Daily Pad Use Research Articles

The Role of Educational Level and Cognitive Status in Men Undergoing Artificial Urinary Sphincter Implantation

OBJECTIVETo examine the relationship between education level, cognitive function of patients and the success/ revision rates of artificial urinary sphincter (AUS) implantation in men with postprostatectomy incontinence. METHODSBetween January 2010 and March 2018, 163 patients (mean age, 68 ± 6.8 years) with moderate-to-severe stress urinary incontinence who underwent AUS implantation were retrospectively examined. Demographic data, body mass index, comorbidities, surgical technique, previous strictures, and radiation therapy were recorded. Incontinence was measured by daily pad use and evaluated by International Consultation on Incontinence Questionnaire-short form. Patients’ overall improvement was assessed using the Patient Global Impression of Improvement questionnaire. Education level was determined using the International Standard Classification of Education. Cognitive status was assessed using the Mini-Mental State Examination. Treatment success was defined as the need for ≤1 pad/day at last follow-up. RESULTSAUS was successful in 77.3% of patients. The International Consultation on Incontinence Questionnaire-short form score improved significantly from 19.9 ± 2.9 to 4.4 ± 5.4 (P = .001). The median outcome reported subjectively on the Patient Global Impression of Improvement scale was 2.1 ± 1.5 (1-7) and self-reported as “much better.” Patients’ education level had statistically no significant relationship with AUS success and revision rates. Similarly, there was no significant relationship between cognitive status, educational level and the need for revision of AUS (P >.05). However, patients with moderate cognitive impairment and a body mass index >30 showed significantly lower AUS success rates (P <.05). CONCLUSIONAUS implantation is safe and effective treatment option especially for nonobese and cognitively intact patients of all educational levels.

Lower urinary tract symptoms (LUTS) before and after robotic-assisted laparoscopic prostatectomy: does improvement of LUTS mitigate worsened incontinence after robotic prostatectomy?

Urinary incontinence is a major concern for patients scheduled for radical prostatectomy. However, after prostatectomy lower urinary tract symptoms (LUTS) may improve and thus mitigate this concern. We assessed LUTS and its interference with the quality of life (QoL) using the short form of the international continence society male questionnaire (ICSMALESF-Q) in patients before and after robot-assisted radical prostatectomy (RARP). Furthermore, we aimed to identify risk factors for postoperative urinary incontinence. Data of all patients who underwent RARP from 2009 to 2014 were prospectively collected in our customized database. We identified 453 eligible patients for whom a preoperative and at least two postoperative datasets including ICSMALESF-Q were available. Both the ICSMALESF-Q at 6 months (P<0.001) and the related QoL at 12 months (P<0.01) have significantly improved after RARP (P<0.001). Two years after RARP ICSMALESF-Q and thus LUTS have improved in 64%, remained unchanged in 18% and worsened in 18% of patients. The daily pad use was 0 in 79% and 0 or 1 pad in 95.6%, respectively. Increased patient age (P<0.05) was significantly associated with an increased average number of pads used per day (multiplicative effect: +2.1% pads for each year). Being in the D'Amico low-risk group reduced the average number of pads used by 22% (P<0.05, multiplicative effect 0.780). The prostate volume, planned nerve sparing, adjuvant or salvage radiotherapy, body mass index (BMI), or a history of transurethral resection of the prostate (TUR-P) before radical prostatectomy were not associated with the postoperative pad use or changes in LUTS. The ICSMALESF-Q and thus LUTS have significantly improved in a majority of patients after RARP and hence the associated QoL improved as well. Preoperative D'Amico low-risk group significantly reduced pad use after RARP, whereas increased age significantly increased postoperative pad use. These results will help providers counsel their patients more appropriately before prostatectomy by focusing not only on pad use and incontinence after RARP, but also on changes of the bothersomeness of LUTS and risk factors in general.

Outcome and complications of adjustable continence therapy (ProACTTM ) in the treatment of urinary incontinence aftertransurethral resection of the prostate: A multicenter study.

AimTo evaluate the outcome of adjustable continence balloons in the treatment of stress urinary incontinence (SUI) after transurethral resection of the prostate (TURP).MethodsIn two tertiary centers, adjustable continence balloons were implanted in 29 patients with post‐TURP SUI between 2007 and 2018. Endpoints of this retrospective multicenter study were patient‐reported changes in pad count and complications. Dry was defined as no pad or one security pad.ResultsPreoperative urinary incontinence was mild in 7 (24%), moderate in 12 (41%), and severe in 10 (35%) patients. The median follow‐up duration was 21 (interquartile range [IQR], 11‐43) months. Within 30 days postoperatively, a Clavien‐Dindo grade less than or equal to II complication occurred in 24% of the patients. Reintervention rate was 24%. Six and 12 months after implantation, the International Prostate Symptom Score (IPSS) quality‐of‐life item improved significantly from 5 (IQR, 5‐6) preoperatively to 3 (IQR, 1‐4.5) and 1 (IQR, 0‐3), respectively. At last visit (median 21 months after implantation), the outcome on continence had improved in 76% of the patients, including, 45% dry patients. After a median follow‐up of 28 months (IQR, 13‐63; N = 23), all but one patient reported improvement on the Patient Global Impression of Improvement (PGI‐I) scale. In detail, 10 patients reported “very much better” condition compared with before the implantation, 10 patients “much better,” two patients “a little better,” and one patient “no change.” Daily pad use decreased from three (IQR, 2‐5) to one (IQR, 0‐2) pads/day (P < 0.001).ConclusionsThis is hitherto, the first study reporting results of adjustable continence balloons in the treatment of post‐TURP SUI. The therapy was found to be safe and efficient. The majority of our study population reported improvement on their condition and greater than or equal to 50% reduction in daily pad use.

Evaluating urinary incontinence before and after radical prostatectomy using the international consultation on incontinence questionnaire-short form.

To evaluate urinary incontinence using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), daily pad use, and 24-h pad weight test before and after radical prostatectomy (RP) chronologically, and the correlation between them. ICIQ-SF and questions on daily pad use provided subjective, and 24-h pad weight test for objective evaluation. In total, 258 cases were recruited. The continence rate at 12 months after RP was 67% for no pad use, 87% for security 1 pad/day, and 94% for 1 pad/day. The median ICIQ-SF total score before and at 1, 3, 6, and 12 months after RP was 0, 10, 7, 5, and 4, respectively. Incontinence patterns differed when comparing ICIQ-SF results pre- and post-RP. Significant correlation existed between the ICIQ-SF total score, 24-h pad weight test, and daily pad use; however, point distribution on each scatter plot varied widely. Comparing results before and at 12 months after RP revealed complete recovery for 35% of patients from the ICIQ-SF total score, 67% from daily pad use, and 64% from the 24-h pad weight test. A combination of all 3 showed a recovery of preoperative levels in 29% of patients. ICIQ-SF was effective and convenient for evaluating UI, including the pattern of UI, after RP. Significant correlation, but wide variations, among ICIQ-SF, daily pad use, and the 24-h pad weight test existed. The best evaluation method would be the one that can compare UI status pre- and post-RP using the ICIQ-SF and 24-h pad weight test.

Short-term evaluation of the adjustable bulbourethral male sling for post-prostatectomy urinary incontinence.

The Argus perineal sling is a minimally invasive surgical option to treat post-prostatectomy stress urinary incontinence (PPSUI). This study retrospectively evaluated the short-term clinical outcomes with the Argus sling for PPSUI management and determined the effects of potential preoperative parameters on intraoperative retrograde leak point pressure (RLPP). In this retrospective review of 16 men with various degrees of stress incontinence after prostatic surgery who underwent Argus sling, PPSUI was evaluated by pad usage, urodynamics, 24-hour pad weight, and validated questionnaires. Findings before and a minimum of 6 months after sling placement were compared. "Cure" was defined as no pad usage or the use of 1 pad for security; "improvement" was defined as a reduction in daily pad use by >50%. After a mean (±SD) follow-up of 9.75 ± 3.51 months, 62.5% of patients were cured, 18.75% were improved, and 18.75% were still incontinent. Preoperative 24-hour pad weight was positively correlated with RLPP (P = .0121, r = 0.6286). Mean RLPP was 37.93 ± 3.45 cmH2 O. During follow-up, 44% of men had transient perineal or scrotal pain managed conservatively. Sling explantation, reported in 3 of 16 patients, was associated with urethral erosion or previous radiation therapy. The Argus male sling can lead to satisfactory results in carefully selected patients. Increased stress urinary incontinence severity based on 24-hour pad weight required higher RLPP to achieve continence. Favorable satisfaction variables and quality of life scores are affected by appropriate intraoperative tensioning pressure.

Outcome and complications of adjustable continence therapy (ProACT™) after radical prostatectomy: 10 years' experience in 143 patients.

To evaluate our outcomes of the adjustable continence balloons ProACT™ for the treatment of male stress urinary incontinence after radical prostatectomy. Between May 2007-August 2016 the ProACT™ was implanted in 143 patients without a history of radiotherapy. Endpoints were patient-reported changes in pad counts and complications. Treatment was considered successful if no pad or just one "security" pad per day sufficed, and improved if daily pad use was reduced by ≥50%. Incontinence before implantation was mild in 36 (25%), moderate in 57 (40%), and severe in 50 (35%) patients. Complications within 30 days were classified by the Clavien-Dindo classification; eight (5.6%) grade I, three (2.1%) grade II, three (2.1%) grade IIIb, and 129 (90.2%) patients had no complication. Revision was done in 43 (30%) patients. The IPSS quality of life item improved significantly from 5.0 (IQR 4.0-5.0) preoperative to 2.0 (IQR 1.0-4.0) and 1.0 (IQR 0.0-3.0) 6 and 12 months after implantation, respectively. After a median follow up of 56 months (range 28 to 79, n = 112), 72 (64%) patients were improved, including 51 (45%) patients were successful. Daily pad use decreased from 3.0 to 1.0 (67% reduction). The median outcome on the Patient Global Impression of Improvement scale was "much better," and 97 (87%) patients perceived improvement. The minimally invasive ProACT™ device showed a clear beneficial continence outcome in patients with stress urinary incontinence after radical prostatectomy. The majority of the patients were satisfied and perceived improvement ≥50% on daily pad use on the long term.

Management of the complications of pubovaginal sling surgery

Objective. To present complications of pubovaginal sling surgery (PVS) and their managements. Methods. A total of 21 patients who underwent PVS in 4 different tertiary refferal centers between June 2014 and May 2016 were reviewed retrospectively. Demographic characteristics of the patients, previous 6 history, daily pad use, Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ) were recorded. Also, the management of the complications were stated. Results. The mean age of the patients were 54.9±12.32 (range, 36-76) years. Six (28.5%) patients had a history of previous incontinence surgery and 15 (71.4%) patients were n aïve . There were no intraoperative complications. The mean daily pad use was decreased from 4.04±0.95 to 0.95±0.86 ( p =0.0001). While mean preoperative UDI-6 scores were decreased from 6.66±2.09 to 2.09±1.22 ( p =0.0001) at postoperative sixth month ; preoperative mean IIQ-7 scores decreased from 16.8±1.16 to 5.09±4.21 ( p =0.0001) at postoperative sixth month. One (4.76%) patient had abdominal hernia at postoperative 2 nd year, three (14.28%) patients had an increased post-micturational residual (150-200ml) and two (9.52%) patients had urinary retention. Conclusion. Although the efficiency of PVS is high; one should aware of complications. The successful management of the complications will increase efficiency and patient satisfaction.

MP85-15 INTRAVESICAL INJECTION OF HIGHLY PURIFIED BOTULINUM TOXIN [INCOBOTULINUMTOXIN A (XEOMIN)] FOR NEUROGENIC BLADDER

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction I1 Apr 2017MP85-15 INTRAVESICAL INJECTION OF HIGHLY PURIFIED BOTULINUM TOXIN [INCOBOTULINUMTOXIN A (XEOMIN)] FOR NEUROGENIC BLADDER Denise Asafu-Adjei, Alex Small, Doreen Chung, Glen McWilliams, and Cory Harris Denise Asafu-AdjeiDenise Asafu-Adjei More articles by this author , Alex SmallAlex Small More articles by this author , Doreen ChungDoreen Chung More articles by this author , Glen McWilliamsGlen McWilliams More articles by this author , and Cory HarrisCory Harris More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2677AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Currently onabotulinumtoxin A (Botox®) is the only FDA-approved form of botulinum toxin for use in the bladder. However there are now alternative toxins on the market approved for muscle spasticity and cosmetics. Incobotulinumtoxin A (Xeomin®) is a highly purified toxin with no complexing proteins, decreased immunogenicity, improved storage and lower cost. The safety and efficacy of incobotulinumtoxin A use in the bladder has not previously been studied. METHODS Patients who received intravesical incobotulinumtoxin A injections for neurogenic or idiopathic detrusor overactivity between 2013 and 2016 were identified. Those who previously received onabotulinumtoxin A had minimum washout interval of 3 months. Baseline characteristics were collected. Outcomes analyzed included UDI-6 scores, IIQ-7 scores, daily incontinence episodes, catheterized volume, pad use, and complications. Analysis with summary statistics and paired t-tests were done with significance p<0.05. RESULTS 14 male patients underwent incobotulinumtoxin A injection. Mean age was 59.8±16.9 years. All patients had neurogenic (n=12, 86%) or idiopathic (n=2, 14%) detrusor overactivity on urodynamics. At baseline, 79% were on oral anticholinergic therapy, 50% were performing CIC, 21% had indwelling catheters and 29% had received previous onabotulinumtoxin A. Initial injection doses were 300 units for 29%, 200 units for 64% and 100 units for 7%. 5 patients (36%) received multiple treatments (2.8±0.4 times) with mean 9.0±4.1 months between sessions. After treatment there were trends toward improvement in mean daily pad use (5.0±6.5 to 2.6±6.3, p=0.33), incontinence episodes (2.7±1.9 to 1.6±2.3, p=0.74), episodes of daytime frequency (7.8±2.7 to 6.6±7.0, p=0.60), CIC volumes (341.7±67.1 to 45070.7 mL, p=0.05) and UDI-6 scores (43.0±30.2 to 18.0±28.1, p=0.19). IIQ-7 scores significantly decreased after treatment (46.4±34.6 to 10.1±18.2, p=0.03). 2 patients (14%) experienced culture-proven urinary tract infections within 30 days of treatment and 1 patient (7%) developed new urinary retention. CONCLUSIONS This is the first study to demonstrate safety and efficacy of intravesical incobotulinumtoxin A in patients with neurogenic or idiopathic detrusor overactivity. Incobotulinumtoxin A may be an attractive alternative to onabotulinumtoxin A, especially given its lower cost. Small sample size limits this data, however early results suggest improvements in quality of life and bladder dynamics. A larger, prospective study will be required to validate these findings. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1153-e1154 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Denise Asafu-Adjei More articles by this author Alex Small More articles by this author Doreen Chung More articles by this author Glen McWilliams More articles by this author Cory Harris More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Transcorporal artificial urinary sphincter in radiated and non - radiated compromised urethra. Assessment with a minimum 2 year follow-up

ABSTRACTPurpose to assess the efficacy of transcorporal artificial urinary sphincter (AUS) implantation on continence for male stress urinary incontinence in cases of prior surgical treatment or/and radiation failure, and as a first option in radiation patients.Materials and Methods From March 2007 to August 2012, 37 male patients were treated with transcorporal AUS AMS™ 800. Twelve patients had primary placement of transcorporal cuff, a surgical option due to a previous history of radiation and 25 patients had secondary procedure after failure of AUS or urinary incontinence surgery. Functional urinary outcomes were assessed by daily pad use, 24-hour Pad-test and ICIQ-SF questionnaire. Quality of life and satisfaction were assessed based on I-QoL and PGI-I questionnaires.Results After a median of 32 months, the continence rate (0 to 1 pad) was 69.7%. Median pad test was 17.5g (0-159), mean ICIQ-SF score was 7.3/21 (±5.4) and mean I-QoL score was 93.9/110. A total of 88% of the patients reported satisfaction with the AUS. The 5-year actuarial revision-free for AUS total device was 51%. Patients for primary implant for radiation were not more likely to experience revision than non-radiation patients. Preservation of erections was reported in half of the potent patients.Conclusions Transcorporal AUS cuff placement is a useful alternative procedure option for severe male UI treatment, especially in patients with a compromised urethra after prior surgery or radiation. A high continence rate was reported and implantation as first option in radiation patients should be considered.

MP87-08 DOES THE ISTOP TOMSTM MALE SLING REMAIN EFFICIENT OVER TIME?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2016MP87-08 DOES THE ISTOP TOMSTM MALE SLING REMAIN EFFICIENT OVER TIME? Philippe Grise, Benoit Malval, Renaud Vautherin, Christian Saussine, and Jean Nicolas Cornu Philippe GrisePhilippe Grise More articles by this author , Benoit MalvalBenoit Malval More articles by this author , Renaud VautherinRenaud Vautherin More articles by this author , Christian SaussineChristian Saussine More articles by this author , and Jean Nicolas CornuJean Nicolas Cornu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2358AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Male sub-urethral slings are widely used for the treatment of post prostatectomy urinary incontinence (PPUI). However, the results of male sling implantation have only been evaluated through short-term studies, and long term outcomes are still unknown. Our objective was to assess the long term efficacy of ISTOP-TOMSTM male sling implantation for PPUI management. METHODS A multicenter prospective observational study was carried out. All patients implanted with an ISTOP-TOMSTM sling between 2007 and 2012 were included. Indications for ISTOP-TOMS implantation was PPUI without bladder dysfunction on urodynamics, with mild to moderate incontinence (24h Pad-Test <400g), and without history of pelvic radiation therapy. Follow-up was performed through a physical examination every year and a phone interview for the last follow-up. The primary endpoint was the number of daily pad use. The statistical analysis was performed using SAS 9.2. RESULTS One hundred patients were considered in the present analysis with a median follow-up of 60 months [19-78]. A significant reduction of daily pad use and a better quality of life according to questionnaires were found up to 5 years (p<0.001). At 3 years follow up, 51% of the patients were dry and 90% used 0 to 1 pad daily, but these rates dropped to 38% and 71% at 5 years, respectively. Nevertheless, quality of life questionnaires and treatment satisfaction remained high at 5 years. No severe complication was recorded. CONCLUSIONS Implantation of ISTOP-TOMSTM for PPUI management in patients without radiation therapy and presenting mild to moderate incontinence appears safe and effective in the long term. However, our results are in favor of recurrence of incontinence with time. These data highlight the need of long term studies in this field, for optimal patient information and clinical decision making. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1117 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Philippe Grise More articles by this author Benoit Malval More articles by this author Renaud Vautherin More articles by this author Christian Saussine More articles by this author Jean Nicolas Cornu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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.

Systematic analysis of treatment results as a quality control instrument using the example of a large European center

Measurement of the quality of treatment has become increasingly important in hospitals. An easy and practical solution in data acquisition is the Patient-Reported Outcome Measurement (PROM). In this article the historical development, general conditions, and difficulties of using the outcome measurement in our patients are describe. In addition, we illustrate the wide range of benefits due to our survey. Based on data from 2008-2013, the functional and oncological results of treatment in our clinic are shown. The main focus lies on the PROMs, e.g., urinary continence evaluated with the daily pad use, sexual function with the IIEF-5 questionnaire, and postoperative complications. A systematic and standardized outcome measurement may help to improve the quality of treatment, provides factual information for patients, and supports medical development.

Effect of Transobturator Midurethral Sling Placement on Urgency and Urge Incontinence: 1-Year Outcomes.

TVT-O placement has been associated with short-term cure/improvement of urgency (U) and urge urinary incontinence (UUI) in a significant proportion of patients. Further, the observed improvement in U/UUI is associated with improved quality of life (QOL). This study is a prospective continuation aimed to determine if the short-term benefit of TVT-O on U/UUI persists at 12 months postoperatively. Patients with stress-predominant mixed incontinence undergoing TVT-O placement were prospectively assessed using 3-day bladder diary and multiple validated incontinence questionnaires focusing on U (Urgency Perception Score), UUI (International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms), and QOL (Incontinence Impact Questionnaire, Short Form). Eighty-seven patients achieved 12-month assessment, at which point improvements (versus baseline) in mean daily pad use (2.5-0.9) and mean incontinence episodes (3.6-0.7) were seen (P < 0.05, both comparisons). Seventy-eight percent of patients reported cure of stress incontinence. Questionnaire scores for UUI improved from 2.0(±1.1) to 1.0(±1.1) (P < 0.001), with 32% and 31% of patients reporting cure and improvement, respectively. Similarly, mean Urgency Perception Score improved from 10.1(±4.4) to 6.7(±4.5) (P < 0.001). Eighty-two percent of the patients did not require anticholinergics over the 12-month follow-up period. Furthermore, U outcomes are associated with improvements in QOL. TVT-O placement is associated with cure/improvement of U and UUI in a significant proportion of patients with mixed urinary incontinence. Further, the observed improvements in U/UUI persist at 12 months and appear to have a durable positive association with QOL.

Transcorporal artificial urinary sphincter implantation as a salvage surgical procedure for challenging cases of male stress urinary incontinence: surgical technique and functional outcomes in a contemporary series

To describe the surgical technique of transcorporal artificial urinary sphincter (AUS) implantation. To assess the efficacy of the AUS on continence and erectile function. A prospective evaluation was conducted between December 2007 and October 2012 at a tertiary referral centre of all male patients treated by transcorporal AUS (AMS800™, AmericanMedicalSystems, Minnetonka, MN, USA) implantation for stress urinary incontinence (SUI) recurrence, after failure of previous anti-incontinence surgery. Functional urinary outcomes were assessed according to daily pad use, the Urinary Symptom Profile questionnaire, and International Consultation on Incontinence Questionnaire - Short-Form. Erectile function was evaluated using the five-item International Index of Erectile Function (IIEF-5) questionnaire and patient satisfaction was assessed by Patient Global Impression of Improvement questionnaire. Data were collected by telephone interview. A total of 23 patients were included. Their mean (sd; range) age was 70 (7; 60-85) years. Of these, 18 patients had urethral atrophy and/or erosion after placement of AUS (11 patients), male sling (four patients) or both (three patients), and five patients had severe urethral atrophy after pelvic radiation therapy. The implantation of the AUS with transcorporal cuff placement was successful in all patients, with no peri-operative complications. Follow-up data over 1 year were available for 17 patients. After a median (sd; range) follow-up of 20 (15; 2-59) months, eight patients were perfectly dry (no pad use and no symptoms), five achieved social continence (less than one pad/day), and four still had SUI (required two or more pads/day). Among six patients who had good preoperative erectile function and were sexually active, four had no decrease in their IIEF-5 score. Transcorporal AUS cuff placement is a useful alternative for challenging cases of male SUI after failure of previous surgical treatment, urethral atrophy or erosion. Erectile function can be maintained despite dissection of the corporal body.

Female Sexuel Function After Trans Obturator Tape Placement for Stress Urinary Incontinance

Objective: To assess the effectiveness of trans obturator tape (TOT) for the surgical treatment of stress urinary incontinance (SUI) on female sexuel function. Methods: We evaluated 34 sexualy active patients, who had stress urinary incontinance. Patients sexuel function evaluated preoperative and 6 months after operation with Female Sexuel Function Index (FSFI) scores. Results: Statistically significant improvements were seen in daily pad use from 2.4±1.1 to 0.2±0.4 (p value <0.001) and incontinence episodes daily number from 3.3±1.3 to 0.5±0.7 (p value <0.001). FSFI and pain score were compared and results were smiliar (from 4.8 ± 0.7 to 4.6±0.8 p value 0.52). Preoperative Female Sexuel Function Index was compared with after the six months results and significant imporovement was carried (from 15.4±2.5 to 19.4±5.5 p value:0.02). Conclusions: TOT sling placement was associated with improvements in validated measures of sexual function.

The Surgical Learning Curve of Artificial Urinary Sphincter Implantation: Implications for Prosthetic Training and Referral

We investigated the surgical learning curve of artificial urinary sphincter implantation using a large, consecutive, single surgeon series. We retrospectively reviewed the results of the first 150 consecutive, virgin artificial urinary sphincter implantations performed by a single surgeon between 1992 and 2003 for post-prostatectomy male stress urinary incontinence. Complication and reoperation rates, and continence outcomes (daily pad use and number of patients with a functional artificial urinary sphincter at last followup) were analyzed as a function of consecutive implant cases. There was a significant decrease in the number of patients with complications (12 vs 3, relative risk 4.0, p = 0.012) and the number with reoperation (11 vs 3, relative risk 3.7, p = 0.026) when the first 25 patients who underwent artificial urinary sphincter implantation were compared to the second 25. No further decrease was noted beyond the first 25 cases. Despite significantly higher complication and reoperation rates in the first 25 cases, equivalent functional outcomes (same postoperative daily pad use and number of patients with a functional artificial urinary sphincter at last followup) were still achieved after artificial urinary sphincter revision. The surgical learning curve of placing a virgin artificial urinary sphincter was about 25 cases, as measured by complication and reoperation rates. This case number was high compared to typical exposure during residency and clinical practice. There is an urgent need to improve urological prosthetic training and emphasize the referral of artificial urinary sphincter cases to regional centers of excellence or to high volume, artificial urinary sphincter implanters to improve the surgical outcome.

The Retrourethral Transobturator Sling Suspension in the Treatment of Male Urinary Stress Incontinence: Results of a Single Institution Experience

Objective. To evaluate functional outcome of the retrourethral transobturator sling suspension (RTS) in the treatment of stress urinary incontinence (SUI) caused by prior prostate surgery. Methods. The RTS (AdVance male sling) was implanted in 32 patients who suffered from mild to severe postsurgical-treatment incontinence at the University Hospital Ulm from September 2010 to September 2011 including 10 patients with prior radiation therapy. Functional data (uroflowmetry, daily pad use, and postvoid residual urine) as well as quality of life with impact of urinary problems (ICIQ-UI SF) were prospectively assessed at baseline and during followup. Results. After a median followup of 9 months (range, 3–14) the incontinence cure rate (no pad usage) was 56.2% and the improvement rate (1-2 pads/day or ≥50% reduction) was 21.9%. No improvement was observed in 21.9%. Daily pad use and ICIQ-UI SF score improved significantly. No major perioperative complications occurred. Postoperatively, 15.6% of the patients exhibited transient acute urinary retention which resolved without further treatment after a maximum of 3 weeks. One patient underwent sling explantation due to dislocation and persistent perineal pain. Conclusions. The implantation of the RTS is a safe and effective procedure in selected patients with SUI resulting from prostate surgery.

Complex Artificial Urinary Sphincter Revision and Reimplantation Cases—How do They Fare Compared to Virgin Cases?

We compared artificial urinary sphincter complication rates, overall reoperative rates, and continence results in virgin cases, revision cases and secondary reimplant cases (with prior erosion or infection). Only male patients with post-prostatectomy stress incontinence with AMS 800™ placement in the bulbar urethra by a single surgeon were included in the study. A total of 169 virgin cases (no prior artificial urinary sphincter surgery), 37 revision cases (eg cuff revision for urethral atrophy, revision of failed components) and 21 secondary reimplant cases (eg after prior explant from urethral erosion or infection) were compared. Secondary artificial urinary sphincter reimplant cases (eg after prior explant from urethral erosion or infection) had fourfold higher future erosion rates compared to virgin cases (p = 0.02, 14.3% vs 3.6%, RR 4.02). In addition, there was no difference in the rates of other complications (device infection, urethral atrophy, mechanical failure, leaks), overall reoperation rates and postoperative continence outcomes (measured by daily pad use) compared to virgin cases. Artificial urinary sphincter revision cases did not have higher complication rates (including subsequent urethral erosion), reoperation rates or worse postoperative continence outcomes compared to virgin cases. Although the difference was not statistically significant, a trend toward higher future device leak rates (10.8% vs 3.6%, RR 3.05, p = 0.063) and higher urethral atrophy rates (16.2% vs 8.9%, RR 1.83, p = 0.18) was noted in artificial urinary sphincter revision cases compared to virgin implant cases. Patients with a history of artificial urinary sphincter explant have a fourfold increased risk of future cuff erosion. Nevertheless, a good functional outcome with an acceptable complication rate may be achieved in most complex reoperative artificial urinary sphincter cases.

I-Stop TOMS Transobturator Male Sling, a Minimally Invasive Treatment for Post-prostatectomy Incontinence: Continence Improvement and Tolerability

To prospectively evaluate the efficacy and tolerability of the I-STOP TOMS transobturator male sling in patients with post-prostatectomy stress urinary incontinence. Minimally invasive techniques, such as slings, are becoming the standard of care for mild to moderate post-prostatectomy incontinence. From March 2007 to June 2009, 122 patients with post-prostatectomy stress urinary incontinence were treated with the I-STOP TOMS sling and followed up for 1 year in the Phase IV HOMme INContinence trial. The preoperative and postoperative evaluation included daily pad use, pad test, questionnaires evaluating urinary function and bother (University of California, Los Angeles, Prostate Cancer Index--urinary function short form, and International Consultation on Incontinence Modular Questionnaire--urinary incontinence short form) and uroflowmetry, including the post-void residual urine volume. Patient satisfaction and perineal pain were also assessed. A total of 103 patients were followed up for 12 months. The surgical procedure was considered easy to perform. The mean daily pad use decreased significantly from 2.4 to 0.6 at 12 months of follow-up; 87.0% of the patients reported improved continence (59.4% completely dry, 20.3% 1 pad/d, 7.3%>1 pad/d), and 13.0% reported no improvement. All quality-of-life scores (University of California, Los Angeles, Prostate Cancer Index--urinary function short form, and International Consultation on Incontinence Modular Questionnaire--urinary incontinence short form) improved significantly after sling implantation. Treatment satisfaction was >90%. The post-void residual urine volume did not increase substantially, and acute urinary retention did not occur. The perineal pain scores were very low at follow-up. Wound infection was seen in 2 patients at the 1-month follow-up visit. The I-STOP TOMS is a good treatment option for patients with post-prostatectomy stress urinary incontinence. With follow-up≤12 months, most patients were continent or had improved continence. The intervention was well tolerated, with few infections.

The role of synthetic slings in male stress incontinence

ObjectiveOur primary aim was to compare the outcomes of synthetic bone-anchored male slings (BAMS) and transobturator male slings (TOMS), to identify preoperative risk factors for failure, and to evaluate patient satisfaction with each procedure. Patients and methodsCharts were reviewed retrospectively of patients who underwent synthetic BAMS or TOMS from 2000 to 2011. Data were categorised into groups based on outcomes of ‘dry’, ‘improved’ and ‘failure’. Success was defined as completely dry or an improvement by >50% in daily pad use. The data analysed included demographics, daily pad use before and after surgery, previous urethral insult, type of prostatectomy, and urodynamic study variables. Data were analysed using logistical regression, the t-test and chi-square analysis, where appropriate. ResultsSixty-eight men were analysed (30 in each group; eight patients were excluded). Daily pad use for the TOMS group changed from 3.5 before to 1.5 after surgery (P=0.001), whilst the BAMS group was unchanged from 3.9 to 3.5 (P=0.747). The TOMS group had a success rate of 23/30 (77%) and a mean (SD) patient global impression of improvement score of 1.67 (0.90), whilst the BAMS group had a success rate of 11/30 (37%) and mean (SD) score of 2.64 (1.12). Urethral insult (P=0.001) and preoperative pad use (P=0.047) were significant predictors of failure. ConclusionTOMS gave better outcomes than BAMS in both performance and patient satisfaction. Patients with a greater severity of incontinence and evidence of urethral insult before surgery should be counselled about the likelihood of suboptimal outcomes with any type of sling placement.