Daily Pad Usage Research Articles

Role performance and factors affecting quality of life in bladder cancer survivors with ileal orthotopic neobladder

ObjectiveBladder cancer survivors with neobladder experience changes in role performance and quality of life (QoL) due to various symptoms and problems, but related studies are limited. Therefore, this study attempted to explore the QoL and factors influencing it in bladder cancer survivors with neobladder. MethodsA cross–sectional descriptive design was used. Data were collected from 100 bladder cancer survivors with a neobladder using the European Organisation for Research and Treatment of Cancer QLQ–C30 and Muscle–Invasive Bladder Cancer Module, the Patient Activation Measure 13, the Enforced Social Dependency Scale, and the Multidimensional Scale of Perceived Social Support. Factors affecting the QoL were identified using multiple regression analysis. ResultsQoL significantly differed by daily pad usage, need for clean intermittent catheterization, and role performance. QoL was correlated with urinary symptoms and problems, future perspective, abdominal bloating and flatulence, body image, role performance, and social support. Role performance, body image, and the need for clean intermittent catheterization were identified as the factors affecting QoL. ConclusionsThe study highlights the importance of bladder cancer survivors continuing their roles at home, at work, and in society after neobladder reconstruction. Specifically, continuing recreational and social activity positively affects QoL, even if the activity range is modified. To help with their role performance, institutional support and changes in social perception are needed. Additionally, education and interventions, including body image enhancement, symptom management, and self–care, should be developed and applied to improve their QoL.

Characterizing patient experiences with repeat artificial urinary sphincter revisions through quantitative surveys and qualitative patient interviews.

Artificial urinary sphincter (AUS) placement remains the gold-standard treatment for post-prostatectomy urinary incontinence (PPUI), despite their need for periodic surgical revision. To understand the experiences of patients who undergo repeat AUS revisions. Mixed design including quantitative surveys and qualitative interviews for thematic analysis. Men with ⩾2 revisions were collected from a single-institution, retrospective database of AUS patients. Participants were interviewed about their prostatectomy, incontinence, AUS placement, and revisions. A survey was administered utilizing validated tools (e.g., Decision Regret Scale (DRS), Incontinence Impact Questionnaire-7) for quantitative analysis. Interview transcripts were used for qualitative thematic analysis. Of 26 respondents, 20 completed the interview. Twenty-three men completed the survey. The mean DRS score for prostatectomy was 24 (standard deviation (SD) = 27), indicating low regret. Median Incontinence Impact Questionnaire score was 54 (SD = 27), with 70% of participants describing their PPUI as "severe." Participants experienced a significant decrease in daily pad usage with AUS placement (5.5 pre-AUS vs 1.4 post-AUS, p < 0.0001). Qualitative analysis revealed themes involving prostatectomy urgency, physician-patient relationships, expectation setting, and quality of follow-up. Most participants (96%) were satisfied with their initial AUS placement and endorsed a positive relationship with their urologist. However, 22% of participants were unaware of device limitations, including the need for revision. Some participants (26%) were uncertain of the status of their AUS, while some participants (35%) desired improved follow-up. Initial improvement and positive experiences with urologists motivate patients to undergo AUS repeat revision. Urologists should emphasize the limitations of the AUS before placement and follow up with patients to evaluate their needs for future care.

Efficacy and Complications of the Re-Adjustable Male Sling System for Stress Urinary Incontinence after Radical Prostatectomy.

The aim of this study was to investigate the outcomes of re-adjustable male slings in pa-tients with postoperative stress urinary incontinence (SUI) following radical prostatectomy (RP). We retrospectively analyzed 18 patients with SUI following RP for prostate cancer, who were treated with re-adjustable male slings from January 2016 to December 2021. The clinical outcomes were evaluated based on daily pad usage and urodynamic studies, both preoperatively and post-operatively. The degree of SUI was categorized as either mild, moderate, or severe. Success was defined as no more pad use or significantly decreased pad use. Complications were classified ac-cording to the Clavien-Dindo system. The mean age of patients was 70.4 ± 5.9 years, and 61.1% of cases were diagnosed as locally advanced prostate cancer. Mild, moderate, and severe SUI were reported as 33.3%, 50.0%, and 16.7%, respectively. The average daily pad use after RP was 3.3 pads and there was a significant reduction in the number of daily pads used after the re-adjustable male sling procedure (3.3 vs. 1.3; p = 0.002). Overall, the operation was considered successful in 11 pa-tients (61.1%), 1 case showed improvement (5.6%), and it was considered unsuccessful in 6 patients (33.3%). Impressively, in the severe incontinence subgroup (three patients), one (33.3%) had im-provement and one (33.3%) had success. Transient perineal discomfort after the operation was the most common complaint. However, two patients had severe complications with bowel injury during sling implantation (Clavien-Dindo grade III). The re-adjustable male sling system was an efficient surgical treatment option for post-RP SUI, even in a locally advanced disease dominant population. One should pay attention to the complication of bowel perforation during surgery.

Modified female mid-urethral sling for the treatment of incontinence after prostate treatment: One-center experience.

The male sling has emerged as a minimally invasive option for incontinence after prostate treatment (IPT) in recent years, but it hasnot yet been introduced into China. This study retrospectively evaluated the clinical outcomes of the modified female mid-urethral sling in the treatment of IPT and explored potential preoperative factors to better predict surgical outcomes. From May 2014 to January 2021, a total of 70 patients with IPT who underwent transobturator male sling procedure using the modified female mid-urethral sling were retrospectively reviewed. All surgeries were performed by a single surgeon. Functional outcomes were evaluated by daily pad usage, and the severity of incontinence was classified as mild (≤2 pads), moderate (3-4 pads), or severe (≥5 pads). Success was defined as no pad usage or 1 pad for safety (cure), or a reduction in daily pad use by >50% (improved). Patients were followed up at 3, 6 months, and yearly thereafter. At a final follow-up of 6-80 months, 35 (50.0%) patients were cured, 12 (17.1%) were improved, and 23 (32.9%) were still incontinent. There was a slight trend of declining continence over time, and the majority of patients remained improved. During follow-up, 25 patients had perineal or scrotal pain, five patients had voiding difficulty and two had de novo urgency, one developed infection and underwent sling explantation. Early urinary retention was the only significant factor linked to better surgical outcomes. The modified female mid-urethral sling represents a viable option for the treatment of IPT. Improved efficacy is seen in patients with a history of early postoperative urinary retention.

PD43-03 FUNCTIONAL OUTCOMES AFTER RADICAL CYSTECTOMY WITH ILEAL NEOBLADDER

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II1 Apr 2018PD43-03 FUNCTIONAL OUTCOMES AFTER RADICAL CYSTECTOMY WITH ILEAL NEOBLADDER Nicolas von Landenberg, Julian Hanske, Sebastian Berg, Jana Schmidt, Marko Brock, Rein-Jüri Palisaar, Christian von Bodman, Florian Roghmann, and Joachim Noldus Nicolas von LandenbergNicolas von Landenberg More articles by this author , Julian HanskeJulian Hanske More articles by this author , Sebastian BergSebastian Berg More articles by this author , Jana SchmidtJana Schmidt More articles by this author , Marko BrockMarko Brock More articles by this author , Rein-Jüri PalisaarRein-Jüri Palisaar More articles by this author , Christian von BodmanChristian von Bodman More articles by this author , Florian RoghmannFlorian Roghmann More articles by this author , and Joachim NoldusJoachim Noldus More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2115AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the functional outcomes after radical cystectomy (RC) with ileal neobladder (INB) in a contemporary cohort of patients with bladder tumor using validated and established questionnaires for continence and sexual function. METHODS The study population consisted of 252 consecutive bladder tumor patients that underwent RC with INB at a single institution between June 2003 and December 2014. The functional follow-up started in January 2011. Continence status was assessed using the daily pad usage >4 months after RC. We defined <=1 pad/24h as continent. Sexual function was evaluated using the International Index of Erectile Function-5 (IIEF-5) and the Female Sexual Function Index-19 (FSFI-19) in women. We defined sexual disorder in men as IIEF<17 and in women as FSFI<26.55. Statistical analyses were conducted (chi2, Kruskal-Wallis, Mann-Whitney U test). RESULTS At the start of functional follow-up, 51 patients were deceased, leading to a final study cohort of 201 patients. Of those, 170/201 (84.6%) were male. Median age at surgery was 61 years (IQR 55–67), 46/201 (22.9%) had a body mass index > 30, 10/201 (5%) had a Charlson Comorbidity Index >=3, 141/201 (70.1%) had an organ defined tumor. Continence questionnaires were returned by 114/201 (56.7%) patients with a continence rate of 79.8% (91/114). IIEF was returned by 88/170 (51.8%) men. Of those, 21/75 (28%) after nerve sparing surgery (NSS) vs. 0/13 (0%) without NSS reported an IIEF>17 (P=0.033). FSFI was returned by 16/31 (51.6%) of the female subgroup. Of those, 3/10 (33%) after NSS vs. 1/6 (16.7%) without NSS reported an FSFI>26.55 (P>0.05). Reported reasons for sexual disorder among those with a FSFI<26.55 were missing partner (4/12; 33.3%), sexual dysfunction of the partner (3/12; 25%), personal age/comorbidities (5/12; 41.7%), incontinence during intercourse (3/12; 25%), dyspareunia (3/12; 25%). There were no significant differences in age, BMI, CCI and tumor stage according to continence status and sexual function. CONCLUSIONS Overall, RC with INB is associated with a relatively low rate of social incontinence. Approximately, one third of the patients that underwent NSS is sexually active after RC. This information should be discussed during patient counseling before RC. Further studies are needed to validate these findings. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e877 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nicolas von Landenberg More articles by this author Julian Hanske More articles by this author Sebastian Berg More articles by this author Jana Schmidt More articles by this author Marko Brock More articles by this author Rein-Jüri Palisaar More articles by this author Christian von Bodman More articles by this author Florian Roghmann More articles by this author Joachim Noldus More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD18-05 EFFECT OF PERIOPERATIVE PATIENT EDUCATION ON LONG-TERM SATISFACTION RATES OF LOW-RISK PROSTATE CANCER PATIENTS AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III1 Apr 2017PD18-05 EFFECT OF PERIOPERATIVE PATIENT EDUCATION ON LONG-TERM SATISFACTION RATES OF LOW-RISK PROSTATE CANCER PATIENTS AFTER RADICAL PROSTATECTOMY Alexander Kretschmer, Alexander Buchner, Markus Grabbert, Anne Sommer, Christian G. Stief, and Ricarda M. Bauer Alexander KretschmerAlexander Kretschmer More articles by this author , Alexander BuchnerAlexander Buchner More articles by this author , Markus GrabbertMarkus Grabbert More articles by this author , Anne SommerAnne Sommer More articles by this author , Christian G. StiefChristian G. Stief More articles by this author , and Ricarda M. BauerRicarda M. Bauer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.865AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Amongst patients diagnosed with localised prostate cancer, the subsets of patients with low-risk disease are of particular interest since several evidence based therapeutic options are available to them, including radical prostatectomy (RP), radiotherapy, and active surveillance. To date, little is known about health-related quality of life with regard to patient satisfaction in general and the effect of perioperative patient counselling in particular. In the current study, we evaluate patient-reported functional outcomes after RP and analyze the effect of perioperative patient education on satisfaction rates among low-risk prostate cancer patients. METHODS Inclusion criteria encompassed low-risk prostate cancer patients as defined by the D′Amico criteria, undergoing nerve-sparing RP excluding pelvic lymphadenectomy. Patient-centred functional outcomes, subjective evaluation of perioperative counselling, and patient satisfaction rates were documented. Stress urinary incontinence (SUI) was assessed by daily pad usage. Erectile dysfunction (ED) was assessed using IIEF5 score. Patients histories were attained from the electronic medical records. The effect of pre-defined predictive features for satisfaction rates was analysed in low-risk patients. Statistical analyses included Fisher exact test, Mann-Whitney-U test, and binary logistic regression models (p<0.05). RESULTS 266 patients met the inclusion criteria. Median follow-up was 94 months (68-118). The global satisfaction rate was 75.1%. Regarding SUI, 69.5% of patients required no pads, 67.1% felt very well informed, while 11.7 % felt poorly educated. Regarding ED, an IIEF score of ≥18 was reached by 33.7%. 59.6% felt very well educated, while 13.0% felt poorly informed. Poor patient counselling regarding SUI and ED led to significantly decreased long-term satisfaction rates [40.7%, 33.3% (p<0.001)]. In multivariate analysis, poor ED patient counselling [OR 0.190, 95%CI 0.055-0.652 (p=0.008)], and postoperative IIEF5 score [OR 3.061, 95%CI 1.013-3.111 (p=0.013)] could be confirmed as independent predictors for patient satisfaction. CONCLUSIONS In the current study, we provide a detailed patient-centred analysis of multiple functional outcome parameters in a long-term follow-up after RP. Firstly, our findings highlight the effect of perioperative patient education on long-term patient satisfaction rates. In addition, our results advocate a structured patient counselling process to increase the postoperative quality of life in low-risk prostate cancer patients that have undergone RP (instead of active surveillance). © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e361 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Alexander Kretschmer More articles by this author Alexander Buchner More articles by this author Markus Grabbert More articles by this author Anne Sommer More articles by this author Christian G. Stief More articles by this author Ricarda M. Bauer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

942 - Perioperative patient education improves long-term satisfaction rates of low-risk prostate cancer patients after radical prostatectomy

To evaluate patient-reported functional outcomes after radical prostatectomy (RP) and to analyse the effect of perioperative patient education on satisfaction rates among low-risk prostate cancer patients. Inclusion criteria encompassed low-risk prostate cancer patients as defined by the D’Amico criteria, undergoing nerve-sparing RP without pelvic lymph node dissection. Patient-centred functional outcomes, subjective evaluation of perioperative counselling, and patient satisfaction rates were documented. Stress urinary incontinence (SUI) was assessed by daily pad usage. Erectile dysfunction (ED) was assessed using IIEF5 score. Patients’ histories were attained from the electronic medical records. The effect of pre-defined predictive features for satisfaction rates was analysed in low-risk patients. Statistical analyses included Fisher’s exact test, Mann-Whitney-U test, and binary logistic regression models (p < 0.05). 266 patients met the inclusion criteria. Median follow-up was 94 months (68–118). The global satisfaction rate was 75.1%. Regarding SUI, 69.5% of patients required no pads. 67.1% felt very well informed, while 11.7% felt poorly educated about postoperative SUI. Regarding ED, an IIEF score of ≥18 was reached by 33.7%. 59.6% felt very well educated, while 13.0% felt poorly informed. Poor patient counselling regarding SUI and ED led to significantly decreased long-term satisfaction rates [40.7, 33.3% (p < 0.001)]. In multivariate analysis, poor ED patient counselling [OR 0.190, 95% CI 0.055–0.652 (p = 0.008)], and postoperative IIEF5 score [OR 3.061, 95% CI 1.013–3.111 (p = 0.013)] could be confirmed as independent predictors for patient satisfaction. Patient-centred functional outcome analysis has illustrated the importance of perioperative patient education on long-term patient satisfaction rates after RP in low-risk prostate cancer patients.

Perioperative patient education improves long-term satisfaction rates of low-risk prostate cancer patients after radical prostatectomy.

To evaluate patient-reported functional outcomes after radical prostatectomy (RP) and to analyse the effect of perioperative patient education on satisfaction rates among low-risk prostate cancer patients. Inclusion criteria encompassed low-risk prostate cancer patients as defined by the D'Amico criteria, undergoing nerve-sparing RP without pelvic lymph node dissection. Patient-centred functional outcomes, subjective evaluation of perioperative counselling, and patient satisfaction rates were documented. Stress urinary incontinence (SUI) was assessed by daily pad usage. Erectile dysfunction (ED) was assessed using IIEF5 score. Patients' histories were attained from the electronic medical records. The effect of pre-defined predictive features for satisfaction rates was analysed in low-risk patients. Statistical analyses included Fisher's exact test, Mann-Whitney-U test, and binary logistic regression models (p < 0.05). 266 patients met the inclusion criteria. Median follow-up was 94 months (68-118). The global satisfaction rate was 75.1%. Regarding SUI, 69.5% of patients required no pads. 67.1% felt very well informed, while 11.7% felt poorly educated about postoperative SUI. Regarding ED, an IIEF score of ≥18 was reached by 33.7%. 59.6% felt very well educated, while 13.0% felt poorly informed. Poor patient counselling regarding SUI and ED led to significantly decreased long-term satisfaction rates [40.7, 33.3% (p < 0.001)]. In multivariate analysis, poor ED patient counselling [OR 0.190, 95% CI 0.055-0.652 (p = 0.008)], and postoperative IIEF5 score [OR 3.061, 95% CI 1.013-3.111 (p = 0.013)] could be confirmed as independent predictors for patient satisfaction. Patient-centred functional outcome analysis has illustrated the importance of perioperative patient education on long-term patient satisfaction rates after RP in low-risk prostate cancer patients.

Long-term Outcome of the Retrourethral Transobturator Male Sling After Transurethral Resection of the Prostate.

PurposeTo evaluate long-term outcomes of AdVance and AdVanceXP male slings in patients with persistent stress urinary incontinence (SUI) after transurethral resection of the prostate (TURP).MethodsA total of 18 consecutive patients received AdVance (n=14) or AdVanceXP (n=4) male sling implantation between 2007 and 2013. Continence was determined by pad use, 24-hour pad testing and validated questionnaires (International Consultation on Incontinence Questionnaire Short Form, ICIQ-SF). Quality of life was evaluated by International Quality of Life (IQoL) score. Patient satisfaction was measured with patient’s global impression of improvement score. Cure was defined as 0–5 g in the 24-hour pad test. Statistical analysis included Fisher exact and Wilcoxon test (P<0.05).ResultsFollow-up was available for 15 patients who underwent further analysis. After a median follow-up of 70 months (range, 18–83 months), mean daily pad usage was 1.8±2.1 pads (P=0.015 vs. baseline level). Mean IQoL score was 66.4±31.6 (P=0.050 vs. baseline level), and mean ICIQ-SF score was 9.5±6.6 (P=0.077 vs. baseline level). Based on 24-hour pad testing, mean daily urine loss was 31.2±64.5 g (median, 0 g; range, 0–209 g). Cure rate was 46.7%, and cure-and-improved rate was 60.0%. Assessing predictive features for success, better results were found in patients who needed up to 4 pads preoperatively (P=0.041) as well as for patients ≤71 years at the time of implantation (P=0.041).ConclusionsThe findings indicate that AdVance and AdVanceXP implantation can be performed effectively and safely in men suffering from SUI after TURP. However, long-term success rates seem to be lower compared to SUI after radical prostatectomy and patients should be counseled accordingly.

Mid-term outcomes after AdVanceXP male sling implantation.

To describe efficacy and safety of the AdVanceXP (Boston Scientific, Marlborough, MA, USA) retrourethral transobturator male sling after a mean follow-up of almost 3 years. A total of 41 patients underwent AdVanceXP implantation between July 2010 and March 2012 by a single surgeon. Patients were prospectively evaluated at baseline, after a mean follow-up of 12months and after an individual maximum follow-up. Efficacy was evaluated by daily pad usage, 24-h pad testing, and validated questionnaires (International Consultation on Incontinence questionnaire [ICIQ]). Patient satisfaction was determined using the Patient's Global Impression of Improvement score; quality of life was evaluated using the International Quality of Life (IQOL) score. Patients needing 0 or 1 safety pad with a daily urine loss <8 g were classified as cured. To assess the changes in outcome over time, a Wilcoxon signed-rank test was used. A P value <0.05 was taken to indicate statistical significance. The mean ± sd follow-up was 33.1 ± 8.1 months. A total of four patients (9.8%) were lost to follow-up. At follow-up, 56.1% of patients used 0 or 1 dry safety pad, 17.1% used 1 pad, and 17.1% used 2 pads. Mean pad use was 0.6 pads per day (P < 0.001 vs baseline) with a mean urine loss of 14 g per day. After nearly 3 years, 46.3% of the patients could be classified as cured and 29.3% could be classified as improved. When comparing respective outcomes after 1 and 3 years, no significant changes in mean daily pad use (0.8 at 1 year; P = 1.000), in ICIQ score (5.0 at 3 years vs 5.2 at 1 year; P = 0.500), or in IQOL score (89.2 at 3 years vs 86.8 at 1 year; P = 0.500) were observed. Patients lost less urine based on 24-h pad testing after nearly 3 years (14 g at 3 years vs 28 g at 1 year; P = 0.106). Subgroup analyses showed no significant differences in efficacy in patients who had previously received radiotherapy or in patients with mild preoperative incontinence. Between 1 and 3 years postoperatively, no complications were detected. The present study had the longest follow-up for AdVanceXP to date and is the first to show a high efficacy even after a mean follow-up of almost 3 years. The results indicate that late-onset complications are rare after AdVanceXP implantation.

AdVanceXP male sling: 2-year results of a multicentre study.

For the treatment of persistent post-prostatectomy incontinence (PPI), several surgical treatment options including male slings are available. In 2010, the second generation of the retrourethral male sling Advance, AdVanceXP, was introduced. Aim of the study was to examine in a prospective multicentre study the outcome of AdVanceXP in the treatment of PPI. Ninety-four patients were treated with AdVanceXP. Patients with nocturnal incontinence, previous incontinence surgery, with coaptive zone <1cm and irradiated patients were excluded. Measurements included: daily pad usage, 24-h pad weight test, post-operative pain in the visual analogue scale, International Quality of Life questionnaire, International Consultation on Incontinence Questionnaire short form, IEEF5 and Patient Global Impression of Improvement. Adverse events were recorded. All patients with no pads and 0-5g in the 24-h pad test were defined as cured and those with a reduction in urine loss >50% as improved. Preoperatively, the median 24-h pad weight test was 274g and daily pad usage was 3. At 1-year follow-up, 66.3% of patients could be classified as cured and 25.3% as improved. After 2years, 73.1% could be classified as cured and 19.6% as improved. Urine loss decreased (p<0.001), and quality of life improved significantly (p<0.001). Mean PGI was 1.5 after 1year and 1.4 after 2years. Majority of complications were minor. No intraoperative complications and five serious post-operative events occurred (grade IIIB complications). No explantation was necessary. AdVanceXP, when correctly indicated, shows good effectiveness and low complication rates after up to 2years.

Male Readjustable Sling (MRS) System for Postprostatectomy Incontinence: Experiences of 2 Centers

To evaluate the outcomes of Male Readjustable Sling (MRS) in patients with postprostatectomy incontinence at 2 unrelated centers and to determine preoperative factors relevant to the outcome. From January 2007 to January 2014, a total of 64 men with urinary incontinence following radical prostatectomy were treated with MRS at 2 centers. Patients were evaluated based on medical history, daily pad usage, urodynamics, and cystoscopy. The clinical outcome was evaluated according to daily pad usage and questionnaires. Success was defined according to reductions in the number of pads used per day after surgery, and factors related to surgical outcome were investigated. The median age of the patients was 70 years (range: 53-84), and the mean follow-up duration was 46.0 ± 19.47 months (range: 12-89). During follow-up, readjustment of the sling was required 1.9 times on average. Daily pad usage decreased significantly from 3.42 ± 2.00 to 0.84 ± 1.20 (P <.001), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score improved (18.65 ± 2.61 to 10.55 ± 6.21, P <.001) without deterioration of voiding symptoms at the last follow-up. MRS was successful in 46 of 64 patients (71.9%). Of the 18 patients who experienced surgical failure, 12 patients required secondary artificial urethral sphincter implantation. The number of daily used pads (odds ratio 1.414) and a history of pelvic irradiation (odds ratio 8.400) were potential risk factors for surgical failure. According to our midterm follow-up data, MRS is an effective and a safe treatment option for radiation-naïve patients with a mild degree of postprostatectomy incontinence.

Risk factors for artificial urinary sphincter failure.

To analyze revision rates and risk factors for artificial urinary sphincter failure. Eighty-four patients underwent implantation of an artificial urinary sphincter in one reference center. Continence rates were defined by daily pad usage. Influence of predefined risk factors for device explantation, revision, differences in preoperative pad usage, and device survival was analyzed using Chi-squared test, Wilcoxon signed-rank test, and Kaplan-Meier analysis. A multivariate analysis was performed using a logistic regression model. A p value below 0.05 was considered statistically significant. After a mean follow-up of 39.7 months, the device was still in situ in 64 patients. In univariate analysis, perioperative need of anticoagulation led to a significant increase in urethral erosion (6 vs. 30 %; p = 0.002) and explantation rate (15 vs. 34 %; p = 0.047). Pelvic irradiation increased postoperative infection rates significantly (0 vs. 10 %; p = 0.018). Penoscrotal approach led to significant increase in urethral erosion rate (0 vs. 21 %; p = 0.015). Implantation of a double cuff led to a significant increase in explantation rate (58 vs. 24 %; p = 0.014), revision rate (75 vs. 38 %; p = 0.017), and infection rate (17 vs. 1 %; p = 0.008). When using cuff size of 3.5 cm, revision rate (20 vs. 50 %; p = 0.026) as well as incontinence rates (40 vs. 82 %; p = 0.014) was significantly lower. In multivariate analysis, only perioperative anticoagulation and double-cuff placement were independent predictors of artificial urinary sphincter failure. Our findings highlight the influence of perioperative anticoagulative therapy. In addition, the current study provides further evidence that double-cuff implantation should be performed only with caution during primary implantation.

Comparison of Clinical Outcomes Between “Ideal” and “Nonideal” Transobturator Male Sling Patients for Treatment of Postprostatectomy Incontinence

To review the clinical outcomes of "ideal" vs "nonideal" postprostatectomy stress urinary incontinence (PPI) patients who underwent male sling placement. The medical records of 95 consecutive patients with PPI who underwent male sling insertion (AdVance male sling, American Medical Systems, Minnetonka, MN) were reviewed. Patients were divided into "ideal" vs "nonideal" cohorts. The ideal group consisted of patients with mild to moderate incontinence (<4 pads/day or <300 g daily pad weight), ability to volitionally contract the external urinary sphincter, no history of pelvic radiation or cryotherapy, no history of previous anti-incontinence surgical procedures, the ability to generate a volitional detrusor contraction when voiding, and a postvoid residual urine volume <100 mL. Patients in the nonideal group did not satisfy all these criteria. Significant reductions in daily pad usage and weight were noted in both cohorts. In the ideal patient group, 66 of 72 patients (92%) would undergo the procedure again. Conversely, only 7 of 23 nonideal men (30%) would undergo the procedure again. Preoperative patient selection can influence favorable outcomes after the treatment of PPI with AdVance male slings. Attention to ideal vs nonideal patient characteristics should be used when counseling men considering male sling surgery.

AdVance and AdVance XP slings for the treatment of post-prostatectomy incontinence

To examine the outcomes with the AdVance XP and AdVance slings in the management of post-prostatectomy incontinence (PPI). Eighty patients were treated with the AdVance resp. AdVance XP at one tertiary reference centre. The initial patients were implanted with the AdVance male sling with no associated surgery. Following the introduction of the AdVance XP sling, subsequent patients were implanted with the AdVance XP slings. Measurements included: daily pad usage, 24-h pad weight test, International Quality of Life Questionnaire, International Consultation on Incontinence Questionnaire Short Form and the Patient Global Impression of Improvement. Adverse events were recorded. Follow-up was available for 39 and 41 patients treated with the AdVance and AdVance XP slings, respectively. At a median follow-up of 24.7 months, 69.3 % of patients could be classified as cured or improved in the AdVance group and at a median follow-up of 11.9 months, 90.3 % of AdVance XP-treated patients. At 3-month follow-up, 96.8 and 97.3 % of patients could be classed as cured or improved in the AdVance and AdVance XP groups, respectively (not significant). There were no perioperative complications. Two AdVance and three AdVance XP serious post-operative complications were reported, which were resolved following treatment. QOL was improved in both treatment groups. Both the AdVance and the AdVance XP slings are effective and safe for the treatment of PPI.

Duloxetine for the treatment of post-prostatectomy stress urinary incontinence

Stress urinary incontinence (SUI) is a known complication following prostatectomy. Duloxetine, a combined serotonin/norepinephrine reuptake inhibitor, can decrease SUI by increasing urethral sphincter contractility. We examined the outcomes of patients with mild to moderate post-prostatectomy SUI treated with duloxetine. We conducted a retrospective review of men treated with duloxetine to manage mild to moderate post-prostatectomy SUI from 2006 to 2012. All patients received oral duloxetine 30 mg once a week, then 60 mg thereafter. Patients were seen one month later to determine drug efficacy and side effects. In total, 94 men were included in the study. Daily pad usage decreased from 2.9 (range: 1-5) to 1.6 (range: 0-4) (p < 0.05). Incontinence Impact Questionnaire (IIQ-7) scores decreased from 13.0 (range: 6-18) to 7.9 (range: 2-16) (p < 0.05). Linear satisfaction scores improved from 0.8 (range: 0-2) to 2.0 (range: 1-3) (p < 0.05). Following a 1-month duloxetine trial, 33/94 (35%) men reported satisfactory SUI improvement and requested to continue the medication. The drug was discontinued in 61/94 (65%) patients due to poor efficacy in 32/94 (34%), intolerable side effects in 14/94 (15%) or both in 15/94 (16%). Reported side effects included fatigue, light-headedness, insomnia, nausea and dry mouth. Duloxetine improved post-prostatectomy SUI in 47/94 (50%) men following a 1-month trial. However, only 33/94 (35%) patients were able to tolerate the drug. Duloxetine may be considered a treatment option for men with mild to moderate post-prostatectomy SUI.

1972 THE ZURICH EXPERIENCES INCLUDING 10 YEAR RESULTS OF 253 CASES TREATED WITH BOTULINUM-A TOXIN INJECTIONS INTO THE DETRUSOR MUSCLE FOR OVERACTIVE BLADDER REFRACTORY TO ANTICHOLINERGICS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-Neurogenic Voiding Dysfunction1 Apr 20121972 THE ZURICH EXPERIENCES INCLUDING 10 YEAR RESULTS OF 253 CASES TREATED WITH BOTULINUM-A TOXIN INJECTIONS INTO THE DETRUSOR MUSCLE FOR OVERACTIVE BLADDER REFRACTORY TO ANTICHOLINERGICS Daniel Max Schmid, Sharmistha Roy-Guggenbuehl, and Tullio Sulser Daniel Max SchmidDaniel Max Schmid Zurich, Switzerland More articles by this author , Sharmistha Roy-GuggenbuehlSharmistha Roy-Guggenbuehl Zollikerberg, Switzerland More articles by this author , and Tullio SulserTullio Sulser Zurich, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2131AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aim of this prospective study was to evaluate the efficacy and long-term results of low-dose (100 U) Botulinum-A toxin (BoNT-A) injections into the detrusor to treat patients suffering from severe non-neurogenic overactive bladder (OAB). METHODS 253 patients (68 m, 185 f; mean age 57 y., 18-87 y.) were treated by injections of 100 U of BoNT-A. Micturition diary, urodynamics, and neurological status were performed before treatment. Clinical and urodynamic checks and quality of life assessment (QoL) were performed at baseline and 12 weeks after BoNT-A treatment. Follow-up included duration of effect, re-injection rate and intervals between treatments. RESULTS Overall, 83 % of patients showed a significant (p<0.001) improvement of their bladder function in regard to symptoms as well as to urodynamic parameters Urgency completely disappeared in 75% and incontinence in 85% within 2 weeks, whereas daily pad usage dropped from 5 to 0.5 pads/day. Frequency decreased from 16 to 7 micturitions and nocturia from 5 to 2.5 (-50%), respectively. MCC increased from mean 230 to 395 ml (+71%), BC rised from 20 to 44 ml/cmH2O. FDV increased from mean 120 to 215 ml. There were no severe side effects except 7 temporary urine retentions and 20 urinary infections. QoL assessment revealed a significant subjective improvement in all urge-related items. In 16 patients clinical benefit was poor due to preop. low compliance. Efficacy duration was mean 8 (+/−2) months. So far, 29% (74/253) of patients were reinjected after the effect had diminished. The time interval between two treatments was mean 13 months (2-50). 21 patients had a third BoNT-A injection and we observed a longer lasting effect of mean + 5 months between the second and third treatment compared to the interval between the first and second treatment.13 pat. had 4 and 1 had 9 injections and urodynamic changes and clinical efficacy were similar to the first treatment. 27.5% of pat. had no further therapy, 40% take ACh. and 3.5% (n=9) underwent SNS. We observed no deterioration of bladder function even after repeated injections. CONCLUSIONS Our results show, that detrusor BoNT-A-injections are an efficient and safe treatment in patients suffering from severe OAB. Overlooking a follow-up time of 10.5 years, we are able to define a relaps rate of 29% after 13 months and an increasing symptom free time in patients undergoing repeated injections. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e795-e796 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Max Schmid Zurich, Switzerland More articles by this author Sharmistha Roy-Guggenbuehl Zollikerberg, Switzerland More articles by this author Tullio Sulser Zurich, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

V-Loc™180 (Covidien Healthcare, Mansfield, MA) is a new unidirectional barbed suture that may reduce loss of tension during a running closure. We evaluated the use of the barbed suture for urethrovesical anastomosis (UVA) during robotic assisted laparoscopic prostatectomy (RALP). Time to completion of UVA, post-operative anastomotic leak rate, and urinary incontinence were compared in patients undergoing UVA with 3-0 unidirectional-barbed suture vs. 3-0 Monocryl™ (Ethicon, Somerville, NJ). Data were prospectively collected for 70 consecutive patients undergoing RALP for prostate cancer between November 2009 and October 2010. In the first 35 patients, the UVA was performed using a modified running van Velthoven anastomosis technique using two separate 3-0 monofilament sutures. In the subsequent 35 patients, the UVA was performed using two running novel unidirectional barbed sutures. At 7-12 days postoperatively, all patients were evaluated with a cystogram to determine anastomotic integrity. Urinary incontinence was assessed at two months and five months by total daily pad usage. Clinical symptoms suggestive of bladder neck contracture were elicited. Age, PSA, Gleason score, prostate size, estimated blood loss, body mass index, and clinical and pathologic stage between the 2 groups were similar. Comparing the monofilament group and V-Loc™180 cohorts, average time to complete the anastomosis was similar (27.4 vs. 26.4 minutes, p = 0.73) as was the rate of urinary extravasation on cystogram (5.7 % vs. 8.6%, p = 0.65). There were no symptomatic bladder neck contractures noted at 5 months of follow-up. At 2 months, the percentage of patients using 2 or more pads per day was lower in the V-Loc™180 cohort (24% vs. 44%, p < 0.02). At 5 months, this difference was no longer evident. Time to complete the UVA was similar in the intervention and control groups. Rates of urine leak were also comparable. While the V-Loc™180 was associated with improved early continence, this difference was transient.

1517 THE ZURICH EXPERIENCES INCLUDING 8 YEAR RESULTS OF 240 CASES TREATED WITH BOTULINUM-A TOXIN INJECTIONS INTO THE DETRUSOR MUSCLE FOR OVERACTIVE BLADDER REFRACTORY TO ANTICHOLINERGICS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy I1 Apr 20101517 THE ZURICH EXPERIENCES INCLUDING 8 YEAR RESULTS OF 240 CASES TREATED WITH BOTULINUM-A TOXIN INJECTIONS INTO THE DETRUSOR MUSCLE FOR OVERACTIVE BLADDER REFRACTORY TO ANTICHOLINERGICS Daniel Schmid, Sharmistha Roy-Guggenbuehl, Tullio Sulser, and Brigitte Schurch Daniel SchmidDaniel Schmid More articles by this author , Sharmistha Roy-GuggenbuehlSharmistha Roy-Guggenbuehl More articles by this author , Tullio SulserTullio Sulser More articles by this author , and Brigitte SchurchBrigitte Schurch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2361AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aim of this prospective study was to evaluate the efficacy and long-term results of low-dose (100 U) Botulinum-A toxin (BoNT-A) injections into the detrusor to treat patients suffering from severe non-neurogenic overactive bladder (OAB). METHODS 240 patients (63 m, 177 f; mean age 57 y., 18-87 y.) were treated by injections of 100 U of BoNT-A. Micturition diary, urodynamics, and neurological status were performed before treatment. Clinical and urodynamic checks and quality of life assessment (QoL) were performed at baseline and 12 weeks after BoNT-A treatment. Follow-up included duration of effect, re-injection rate and intervals between treatments. RESULTS Overall, 84 % of patients showed a significant (p<0.001) improvement of their bladder function in regard to symptoms as well as to urodynamic parameters: Urgency completely disappeared in 75% and incontinence in 85% within 2 weeks, whereas daily pad usage dropped from 5 to 0.5 pads/day. Frequency decreased from 15 to 7 micturitions and nocturia from 5 to 2.5 (-50%), respectively. MCC increased from mean 235 to 390 ml (+63%), BC rised from 21 to 45 ml/cmH2O. FDV increased from mean 120 to 212 ml. There were no severe side effects except 7 temporary urine retentions and 20 urinary infections. QoL assessment revealed a significant subjective improvement in all urge-related items. In 16 patients clinical benefit was poor due to preop. low compliance. Efficacy duration was mean 8 (+/-2) months. So far, 27.5% (66/240) of patients were reinjected after the effect had diminished. The time interval between two treatments was mean 13 months (2-50). 15 patients had a third BoNT-A injection and we observed a longer lasting effect of mean + 5.5 months between the second and third treatment compared to the interval between the first and second treatment. 9 pat. had 4 and 1 had 7 injections and urodynamic changes and clinical efficacy were similar to the first treatment. 30% of pat. had no further therapy, 39.8 take ACh. and 2.7% (n=6) underwent SNS. We observed no deterioration of bladder function even after repeated injections. CONCLUSIONS Our results show, that detrusor BoNT-A-injections are an efficient and safe treatment in patients suffering from severe OAB. Overlooking a follow-up time of 8.5 years, we are able to define a relaps rate of 27.5% after 13 months and an increasing symptom free time in patients undergoing repeated injections. Zurich, Switzerland© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e585 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Schmid More articles by this author Sharmistha Roy-Guggenbuehl More articles by this author Tullio Sulser More articles by this author Brigitte Schurch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Patient Satisfaction After Dual Implantation of Inflatable Penile and Artificial Urinary Sphincter Prostheses

Since description of the transverse scrotal approach for artificial urinary sphincter (AUS) placement, simultaneous implantation of an inflatable penile prosthesis (IPP) and AUS through a single incision has been shown to constitute safe, efficient, and cost-effective treatment for men plagued by both erectile dysfunction and urinary incontinence. We present patient satisfaction outcomes after simultaneous dual implantation (DI) of an IPP and AUS. We compared outcomes of postprostatectomy patients who underwent DI to those receiving IPP or AUS alone from 2001 to 2006. Telephone interviews using a standard questionnaire were conducted to evaluate prosthetic functionality, ease of use, and patient satisfaction. A total of 95 men were evaluated (31 for IPP alone, 31 for AUS alone, and 33 for DI). Daily pad usage decreased from 4.6 to 0.8 pads per day with AUS alone and 6.1 to 1.3 pads per day with DI. Patients were similarly satisfied with IPP rigidity during inflation and flaccidity during inactivation in both IPP and DI groups (4.1 to 4.4 for rigidity and 3.9 for flaccidity [1 = "unhappy" and 5 = "happy"]). Ease of scrotal pump operation was similar in all groups, as was overall prosthetic satisfaction. Most patients stated that they would recommend the DI procedure to a friend or relative (87% to 94%) or have the procedure done again (77% to 94%). Dual implantation produces encouraging outcomes in patient satisfaction, ease of use and functionality that are similar to those found after placement of either IPP or AUS alone.