Complete Urinary Continence Research Articles

Outcomes of open radical retropubic prostatectomy surgery using the levator fascia anterior-superior release method

Background. One of the common treatments for prostate cancer is radical prostatectomy, which is performed in different ways. One of the advantages of the nerve bundle preservation method is better exposure, decrease in rectal damage the lower rectum. In addition, the possibility of a positive margin is less. Therefore, this study aimed to examine the results of using the high anterior release (HAR) technique in radical open prostatectomy surgery. Methods. In this cross-sectional study, after examining patients and their entry into the study and obtaining their medical records, questions were asked to assess erectile function and urinary incontinence. The prostate-specific antigen level was checked before and after the operation. In addition, the average surgical time, blood loss, and hospitalization time were evaluated. Finally, the data were analyzed using the SPSS statistical analysis program, version 19. Results. In this study, 102 patients underwent radical prostatectomy, with an average age of 62.33 years. About 56.9% of patients had stage t2b. During the 6-month follow-up after surgery, 70.5% of patients had complete urinary continence. Data analysis demonstrated that there is a direct relationship between urinary incontinence, with a history of radiotherapy (P<0.001), and the stage of the disease (P=0.019). After surgery, 61.8% of patients were satisfied with the erection function. Conclusion. The results of this study revealed that urinary incontinence and erectile dysfunction are relatively common complications of this surgery. However, compared to other similar studies, the incidence of these two complications is lower. Practical Implications. Urinary incontinence and erectile dysfunction are relatively prevalent complications of radical prostatectomy surgery using the HAR technique. Nonetheless, the incidence of these two complications is lower compared to other similar studies.

Robot-assisted Periprostatic Artificial Urinary Sphincter Implantation in Men with Neurogenic Stress Urinary Incontinence: Description of the Surgical Technique and Comparison of Long-term Functional Outcomes with the Open Approach

BackgroundPeriprostatic artificial urinary sphincter implantation (pAUSi) is a rare yet relevant indication for male neurogenic stress urinary incontinence (SUI). ObjectiveTo describe the surgical technique of robot-assisted pAUSi (RApAUSi) and compare the long-term functional results with the open pAUSi (OpAUSi). Design, setting, and participantsData of 65 consecutive men with neurogenic SUI undergoing pAUSi between 2000 and 2022 in a tertiary centre were collected retrospectively. Surgical procedureThirty-three patients underwent OpAUSi and 32 underwent RApAUSi. OpAUSi cases were performed by a single surgeon, experienced in functional urology and prosthetic surgery. RApAUSi cases were performed by the same surgeon together with a second surgeon, experienced in robotic surgery. MeasurementsOutcome measures were achievement of complete urinary continence, intra- and postoperative complications, and surgical revision–free survival (SRFS). Results and limitationsRApAUSi showed superior results to OpAUSi in terms of median (interquartile range) operative time (RApAUSi: 170 [150–210] min vs OpAUSi: 245 [228–300] min; p < 0.001), estimated blood loss (RApAUSi: 20 [0–50] ml vs OpAUSi: 500 [350-700] ml; p < 0.001), and median length of hospital stay (LOS; RApAUSi: 5 [4–6] d vs OpAUSi: 11 [10–14] d; p < 0.001). Clavien-Dindo grade ≥3a complications occurred more frequently after OpAUSi (RApAUSi: 1/32 [3%] vs OpAUSi: 10/33 [30%]; p = 0.014). Achievement of complete urinary continence (zero pads) was comparable between the groups (RApAUSi: 24/32 [75%] vs OpAUSi: 24/33 [73%]; p = 0.500). The median follow-up periods were 118 (50–183) and 56 (25–84) mo for OpAUSi and RApAUSi, respectively (p < 0.001). A tendency towards longer SRFS was observed in the RApAUSi group (p = 0.076). The main study limitation was its retrospective nature. ConclusionsRApAUSi is an efficient alternative to OpAUSi, resulting in shorter operative times, less blood loss, fewer severe complications, and a shorter LOS with similar functional results and need for revision surgery. Patient summaryCompared with open periprostatic artificial urinary sphincter implantation (pAUSi), robot-assisted pAUSi leads to faster recovery and similar functional results, with fewer postoperative complications.

Сравнительный анализ робот-ассистированной и открытой радикальной цистэктомии с ортотопической деривацией мочи

Robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder creation is a complex surgical procedure, which is gradually becoming an alternative to open surgery.To compare the perioperative, functional and oncological outcomes of open radical cystectomy (ORC) and RARC.RARC with ileocystoplasty was performed in 25 patients, including 24 men. The average age was 65.5 years. ORC was done in 30 patients (28 men; control group) with the mean age of 67.2 years. In RARC, the ureters were isolated at the level of lower thirds, the bladder was dissected from the rectum on both sides, then the bladder vessels were divided using clips, and the urethra was cut off. After pelvic lymph node dissection, 50 cm of the ileum was resected. Then two distal segments were folded in a U-shape, a 1.5 cm incision was made in the lower part, and an anastomosis with the urethra was carried out. Further, these segments were detubularized and a modified Studer reservoir was created. The ureters were implanted into the tubular part. In ORC, urine diversion was also done using Studer technique. In both groups, the operation time, the volume of blood loss, the number of complications, the duration of hospitalization, the proportion of daytime and nighttime continence were evaluated.The mean time for RARC and ORC was 380 (320-580) and 260 (220-320) min, respectively (p<0.05). In the group of RARC, the volume of blood loss was 85 (50-250) ml and no blood transfusion was performed, while in ORC, the volume of blood loss was 520 (350-1400) ml, an average of 480 (0-840) ml of blood was transfused (p<0.05). After RARC, 30- and 90- complications rate was 32.0% (n=8) and 24.0% (n=6), respectively, compared to 40.0% (n=12) and 30.0% (n=9) in ORC. One patient died due to myocardial infarction during the 90-day follow-up period after RARC (grade V complication according to Clavien). The average number of removed lymph nodes in the RARC group was 15 (10-18). One patient had lymph node metastases. There were no cases of local recurrence. In ORC, the average number of lymph nodes was 16 (11-20), metastases were detected in 2 patients. One of them was subsequently diagnosed with local recurrence. There was no significant difference in the number of lymph nodes removed between two groups. After RARC, 20 (80.0%) patients had complete urinary continence, while 5 patients (20.0%) used 1-2 pads per day. Night continence was preserved in 15 cases (60.0%). After ORC, complete urinary continence was seen in 23 cases (76.7%). Five patients (20.0%) used 1-2 pads per day and two patients (6.7%) used 2-3 pads per day. Night continence after ORC was preserved in 17 cases (56.7%).RARC is a minimally invasive method of surgical treatment of patients with muscle-invasive bladder cancer. Compared with ORC, a significantly lower rate of complications and blood transfusions is documented, but RARC requires a longer operation time. Both interventions provide the equivalent oncological and functional outcomes, which are in line with published data.

Urinary continence disparities in patients with anorectal malformations

PurposeWhile fecal incontinence is a primary concern for many children with anorectal malformations (ARM), urinary incontinence is also prevalent in this population. Racial, ethnic, and socioeconomic disparities in urinary continence have been observed in other conditions, but have not been previously evaluated in ARM. We aimed to evaluate urinary continence and associated demographic and socioeconomic characteristics in individuals with ARM. MethodsWe performed a multicenter retrospective study of ARM patients evaluated at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). We included all patients with ARM 3 years and older. The primary outcome was urinary continence which was categorized as complete (no accidents), daytime (accidents at night), partial (rare or occasional accidents), and none (frequent accidents or no continence). We evaluated for associations between urinary continence and race, sex, age, insurance status, and adoption status, employing Kruskal-Wallis and trend tests. Secondary outcomes included bladder management strategies such as clean intermittent catheterization and continence surgery. P-value < 0.05 was considered significant. ResultsA total of 525 patients with ARM were included. Overall, 48% reported complete urinary continence, and continence was associated with greater age. For school-aged children (age ≥ 5 years), 58% reported complete continence, while 30% reported none. Public insurance and adoption status were associated with decreased likelihood of incontinence. ConclusionsWe observed a novel finding of disparities in urinary continence for children with ARM related to insurance and adoption status. Further investigation regarding the etiologies of these inequities is needed in order to affect clinical outcomes.

PD19-03 A RANDOMISED CONTROLLED TRIAL TO ASSESS THE BENEFIT OF POSTERIOR RHABDOSPHINCTER RECONSTRUCTION IN EARLY URINARY CONTINENCE RECOVERY AFTER ROBOT ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD19)1 Sep 2021PD19-03 A RANDOMISED CONTROLLED TRIAL TO ASSESS THE BENEFIT OF POSTERIOR RHABDOSPHINCTER RECONSTRUCTION IN EARLY URINARY CONTINENCE RECOVERY AFTER ROBOT ASSISTED RADICAL PROSTATECTOMY Lucas Regis, Oriol Moreno, Aina Salazar, Jacques Planas, Ana Celma, Anna Santamaria, Enrique Trilla, and Juan Morote Lucas RegisLucas Regis More articles by this author , Oriol MorenoOriol Moreno More articles by this author , Aina SalazarAina Salazar More articles by this author , Jacques PlanasJacques Planas More articles by this author , Ana CelmaAna Celma More articles by this author , Anna SantamariaAnna Santamaria More articles by this author , Enrique TrillaEnrique Trilla More articles by this author , and Juan MoroteJuan Morote More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002008.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Posterior rhabdosphincter reconstruction (PRR) has been proposed to improve early urinary continence recovery after radical prostatectomy (RP). In order to generate type Ib evidence, we designed a randomised controlled trial to was to analyze continence recovery in patients undergoing robot-assisted RP (RARP) with or without PRR, according to different methods of continence assessment. METHODS: We conducted a double-blinded randomized clinical trial (NCT03302169) to detect a 20% difference of continence rate at 1 month. A group of 152 patients with cT1c-3a N0M0 prostate cancer were randomised (72 to control arm and 80 to PRR arm) and were followed for 12 months. The main continence definition applied was “no pad use” (complete recovery). The use of 0-1 pad was applied as a secondary definition of continence. Validated questionnaires (EPIC26, ICIQ-SF and IPSS) were applied at 1, 3, 6 and 12 months after catheter removal. Surgeons were notified of computer randomization (random.org) after prostate excision. Patients and data gatherers were blinded to treatment allocation. RESULTS: Preoperative clinical and functional variables were equivalent between study arms. The recovery of complete urinary continence hazard ratio at one month was 2.312 (95%CI: 1.081- 28 4.937), p =0.030. Urinary functional recovery was observed in 33.8% of PRR arm patients and 18.1% of 29 those in the control arm, p =0.022. At three months, the rates were 58.8% 30 and 43.1% respectively, p=0.038. The median time to reach complete urinary continence was 106 days (95CI: 31 73-139) in the control arm and 64 days (95%CI: 39-89) in PRR arm, p =0.897. When analyzing the use of 0-1 pad, the time to continence in the PPR arm was 13 days (95%CI 9-17) and 16 days (95%CI: 10-22) in the control arm, p =0.649. Questionnaires did not detect differences in the urinary continence rates at 1, 6 and 12 months. No differences in pathological outcomes, early and late surgical complications were observed between both arms. CONCLUSIONS: PRR is a safe surgical technique that increases early urinary continence recovery after RARP when strict continence definition is used. Not all urinary continence measurement methods were able to discriminate early recovery in patients that underwent PRR. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e362-e362 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lucas Regis More articles by this author Oriol Moreno More articles by this author Aina Salazar More articles by this author Jacques Planas More articles by this author Ana Celma More articles by this author Anna Santamaria More articles by this author Enrique Trilla More articles by this author Juan Morote More articles by this author Expand All Advertisement Loading ...

Simple prostatectomy using the open and robotic approaches for lower urinary tract symptoms: A retrospective, case-control series.

We aimed to assess the outcome of our series of simple prostatectomy at our institution using the open simple prostatectomy (OSP) and robotic-assisted simple prostatectomy (RASP) approaches. We conducted a retrospective chart review of men who underwent OSP and RASP at Western University, in London, ON. Preoperative, intraoperative, and postoperative data were collected and analyzed. From 2012-2020, 29 men underwent a simple prostatectomy at our institution. Eight patients underwent an OSP and 21 patients underwent a RASP. The median age was 69 years. Preoperative median prostate volume was 153 cm&lt;sup&gt;3&lt;/sup&gt; (range 80-432). The surgical indications were failed medical treatment, urinary retention, hydronephrosis, cystolithiasis, and recurrent hematuria. The median operative time was 137.5 minutes in OSP and 185 minutes in RASP (p=0.04). Median estimated blood loss was 2300 ml (range 600-4000) and 100 ml (range 50-400) in the open and robotic procedures, respectively (p=0.4). The mean length of hospital stay was shorter in the RASP group, one day vs. three days (z=4.152, p&amp;lt;0.005). Perioperative complication rates were significantly lower in the group undergoing RASP, with no complications recorded in this group (p=0.004). Both groups demonstrated excellent functional results, with most patients reporting complete urinary continence (p=0.8). We report very good perioperative outcomes, with a minimal risk profile and excellent functional results, leading to marked improvement in patients' symptoms at followup after both the OSP and RASP approaches. RASP was associated with a shorter length of hospital stay, decreased blood loss, and a lower complication rate.

PD36-12 DOES MIRABEGRON HAVE A POSITIVE IMPACT ON SEXUAL FUNCTION IN FEMALES WITH OVERACTIVE BLADDER?

You have accessJournal of UrologySexual Function/Dysfunction: Female (PD36)1 Apr 2020PD36-12 DOES MIRABEGRON HAVE A POSITIVE IMPACT ON SEXUAL FUNCTION IN FEMALES WITH OVERACTIVE BLADDER? Samer Morsy, Hussein Hussein*, Dalia Abdel Azim, Sarah Hassan, and Eman Hussein Samer MorsySamer Morsy More articles by this author , Hussein Hussein*Hussein Hussein* More articles by this author , Dalia Abdel AzimDalia Abdel Azim More articles by this author , Sarah HassanSarah Hassan More articles by this author , and Eman HusseinEman Hussein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000907.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) may be associated with unpleasent effect on female sexual function. Mirabegron, a β3 receptor agonist, improves OAB symptoms, but there is limited information about its role on female sexual dysfunction (FSD). Aim of the study was to assess the impact of Mirabegron on FSD in women affected by idiopathic OAB. METHODS: One hundred sexually active women suffering from idiopathic OAB were included in the study. Patients were assessed by means of a urogynecologic physical examination and were asked to complete the 3-day voiding diary, the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-SF), the Female Sexual Function Index (FSFI) questionnaire and VAS, before and 12 weeks after treatment with Mirabegron 50 mg once daily dose. In addition, at the same time points, patients underwent uroflowmetry with the measurement of post- void residual volume (PVR). RESULTS: At baseline all patients were affected by OAB symptoms, with 98/100 patients (98%) presenting with FSD. At 12- weeks follow- up, OAB symptoms improved significantly in all patients, with 59.5% of subjects achieving a complete urinary continence. FSFI Total Score significantly improved in 84/100 patients (84%) from 18.9 ± 4.3 to 21.8 ± 4.5 (p < 0.0001). Thirty two cases (32%) presented with no FSD. Also mean ± SD scores of ICIQ-SF and VAS significantly improved (from 17.1 ± 5 to 7.9 ± 4.8 and from 3.9 ± 1.2 to 6.9 ± 1.2 respectively, p < 0.000). CONCLUSIONS: Mirabegron 50 mg control urinary symptoms in women with OAB, and also induces a significant improvement in their sexual life. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e727-e727 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samer Morsy More articles by this author Hussein Hussein* More articles by this author Dalia Abdel Azim More articles by this author Sarah Hassan More articles by this author Eman Hussein More articles by this author Expand All Advertisement PDF downloadLoading ...

The impact of Mirabegron on sexual function in women with idiopathic overactive bladder

BackgroundOveractive bladder (OAB) can frequently exert a negative effect on female sexual function. Mirabegron, a β3 receptor agonist, improves OAB symptoms, but there are very few information about its role on female sexual dysfunction (FSD). Aim of the study was to assess the impact of Mirabegron on FSD in women affected by OAB.MethodsFifty sexually active women suffering from idiopathic OAB were included in the study. Patients were assessed by means of a urogynecologic physical examination and were asked to complete the 3-day voiding diary, the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-SF), the Female Sexual Function Index (FSFI) questionnaire and VAS, before and 12 weeks after treatment with Mirabegron. In addition, at the same time points, patients underwent uroflowmetry with the measurement of post- void residual volume (PVR).ResultsAt baseline all patients were affected by OAB symptoms, with 49/50 patients (98%) presenting with FSD. At 12- weeks follow- up, OAB symptoms improved significantly in all patients, with 59.5% of subjects achieving a complete urinary continence. FSFI Total Score significantly improved in 42/50 patients (84%) from 18.9 ± 4.3 to 21.8 ± 4.5 (p < 0.0001). Sixteen cases (32%) presented with no FSD. Also mean ± SD scores of ICIQ-SF and VAS significantly improved (from 17.1 ± 5 to 7.9 ± 4.8 and from 3.9 ± 1.2 to 6.9 ± 1.2 respectively, p < 0.000).ConclusionsMirabegron not only is able to control urinary symptoms in women with OAB, but also induces a significant improvement in their sexual life.

Feasibility of mirabegron in the treatment of overactive bladder in patients affected by Parkinson's disease: A pilot study.

Background:We investigated the effectiveness and safety of mirabegron oral treatment in a group of patients with Parkinson’s disease (PD) and overactive bladder (OAB), refractory to antimuscarinics.Materials and methods:Thirty patients with PD and refractory OAB were prospectively included in the study. At baseline, motor symptoms, severity of disease and cognitive status were assessed with the Hoehn–Yahr Scale, the Unified Parkinson’s disease Rating Scale, the Mini Mental State examination and the Montreal Cognitive Assessment. At baseline, urinary symptoms, satisfaction with treatment and the impact of urinary incontinence on quality of life (QoL) were assessed with the 3-day voiding diary, the Visual Analogue Scale (VAS), the Incontinence–QoL questionnaire and urodynamics. Patients started assuming mirabegron 50 mg tablets once daily. Evaluation of urinary symptoms and related questionnaires, motor symptoms, severity of PD and uroflowmetry with postvoid residual volume measurement were then repeated at the 3- and 6-month follow up. Side effects were also noted.Results:At baseline, the most frequently reported urinary symptoms were: urinary urgency (present in all the patients), urge urinary incontinence in 28/30 (93.3%) and increased daytime urinary frequency in 25 (83.3%) patients. At the 3-month follow up, 7 out of the 30 patients achieved a complete urinary continence. Significant improvements in VAS and Incontinence–QoL scores were observed in 24 patients. These benefits were maintained for the whole observation period. Four patients discontinued treatment due to poor efficacy, and two due to the cost of the drug.Conclusions:Mirabegron is a safe and effective treatment in patients with PD and OAB refractory to anticholinergics in the short-term follow up.

Mid term functional results following surgical treatment of recto-urinary fistulas postprostate cancer treatment

To evaluate the mid term functional results of patients treated for RUF and to determine an optimal treatment strategy to improve their quality of life. Recto-urinary Fistula (RUF) is a rare complication following prostate cancer treatment, and can have a major impact on patients' quality of life. There is a lack of consensus concerning the best approach and different techniques have been proposed: endoscopic, transrectal, perineal and transperitoneal (open, laparoscopic or robotic). We retrospectively reviewed the charts of patients who underwent RUF repair from January 2001 to December 2010 at our Institute. 16 patients who developed RUF following prostate cancer treatment were included in the study. The fistula had to be confirmed both clinically and by imaging. All patients had follow up consultation every 3 month for the first year and then annually. They were asked to fill questionnaires evaluating functional outcomes. The International Continence Society (ICS) score was used to assess the postoperative urinary continence. Fecal continence was evaluated with the Wexner score and sexual function was assessed with the International Index for erectile function (IIEF-5) score. Eighty-seven percent patients (14/16) in our series developed RUF as a consequence of prostate cancer surgery and 13% (2/16) postbrachytherapy (BT). All patients initially had a diversion colostomy and a supra pubic catheter. 69% (11/16) underwent primary YM repair and 73% (8/11) were successful. 2/3 primary failures were successfully retreated with graciloplasty. Primary gracilis flap interposition (GFI), on 3 non-irradiated patients were successful (100%). Primary GFI postbrachytherapy, no patient had recover urinary and digestive continuity. In total primary GIF was successful in 60% (3/5). Over all long term, success rate with a urinary and digestive continuity and without recurrence of the fistula was 81% (13/16). Mid term functional results were evaluated at mean follow up of 40 months (14-92). 13% (2/16) achieved complete urinary continence, 48% (7/16) required single pad, 25% (4/16) developed major incontinence, 7% (1/16) required urinary diversion and 13% (2/16) developed complete urethral closure post BT requiring permanent suprapubic catheterization. Colostomy was reversed in 93% (15/16) cases. 75% (12/16) achieved complete faecal continence, minor incontinence (wexner score 3-4) was seen in 13% (2/16) and major incontinence (wexner score 14) in 7% (1/16) and 7% (1/16) required a long term colostomy. 19% (3/16) developed colostomy related complications. Only 13% (2/16) achieved adequate erections with the use of intra cavernosal prostaglandin injections. RUF following prostate cancer treatment is a serious complication with severe repercussion on patients' quality of life. Surgical repair with the York Mason technique or Gracilis Flap interposition is associated with good success rates. If available pediculed gracilis muscle should be used as it offers better success rates. 3.

Robot-Assisted Radical Prostatectomy Is More Beneficial for Prostate Cancer Patients: A System Review and Meta-Analysis.

BackgroundRobot-assisted radical prostatectomy (RARP) is increasingly used worldwide, but comparisons of perioperative, functional, and oncologic outcomes among RARP, laparoscopic radical prostatectomy (LRP), and open radical prostatectomy (ORP) remain inconsistent.Material/MethodsSystematic literature searches were conducted using EMBASE, PubMed, the Cochrane Library, CNKI, and Science Direct/Elsevier up to April 2017. A meta-analysis was conducted using Review Manager and Stata software.ResultsWe included 33 studies. Meta-analysis revealed that blood loss, transfusion rate, and positive surgical margin (PSM) rate were significantly lower following RARP compared with LRP (SMD (95% confidence interval [CI]) 0.31 [0.01, 0.61]; combined ORs (95% CI) 5.32 [1.29, 21.98]; 1.27 [1.10, 1.46]) and ORP (SMD (95% CI) 0.75 [0.30, 1.21]; and combined ORs (95% CI) 3.44 [1.21, 9.79]); positive surgical margin (PSM) rates were significantly lower following RARP compared with LRP (combined ORs (95% CI) 1.27 [1.10, 1.46]), but not ORP. Operation time was also shorter for RARP than for LRP. The rates of nerve-sparing, recovery of complete urinary continence, and recovery of erectile function were significantly higher following RARP compared with LRP (combined ORs (95% CI) 0.55 [0.31, 0.95]; 0.66 [0.55, 0.78]; 0.46 [0.30, 0.71]) and ORP (combined ORs (95% CI) 0.36 [0.21, 0.63]; 0.33 [0.15, 0.74]; 0.65 [0.37, 1.14]).ConclusionsThis meta-analysis demonstrates that RARP results in better overall outcomes than LRP and ORP in terms of blood loss, transfusion rate, nerve sparing, urinary continence and erectile dysfunction recovery, and suggests that RARP offers better results than LRP and ORP in treatment of prostate cancer. However, studies with larger sample sizes and long-term results are needed.

AB059. Pelvic floor reconstruction after radical prostatectomy: a systematic review and meta-analysis of different surgical techniques

BackgroundA meta-analysis was conducted to evaluate the effect of different techniques of pelvic floor reconstruction on urinary continence.MethodsA comprehensive search was made for trials that evaluated the efficacy of pelvic floor reconstruction. Relevant databases included PubMed, Embase, Cochrane, Ovid, Web of Science databases and relevant trials from the references. Random-effects model was used to estimate risk ratios (RRs) statistics.ResultsPooled results of patients treated with posterior reconstruction demonstrated complete urinary continence improved at all timepoint following catheter removal. Anterior suspension was associated with improvement only at 28–42 days.ConclusionsPatients who underwent RP and PR had the least urinary incontinence. No significant benefit was observed after AS. AR + PR and AS + PR had little benefit in the post-operative period.

Pelvic Floor Reconstruction After Radical Prostatectomy: A Systematic Review and Meta-analysis of Different Surgical Techniques

Radical prostatectomy (RP) is the gold standard for the treatment of localized PCa. A meta-analysis was conducted to evaluate the effect of different techniques of pelvic floor reconstruction on urinary continence. A comprehensive search was made for trials that evaluated the efficacy of pelvic floor reconstruction. Relevant databases included PubMed, Embase, Cochrane, Ovid, Web of Science databases and relevant trials from the references. Random-effects model was used to estimate risk ratios (RRs) statistics. Pooled results of patients treated with posterior reconstruction (PR) demonstrated complete urinary continence improved at 1–4, 28–42, 90, 180 and 360 days following catheter removal. Anterior suspension (AS) was associated with improvement only at 28–42 days. The anterior reconstruction (AR) + PR was associated with urinary continence at 1–4, 90 and 180 days. AS + PR was not associated with any benefit. And PR improved social urinary continence at 7–14 and 28–42 days. No benefit was associated with AS. AR + PR had better outcomes at 90 and 180 days. AS + PR was significant improved at 28–42 and 90 days. Patients who underwent RP and PR had the least urinary incontinence. No significant benefit was observed after AS. AR + PR and AS + PR had little benefit in the post-operative period.

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.

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.

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 ...

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.

The Long-Term Outcome of the Turner-Warwick Vaginal Obturator Shelf Urethral Repositioning Colposuspension Procedure for Urodynamically Proven Stress Urinary Incontinence

Objective: To analyze long-term continence, voiding dysfunction and secondary prolapse rates following Turner-Warwick Vaginal Obturator Shelf Urethral Repositioning colposuspension (VOSURP) for urodynamically proven stress urinary incontinence (USUI). Patients and Methods: Telephone and/or outpatient review of the outcomes of 50 consecutive patients undergoing VOSURP between 1997 and 2008 was conducted. Outcomes assessed included urinary continence (pad free/leak free), need to self-catheterise (ISC), secondary posterior pelvic organ prolapse (POP) development and need for further continence and POP-related surgical interventions. All patients with continued/recurrent urinary incontinence had repeat videourodynamics. Results: At a median follow-up of 108.5 months (17-153), complete urinary continence was reported in 41 (82%) of patients, post procedure new onset ISC in 2 (4%) and new onset posterior POP in 2 (4%). The cause of continued urinary incontinence was persistent USUI in 3 (6%), new onset idiopathic detrusor overactivity (IDO) in 4 (8%) and failure of resolution of pre-existing IDO in 2 (4%). Conclusions: Long-term complete urinary continence and cure of USUI following VOSURP are excellent at 82 and 94%, respectively. Voiding dysfunction and secondary POP procedure rates are low. The VOSURP is an excellent alternative to classical Burch colposuspension for the treatment of primary and recurrent USUI.

Robot-assisted radical prostatectomy - review of the literature concerning oncological and functional outcome of patients

In 2000, the first robot-assisted radical prostatectomy (RARP) worldwide for treatment of prostate cancer (PCa) was performed in Frankfurt/Main (Germany). Since then, this surgical method has broadly dispersed. In the US, RARP currently already represents the most frequently applied surgical technique for treatment of localized PCa, although until now the potential benefits of RARP in comparison to alternative surgical procedures have still not been evaluated in prospective randomized trials. Against the background that also in Germany a continuously and fast growing number of patients are treated by RARP, the present article provides a comprehensive and critical review of internationally published data concerning oncological and functional results of RARP. The main focus represents evaluation of the safety of this procedure with respect to achieving Pentafecta criteria (i.e. no biochemical recurrence, complete urinary continence and erectile function, negative surgical margins, and no postoperative complications), which were primarily described by Patel et al. in 2011.

Effects of Reconstructive Surgery on Bladder Function in Patients with Anorectal Malformations

Bladder dysfunction is common in patients with anorectal malformations and can be congenital or acquired as a consequence of surgery. We investigated the effects of surgical correction of anorectal malformations on bladder function. The charts of all 341 patients who underwent surgery atour center between 1990 and 2010 were retrospectively analyzed for preoperative and postoperative videourodynamics. A total of 52 patients were eligible for study inclusion. Each assessment was scored according to International Children's Continence Society standards. Urodynamic study indicated normal bladder function preoperatively in 36 patients (69%) and postoperatively in 37 (71%). Median bladder emptying efficiency and relative bladder capacity changed significantly after posterior sagittal anorectoplasty. Bladder function according to International Children's Continence Society standards did not change postoperatively in 43 patients (83%). In 1 of 4 patients with deterioration of bladder function the deterioration could be attributed solely to surgery. Clinical outcome was available in 38 patients and showed complete urinary continence with spontaneous voiding in24(63%). Seven of 25 patients (28%) with preoperative videourodynamics indicating normal bladder function demonstrated dysfunctional voiding at latestfollowup. Urodynamic and clinical outcomes after anorectal malformation repair are good, with 63% of patients being continent of urine. Urodynamic studies are of limited value in preoperative settings in these patients. Current techniques of reconstructive surgery for anorectal malformations seem to preserve bladder function in the majority of patients.