ranging 90-300 ml). The average postoperative hospital stay was (17±2)days (ranging 15-20 days). Postoperative intestinal function recovery time ranged from 1.3 to 2.2 days, mean (1.7±0.4)days. Surgical margins were all negative. Lymph node positive rate was 21.6% (8/37). After 1 month, 22 cases achieved complete continence. After 3 months, 35 cases get fully self-control urination, 8 cases have noctual incontinence. Postoperative follow-up ranged from 6 to 24 months, no recurrence or distant metastasis was found in this study. After 6 months, cystoscopy showed no obvious formation of bladder stones. Neo-bladder capacity ranged from 270 to 350 ml. The urodynamic examination showed bladder pressure was maintained between 19 and 25cm H2O. Conclusions Pure robotic-assisted radical cystectomy can achieve better bladder resection, better remaining of urethral and neurovascular bundles and good control of urinary continence after operation. Endo-GIA assisted orthotopic U-shaped ileal bladder need shorter intestinal tract and cause less influence to the intestinal function. The neo-bladder shape is more regular, simple doing, earn shorter operation duration, less bleeding, quick recovery, which is a safe and effective surgical approach. Key words: Urinary bladder cancer; Pure robotic-assisted; Radical cystectomy; Orthotopic U-shape ileal neobladder

Outcomes and satisfaction in pediatric patients with Chait cecostomy tubes

Patients with spina bifida and other spinal dysraphisms commonly suffer from fecal incontinence and constipation, which can be treated with antegrade continence enemas. Currently, information regarding outcomes and satisfaction in children who have Chait cecostomy tubes is lacking. The aim of our study was to evaluate the effectiveness of Chait cecostomy tubes in management of constipation in children with spinal dysraphisms. A questionnaire was completed by patients and/or their families during office visits at the University of Iowa or Nationwide Children's Hospital during follow-up pediatric urology office visits. Two study groups completed the questionnaires: 1) Patients with neurogenic bowels who had a cecostomy tubein place (CT) and 2) patients with neurogenic bowels with no cecostomy tube (NCT). The survey used Likert scaled and nonrated questions to assessdemographics, bowel continence, and satisfaction. A total of 86 patients completed the questionnaire: 53 CT patients and 33 NCT patients. CT patients rated the effectiveness of their cecostomy tube in managing their constipation significantly higher than the NCT group rated the effectiveness of their conventional bowel management methods (p<0.001). Within the CT group, 48% of patients had complete or near complete continence, 40% had partial fecal incontinence, while only 12% remained incontinent. Of the CT respondents, 88% were overall satisfied with the cecostomy tube (Figure) and 92% would have the cecostomy tube placed again. In addition, hygiene, independence, and social confidence were significantly improved compared with baseline. Complications associated with the Chait tube included granulation tissue that required treatment (60%) and pain with irrigation (24%). CT patients reported significantly improved constipation management, fecal continence, and improved quality of life compared with NCT patients. Our pilot study demonstrates that the Chait cecostomy tube is a well-tolerated, effective means for treating constipation and achieving fecal continence with minimal side effects in patients with neurogenic bowels.

Functional Outcomes Following Laparoscopic Ileal Pouch-Anal Anastomosis in Patients with Chronic Ulcerative Colitis: Long-Term Follow-up of a Case-Matched Study

BackgroundLaparoscopic ileal pouch-anal anastomosis (L-IPAA) has been increasingly adopted over the last decade due to short-term patient-related benefits. Several studies have shown L-IPAA to be equivalent to open IPAA in terms of safety and short-term outcomes. However, few L-IPAA studies have examined long-term functional outcomes. We aimed to evaluate the long-term functional outcomes of L-IPAA as compared to open IPAA. MethodsA previous case-matched cohort study at our institution compared short-term outcomes between L-IPAA and open IPAA from 1998 to 2004. For this study, we selected all patients from this case-matched cohort study with chronic ulcerative colitis (CUC) who had follow-up functional data of greater than 1 year. Functional data was obtained through prospective surveys, which were sent annually to all IPAA patients postoperatively. ResultsOne hundred and forty-nine patients (58 L-IPAA, 91 open IPAA) with a median 8-year duration of follow-up were identified. There were no differences in demographics and long-term surgical outcomes between groups. Stapled anastomosis was more common in the laparoscopic group (91.4 versus 54.9%, p < 0.001). Stool frequency during daytime (>6 stools, L-IPAA 32.8%, open 49.4%, p = 0.048) and nighttime (>2 stools, L-IPAA 13.8%, open 30.6%; p = 0.024) was significantly lower in the L-IPAA group. Ability to differentiate gas from stool was not different (p = 0.13). Rate of complete continence was similar in L-IPAA and open groups (L-IPAA 36.2%, open 21.8%, p = 0.060). There was no difference in use of medication to control stools, perianal skin irritation, voiding difficulty, sexual problems, and occupational change between groups. Subgroup analysis to evaluate for any group differences attributable to anastomotic technique demonstrated only that stapled anastomoses lead to more perianal skin irritation in the L-IPAA group (L-IPAA = 60.4% versus open IPAA = 38.8%; p = 0.031). ConclusionOverall, L-IPAA has comparable functional results to the open approach with slightly lower daytime and nighttime stool frequency. This difference may be attributed to a greater number of stapled anastomoses performed in the laparoscopic cohort.

Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy.

We sought to investigate the impact of preoperative and postoperative membranous urethral length (MUL) on urinary continence using 3 Tesla (3T) magnetic resonance imaging (MRI) after robotic-assisted radical prostatectomy (RARP). Between 2008 and 2013, 190 men with RARP underwent preoperative and postoperative MRI. Patients who received adjuvant radiotherapy or who were lost to followup were excluded, leaving 186 patients eligible for analysis. Preoperative MUL was estimated from the prostate apex to the penile bulb, while postoperative MUL was estimated from the bladder neck to penile bulb. Patients with no pads or protection were considered to have complete continence. Logistic regression analysis was used to identify predictors associated with urinary incontinence at six and 12 months. Age was commonly associated with urinary incontinence at six and 12 months. In addition, diabetes mellitus (DM) was another factor associated with urinary incontinence at 12 months. When adjusting these variables, preoperative MUL ≤16 mm (95% confidence interval [CI] 1.01-1.14; p=0.022), postoperative MUL ≤14 mm (95% CI 1.16-9.80; p=0.025) and percent change of MUL >18% (95% CI 1.17-7.23; p=0.021) were significantly associated with urinary incontinence at six months. However, at 12 months, preoperative MUL ≤13.5 mm (95% CI 1.85-19.21; p=0.003) and postoperative MUL ≤13 mm (95% CI 1.24-13.84; p=0.021) had impacts on urinary incontinence, but not percent change of MUL. Preoperative and postoperative MUL were significantly associated with urinary continence recovery after RARP. Therefore, efforts to preserve MUL are highly recommended during surgery for optimal continence outcomes after RARP.

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.

Case Report: Long Term Follow Up of Bladder Exstrophy Repaired in Stages with Complete Urinary Continence

Bladder exstrophy is a rare congenital anomaly displaying symptoms such as the urinary bladder turned inside out, an exposed dorsal urethra, foreshortened penis, anteriorly displaced anus and widely separated symphysis pubis. This abnormality is managed by many methods, one of which includes a functional reconstruction. Themajor goals of surgical intervention are: Preservation of the renal function, achieving urinary continence with adequate sexual function and acceptable cosmetic appearance. In this report we present a long term follow up (25 years) of a male patient with classical type bladder exstrophy, managed at our hospital in stages, he is fully continent and voids spontaneously without clean intermittent self-catheterization, with normal renal function, adequate penile erection and has ejaculation.

A Randomized Study of Intraoperative Autologous Retropubic Urethral Sling on Urinary Control after Robotic Assisted Radical Prostatectomy

We evaluated whether placement of a retropubic urethral sling fashioned from autologous vas deferens during robotic assisted radical prostatectomy would improve recovery of continence. In a phase 2, single blind trial age stratified patients were randomized to undergo robotic assisted radical prostatectomy by multiple surgeons with or without sling placement. The outcomes were complete continence (0 urinary pads of any type) and near continence (0, an occasional or 1 pad per day) at 6 months, which was assessed by the Fisher exact test and logistic regression. The Kaplan-Meier method and the log rank test were used to evaluate time to continence. EPIC-UIN (Expanded Prostate Cancer Index Composite-Urinary Inventory) and I-PSS (International Prostate Symptom Score) 1, 3 and 6 months after catheter removal were evaluated by mixed models for repeated measures. Of 203 patients who were recruited 95 and 100 were randomized to undergo sling and no sling placement, respectively, and completed postoperative interviews. Six months after surgery the proportions reporting complete and near continence (66% and 87%, respectively) and times to complete and near continence were similar in the groups. Younger age was associated with a higher likelihood of complete continence (OR 1.74 per decreasing 5-year interval, 95% CI 1.23-2.48, p <0.01) and near continence (OR 2.18 per decreasing 5-year interval, 95% CI 1.21-3.92, p <0.01) adjusting for clinical, urinary and surgical factors. Adjusted EPIC-UIN and I-PSS scores changed with time but did not differ between the groups. No serious adverse events were observed. This trial failed to demonstrate a benefit of autologous urethral sling placement at robotic assisted radical prostatectomy on early return of continence at 6 months. Continence was related to patient age in adjusted models.

Use of sigmoid colon in orthotopic neobladder reconstruction: Long-term results.

To present our experience with a sigmoid orthotopic neobladder. We retrospectively evaluated the functional and oncological outcomes of 160 patients who underwent orthotopic neobladder reconstruction using a detubularized 20-25-cm sigmoid segment at our institution. Each patient was evaluated every 3 months the first year, every 6 months for the next 4 years and annually thereafter. Urodynamic studies of all consenting patients were carried out after 6 months, and 2, 5 and 10 years. We carried out the log-rank test, and used Cox regression models and Kaplan-Meier survival analysis. The anova test was used to compare urodynamic findings over time. Mean follow up was 6.8 years (range 0.65-21.7 years). Overall survival was 58.1% at 5 years, and 47.1% at 10 years. Early complications occurred in 36 patients (22.6%); late complications in 40 (25%). Stage V chronic kidney disease developed in two patients (1.3%). Complete (daytime and night-time) continence, defined as no need for pads or condom devices, was achieved by 45% of patients at 5 years, daytime continence was achieved by just 36% of patients; both were unchanged at 10 years. A significant difference emerged in maximal neobladder capacity and post-void residual values between 6 months and 2 years, and between 2 and 5 years (P < 0.01 and P = 0.03, respectively). Sigmoid neobladder continence and capacity significantly improve over the first 5 years, and they remain stable over the long term. Upper urinary tract function is not affected by endoluminal pressure, and the rate of metabolic imbalance is negligible.

VE39 - New technique of reconstruction of urethral support during robot-assisted radical prostatectomy reducing time to complete continence

VE39 - New technique of reconstruction of urethral support during robot-assisted radical prostatectomy reducing time to complete continence

A Posterior Anal Sling for Fecal Incontinence

Background The transobturator posterior anal sling (TOPAS) system is a posterior anal sling that is a minimally invasive, self-fixating polypropylene mesh intended to treat fecal incontinence (FI) in women who have failed conservative therapy. Objective We are reporting 1-year outcome in a prospective, multicenter study under investigational device exemption, evaluating this new treatment modality. Study Design A total of 152 women were implanted with the TOPAS system at 14 centers in the United States. FI was assessed preoperatively and at the 12-month follow up with a 14-day bowel diary, Cleveland Clinic Incontinence Scores, and FI Quality of Life questionnaires. Treatment success was defined as reduction in number of FI episodes of ≥50% compared to baseline. Missing bowel diary data were considered treatment failures. The Wilcoxon signed rank test was used to compare changes observed at 12 months vs baseline. Results Mean age was 59.6 years old (SD 9.7). The mean duration of FI was 110 mo (range 8-712) months. Mean length of the implant procedure was 33.4 (SD 11.6) minutes. Mean EBL was 12.9 (SD 10.5) mL. Average follow-up was 24.9 months. At 12 months, 69.1% of patients met the criteria for treatment success, and 19% of subjects reported complete continence. FI episodes/wk decreased from a median of 9.0 (range 2-40) at baseline to 2.5 (range 0-40) ( P P P P P Conclusion The TOPAS system provides significant improvements in FI symptoms and quality of life with an acceptable AE profile and may therefore be a viable minimally invasive treatment option for FI in women.

Integrated low-intensity biofeedback therapy in fecal incontinence: evidence that "good" in-home anal sphincter exercise practice makes perfect.

Biofeedback therapy (BFT) is an established treatment for fecal incontinence (FI), with access often being restricted to tertiary centers due to resources and the perceived requirement for high-intensity regimes. However, the optimal regime remains unknown. We evaluated outcomes from our low-intensity integrated BFT program in a secondary care center. Outcomes of our BFT service for FI were evaluated retrospectively. Response was defined by ≥50% improvement in FI frequency from baseline or complete continence. Responders were compared to non-responders for factors including symptoms, manometry data, sphincter exercise technique and duration of practice, and the number and frequency of sessions. Where patients dropped out, outcomes and the reason for dropout were obtained retrospectively. Fecal incontinence patients (n=205, median 62years, 72% female) attended a median (IQR) 3 (2) BFT sessions with 55 (36) days between visits. Overall, 146/205 (71%) responded with 97/205 (47%) achieving continence. Fecal incontinence frequency improved dramatically in completed cases (P=0.000). While non-response was associated with males (P=0.03) and dropout (P=0.000), "good" anal sphincter exercise technique (P=0.008) and longer in-home practice (P=0.007) and more sessions (P=0.04) were associated with response. Dropout rate was 80/205 (39%), with the reason for dropout being obtained in 80%. Despite low-intensity BFT, comparable outcomes to data from tertiary centers were achieved. Our data emphasize the importance of technique and in-home practice of anal sphincter exercises. Customizing BFT intensity based on predictive factors and encouraging in-home practice may optimize outcomes, reduce dropout rates, and rationalize resources.

The impact of previous prostate surgery on the outcomes of laparoscopic radical prostatectomy.

The aim of this study was to evaluate the outcomes in laparoscopic radical prostatectomy (LRP) in patients who had undergone prior prostate surgery (PPS). In this study 946 consecutive LR P patients were included and a retrospective comparison between those patients who had received PPS (group A) and those who had not received PPS (group B) was carried out. The preoperative, intraoperative and postoperative data was collected in a prospectively-maintained database. All complications occurring ≤30 days after surgery were recorded and defined according to the Dindo-modification of the Clavien system. Longer operative time, greater blood loss, longer catheterization time, higher incidence of lymphocele, rectal injury and anastomotic stricture were found to be more frequent in group A. No statistically significant difference was noted between the two groups in terms of positive surgical margin rate and Biochemical recurrence free survival (BCRFS). Complete urinary continence rate resulted significantly higher in group B patients at both 1-year and 2-year follow-up. Potency rate resulted better in group B patients even if a statistically significant difference for both unilateral and bilateral nerve sparing techniques was not reached. LRP procedure can be safely performed on patients who have previously undergone PPS without compromising oncologic safety whereas a negative impact on functional outcome in terms of achieving a complete urinary continence rate and sexual potency should be expected.

Bladder and bowel continence in bilateral cerebral palsy: A population study

The attainment of continence is an important milestone in all children, including those with disability. To describe the age of bladder and bowel continence in children with bilateral cerebral palsy (BCP), and the association with intellectual impairment (II) and severity of motor disability. The parents of 346 children with BCP were interviewed as part of a population-based prospective study of the children at 3, 7, and 17 years of age. The age of bladder and bowel continence by day and night was ascertained and compared with controls from the Avon Longitudinal Study of Parents and Children (ALSPAC). The median age for daytime bladder and bowel continence in BCP children was 5.4 years compared with 2.4 years in the controls. At 13.8 years of age, 59.4% of BCP children and 99% of controls were continent by day. In BCP children, there was no difference between the attainment of daytime bladder and bowel control. Night-time bladder and bowel control was slower and less completely attained, with 50% of BCP children continent by the age of 11.8 years compared with 3 years in control children. At 13.8 years of age, 51.9% of BCP children compared with 99.4% of controls were continent for bowel and bladder at night. Gross Motor Functional Classification Score (GMFCS) and intellectual ability (IA) (II) were strongly associated with continence attainment (P<0.0001), but gender was not. Delayed and less complete continence attainment was noted in other clinic series of children with cerebral palsy (including hemiplegics) and children with II. Severity of motor disability (GMFCS), and II impacted on other aspects of toilet training, such as: motivation, understanding, communication, and independence skills. The presence of neurogenic bladder and bowel dysfunction can occur in all levels of GMFCS. Thus, there are many reasons that can prevent continence attainment. Children with BCP achieved day and night-time bladder and bowel continence more slowly and less completely than controls, with 60.8% being continent by day and 54.6% by night at the age of 17 years. The majority of BCP children who were continent by day had achieved this by the age of 5.5 years (86%). At least 88% of BCP children with GMFCS I/II and normal, specific or mild learning impairment were continent for bladder and bowel by day and night. Expectations should be shared with parents, and failure to attain expected continence should be actively investigated.

Less is more—A pilot study evaluating one to three intradetrusor sites for injection of OnabotulinumtoxinA for neurogenic and idiopathic detrusor overactivity

To determine if minimizing the number of onabotulinumtoxinA (BTX) injection sites to one to three locations provides similar clinical efficacy and duration of effect compared to the established technique in treating patients with neurogenic (NDO) or idiopathic detrusor overactivity (IDO). Prospective data were collected on BTX naïve patients with NDO or IDO who were intolerant or refractory to oral medications. Patients were treated with 100-300 U of BTX via one to three injection sites. Patients completed the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) prior to and after treatment. The primary endpoint was defined as ICIQ-SF score improvement of >5 points. Secondary endpoints included subjective success, complete continence, quality of life score, post void residual (PVR), duration of effect and adverse events. Fourty-five patients (22 IDO, 23 NDO) were included. ICIQ-SF score improvement of >5 points was achieved in 73% (IDO 55%, NDO 91%) and the subjective success rate was 69% (50% IDO, 87% NDO). 52% of NDO patients attained complete continence. PVR increased by a mean of 32 and 156 ml in the IDO and NDO groups. Hematuria occurred in 6.7% and symptomatic urinary tract infection occurred in 11.1%. No systemic BTX adverse events occurred. Mean duration of effect was 31 weeks. Our technique for administering BTX via one to three intradetrusor injection sites has similar clinical efficacy and rates of adverse events compared to the established technique for treating patients with IDO and NDO. Neurourol. Urodynam. 36:1104-1107, 2017. © 2016 Wiley Periodicals, Inc.

Advanced Reconstruction of Vesicourethral Support (ARVUS) during Robot-assisted Radical Prostatectomy: One-year Functional Outcomes in a Two-group Randomised Controlled Trial

BackgroundThe advent of robotics has facilitated new surgical techniques for radical prostatectomy. These allow adjustment of pelvic anatomical and functional relationships after removal of the prostate to ameliorate postprostatectomy incontinence (PPI) and reduce the time to complete continence. ObjectivesTo describe the results of a new surgical technique for reconstruction of vesicourethral anastomosis using the levator ani muscle for support during robot-assisted radical prostatectomy (RARP). Design, setting, and participantsA prospective, randomised, single-blind study among 66 consecutive patients with localised prostate cancer (cT1–2N0M0) undergoing RARP from June to September 2014, 32 using the new technique and 34 using the standard posterior reconstruction according to Rocco. Surgical procedureIn the advanced reconstruction of vesicourethral support (ARVUS) intervention group, the fibres of the levator ani muscle, Denonvilliers fascia, retrotrigonal layer, and median dorsal raphe were used to form the dorsal support for the urethrovesical anastomosis. Suture of the arcus tendineus to the bladder neck served as the anterior fixation. MeasurementsWe compared demographic data and preoperative and postoperative functional and oncologic results for the two groups. The primary endpoint was continence evaluated at different time points (24h, 2, 4, and 8 wk, and 6 and 12 mo). The secondary endpoints were perioperative and postoperative complications and erectile function. Results and limitationsUsing a continence definition of 0 pads/d, the continence rates for the ARVUS versus the control group were 21.9% versus 5.9% at 24h (p=0.079), 43.8% versus 11.8% at 2 wk (p=0.005), 62.5% versus 14.7% at 4 wk (p<0.001), 68.8% versus 20.6% at 8 wk (p<0.001), 75.0% versus 44.1% at 6 mo (p=0.013), and 86.66% versus 61.29% at 12 mo (p=0.04). International Index of Erectile Function questionnaire results at 6 and 12 mo after surgery showed similar potency rates for the control group (40.0% and 73.33%) and the ARVUS group (38.8% and 72.22%). There were four postoperative complications (2 in each group): three haematomas requiring transfusion and one lymphocele that needed drainage. No urinary retention, anastomosis leak, or perineal pain was observed. Limitations include the small sample size and the single-institution design. ConclusionsThe ARVUS technique yielded better urinary continence results than standard posterior reconstruction, with no negative impact on erectile function, complication rate, or oncologic outcome. External validation is warranted before clear recommendations can be made. Patient summaryWe showed that postprostatectomy incontinence can be assuaged using a new technique for vesicourethral anastomosis reconstruction during robot-assisted radical prostatectomy (RARP). This could significantly improve the quality of life of patients after RARP. More studies are needed to support our results.

Transurethral assistant transumbilical laparoendoscopic single-site radical prostatectomy.

The laparoendoscopic single-site (LESS) technique is the latest technical innovation in laparoscopic surgery to undergo exponential development in urology. This study undertaken to illustrate our initial experience LESS radical prostatectomy (RP) and analyze early outcomes. Nineteen patients diagnosed with prostate cancer underwent LESS-RP in our institute. The patients were divided into two groups: conventional LESS and transurethral assistant LESS. Preoperative, perioperative, postoperative, pathologic, and functional outcomes data were assessed. With the help of a transurethral assistant, the mean operation and anastomosis time were decreased markedly. No focal positive margins were encountered. No prostate-specific antigen recurrence was detected 1 month postoperatively. Complete continence recovery (no pad) was observed in 32% of the patients at 1 month after the operation. No intraoperative and postoperative complications were reported. LESS-RP is a feasible and effective surgical procedure for treatment of prostate cancer. Moreover, transurethral assistant LESS could reduce the difficulty of LESS-RP and shorten the operation time.

PD44-07 PELVIC FRACTURE URETHRAL DISTRACTION DEFECT (PFUDD) WITH ASSOCIATED RECTAL INJURY: A REVIEW OF ACUTE AND DEFINITIVE UROLOGIC MANAGEMENT WITH LONG TERM OUTCOMES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III1 Apr 2016PD44-07 PELVIC FRACTURE URETHRAL DISTRACTION DEFECT (PFUDD) WITH ASSOCIATED RECTAL INJURY: A REVIEW OF ACUTE AND DEFINITIVE UROLOGIC MANAGEMENT WITH LONG TERM OUTCOMES Brian Montgomery and Douglas Husmann Brian MontgomeryBrian Montgomery More articles by this author and Douglas HusmannDouglas Husmann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1799AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES PFUDD with concurrent rectal injuries are rarely reported, occurring in 3% of patients having a PFUDD. The purpose of this study is to describe the management and long term sequela of a series of patients with this complex of injuries. METHODS We retrospectively reviewed all patients presenting with a PFUDD to our institution from 1990 to 2015. All charts were reviewed to determine the presence of concurrent rectal and bladder injuries, the development of complications, and the initial and definitive treatments. RESULTS A total of 17 patients had PFUDD and concurrent rectal injuries. Median follow-up after definitive urologic reconstruction is 3 years. Concurrent bladder neck lacerations existed in 52% (9/17) and sacral spinal cord injuries in 12% (2/17). In the 9 patients that had concurrent bladder neck lacerations, 44% (4/9) initially underwent primary repair of both the bladder neck and urethral injury; two developed chronic incontinence (one eventually managed by cystectomy and continent diversion), one has stress urinary incontinence, and one restrictured the urethra (managed by continent stoma). In the 33% (3/9) managed with initial closure of the bladder neck and SP tube diversion; two underwent creation of a continent stoma and one preferred long term management with a SP tube. In the 23% (2/9) managed with repair of bladder neck and SP tube; both developed chronic pelvic abscess formation, eventually managed by cystectomy and colon conduit urinary diversion. In the 8 patients without a bladder neck laceration, seven were managed by SP tube alone and one with SP tube with urethral realignment. All developed an obliterative urethral stricture. 75% (6/8) underwent urethral reconstruction and 25% (2/8) chose long term management by a SP tube. In the 6 patients undergoing reconstruction, 50% (3/6) developed complications. One has chronic incontinence and underwent bladder neck closure and SP tube placement, one has stress incontinence, and one redeveloped a stricture managed by urethrotomy. In essence, four patients are continent and without evidence of recurrent stricture. Based on SHIM scores, 88% (15/17) have severe erectile dysfunction and 12% (2/17) have mild ED. CONCLUSIONS PFUDD associated with a rectal injury is frequently associated with concurrent bladder neck lacerations and difficulty with regaining continence. Following definitive reconstruction, normal voiding and complete urinary continence developed in only 24% (4/17). Normal erectile capability was present in only 12% (2/17). © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1000 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Brian Montgomery More articles by this author Douglas Husmann More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urinary Continence in German and Brazilian Individuals With Spina Bifida: Influence of Intermittent Catheterization.

The purpose of this study was to identify the factors associated with acquisition of urinary continence following introduction of intermittent catheterization (IC). Cross-sectional study. The study sample comprised 104 females and 84 males. Their median age was 11 years (interquartile range = 6.0-22.0 years). Data were collected in 2 settings, the Rehabilitation Hospital in Belo Horizonte Brazil and Dortmund University North-Rhine, Westphalia, Germany. Ninety-four Brazilian and 94 German individuals who had experienced IC participated in the study. Data were collected using printed (Brazil) and online (Germany) questionnaires and analyzed using multivariate logistical regression and analysis of variance. Out of the 188 participants, 62.2% (117) achieved complete or partial continence. We found that increasing the frequency of IC increases the likelihood that the patient will acquire continence with IC. Using self-catheterization can increase the likelihood of acquiring continence (partial or complete) up to 2.9 times, in relation to someone who uses no self-catheterization. Among patients with spina bifida and neurogenic bladder dysfunction, acquisition of urinary continence after initiating IC was influenced by the use of self-catheterization and daily frequency of IC.

Ultrasound evaluation of the striated urethral sphincter as a predictive parameter of urinary continence after radical prostatectomy.

The purpose of this study was to evaluate preoperatively the results of transrectal ultrasound (TRUS) in the detection of morphological, vascularization status of urethral rhabdosphincter (RS) and evaluate the correlation with urinary continence after radical prostatectomy (RP). 211 patients who underwent RP were prospectively studied using TRUS scan of the RS thickness. At the end of the examination a study was performed with the use of colour-Doppler for the assessment of the RS vascularity pattern. The level of continence was graded on a 5 point scale as: 1 = complete continence, 2 = 1 pad daily, 3 = 2-3 pads daily, 4 = 4 or more pads daily, and 5 = complete incontinence. It was possible to visualize the rhabdosphincter and its vascularity in all patients. Patients with normal continence (level 1 and 2) showed a sphincter-muscle thickness of 3.5 mm (± 0.4) and a hypoechoic ultrasound pattern. With respect to the other levels 3, 4 and 5 of urinary incontinence RS thickness was 2.8 mm (± 0.5), 2.1 mm (± 0.6), 1.7 (± 0.7) respectively. Incontinence after RP (≥ 3 level) was associated with urethral sphincter deficiency in the great majority of patients. Statistical significant differences were observed in the vascularity between continent and incontinent men in all measured vascularity variables (p &lt; 0.005). This study suggests that RS integrity is a good predictor of urinary continence after RP and this information can be important during the preoperative phase as part of the informed consent.

A Rare Case of Nocturnal Urinary Incontinence and Menuria after Lower Segment Cesarean Section

ABSTRACT Misgav Ladach technique for lower segment cesarean section (LSCS) is considered advantageous universally, but debate still continues about nonclosure in layers and further consequences; hence, careful selection of cases and intraoperative decision of closure in layers is important. The classical Youssef's syndrome comprises cyclic hematuria, amenorrhea, menuria, and complete urinary continence in a patient who had LSCS. Hereby, we present a case report of a woman who suffered with chronic pelvic pain, menuria, and nocturnal eneuresis after her LSCS for obstructed labor, although not exactly the same as Youssef syndrome but rare in occurrence and relieved after adhesiolysis and gonadotropin-releasing hormone (GnRH) analog therapy. How to cite this article Chaudhry P, Shrivastava DS, Bhute S, Jajoo S. A Rare Case of Nocturnal Urinary Incontinence and Menuria after Lower Segment Cesarean Section. J Med Sci 2016;2(1):23-25.