Daily Pad Use Research Articles

Prevalence and risk factors for overactive bladder symptoms in patients with artificial urinary sphincter

To demonstrate the prevalence and risk factors for overactive bladder symptoms associated with artificial urinary sphincter implantation, we investigated the patients who underwent primary artificial urinary sphincter implantation with severe urinary stress incontinence. Forty-eight patients who completely answered the questionnaires of the overactive bladder symptom score before surgery were included. Patient characteristics, urinary status at pre and 1, 3, 6, and 12 months post-device activation, and predictive factors for overactive bladder symptoms were examined. Sixty percent of the patients had preoperative overactive bladder symptoms. Until 12 months after device activation, 35–40% of all patients had overactive bladder symptoms. The rate of persistent and de novo postoperative overactive bladder symptoms was 44.8% and 26.3%, respectively. Daily pad use was not different between patients w/wo overactive bladder symptoms. The only risk factor for postoperative overactive bladder symptoms was a max cystometoric capacity < 200 mL measured by a preoperative urodynamic study. Attention must be given to both persistent and de novo overactive bladder symptoms associated with artificial urinary sphincter implantation for patients with stress incontinence. Counsel should equally be provided for preoperative overactive bladder symptoms, especially in cases with a cystometric capacity < 200 mL.

Comparison of In-person Versus Online Comprehensive Pelvic Floor Rehabilitation Program Following Prostatectomy

ObjectiveTo compare continence outcomes in post-prostatectomy patients undergoing supervised in-person versus online pelvic floor muscle training and pelvic floor education (iPMFT versus oPFMT/PFE). Despite the proven benefit of in-person PFMT for urinary incontinence (UI) following prostatectomy, numerous barriers impede access. We developed a comprehensive online program to deliver oPFMT/PFE. MethodsWe performed a retrospective review of patients receiving iPFMT versus oPFMT/PFE with minimum 12-month follow-up. Outcomes were assessed at 3-weeks, 3-, 6-, and 12-months following robotic-assisted laparoscopic prostatectomy using validated ICIQ-MLUTS and IIQ-7 questionnaires and additional items (daily pad use (PPD) and satisfaction). The primary study outcome was ICIQ-MLUTS SUI domain score (SDS). Secondary outcomes were PPD, PPD cure (0 PPD at 12-months), SUI cure (12-month SDS = baseline score), and QOL score (IIQ-7 Sum). ResultsAnalysis included 41 men. Though men enrolled in oPFMT/PFE demonstrated lower SUI domain scores than iPFMT at most time points (3w p<0.01, 3m p=0.04, 6m p=0.15, 12m p=0.04), the rate of improvement from 3-weeks to other time points was similar between groups (p=NS at all time points)). SDS Cure was no different for oPFMT/PFE (75%, 15/20) compared to iPFMT (60%, 12/20, p=0.3). PPD and IIQ-7 were also similar at all time points and demonstrated a similar rate of decrease over time through 12 months. ConclusionsSignificant and similar improvements in UI and QOL are seen both in men completing iPFMT or oPFMT/PFE programs. Our novel online program provides another option to improve PFMT/PFE access in men undergoing RALP.

The effects of psychological factors on urinary incontinence after robotic radical prostatectomy: pilot study

Urinary incontinence (UI) is a frequent complication of radical prostatectomy (RP), and identifying preoperative predictors may assist in patient selection and continence rehabilitation. We investigated the association between preoperative psychological factors and UI after RP. Consenting patients planned for RP were recruited prospectively to this pilot study. They responded to preoperative psychological surveys, including a depression anxiety stress scale, coping behavior questionnaire, general self-efficacy scale, revised life orientation test and locus of control scale (LCS). Incontinence severity was assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and daily pad usage at 6 months after surgery. Correlation tests and linear regression models evaluated the association between psychological factors and UI. Twenty-five men with a median age of 69 years were enrolled. Continence outcomes at 6 months were a median ICIQ-SF score of 11 (Interquartile range (IQR) 7–14) and a median use of 2 pads per day (IQR 1–5). LCS was linearly correlated to ICIQ-SF scores (p = 0.05) and daily pad use (p = 0.005). Age and pathological staging were also linearly correlated to incontinence severity. LCS remained linearly associated with daily pad use on multivariate analysis adjusting for age and pathology (β = 0.61, p = 0.007). Locus of control is a psychological predictor for post-RP UI severity, and patients with external control may be prone to worse incontinence. The LCS may be used when counseling patients before surgery in order to clarify expectations regarding postoperative continence. Future studies to evaluate whether psychological intervention may be beneficial for continence rehabilitation are warranted.

Factors Affecting The Success Of Vaginitis Treatment In Pregnant Women ; A Prospective Cohort Study

Introduction&#x0D; Anatomy, physiology, and flora of the female genital system change due to pregnancy-related hormonal, metabolic, endocrinological, and immunological reasons. Dysbiosis increases the risk of spontaneous preterm birth with chronic inflammatory processes by causing infections in the fetoplacental unit by the ascending or hematogenous route. &#x0D; Our study aimed to reveal the bad personal habits and practices predispose to vaginitis, create resistance to treatment, and cause recurrences in pregnant women with vaginitis. &#x0D; &#x0D; Material-Methods&#x0D; Our descriptive study was conducted on a group of patients who applied to the Department of Obstetrics and Gynecology, between December 2021 and April 2022, with the ethics committee's approval. Our study group consists of 178 pregnant women over 18 who are literate, cooperative, and volunteered to answer all the questions in the questionnaire.&#x0D; &#x0D; Results&#x0D; Vaginal douching in 71.9% (128 people) of the participants, not ironing their underwear at all in 67.4% (120 people), cleaning the perineum from back to front in 66.9% (119 people), 61.2% daily pad use in 61.2% (109 people), synthetic laundry use in 41% (73 people), use of genital cleaning products in 16.3% (29 people), hand washing underwear in 7.3% (13 people) and 5.6% (10 people) had frequent sexual intercourse behavior. Regarding genital area cleaning, 11.2% (20 people) of the patients knew about using white vinegar, and 3.4% (6 people) used the acidic mixture. 6.7% (12 people) of the participants knew the use of vaginal probiotics.&#x0D; Conclusion&#x0D; Considering the results of our study, it can be said that wrong practices regarding genital hygiene continue, especially in women from low socio-economic and cultural levels.&#x0D; In this respect, the women need training on genital hygiene as a preventive measure due to the mistakes they make in practice related to genital hygiene and the possibility of experiencing a genital infection in a significant part of them.&#x0D; In conclusion, considering that the most significant deficiency in the occurrence of genital infections in women is the lack of education, it is recommended that all health professionals develop a training plan to prevent genital infections and apply it to women in the regions they work.

MP71-04 ADJUSTABLE ARTIFICIAL SPHINCTER VICTO IN THE TREATMENT OF URINARY INCONTINENCE: EARLY RESULTS IN A COHORT OF HIGH-RISK CASES IN A PROSPECTIVE SINGLE CENTER STUDY

You have accessJournal of UrologyCME1 Apr 2023MP71-04 ADJUSTABLE ARTIFICIAL SPHINCTER VICTO IN THE TREATMENT OF URINARY INCONTINENCE: EARLY RESULTS IN A COHORT OF HIGH-RISK CASES IN A PROSPECTIVE SINGLE CENTER STUDY Ghazal Ameli, Peter Weibl, Michael Rutkowski, and Wilhelm Huebner Ghazal AmeliGhazal Ameli More articles by this author , Peter WeiblPeter Weibl More articles by this author , Michael RutkowskiMichael Rutkowski More articles by this author , and Wilhelm HuebnerWilhelm Huebner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Victo is an adjustable artificial urinary sphincter (AUS), consisting of three parts which are preconnected. A pressure regulating balloon, a cuff, and a pump, which includes a self-sealing port for adjustment. The objective of the present study is to test the efficiency and practicality of VICTO in the control of stress urinary incontinence (SUI) and to evaluate the short- and long-term complications. METHODS: A total of 32 patients were included between 1/2020 and 4/2022, the trial is still ongoing and estimated end of the clinical trial is May 2025.41% of the patients in this cohort has undergone prior procedures for SUI: sling n=4, ProACT n=4, AMS 800=1, 3 patients had multiple SUI surgeries. 38% of the patients had undergone secondary irradiation therapy. Additionally, 9 patients had undergone procedures for bladder neck pathologies or urethral strictures.All patients underwent artificial urethral sphincter (AUS) implant “VICTO” according to established technique. The mean age was 71.9 years, 41% of the patients had systemic arterial hypertension and 19% diabetes mellitus.Functional urinary outcomes were assessed according to daily pad use and a standardized questionnaire. Data were collected as part of the follow up care of these patients. RESULTS: The reduction in number of pads compared between baseline and Follow-Up was significant (p<0,001). Cure of urinary incontinence was defined as using either 0 or 1 p/d. All the index patients in this cohort (n=7) were cured. In total 64.5% of the patients reported to be dry and were cured by definition. Additionally, 19.4% patients reported improvement of ≥50 % according the PGI-I (Patients Global Impression of Improvement).Two erosions were reported over the FU-period (mean 4.6 months). One infection occurred after traumatic catheterization without deactivation of the device followed by urethral erosion, infection and explantation of the device. Both patients with erosion had previous pelvic irradiation.One explantation was reported at day 2 after implantation, the presumable cause of explantation was unrecognized intra-operative urethral injury and consequently urethral erosion and was excluded from the study. CONCLUSIONS: In this complex group with mostly high-risk patients, all men with uncomplicated SUI (no previous surgeries and no history of irradiation) were cured after device implantation. The overall treatment success was 84 % according PGI-I and 65% according to pad per day usage. Despite the above average number of patients with risk factors for failure in this cohort, the results of the current trial are consistent with the evidence in literature. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1014 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ghazal Ameli More articles by this author Peter Weibl More articles by this author Michael Rutkowski More articles by this author Wilhelm Huebner More articles by this author Expand All Advertisement PDF downloadLoading ...

MP67-10 CLINICAL FACTORS ASSOCIATED WITH EARLY RETURN OF URINARY CONTROL FOLLOWING RETZIUS-SPARING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP67-10 CLINICAL FACTORS ASSOCIATED WITH EARLY RETURN OF URINARY CONTROL FOLLOWING RETZIUS-SPARING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY Ruben Blachman-Braun, Dinno F Mendiola, Carole Lahana, Chad R. Ritch, Sanoj Punnen, Bruno Nahar, Dipen J Parekh, and Mark L Gonzalgo Ruben Blachman-BraunRuben Blachman-Braun More articles by this author , Dinno F MendiolaDinno F Mendiola More articles by this author , Carole LahanaCarole Lahana More articles by this author , Chad R. RitchChad R. Ritch More articles by this author , Sanoj PunnenSanoj Punnen More articles by this author , Bruno NaharBruno Nahar More articles by this author , Dipen J ParekhDipen J Parekh More articles by this author , and Mark L GonzalgoMark L Gonzalgo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A potential side effect following radical prostatectomy is urinary incontinence. Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) has been associated with improved urinary control outcomes. We investigated the impact of clinical variables and intraoperative surgical findings on recovery of urinary control following RS-RARP. METHODS: Data was collected from a single-surgeon, single-institution prospective database of patients who underwent RS-RARP from May 2020 to July 2022 with≥3 months of follow up. Those without EPIC-CP (Expanded Prostate Cancer Index Composite for Clinical Practice) or unknown prostate size at baseline were excluded. Daily pad use and EPIC-CP urinary incontinence symptom score domain (EPIC-CP UISS) were used to assess continence status. Multivariable-adjusted logistic regression was performed to assess clinical variables associated with 3-month continence (EPIC-CP UISS≤3) following surgery. RESULTS: A total of 295 men were analyzed, 49 (16.6%) had a median lobe (ML) confirmed intraoperatively, 27 (9.2%) required bladder neck reconstruction (BNR) using a tennis-racket suturing technique, and 139 (47.1%) had bilateral nerve-sparing (BNS). A total of 145 (49.2%) and 224 (76.6%) men reported using 0 or 0-1 pad per day ≤1 week following catheter removal, respectively. At 3-month follow up, 65.4% and 86.1% of men reported using 0 or 0-1 pad per day, respectively; 81.7% of men had EPIC-CP UISS ≤3. Approximately 90% and 97% of men reported using 0 or 0-1 pad per day 12 months following surgery, respectively. Diabetes mellitus (DM) was associated with worse continence (OR=0.403, p=0.027), and BNS was associated with better continence (OR=3.595, p=0.003) at 3 months. Prostate size, presence of a ML, and BNR were not associated with worse urinary control at 3 months (Table 1). CONCLUSIONS: Early continence rates after RS-RARP are encouraging with the majority of men being completely dry or using 0-1 pad per day within 1 week of catheter removal and by 3 months following surgery. DM has a negative impact and BNS has a positive impact on return of early continence. Age, prostate size, presence of ML, and BNR did not have a significant impact on early recovery of urinary control after RS-RARP. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e946 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ruben Blachman-Braun More articles by this author Dinno F Mendiola More articles by this author Carole Lahana More articles by this author Chad R. Ritch More articles by this author Sanoj Punnen More articles by this author Bruno Nahar More articles by this author Dipen J Parekh More articles by this author Mark L Gonzalgo More articles by this author Expand All Advertisement PDF downloadLoading ...

POST-PROSTATEKTOMİ İNKONTİNANSTA İNTRİNSİK SFİNKTER DİSFONKSİYONU DIŞINDAKİ NEDENLER DE AKILDA BULUNDURULMALIDIR

Objective: This study aims to determine the causes of urinary incontinence and accompanying bladder pathologies in patients with persistent incontinence 12 months after radical prostatectomy.&#x0D; Methods: Thirty-four patients who underwent open radical retropubic prostatectomy (RRP) due to localized prostate cancer and incontinent after surgery between January 2015 and December 2020 and underwent urodynamic study (UDS) were retrospectively reviewed. All UDSs were performed according to the ICS protocol of good urodynamic practice and assessed by the same doctor. Patients were assessed by demographic and clinical parameters including age, body mass index (BMI), comorbidity, preoperative PSA level, prostate volume (PV), transrectal prostate biopsy Gleason score, clinical stage, pathological ISUP grade, pathological stage, lymph node positivity, international consultation on incontinence questionnaire-short form and subjective questionnaire for daily pad use.&#x0D; Results: Urodynamic studies showed that 29 patients (85.2%) had intrinsic sphincter deficiency (ISD). Nine (26.4%) of 29 patients with ISD had a secondary diagnosis of overactive bladder (OAB), impaired detrusor contractility (IDC) and OAB+IDC 9 (11.6%), 4 (11.6%), 1 (2.9%), respectively. Nineteen patients (55.8%) had a sole diagnosis of ISD, whereas 15 patients (44.1%) had another primary diagnosis or a secondary diagnosis other than ISD. &#x0D; Conclusion: Although ISD is the most common cause of persistent urinary incontinence in patients after radical prostatectomy, it should be taken into account that overactive bladder and impaired detrusor contractility are also accompanied by a significant proportion of patients.

Long-Term Functional Outcomes and Quality of Life after Male Transobturator-Retrourethral Sling Surgery

Introduction: Post-prostatectomy urinary incontinence (PPUI) has an enormous impact in quality of life (QoL). Transobturator-rethrourethral sling (AdVance^TMXP sling) is a well-established treatment option although there is paucity of data on long-term outcomes. Our objective was to assess the long-term functional outcomes and QoL in a cohort of men undergoing AdVance^TMXP sling surgery. Methods: Retrospective observational study of men undergoing AdVance^TMXP sling in a tertiary referral institution from August 2013 to July 2020. 55 patients met the inclusion criteria, with a minimum follow-up of 12 months. Main outcomes were pre- and post-operative daily pad use and scoring in the ICIQ-SF questionnaire. Post-operative complications were assessed following the Clavien-Dindo classification system. QoL and satisfaction with the procedure were assessed through direct interview. Results: Mean number of pads prior to surgery was 3.1, and mean ICIQ-SF score was 13.5. After surgery, mean daily pads use went to 1.2, and mean ICIQ-SF dropped to 5. With a mean follow-up of 42.36 months, 21.8% patients did not use any pads/day and 76.4% achieved social continence (0–1 pad/day). We found no statistically significant differences in outcomes of patients with follow-up of <36 months, 36–48 months, and >48 months (p = 0.067). Conclusions: AdVance^TMXP sling implantation in men with PPUI improves urinary incontinence and QoL, and their results are sustained over time.

Correlation between extended pelvic lymph node dissection and urinary incontinence at early phase after robot-assisted radical prostatectomy.

To investigate the impact of extended pelvic lymph node dissection (ePLND) on urinary incontinence (UI) at early post-surgery robot-assisted radical prostatectomy (RARP). Patients who underwent RARP without cavernous nerve sparing were included between 2014 and 2019. Patient data were obtained prospectively. The associations between ePLND and postoperative urinary continence were defined as a maximum of one daily pad use. International prostate symptom score (IPSS) was examined. Expression of synaptophysin and tyrosine hydroxylase (TH) in perilymph node adipose tissue (PLA) was evaluated by immunohistochemistry. In total, 186 and 163 patients underwent RARP with and without ePLND. Urinary continence rate at 1 month postoperatively among patients with ePLND was lower than those without ePLND (24.1% vs. 35.1%, p< 0.05), however, not significantly different at 3, 6, and 12 months after RARP (57.4 vs. 62.6%, 73.1 vs. 74.2%, and 83.0 vs. 81.2%, respectively). Total and voiding plus postvoiding IPSS scores at 1 month were higher in patients with ePLND than in those without ePLND (14.5 ± 0.5 vs. 13.6 ± 0.6, 7.0 ± 0.3 vs. 6.2 ± 0.4, respectively, p< 0.05). In univariate and multivariate analyses, larger prostate volume and ePLND were factors associated with an increased UI rate. Among patients who underwent ePLND, synaptophysin and TH-positive nerve fibers were detected in PLA. Detection of synaptophysin and TH-immunopositive nerves suggested denervation of sympathetic and peripheral nerves caused by ePLND might be associated with a higher UI rate and poor urinary symptoms at an early stage after RARP.

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.

Oral 13 - The Transobturator Sub-urethral Sling: A Safe and Effective Option for all Degrees of Post Prostatectomy Urinary Incontinence

Male stress urinary incontinence (SUI) after radical prostatectomy (RP) is common. The surgical standard of care traditionally has been placement of an artificial urinary sphincter (AUS) but since its introduction the transobturator male sling has been shown to have particular unique advantages. Our aim was to assess outcomes of a consecutive series of suburethral sling insertions in men presenting with all degrees of post RP SUI.A consecutive cohort of men undergoing AdVance sling insertion following RP were studied. Parameters assessed included pre and postoperative urinary function, 24 hour pad use, quality of life (QoL) outcomes, complications and further treatments. Degree of incontinence was categorized as mild (1-2), moderate (3-5) or severe (≥ 6) depending on daily pad use. Patients were reviewed at 1, 4 and 6 months. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess symptom severity and QoL outcomes.Seventy-seven patients were included, mean age 68 and mean time to sling post RP 34 (8-113) months. Preoperative degree of incontinence: mild 22%, moderate 58%, severe 20%. Fourteen percent had undergone post RP radiation therapy (RT). In total 73% experienced complete resolution of symptoms post sling, 12% significant improvement, 15% no reduction in pad use. Sixty percent with severe incontinence were classified as cured (no pad or 1 dry pad for security reasons). When patients with preoperative RT were excluded, cure rate rose to 82%. On follow up survey at 30 months (mean), the ICIQ-SF score decreased from baseline 17.7 (9-21.0) to 8.0 (0-20) (p < 0.0001), CI 95% (8-12).Suburethral slings are effective and safe for all degrees of post RP incontinence, are associated with improved QoL parameters and with appropriate selection and counseling are a viable option for more severe degrees of post RP SUI.

Adjustable Continence Therapy (ACT®) balloons to treat female stress urinary incontinence: effectiveness, safety and risk factors of failure and complication.

To assess the effectiveness, safety and risk factors of failure and complications associated with Adjustable Continence Therapy (ACT®) balloons as a treatment for female stress urinary incontinence (SUI). In the present multicentric retrospective study, all women implanted with ACT® balloons between 2000 and 2018 were considered eligible. Effectiveness and safety were assessed at 1 year, and risk factors for failure and complications were sought. The effectiveness was categorized into three distinct groups: Success = maximum 1 pad/day and patient's impression of improvement using a numerical rating scale (NRS) ≥ 8/10; Improvement = decrease of daily pad use and NRS ≥ 5/10; Failure = increase or stability of daily pad use or NRS < 5/10. The intra- and postoperative surgical complications were collected. Over the study period, 281 women were included. Among them, 104 (37.0%), 94 (33.5%) and 83 (29.5%) were categorized as success, improvement, and failure, respectively. Intra-, early and late postoperative complications occurred in 13 (4.6%), 35 (12.5%) and 75 (26.7%) women, respectively. Most early surgical complications were minor according to the Dindo-Clavien classification. Of women that presented a late postoperative surgical complication, 64 (22.8%) underwent an explantation performed under local or general anesthesia without associated sequalae. The short-term effectiveness associated with ACT® balloons, their minimally invasive implantation and the frequent but easily manageable and sequelae-free complications suggest that they should be part of the therapeutic arsenal for female SUI.

Adjustable continence balloons in postprostatectomy incontinence: Outcomes and complications.

The objective of this study was to assess the mid-term efficacy and safety of adjustable continence therapy (ProACT™) for the treatment of male stress urinary incontinence (SUI) after radical prostatectomy (RP). Single-center retrospective study including male patients implanted with ProACT™ periurethral balloons for SUI after RP between 2007 and 2017, mainly with flexible cystoscopic guidance. Efficacy was assessed using a composite endpoint with subjective (patient's impression of improvement (PII), using a 0-100 numeral rating scale) and objective outcomes (decrease in daily pad use). Postoperative success was defined as a PII ≥ 80%, associated with the use of 0-1 pad daily. Improvement was defined as a PII ≥ 50% and a decrease ≥50% in the number of daily pads used. Two hundredmen with a median age of 68 (64-73) years were included. Seventeen percent(n = 34) had had prior radiotherapy and 15.5% (n = 31) had had prior SUI surgery. The median follow-up was 43 (19-71) months. The severity of SUI was as follows: mild in 119 (59.5%), moderate in 48 (24%), and severe in 33 patients (16.5%). Severe SUI and a history of prior radiotherapy were associated with a lower success rate (p = 0.033 and p < 0.0001). The overall reoperation rate was 34%, with 5.6% (n = 11) requiring a third implantation. Of the patients,29.4% (n = 58) required an artificial urinary sphincter to treat SUI. At the last follow up, among the overall population, the success rate was 40.1% and the median PII was 18.3%. For patients in whom the balloons were still in place (n = 132), the cumulative success and improvement rate was 78%, with a median PII of 72%. The minimally invasive ProACT™ device provides a clear beneficial continence outcome in patients with SUI after radical prostatectomy. Severe SUI or prior radiotherapy were associated with a lower success rate in our study.

V04-06 TRANSPERINEAL BULBOVESICAL ANASTOMOSIS AND STAGED ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR EXTENSIVE POSTERIOR URETHRAL STENOSES

You have accessJournal of UrologyCME1 May 2022V04-06 TRANSPERINEAL BULBOVESICAL ANASTOMOSIS AND STAGED ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR EXTENSIVE POSTERIOR URETHRAL STENOSES Akio Horiguchi, Masayuki Shinchi, Kenichiro Ojima, Yusuke Hirano, Ryuichi Azuma, and Keiichi Ito Akio HoriguchiAkio Horiguchi More articles by this author , Masayuki ShinchiMasayuki Shinchi More articles by this author , Kenichiro OjimaKenichiro Ojima More articles by this author , Yusuke HiranoYusuke Hirano More articles by this author , Ryuichi AzumaRyuichi Azuma More articles by this author , and Keiichi ItoKeiichi Ito More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002560.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Posterior urethral stenosis is a complication occurring secondary to transurethral prostate surgery and prostate cancer treatment, and its management remains a significant reconstructive challenge. We herein report our surgical technique of transperineal bulbovesical anastomosis and staged artificial urinary sphincter implantation for extensive posterior urethral stenoses. METHODS: Two male patients aged 77 and 76 years were referred to us for definitive management for posterior urethral stenosis (brachytherapy for prostate cancer, and repeat transurethral surgery for benign prostatic hyperplasia, respectively). A suprapubic tube was placed in both patients due to urinary retention after exhaustive urethrotomies and dilatations. Both patients had normal bladder capacity and extensive posterior urethral stenoses extending from the bulbomembranous junction to the entire prostatic urethra. After making a midline perineal incision, the bulbar urethra was fully mobilized up to the penoscrotal junction distally and transected at the obstruction site. The corpora cavernosa was separated, and a wedge of the inferior pubic bone was excised to expose the ventral side of the bladder neck in the same manner as the repair of pelvic fracture urethral injury. The scarred prostatic tissue was meticulously excised, and the bladder neck was opened. The bladder mucosa was everted and fixed to the surrounding tissue to create an anastomosis site. Eight interrupted 4-0 PDS sutures were placed to reapproximate the bulbar urethra and bladder neck. After confirming the absence of recurrent stenosis at the anastomosis site at 6 months postoperatively, an artificial urethral sphincter was implanted using a transcorporeal approach. We followed up the patients every 6 months, performed uroflowmetry, flexible cystoscopy, and examined the amount of daily pad use. RESULTS: The operative time and blood loss during bulbovesical anastomosis was 163 minutes and 201 ml in case 1 and 193 minutes and 66 ml in case 2, respectively. No Clavien grade 2 or greater perioperative complications were observed. No recurrent stenosis on cystoscopy was found after 20 and 26 months in cases 1 and 2, respectively. The maximum flow rate and the amount of daily pad use at the last recorded follow up was 32 ml/s and no pad in case 1 and 44 ml/s and one pad in case 2. CONCLUSIONS: A bulbovesical anastomosis combined with staged artificial urethral sphincter placement could effectively manage extensive posterior urethral stenoses. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e368 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akio Horiguchi More articles by this author Masayuki Shinchi More articles by this author Kenichiro Ojima More articles by this author Yusuke Hirano More articles by this author Ryuichi Azuma More articles by this author Keiichi Ito More articles by this author Expand All Advertisement PDF downloadLoading ...

ProACT in the management of stress urinary incontinence after radical prostatectomy. What happens after 8 years of follow up? monocentric analysis in 42 patients.

Stress urinary incontinence is defined by a complaint of any involuntary loss of urine on effort or physical exertion or on sneezing or coughing and represents a major complication after radical prostatectomy. According to surgical technique, incidence of post-prostatectomy incontinence varies from open (7-39.5%), laparoscopic (5-33.3%) or robotic-assisted (4-31%) approaches. The ProACT® device (Uromedica, Inc., MN) is a possible surgical option for the treatment of this condition. We retrospectively analyzed surgical records of consecutive patients underwent ProACT® implantation in our department between January 2006 to November 2010. We collected data at 6 and 12months after surgical approach about the daily pad use, International Prostatic Symptoms Score and its quality of life domain. 42 patients were included in the final analysis. Most patients (92.9%) received minimally invasive surgery for treating prostate cancer. During the follow up after 6 and 12months, the daily pad, International Prostatic Symptom Score and its quality of life domain significantly improved compared to preoperative outcomes. The logistic regression analysis found that presence of comorbidities was the only predictive factor of low satisfaction rate (PGE-I>2) in patients who underwent ProACT® implant. ProACT® implant represents an effective and safe treatment for post-prostatectomy stress urinary incontinence with a high satisfaction degree and a low rate of complications.

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.

Adjustable continence therapy (ACT®) balloons to treat neurogenic and non-neurogenic female urinary incontinence.

To compare efficacy and safety between neurogenic and non-neurogenic women after adjustable continence therapy (ACT®) balloons implantation to treat stress urinary incontinence (SUI) due to intrinsic sphincter deficiency. In the present retrospective multicentric study, all neurogenic and non-neurogenic women implanted with ACT® balloons between 2000 and 2018 were considered for inclusion. Efficacy was compared 1 year after implantation, and women were allocated in three different groups as follows. Success: maximum 1 pad per day and patient's impression of improvement assessed using a numeral rating scale (NRS) ≥8/10. Improvement: decrease of daily pad use and/or NRS ≥5/10. Failure: increase or stability of daily pad use or NRS <5/10. Overall surgical complications and explantations were compared 1 year after implantation. Among the 277 included women, 51 presented with a neurologic underlying disease. Mean age at implantation was 68.5 years. There was no significant difference in efficacy between neurogenic and non-neurogenic women with a success rate of 39.2% and 36.3%, respectively (p = 0.69). Similarly, improvement rate was reported to be 31.4% and 33.6%, in neurogenic and non-neurogenic women, respectively (p = 0.92). The overall surgical complications rate (24% vs. 34.5%, p = 0.15) and the explantation rate (19.6% vs. 28.8%, p = 0.18) were not significantly different. ACT balloons may be proposed to treat mixed or SUI in females with ISD. Efficacy and safety profiles appear to be similar in both neurogenic and non-neurogenic patients.

Restoration of Continence after Prostatectomy is Associated With Weight Loss: A Pilot Study

To examine association between post-prostatectomy incontinence (PPI) severity and weight changes before and after restoration of continence via artificial urinary sphincter (AUS). Single surgeon, retrospective review of urologic prosthetic surgery (UPS) after radical prostatectomy (RP). A cohort of post-RP inflatable penile prosthesis (IPP) patients served as a surgical control. Body Mass Index (BMI) and total body weight were assessed pre and post-UPS. Multivariable linear regression was utilized to assess BMI changes post-UPS. 187 AUS and 63 IPP patients met selection criteria. Greater PPI severity was associated with faster BMI gain after RP (coeff. 0.14 kg/m2, P=0.03, per pad used) and magnitude of incontinence improvement (mean reduction in daily pad use) after AUS insertion was associated with greater BMI reduction at 12 months post-UPS (coeff. - 0.13kg/m2, P=0.04). On multivariable regression, AUS insertion was associated with a decrease in BMI by - 2.83 kg/m2 12 months post-UPS (P=0.02). Twelve months post-UPS, men with AUS exhibited a mean BMI reduction of -1.0 kg/m2 compared to a mean BMI increase in the IPP cohort of 0.4kg/m2 (P < 0.01). Compared to IPP, AUS patients experienced absolute body weight reduction by 6 kg [Median(IQR): 90.4 (80.3-100.1) vs 96.4 (87.1-108.8) kg, P=0.03], with nearly one-third having clinically significant weight loss (>5% body weight) at 12 months post-UPS (31.8% vs 8.3%, P < 0.01). Severe PPI appears to be associated with weight gain and correction of PPI via AUS insertion with weight loss.

Long-term efficacy and safety of artificial urinary sphincter AMS 800&lt;sup&gt;ТМ&lt;/sup&gt; implantations

Introduction. Stress urinary incontinence in men in most cases occurs after radical prostatectomy or surgery of benign prostate hyperplasia. In addition to a significant reduction in the quality of life, the treatment and care of such patients require significant financial costs. Purpose of the study . To study the long-term efficacy and safety of artificial urinary sphincter (AUS) implantation. Materials and methods . AUS was implanted in 52 patients with severe stress urinary incontinence (UI) from 2004 to 2020. Urine loss was estimated by the urinary diary. A cure was considered as the use of ≤ 1 pad per day («social continence»). The quality of life was assessed using a numeric scale (from 0 to 100), IPSS-QoL, and the ICIQ-UI SF questionnaire. Complications were described according to the Clavien-Dindo classification. Results. The median age was 67.5 years (IQR 63 - 72 years). The causes of severe stress UI were the following: radical prostatectomy - 29 (55.8%) patients, transurethral resection of the prostate — 12 (23.1%), transvesical simple prostatectomy — 5 (9.6%), others — 6 (11.5%) patients. Median time after the intervention that caused UI was 24 months (IQR 13-36 months). Both perineal (67%) and penoscrotal (33%) approaches were used. The results of implantation efficiency were evaluated in 43 patients. A significant decrease in the median urine loss from 800 ml (IQR 700 - 1100 ml) to 0 ml (IQR 0-30 ml) was registered at a median follow-up of 100.4 months (IQR 70.5 - 136.9 months). There was also a statistically significant reduction in daily pad use from 7 (IQR 6-8) to 1 (IQR 0 - 1). 36 (84%) patients met the cure criteria. Improvement was noted in 6 (14%) patients, failure - in 1 (2%) patient. Median IPSS-QoL scores decreased from 4 (IQR 4-5) to 2 (IQR 1 - 2), p < 0.05, numeric analog scale scores improved from 25 (IQR 20 - 35) to 80 (IQR 60 - 90), p < 0.05., The ICIQ-UI SF score was 7 (IQR 1-9) after treatment. Complications more than grade II according to the Clavien-Dindo classification were registered in 15 (28.8%) patients. Conclusion. AUS implantation provides satisfactory results in reducing urine loss and improving quality of life but it's accompanied by a high rate of complications and revisions in long-term follow-up.

Prospective evaluation of urinary continence after laparoscopic radical prostatectomy using a validated questionnaire and daily pad use assessment: which definition is more relevant to the patient's perception of recovery?

IntroductionNo standard definition for urinary continence after radical prostatectomy exists, and there are discrepancies in continence rates reported in the literature, as well as rates reported by physicians and patients. Therefore, we used two tools, a validated questionnaire and daily pad use, to identify the criteria that best reflects patients’ perceptions of continence recovery.Material and methodsThis is a prospective study of 74 patients who underwent nerve-sparing laparoscopic radical prostatectomy. Continence was assessed monthly for 3 months following catheter removal using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) and by recording the number of pads the patients used on a daily basis. According to daily pad use, patients were categorized as either dry (no-pads), socially continent (0–1 pad) or incontinent (≥2 pads).ResultsSeventy-four patients were enrolled with a mean age of 64.3 (±5.6) years. There were no significant differences in continence rates using scores from the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-UI SF) or no-pad use (29.7% vs 32.4%, 45.9% vs 48.6% and 54.1% vs. 54.1%, at the 1-, 2- and 3-month follow-ups, respectively). However, the number of socially continent patients was significantly higher (59.5%, 70.3% and 81.1%, at the 1-, 2- and 3-month follow-ups, respectively [p <0.001]).ConclusionsThe totally dry definition better reflected patients’ perceptions rather than the socially continent definition for the evaluation of continence recovery following laparoscopic radical prostatectomy. To avoid discrepancies, we recommend the use of a validated questionnaire as well as the no-pad definition to standardize the reporting of post radical prostatectomy continence rates.