Continence Function Research Articles

The Integral Theory, Pelvic Floor Biomechanics, and Binary Innervation.

The pelvic floor biomechanics and sphincter functioning are essential for understanding pelvic floor dysfunction and the pathophysiology of the pelvic organs. The pelvic floor consists of muscles, fascial connections and ligaments. The Integral Theory Paradigm (ITP) explains the musculoskeletal entity of the sphincter mechanism and the pathophysiology of pelvic organ function. The ITP explains the pelvic floor function determined by 3 directional muscle forces: forward, backwards and downward-acting muscle vector forces that form an anterior and posterior resultant. The resultant equilibrium is essential for urinary continence, voiding and defecation. Loose ligaments disturb the equilibrium of the pelvic floor's muscular function with consequences for the organ function's continence, evacuation, and sensory perception.

Perineal Urethrostomy for Complex Urethral Strictures: Long-Term Patient-Reported Outcomes From a Reconstructive Referral Center and a Scoping Literature Review.

There is a paucity of long-term objective and patient-reported outcomes after definitive perineal urethrostomy for complex urethral strictures. Our objective is to determine comprehensive long-term success of perineal urethrostomy with our 15-year experience at a reconstructive referral center. Patients who underwent perineal urethrostomy between 2009 and 2023 were identified. A comprehensive long-term follow-up was conducted, evaluating both objective outcomes (retreatment-free survival) and subjective outcomes through the use of validated questionnaires. Additionally, to provide further context for our findings, we conducted a scoping review of all studies reporting outcomes following perineal urethrostomy. Among 76 patients, 55% had iatrogenic strictures, with 82% previously undergoing urethral interventions. At a median follow-up of 55 months, retreatment-free survival was 84%, with 16% of patients experiencing perineal urethrostomy recurrent stenosis. Patient-reported outcomes revealed a generally satisfactory voiding function (Urethral Stricture Surgery Patient-Reported Outcome Measure Lower Urinary Tract Symptoms score) and continence (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form), with median scores of 4 (range 0-24) and 0 (range 0-21), but with bimodal distributions of sexual function scores (median International Index of Erectile Function-Erectile Function domain: 3.5; median Male Sexual Health Questionnaire-Ejaculation Scale: 21). Treatment satisfaction was very high with a median International Consultation on Incontinence Questionnaire-Satisfaction outcome score of 21 (range 0-24). The scoping review revealed varying success rates ranging from 51% to 95%, highlighting difficulties in comparison due to variable success definitions and patient case mix. Perineal urethrostomy provides effective treatment for complex anterior urethral strictures, with high patient satisfaction, preserved continence function, and favorable voiding outcomes. It presents a viable option for older and comorbid patients, especially after thorough counseling on expected outcomes and potential risks.

Long-term outcomes of fistula-tract laser closure for complex perianal fistulizing Crohn's disease.

Fistula-tract laser closure (FiLaC™) has shown promising outcomes in perianal fistulizing Crohn's disease (pfCD). However, most studies assessed a mixed cohort encompassing pfCD and cryptoglandular fistulas during a short follow-up period. This study aimed to evaluate the long-term treatment outcomes of FiLaC™ in patients with complex pfCD. Data from patients with complex pfCD who underwent FiLaC™ during deep remission of Crohn's disease between January 2019 and December 2020 were retrospectively analyzed. Patient demographics, surgery history, and medication strategy were registered before surgery. Follow-ups were scheduled at 1, 2, and 3months after FiLaC™, and at 2-month intervals thereafter. The primary endpoint was clinic healing, while clinic remission/unhealed/recurrence were classified as unhealed. Additionally, adverse events and Wexner fecal incontinence score were documented. Forty-nine patients (40 men and 9 women) with a median age of 26.0 (19.0-35.5) years were included with a median follow-up of 50.0 (39.5-54.0) months. Of these, 31 (63.3%) patients achieved fistula healing, 3 (6.1%) experienced improvement, 3 (6.1%) remained unhealed, and 12 (24.5%) experienced recurrence. Montreal A category was lower in the healed group (P < 0.001). No major complications, such as bleeding or fecal or urinary incontinence, were observed, and pain was transient. The Wexner incontinence score decreased significantly at the last available follow-up, indicating an intact postoperative continence function (P = 0.014). PCDAI scores were significantly higher in the unhealed group (P = 0.041). FiLaC™ is an efficient and safe sphincter-saving procedure for patients with complex pfCD.

Urinary continence following extraperitoneal radical prostatectomy: impact of surgical technique and pelvic fascial spaces reconstruction

Introduction. Urinary incontinence is a common complication of radical prostatectomy. The development of surgical techniques when performing radical prostatectomy that improve the function of urinary continence after surgery is actual.Objective. To compare urinary continence functions in long-term follow-up after open and laparoscopic radical prostatectomy when only posterior or combined (anterior + posterior) reconstruction of the pelvic fascial spaces is performed.Materials &amp; methods. The study included 130 patients aged 63.0 [59.0; 68.0] years with local prostate cancer (сT1a-2сN0-xM0; 1 – 4 ISUP groups), subjected to non-nerve-sparing retropubic radical prostatectomy with posterior reconstruction and non-nerve-sparing extraperitoneal laparoscopic radical prostatectomy with isolated posterior or combined (anterior + posterior) fascial reconstruction of the pelvic fascial spaces. Postoperative continence function was studied at 1, 3, 6, and 12 months following surgery using a standard pad test.Results. The incidence of urinary continence was higher at all follow-up periods during laparoscopic surgery. From the 6-months follow-up, these patients did not have severe urinary incontinence. At the same time, the rate of growth of some patients who began to retain urine did not depend on the method of reconstruction of the pelvic fascial spaces. The use of combined reconstruction of the pelvic fascial spaces at 12-months follow-up showed an advantage in urinary continence over performing only posterior reconstruction. Such patients achieved urinary continence in 90% of cases compared to 80.0% of cases. At the same time, the restoration of urinary continence at all periods of observation had a relatively uniform linear rate of increase in the indicator.Conclusion. Reconstruction of the pelvic fascial spaces during open and laparoscopic radical prostatectomy allows one to achieve satisfactory continuation in the postoperative period. However, higher efficiency is achieved when using a combined reconstruction technique.

Aquablation versus HoLEP in patients with benign prostatic hyperplasia: a comparative prospective non-randomized study

PurposeThe question of best surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) remains controversial. We compared the outcomes of aquablation and holmium laser enucleation of the prostate ("HoLEP") in a prospective cohort.MethodsPatients with BPH underwent aquablation or HoLEP according to their preference between June 2020 and April 2022. Prostate volume (“PV”), laboratory results, postvoid residual volume, uroflowmetry, IPSS, ICIQ-SF, MSHQ-EjD, EES and IIEF were evaluated preoperatively and at three, six and 12 months postoperatively. We also analyzed perioperative characteristics and complications via the Clavien Dindo („CD“) classification.ResultsWe included 40 patients, 16 of whom underwent aquablation and 24 HoLEP. Mean age was 67 years (SD 7.4). Baseline characteristics were balanced across groups, except the HoLEP patients’ larger PV. IPSS fell from 20.3 (SD 7.1) at baseline to 6.3 (SD 4.2) at 12 months (p < 0.001) without differences between aquablation and HoLEP. HoLEP was associated with shorter operation time (59.5 (SD 18.6) vs. 87.2 (SD 14.8) minutes, p < 0.001) and led to better PV reduction over all timepoints. At three months, aquablation’s results were better regarding ejaculatory (p = 0.02, MSHQ-EjD) and continence function (p < 0.001, ICIQ-SF). Beyond three months, erectile, ejaculatory, continence function and LUTS reduction did not differ significantly between aquablation and HoLEP. CD ≥ grade 3b complications were noted in six patients in aquablation group while only one in HoLEP group (p = < 0.01).ConclusionsWhile aquablation revealed temporary benefits regarding ejaculation and continence at three months, HoLEP was superior concerning operation time, the safety profile and volumetric results.

Patient reported outcome and quality of life measured by a simple questionnaire in patients with symptomatic benign prostate hyperplasia treated by holmium laser enucleation of the prostate (HoLEP).

Holmium Laser Enucleation of the Prostate (HoLEP) is established as an effective transurethral treatment option for LUTS due to BPH with improved postoperative outcome. The aim of this study was to evaluate the medium-term results by patient reported outcome measurement and to detect potential risk factors for postoperative complications or impaired outcome. We performed a retrospective single-center cohort study including all patients undergoing HoLEP in the study center between April 2019 and December 2021. Therefore, perioperative parameters and postoperative outcome was documented and all patients were asked for their outcome (PROM), complications, IPSS, QoL and changes in sexual and continence function by a questionnaire at a single time point. In the study period, a total of 541 patients with a mean age of 72.5 ± 8.4 years were treated by HoLEP in the study center. 71.7% of the questionnaires were returned after a mean observation period of 14.9 ± 6.3 month. 91% of the patients reported to the single-timepoint questionnaire reporting a good satisfaction with the procedure and a low postoperative complication rate. The international prostate symptom score could be reduced significantly to 6.2 ± 5.7 (preoperative 19.0 ± 7.2; p < 0.001). Patients with an ASA score ≥ 3, prostate volume > 80 ml, medication with platelet inhibitors or DOAK or preoperative need of an indwelling catheter didn't show an increased complication rate. The overall satisfaction with the procedure and its results are high. We could not identify any independent risk factors for postoperative complications after HoLEP. The used questionnaire is a simple tool for postoperative patient reported outcome measurement with a good correlation to clinical parameters.

The Oncological and Functional Prognostic Value of Unconventional Histology of Prostate Cancer in Localized Disease Treated with Robotic Radical Prostatectomy: An International Multicenter 5-Year Cohort Study

Background and objectiveThe impact of prostate cancer of unconventional histology (UH) on oncological and functional outcomes after robot-assisted radical prostatectomy (RARP) and adjuvant radiotherapy (aRT) receipt is unclear. We compared the impact of cribriform pattern (CP), ductal adenocarcinoma (DAC), and intraductal carcinoma (IDC) in comparison to pure adenocarcinoma (AC) on short- to mid-term oncological and functional results and receipt of aRT after RARP. MethodsWe retrospectively collected data for a large international cohort of men with localized prostate cancer treated with RARP between 2016 and 2020. The primary outcomes were biochemical recurrence (BCR)-free survival, erectile and continence function. aRT receipt was a secondary outcome. Kaplan-Meier survival and Cox regression analyses were performed. Key findings and limitationsA total of 3935 patients were included. At median follow-up of 2.8 yr, the rates for BCR incidence (AC 10.7% vs IDC 17%; p < 0.001) and aRT receipt (AC 4.5% vs DAC 6.3% [p = 0.003] vs IDC 11.2% [p < 0.001]) were higher with UH. The 5-yr BCR-free survival rate was significantly poorer for UH groups, with hazard ratios of 1.67 (95% confidence interval [CI] 1.16–2.40; p = 0.005) for DAC, 5.22 (95% CI 3.41–8.01; p < 0.001) for IDC, and 3.45 (95% CI 2.29–5.20; p < 0.001) for CP in comparison to AC. Logistic regression analysis revealed that the presence of UH doubled the risk of new-onset erectile dysfunction at 1 yr, in comparison to AC (grade group 1-3), with hazard ratios of 2.13 (p < 0.001) for DAC, 2.14 (p < 0.001) for IDC, and 2.01 (p = 0.011) for CP. Moreover, CP, but not IDC or DAC, was associated with a significantly higher risk of incontinence (odds ratio 1.97; p < 0.001). The study is limited by the lack of central histopathological review and relatively short follow-up. Conclusions and clinical implicationsIn a large cohort, UH presence was associated with worse short- to mid-term oncological outcomes after RARP. IDC independently predicted a higher rate of aRT receipt. At 1-yr follow-up after RP, patients with UH had three times higher risk of erectile dysfunction post RARP; CP was associated with a twofold higher incontinence rate. Patient summaryAmong patients with prostate cancer who undergo robot-assisted surgery to remove the prostate, those with less common types of prostate cancer have worse results for cancer control, erection, and urinary continence and a higher probability of receiving additional radiotherapy after surgery.

Comparison of senhance and da vinci robotic radical prostatectomy: short-term outcomes, learning curve, and cost analysis.

The Senhance® Robotic System is a new laparoscopy-based platform that has been increasingly used in radical prostatectomy (RP) procedures. The purpose of this study is to compare the outcome of Senhance RP (SRP) with da Vinci RP (DRP) cases. From August 2019 to April 2022, we prospectively recruited 63 cases of SRP. We compared the perioperative data, postoperative complication rates, short-term surgical outcomes (3-month postoperative undetectable prostate-specific antigen (PSA) and incontinence rates), learning curves, and cost analysis with data from 63 matched da Vinci Xi RP cases. There was no difference in BL (180 versus 180 ml, p = 0.86) and postoperative surgical complication rate (Clavient -Dindo grade I-IV, 25.3 versus 22.2%, p = 0.21) between the SRP cases and the DRP. Regarding the oncologic and continence function, there was no difference between positive margin rate (36.5% versus 41.3%, p = 0.58), rate of undetectable PSA level at postoperative 3 months (68.3 versus 66.7%, p = 0.85), and incontinence rate (14.3 versus 15.9%, p = 1.0) at postoperative 3 months between the two cohorts. The learning curve showed a quick downward slope for laparoscopic experienced surgeons. The median pocket cost for SRP patients in our hospital was $4170, which was lower than $7675 for the DRP patients. Safety and short-term outcomes are comparable between SRP and DRP. For experienced LRP surgeons, using the Senhance system to perform RP is straightforward. With a more affordable price as its biggest advantage, the Senhance system may serve as a safe and effective alternative for robotic RP.

Mucomucosal anastomotic non-transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures.

To present a surgical modification for the repair of bulbar urethral strictures containing short, highly obliterative segments and report on long-term objective and patient-reported outcomes. We considered patients undergoing bulbar buccal mucosal graft urethroplasty (BMGU) between July 2016 and December 2019. Eligibility criteria for mucomucosal anastomotic non-transecting augmentation (MANTA) urethroplasty were strictures of ≥2 cm with an obliterative segment of ≤1.5 cm. The stricture is approached ventrally to avoid extensive dissection and mobilisation. Dorsally, the scar is superficially excised and the spongiosum is left intact. Dorsal mucomucosal anastomosis is complemented by ventral onlay graft. Perioperative characteristics were prospectively collected including uroflowmetry data and validated patient-reported outcome measures on voiding, erectile, and continence function. We evaluated functional follow-up, incorporating patient-reported (lower urinary tract symptoms [LUTS] score) and functional success. Recurrence was defined as need of re-treatment. Of 641 men treated with anterior BMGU, 54 (8.4%) underwent MANTA urethroplasty. Overall, 26 (48%) and 45 (83%) had a history of dilatation and urethrotomy, respectively, and 14 (26%) were redo cases. Location was bulbar in 38 (70%) and penobulbar in 16 patients (30%), and the mean (SD) graft length was 4.5 (1.4) cm. At a median (interquartile range) follow-up of 41 (27-53) months, the functional success rate was 93%. Whereas the median LUTS score significantly improved from baseline to postoperatively (13 vs 3.5; P < 0.001), there was no change in erectile function (median International Index of Erectile Function - erectile function domain score 27 vs 24) or urinary continence (median International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form sum score 0 vs 0; all P ≥ 0.4). All patients were 'satisfied' (27%) or 'very satisfied' (73%) with the outcome of their operation. With excellent long-term objective and patient-reported outcomes, MANTA urethroplasty adds to the armamentarium for long bulbar strictures with a short obliterative segment.

Can salvage Retzius-sparing robotic-assisted radical prostatectomy improve continence outcomes? A systematic review and meta-analysis study.

Salvage Radical Prostatectomy is challenging and associated with high rates of incontinence. The novel Retzius-sparing RARP (RS-RARP) approach has shown impressive high immediate and 1-year continence rates (> 90%) when applied as primary treatment. The purpose of this study is to evaluate the impact of salvage Retzius-sparing RARP (sRS-RARP) on continence outcomes in the salvage scenario. Using PRISMA guidelines, a systematic review and meta-analysis of articles was conducted on Medline through PubMed and on Cochrane through Central Register of Controlled Trials databases. Inclusion and exclusion criteria were used to select 17 retrospective cohort studies published until April 2023 about sRS-RARP and continence. Data were extracted independently by at least two authors. The International Prospective Register of Systematic Reviews (PROSPERO) was registered. Retrospective studies were subjected to a domain-based risk of bias assessment in accordance with the Newcastle-Ottawa quality assessment scale cohort studies (NOS). Prostate cancer patients were chosen from prospective nonrandomized or randomized sRS-RARP or sS-RARP studies that examined continence outcomes. Seventeen studies were included: 14 were retrospectives only and 3 described retrospective comparison cohorts (sRS-RARP vs sS-RARP). All the retrospective studies were of "fair" quality using the NOS. sRS-RARP may increase recovery of urinary continence after surgery compared to sS-RARP [OR 4.36, 95% CI 1.7-11.17; I2 = 46.8%; studies = 4; participants = 87]. sRS-RARP approach has potential to improve continence outcomes in the salvage setting. sRS-RARP approach has potential to positively impact continence function on patients who underwent salvage surgery.

Current Therapy of Cryptoglandular Anal Fistula: Gold Standards and Alternative Methods.

Cryptoglandular anal fistulas are one of the most common colorectal diseases and occur with an incidence of about 20/100,000. Anal fistulas are defined as an inflammatory junction between the anal canal and the perianal skin. They develop from an abscess or chronic infection of the anorectum. Surgical treatment of the disease is the method of choice. Even when treating an acute abscess, its cause should be sought at the same time. If there is a connection to the anal canal without affecting relevant parts of the sphincter muscles, primary fistulotomy should be performed. If larger parts of the sphincter muscle are involved, the insertion of a seton drain is usually useful. There are essentially two recommendations for the elective treatment of cryptoglandular anal fistulas. Distal fistulas should be excised, with the proviso that as little sphincter muscle as possible is sacrificed. In the case of highly proximally located and complex fistulas, sphincter-preserving surgical techniques should be used. In this case, the method of choice is the mucosal or advancement flap. Alternatively, clips, fibrin injections, fistula plugs, fistula ligatures, or laser-based procedures are described in the literature. In the case of intermediate fistulas, a fistulectomy with primary sphincter reconstruction can be useful. Every operation is carried out as a compromise between definitive healing of the fistula and a potential risk to the patient's continence. It is often difficult to make a reliable prognosis about the continence function to be expected postoperatively. In addition to the fistula morphology, particular attention should be paid to whether previous proctological operations have already been performed, the gender of the patient, and whether there are pre-existing sphincter dysfunctions. Since the surgeon's expertise plays a decisive role in the success of the treatment, the procedure should be carried out in a specialist proctological centre, especially in the case of complex fistulas or in the case of a condition after previous operations. In addition to the classic procedures, such as fistulectomy or the plastic fistula closure, this article examines alternative methods and their areas of application.

Correlation between self-perception of pelvic floor muscle activity and electromyography

Background: In the pelvis we find the pelvic floor muscles (PFM), and these are responsible for supporting the pelvic organs, sexual function and maintenance of continence. Lack of awareness of this musculature can lead to incorrect contraction and relaxation failure resulting in possible dysfunctions. Aims: To correlate female selfperception of PFM movements with electromyographic data. Method: cross-sectional study. During the lecture, the women answered whether they knew how to contract and relax their PFM, and whether or not they chose to participate in the physical assessment through electromyography. During the EMG it was necessary to contract and relax the pelvic floor. Results: Of all the participants, 66.7% said they knew how to relax and 50% said they knew how to relax, but the EMG showed that 75% did not obtain an effective contraction and 83.3% did not know how to relax properly. Conclusion: the lack of female self-perception of PFM activity is a fact, given that the participants believed they knew how to contract and relax, but the EMG showed the opposite.

Comparison of Heuristic Algorithms in Identification of Parameters of Anomalous Diffusion Model Based on Measurements from Sensors.

In recent times, fractional calculus has gained popularity in various types of engineering applications. Very often, the mathematical model describing a given phenomenon consists of a differential equation with a fractional derivative. As numerous studies present, the use of the fractional derivative instead of the classical derivative allows for more accurate modeling of some processes. A numerical solution of anomalous heat conduction equation with Riemann-Liouville fractional derivative over space is presented in this paper. First, a differential scheme is provided to solve the direct problem. Then, the inverse problem is considered, which consists in identifying model parameters such as: thermal conductivity, order of derivative and heat transfer. Data on the basis of which the inverse problem is solved are the temperature values on the right boundary of the considered space. To solve the problem a functional describing the error of the solution is created. By determining the minimum of this functional, unknown parameters of the model are identified. In order to find a solution, selected heuristic algorithms are presented and compared. The following meta-heuristic algorithms are described and used in the paper: Ant Colony Optimization (ACO) for continous function, Butterfly Optimization Algorithm (BOA), Dynamic Butterfly Optimization Algorithm (DBOA) and Aquila Optimize (AO). The accuracy of the presented algorithms is illustrated by examples.

Effect of M-cholinoblockers on the Clinical Course of Urinary Incontinence in Patients with an Artifical Bladder

The objective: to study the M-cholinoblockers effect by urinary incontinence after the formation of an artificial bladder and to analyze the effectiveness of pharmacological correction on survival and quality of life. Materials and methods. 114 patients after radical cystectomy with the formation of a neobladder at various stages of the postoperative period involved in the study. The significant urinary incontinence of different degrees, which affected the patient’s quality of life, was determined in 27 (23.7%) persons who were included in solifenacin effect study group. To identify the degree of severity and the dynamics of recovery of the continence function, a questionnaire was conducted among patients who had urinary incontinence during the day and at night. With the help of a comprehensive study on the Delphis KT urodynamic unit, an analysis of urodynamic parameters in urinary incontinence was carried out. Results. After the formation of an artificial bladder, the patients had more stable daytime continence due to mental control over urination and understanding the need to urinate according to time. The situation was more complicated in patients with nocturnal urinary incontinence after radical cystectomy and the formation of an artificial bladder. However, after 2 weeks of treatment with solifenacin, patients had a significant improvement in the function of nocturnal urinary retention. After treatment with solifenacin patients had an improvement in daytime urinary retention by 37.2 % and nighttime urinary retention by 48.9 %. Two-week treatment with solifenacin significantly improved the patient’s quality of life and the dynamics of enterocystomanometry indicators, as evidenced by the results of control studies. The indicator of the subjective sensitivity level increased statistically significantly by 35.24 % compared to the group before treatment and amounted to 304.2±62.1 cm of water column (p≤0.05). The level of the first urge to urinate also increased reliably by 20.4 % – 458.2±81.0 cm of water column (p≤0.05). The level of urge to urinate was 636.1±92.8 ml (p≤0.05), which was statistically significantly higher by 17.5 % compared to patients who did not take solifenacin. Conclusions. The use of M-cholinoblockers in the correction of urinary incontinence in patients with an artificial urinary bladder due to the action on the smooth muscles of the intestines through parasympathetic innervation improves urodynamic indicators and the quality of life of the patients.

Study of female pelvic floor muscle in overactive bladder based on MRI 3D reconstruction

BackgroundThis study examined the three-dimensional (3D) morphological changes of the urination and urinary continence anatomical structures in overactive bladder (OAB) patients, to offer a morphological data for OAB diagnosis and treatment.MethodsEleven OAB patients, 9 healthy females and 22 pelvic organ prolapse (POP) patients were enrolled and underwent MRI scans. The anatomical components of urination (bladder detrusor) and the urinary continence (main part of the urethral sphincter, compressor urethrae, and levator ani muscle (LAM) were 3D reconstructed and measured with Amira software. We also analyze the relativity between pelvic floor muscle’s morphological parameters among the volunteers, OAB and POP group.ResultsThrough 3D reconstruction, increased thickness and volume of the bladder detrusor were found in the OAB patients compared with volunteers (3.1 ± 0.7 mm vs. 1.9 ± 0.3 mm; P = 0.000 and 50,632.0 ± 19,724.7 mm3 vs. 23,386.6 ± 7826.3 mm3; P = 0.001). The volume of LAM showed no significant difference between the OAB patients and volunteers (27,089.4 ± 5015.0 mm3 vs. 27,294.4 ± 4461.4 mm3; P = 0.924); whereas, LAM’s volume of the POP patients was significantly larger than that of the volunteers (34,130.6 ± 7968.3 mm3 vs. 27,294.4 ± 4461.4 mm3; P = 0.023). The thickness and volume of the main part of urethral sphincter were significantly lower in the OAB patients compared with volunteers (2.2 ± 0.5 mm vs. 2.7 ± 0.3 mm; P = 0.018 and 2558.6 ± 703.2 mm3 vs. 23,267.3 ± 681.9 mm3; P = 0.035). The volume of the compressor urethrae was significantly lower in the OAB patients than that in the volunteers (630.3 ± 301.2 mm3 vs. 866.1 ± 514.2 mm3; P = 0.247).ConclusionsIn OAB patients, the bladder detrusor has long-term tension and contraction, which thickened muscle and increased volume, and aggravate urination. The compressor urethral and main part of urethral sphincter are weaker and the anterior part of LAM hiatus is relaxed, easily resulting in leakage of urine and ultimately incontinence. The MRI 3D reconstruction and measurement can help to evaluate pelvic floor urination and continence function, and accurately diagnose.

Differential effects on urethral function, epithelial morphology, and molecular profile in two different rat models of stress urinary incontinence by simulated birth trauma or estrogen deficiency

ABSTRACT Introduction Stress urinary incontinence (SUI) is the common type of urinary incontinence with a significantly negative impact on quality of life, including sexual dysfunction, in women. Although the etiology of SUI in women seems to be multifactorial, multiple vaginal parities and estrogen deficiency (ED) are considered to be major risk factors of SUI in elderly women. Thus, animal models of simulated birth trauma induced by multiple vaginal distention (VD) and ED induced by bilateral ovariectomy (OVX) have been used to study the SUI pathophysiology in rats. In previous studies, bilateral ovariectomy (OVX) reportedly induces the morphological changes in the rat urethral epithelium. It has also been reported that serotonergic (5HT+) paraneurons uniquely located in the urethra modulate urethral sensory function and that their numbers decrease in aged or diabetes rats. However, the difference of changes in the urethra such as those in epithelial morphology and expression of 5HT+ paraneurons in the urethra, in these two models has not been well characterized. Objective We therefore evaluated the histological changes of the urethral epithelium and 5HT+ cell expression, and urethral continence function in rats with OVX-induced ED or VD-induced simulated birth trauma. Methods Nulliparous SD rats were divided into: (1) sham group; (2) OVX 3-weeks group; (3) OVX 6-weeks group; (4) VD-1 group (1 time VD 2 weeks before assays); (5) VD-3 group (3 times VDs every 2 weeks). VD was induced by balloon catheter inflation for 4 hours in the vagina under isoflurane anesthesia. Urethral function was evaluated by the amplitude of urethral pressure responses during sneezing (A-URS) and urethral baseline pressure (UBP), which was measured by a microtransducer-tipped catheter inserted into the mid-urethra (n=6, each group). Following the urethral function analysis, the mid urethra was harvested, and the tissue sections (10 μm) were stained with Hematoxylin-eosin (H&amp;E) and anti-5HT antibodies for immunofluorescent detection of 5HT+ paraneurons. In addition, in separate groups of rats, changes in urethral mRNA levels of tryptophan hydroxylase-1 (TPH1), a key enzyme of 5HT synthesis, were quantified by RT-PCR (n=6, each group). All data are represented as means ± SE. P &amp;lt; 0.05 was considered significant. Results OVX 6-weeks and VD-3 rats exhibited significant decreases in UBP and A-URS vs. sham (Fig. 1A). The mean epithelial thickness was significantly decreased in OVX 3, 6-weeks, VD-1 and 3 rats (Fig 1B,C) vs. sham. The number of urethral 5HT+ paraneurons was significantly decreased in OVX 3, 6 weeks, VD-1 and 3 rats (Fig. 2A,B) vs. sham. TPH-1 mRNA levels were significantly decreased in OVX 3, 6-weeks and VD-3 rats (Fig. 2C) vs. sham. Conclusions These results indicate that urethral epithelial atrophy and loss of 5HT+ paraneurons occur prior to SUI- inducing urethral dysfunction in both models, with the changes being rapid and greater in OVX compared to VD. These histological changes in the urethra may contribute to the establishment of SUI in ED and multiple birth trauma. Disclosure Work supported by industry: no.

Sphincter-Preserving Fistulectomy Is an Effective Minimally Invasive Technique for Complex Anal Fistulas.

BackgroundThe optimal treatment of complex anal fistulas remains unclear, though many different sphincter-preserving procedures have been described. A minimally invasive technique with a better outcome is desired. The purpose of this study was to present a new technique—sphincter-preserving fistulectomy (SPF) and its clinical outcomes.Materials and MethodsA retrospective study was performed to compare the efficacy and outcomes of SPF with ligation of the intersphincteric fistula tract (LIFT) in the management of complex anal fistulas in regards to postoperative pain, complications, wound healing time, recurrence, overall success rate, fecal continence function, and quality of life. Continence function was evaluated using the Wexner incontinence scale and anal manometry. The fecal incontinence quality of life (FIQL) scale was used to assess patients' quality of life.ResultsFrom June 2020 to July 2021, 41 patients with 43 SPF procedures and 35 patients with 35 LIFT procedures were included. Postoperative pain was comparable between two groups. The morbidity rate and the mean wound healing time in the SPF group were lower than those in the LIFT group (2.3% vs. 48.6%, p < 0.001; 1.4 ± 0.3 vs. 1.7 ± 0.4 months, p = 0.001). At a mean follow-up duration of 11.4 ± 3.5 months in the SPF group and 10.7 ± 4.3 months in the LIFT group, SPF achieved a better overall success rate than LIFT (97.7% vs. 77.1%, p = 0.014). Three patients in the SPF group and 4 patients in the LIFT group who all underwent a simultaneous fistulotomy procedure complained new incontinence of flatus. There was no statistical difference between the two groups in regards to the Wexner scores (p = 0.790), the maximum resting anal canal pressure (p = 0.641), the maximum squeeze pressure (p = 0.289), and the FIQL scores including lifestyle (p = 0.188), coping (p = 0.188), depression (p = 0.850), and embarrassment (p = 0.910).ConclusionsSPF is a novel, safe, and effective minimally invasive technique for the management of complex anal fistulas, with a promising success rate and negligible impairment on continence. Future prospective studies are needed to evaluate the long-term outcomes of SPF.

Urinary continence and erectile dysfunction results in robot-assisted radical prostatectomy with endopelvic fascia preservation

Introduction: Radical prostatectomy is the treatment of choice for patients with organ-confined prostate cancer due to its oncological benefits and survival. With the advancement of technology, surgical techniques have been modified, and robot-assisted radical prostatectomy (RARP) is currently the procedure with the most advanced technology. Due to its multiple advantages, such as short-term functional and surgical results, shorter hospital stay and minimal invasiveness, it constitutes a valid therapeutic option to consider for this group of cancer patients.&#x0D; Objective: To compare the results obtained in urinary continence and erectile dysfunction after RARP with a standard da Vinci® system with 4 arms, between a group of 43 patients who underwent said procedure, without preservation of the endopelvic fascia in 2018, and 68 patients who underwent the same procedure with endopelvic fascia preservation, between January 2019 and February 2021, all at the Hospital Carlos Andrade Marín, in Quito.&#x0D; Methodology: A retrospective longitudinal descriptive observational study was made, with the comparison of 68 prostate cancer patients who underwent radical surgery with endopelvic fascia preservation at the Hospital Carlos Andrade Marín, between January 2019 and February 2021, and 43 patients who had the same surgery but without endopelvic preservation, in the year 2019.&#x0D; Results: One hundred eleven surgeries for prostate cancer with the robot-assisted radical prostatectomy technique were performed. Forty-three (37.8%) surgeries were made without endopelvic fascia preservation, and 68 (61.3%) were made with endopelvic fascia preservation.&#x0D; At the first month of follow-up, 25 (58%) patients of the RARP without endopelvic fascia preservation group, presented with severe erectile dysfunction, 11 (26%) with moderate erectile dysfunction, 6 (14%) with moderate to mild erectile dysfunction, and 1 (2%) with mild erectile dysfunction. At 6 months follow-up, of the 25 patients with severe dysfunction, 2 presented with moderate dysfunction and 23 remained with severe dysfunction. Of the patients who underwent RARP with endopelvic fascia preservation, 54 (80%) presented with mild incontinence, and 3 (4%) were completely continent making use of this technique. Furthermore, at 9 months follow-up, 90% of the patients had complete continence and 10% mild incontinence. Fifty six percent of the RARP patients with endopelvic fascia preservation presented severe sexual dysfunction at the first postoperative month. However, after pharmacological treatments, only 19% remained with erectile dysfunction.&#x0D; Conclusion: RARP is a safe and minimally invasive technique, it improves surgical and functional results, in the short and long terms, with respect to continence and sexual function. Endopelvic fascia preservation could improve results in the long term for continence and erectile dysfunction.

Preventive intraoperative methods for restoring urine function after laparoscopic and open radical prostatectomy

Purpose of the study. To evaluate the effectiveness of preserving the anatomical structures surrounding the prostate gland for prophylactic intraoperative restoration of urinary retention functions in the postoperative period.&#x0D; Materials and methods. A study was carried out in 86 patients with prostate cancer after performing radical prostatectomy from 2013 to 2021. Men were divided into 4 groups:&#x0D; Group 1 – LRP with preservation of the puboprostatic ligaments, pubo-perineal muscle, pelvic fascia and neurovascular bundles of the penis.&#x0D; Group 2 – LRP with complete preservation of the anatomical structures of the small pelvis without preserving the neurovascular bundles of the penis.&#x0D; Group 3 – ORP with preservation of the puboprostatic ligaments, pubo-perineal muscle, pelvic fascia and neurovascular bundles of the penis.&#x0D; Group 4 – RRP with complete preservation of the anatomical structures of the small pelvis without preserving the neurovascular bundles of the penis.&#x0D; In group 1, in which LRP was performed, 58 patients with prostate cancer T1N0M0 and T2N0M0.&#x0D; In group 2 LRP 12 patients with prostate cancer T1N0M0 and T2N0M0.&#x0D; There were 12 patients with prostate cancer T1N0M0 and T2N0M0 in group 3 with RRP.&#x0D; There are 4 patients with prostate cancer T1N0M0 and T2N0M0 in group 4 with RRP.&#x0D; He diagnosis of prostate cancer in all patients was established on the basis of a histological examination of preparations obtained by performing a transrectal multifaceted biopsy of the prostate gland. The basis for performing a biopsy was an increase in the level of prostate-specific antigen (PSA) in the blood above 4 ng/ml, the presence of pathological nodes according to MRI of the pelvic organs with contrast, as well as suspicious areas of the prostate gland during digital rectal examination. A study was carried out in 86 patients with prostate cancer after performing radical prostatectomy from 2013 to 2021.&#x0D; Research results and their discussion. 12 patients of group 3 underwent open surgery-radical prostatectomy. RRP (12 people) with preservation of the pubo-prostatic ligaments, pubo-perineal muscle, pelvic fascia and neurovascular bundles of the penis.&#x0D; In 4 patients of group 4, RRP with complete preservation of the anatomical structures of the small pelvis without preservation of the neurovascular bundles of the penis.&#x0D; We do not dwell on the method of performing the operation, it is known, all 16 patients underwent lymphadenectomy.&#x0D; The average operation time in the groups LRP 1 group, LRP 2 group did not differ significantly, and amounted to 147,16. And in a comparative analysis in group 3 RR, Group 4 RR there was a difference of 89,29, open operations were performed much faster.&#x0D; In our study, the criterion for urinary retention was the absence of the patient's need to use safety pads. This definition is adhered to by many specialists involved in the surgical treatment of prostate cancer. The use of at least 1 safety pad was equivalent to urinary incontinence. And it was considered a complication after the operations performed. Inourstudy, themeantimetorestoration of the full urinary continence function was the longest where the standard surgical procedure was performed, and the shortest was in the groups where the maximum preservation of the anatomical structures of the periprostatic anatomical zone was performed.&#x0D; Conclusions. 1. The main mechanism for the rapid restoration of urinary retention in patients after radical prostatectomy with prostate cancer is the maximum preservation of the pubo-prostatic ligaments and the pubo-perineal muscle, which makes it possible to fully restore the function of urinary retention within a month. 2. Preservation, only of the neurovascular bundle of the penis, is not enough to restore the function of early urinary retention after surgery.

Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients

IntroductionLateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF.MethodsWe studied 110 female patients affected by CAF undergone fissurectomy and anoplasty with V–Y cutaneous flap advancement associating pharmacological sphincterotomy in patients with hypertonic IAS. The follow up was at least for 2 years. The goals were patient’s complete healing, the evaluation of FI, recurrence rate and manometry parameters.ResultsAll wounds healed within 40 days after surgery. We recorded 8 cases of recurrences 6 healed with medical therapy and 2 with dilatation. We recorded 2 “de novo” temporary and low grade post-operative cases of FI. Post-operative value of MRP were unmodified in patient with normotonic IAS but significantly lower at 12 months follow up as compared with the pre-operative ones in patients with hypertonic IAS; after 24 months from surgery MRP values were within the normal range.ConclusionThe fissurectomy and anoplasty with V–Y cutaneous flap alone or in association with a pharmacological sphincterotomy in patients with hypertonic IAS may represent an effective approach for the treatment of CAF in female patients.