Daily Pad Use Research Articles

1349 RE-ASSESSMENT OF SUBJECTIVE OUTCOMES OF THE ADVANCE™ SLING – INSIGHT INTO THERAPEUTIC DURABILITY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence—Evaluation & Therapy1 Apr 20111349 RE-ASSESSMENT OF SUBJECTIVE OUTCOMES OF THE ADVANCE™ SLING – INSIGHT INTO THERAPEUTIC DURABILITY Hanhan Li, Bradley Gill, Amy Nowacki, Hadley Wood, and Sandip Vasavada Hanhan LiHanhan Li Cleveland, OH More articles by this author , Bradley GillBradley Gill Cleveland, OH More articles by this author , Amy NowackiAmy Nowacki Cleveland, OH More articles by this author , Hadley WoodHadley Wood Cleveland, OH More articles by this author , and Sandip VasavadaSandip Vasavada Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1170AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The male transobturator sling is a viable option for patients who experience mild to moderate incontinence after prostatectomy. Previous studies have demonstrated quantitative success in treating post-prostatectomy incontinence (PPI). This study focuses on the durability of patient perceived efficacy. METHODS Telephone survey and retrospective chart review were conducted on patients receiving a sling prior to 2010 by either of two surgeons at a large academic institution. Of this group, 35 patients were previously surveyed in 2008. Telephone survey included the Patient Global Impression of Improvement (PGI-I) and Severity (PGI-S) of incontinence, questions concerning pre- and post-sling pad quantity, type, and usage, and durability of sling efficacy. Patient-determined success was defined as “very much” or “much” better PPI on the PGI-I without subsequent incontinence therapies. Patients lost to follow-up were analyzed as failures. RESULTS A total of 67 patients (mean age 67, BMI 27) received the sling at median 23 months [Q1–Q3: 14–90] post-prostatectomy. PPI treatments included Kegel exercises (27%), external clamp (7%), anticholinergics (25%), collagen (12%), durasphere (4%), bone-anchored sling (1%), and artificial urinary sphincter (AUS) (7%). Per chart, a mean 2.8 (SD 2.3) pads were used daily pre-sling. Telephone follow-up was successful in 58 (87%) patients at a mean of 23 months post-sling. Patients reported improvement in PPI as “very much” (41%), “much” (19%), and “a little” (14%) better. Of the rest, 16% reported “no change” or worsening PPI as “a little” (3%), “much” (5%), and “very much” (2%) worse. Pad usage post-sling decreased from 3 to 1.5 (p<0.0001). For patients whose post-sling improvement worsened over time (n=20), only one felt something “tear” or “pull” after surgery. Men who responded to both surveys (n=23) with mean follow-up at 9 and 31 months post-sling reported an increase in daily pad use from 1.3 to 2.1 (p=0.03). A total of 15 (22%) patients sought additional incontinence therapies: bulking injections (4), AUS (4), external clamps (4), exercises (3), medications (2), and acupuncture (1). Overall patient-determined success rate, as defined, was 43%. Patients new to this second study had success at first follow-up (53%) similar to those previously assessed, who now show reduced (32%) patient-perceived effectiveness. CONCLUSIONS Most patients receiving the AdVance™ sling do see improvement in PPI and a decrease in pad usage but durability of perceived benefit decreases over time, requiring some patients to seek further therapies. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e539 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hanhan Li Cleveland, OH More articles by this author Bradley Gill Cleveland, OH More articles by this author Amy Nowacki Cleveland, OH More articles by this author Hadley Wood Cleveland, OH More articles by this author Sandip Vasavada Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

What is the long‐term relevance of clinically detected postoperative anastomotic urine leakage after robotic‐assisted laparoscopic prostatectomy?

• To determine whether patients with postoperative clinically detected anastomotic urine leaks are at increased risk for poorer erectile function, urinary incontinence and bladder neck contracture (BNC) after robotic-assisted laparoscopic radical prostatectomy. • A retrospective review of all patients undergoing RALRP from October 2005 until December 2009 by a single surgeon (R.B.N.) was conducted. Clinically detected anastomotic urine leak was defined as drain output consistent with urine at more than 24 h postoperatively. The presence of BNC was identified on cystoscopy. • Erectile function was measured with the Sexual Healthy Inventory for Men (SHIM) questionnaire. Incontinence was measured by patient-reported daily pad use. • Univariate and multivariate analyses were performed. Outcomes were assessed at the most recent follow-up. • Among 213 patients eligible for inclusion, 27 experienced an anastomotic urine leak (12.7%). • At a mean long-term follow-up of 24.2 months, there was no difference in SHIM scores (7.0 vs 13.1; P= 0.101), continence rates (87.5% vs 85.2%; P= 0.999) or risk of BNC (7.4% vs 3.2%; P= 0.268) between patients with and without postoperative anastomotic urine leaks, respectively. • The results did not change after controlling for covariates in a multivariate analysis. • The present study suggests that patients with clinically detected postoperative anastomotic urine leaks do not necessarily have worse long-term outcomes of erectile function, continence and risk of BNC.

Results of the AdVance Transobturator Male Sling After Radical Prostatectomy and Adjuvant Radiotherapy

To prospectively evaluate the efficacy of the functional AdVance transobturator sling for the treatment of male stress urinary incontinence (SUI) in patients after radical prostatectomy and additional adjuvant radiotherapy. Between February 2007 and November 2008, 24 patients with postprostatectomy SUI (ICS grade 2-4) and additional adjuvant radiotherapy were treated consecutively with the AdVance sling. Preoperatively, intensive workup, including urodynamic assessment and flexible urethroscopy, was performed. Physical examinations (pad test, uroflowmetry, ultrasound) and questionnaires (I-QOL score, ICIQ-UI-SF score) were performed during baseline and during follow-up. Cure rate was defined as no pad use or one dry pad, and improved rate as 1-2 pads or reduction of pads by ≥50%. After a median follow-up of 18.0 months (range 12-33 months, mean 18.8 months), the success rate was 50%. Daily pad use and pad weight in the 1-hour pad test decreased significantly. Patients with ICS grade 2 SUI exhibited a trend for a better success rate in comparison with patients with grade 3 and 4 SUI. Results were durable over time. Postoperatively, 16.7% of the patients exhibited transient acute urinary retention which resolved without further treatment after a maximum of 6 weeks. 1 sling had to be removed because of initial misplacement. In selected patients after adjuvant radiotherapy, the AdVance sling achieved a success rate of 50% and results were stable in a median follow-up of 18 months. Complication rates were low and comparable to complication rates for patients without additional radiotherapy.

Single Incision Mid-urethral Sling for Treatment of Female Stress Urinary Incontinence

To present the longitudinal outcomes in an observational cohort of patients who had undergone treatment of stress urinary incontinence with a single incision mid-urethral sling (MUS). A prospective, observational study of all female patients who had undergone surgical intervention with the MiniArc MUS was performed. The surgical candidates underwent history and physical examination and urodynamic testing, as indicated. Quality of life questionnaires (Urogenital Distress Inventory [UDI-6] and Incontinence Impact Questionnaire [IIQ-7]) were administered preoperatively. The salient operative data were recorded. The patients were followed up postoperatively for evidence of treatment success and adverse events. The patients completed the UDI-6, IIQ-7, and Female Sexual Function Index questionnaires at 1 and 12 months after treatment. From September 2007 to October 2008, 120 patients underwent placement of the MiniArc MUS for the treatment of stress urinary incontinence. The mean patient age was 58.4 years. The mean body mass index was 27.2 kg/m(2). The mean preoperative daily pad use was 2.4. The mean preoperative IIQ-7 and UDI-6 score was 86.58 and 62.5, respectively. Of the 120 patients, 108 (90%) completed a minimum follow-up period of 12 months. Of these 108 patients, 101 (94%) were cured/dry. The mean postoperative pad use was 0.2 (P < .001). The mean IIQ-7 and UDI-6 score was 13.32 (P < .001) and 12.5 (P < .001), respectively. The Female Sexual Function Index results demonstrated no discomfort with intercourse in 49%, occasional discomfort in 9%, and frequent discomfort in 2%. The remaining 40% of our patients were not sexually active. Our results have shown that the MiniArc MUS offers excellent outcomes that are durable at 1 year after treatment.

The 1 year outcome of the transobturator retroluminal repositioning sling in the treatment of male stress urinary incontinence

To evaluate the efficacy and safety of a transobturator retroluminal repositioning sling suspension in the treatment of male stress urinary incontinence (SUI) after prostate surgery. In 118 men with SUI after prostatic surgery, a transobturator retroluminal repositioning sling suspension was implanted. Patients were evaluated including: complete history and physical examination, 24-h pad test, a questionnaire (International Consultation on Incontinence Questionnaire, Short-Form), urodynamic evaluation and endoscopy. The surgical technique was described previously. The findings before and at 1 year after sling placement were compared. At the 12-month follow-up, 73.7% of the men were cured, 16.9% were improved, and 9.3% were still incontinent. After sling placement the daily pad use decreased significantly (P < 0.001), while the ICIQ-SF improved significantly (P < 0.01). The detrusor voiding pressure, postvoid residual urine volume and maximal flow rates remained unchanged, while the Valsalva leak-point pressure improved significantly (P < 0.01). In 19.5% of the men, there was transient scrotal pain or perineal discomfort. In 5.1% of the men, postoperative urinary retention occurred but resolved spontaneously after a few weeks of catheter placement. In 1.7% of the men adductor pain was reported, which resolved spontaneously. There were no major complications. The transobturator retroluminal repositioning sling suspension for the treatment of male SUI is effective and safe with a low complication rate after 1 year of follow-up.

Repeat Retrourethral Transobturator Sling in the Management of Recurrent Postprostatectomy Stress Urinary Incontinence After Failed First Male Sling

BackgroundA failure rate between 20% and 45.5% after retrourethral transobturator sling (RTS) is reported. Recommendations for the management of persistent or recurrent postprostatectomy stress urinary incontinence (SUI) after failed male sling do not exist. ObjectiveThe aim of this study was the prospective evaluation of the efficacy of repeat RTS (RRTS) in patients after failed first RTS. Design, setting, and participantsBetween March 2007 and August 2009, 35 patients with mild to severe SUI after failed first RTS were treated with a second AdVance sling (American Medical Systems, Minnetonka, MN, USA). MeasurementsPreoperative and postoperative evaluation included daily pad use, 1-hr pad test, postvoiding residual (PVR) urine, uroflowmetry, and quality-of-life (QoL) scores. Results and limitationsAfter 6 mo, 45.5% (15 of 33 patients) showed no pad use; 30.3% (10 of 33 patients), one dry “security” pad; 3% (1 of 33 patients), one wet pad; 6.1% (2 of 33 patients), two pads; 3% (1 of 33 patients), pad reduction ≥50%; and 12.1% (4 of 33 patients), treatment failure. After 16.6 mo, 34.5% (10 of 29 patients) showed no pad use; 37.9% (11 of 29 patients), one dry “security” pad; 3.4% (1 of 29 patients), one wet pad; 3.4% (1 of 29 patients), two pads; 10.3% (3 of 29 patients), pad reduction ≥50%; and 10.4% (3 of 29 patients), treatment failure. Daily pad use and pad weight decreased significantly. PVR and uroflowmetry results showed no significant change. QoL improved significantly. Postoperative acute urinary retention was observed in 23.6% of patients. ConclusionsRRTS is an effective and safe treatment option for the management of SUI after failed first RTS.

Global Postural Re-education: an alternative approach for stress urinary incontinence?

Objective The aim of this study was to evaluate the impact of Global Postural Re-education (GPR) on stress urinary incontinence symptoms and to compare it to Pelvic Floor Muscle Training (PFMT). Study design Fifty-two women with stress urinary incontinence were distributed into two groups: Group 1 (G1) was submitted to weekly sessions of GPR for three months and Group 2 (G2) performed Pelvic Floor Muscle Training four times a week for three months. Patients were evaluated through the King's Health Questionnaire, a three-day voiding diary including daily pad use and a Functional Evaluation of the Pelvic Floor (FEPF), before treatment (T0), at the end of treatment (T1) and six months after treatment (T2). Results The number of leaking episodes dropped significantly in both groups at the end of treatment and at six months follow-up, with a significantly greater decrease in G1. Daily pad use dropped significantly in both groups. At the end of treatment, 72% of the patients in G1 and 41% of the patients in G2 needed no pads and at six-month follow-up, 84% and 50%, respectively. FEPF improved significantly in both groups, with no significant difference between the groups ( P = 0.628). The King's Health Questionnaire demonstrated significant improvement in both groups and in all domains. The GPR group presented higher adherence to treatment, with no dropouts. Conclusions GPR could represent an alternative method to treat stress urinary incontinence in women, should the results be long lasting.

V171 SALVAGE SPIRAL SLING TECHNIQUES: ALTERNATIVES FOR THE MANAGEMENT OF DISABLING RECURRENT URINARY INCONTINENCE IN FEMALES

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction & Incontinence)1 Apr 2010V171 SALVAGE SPIRAL SLING TECHNIQUES: ALTERNATIVES FOR THE MANAGEMENT OF DISABLING RECURRENT URINARY INCONTINENCE IN FEMALES Alejandro R. Rodriguez, Tariq Hakki, Jorge Caso, Raul Ordorica, and Jorge Lockhart Alejandro R. RodriguezAlejandro R. Rodriguez More articles by this author , Tariq HakkiTariq Hakki More articles by this author , Jorge CasoJorge Caso More articles by this author , Raul OrdoricaRaul Ordorica More articles by this author , and Jorge LockhartJorge Lockhart More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.226AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Females with recurrent stress urinary incontinence (SUI) following anti-incontinence surgery represent a therapeutic challenge. In our experience and that of others, standard sling procedures have failed to consistently correct these problems. In this video we are presenting a variety of spiral sling techniques that were used in these situations. METHODS Between January 2007 and July 2008, 30 female patients with persistent SUI following multiple failed anti-incontinence procedures were evaluated. The main indication for placement of a spiral sling included one or both of the following: 1.Failed previous anti-incontinence procedures with at least one prior sling placement and 2.ISD incontinence without concomitant urethral mobility. Preoperative evaluation included medical history, quality of life questionnaire, physical examination, urinalysis and culture, a Stamey score, cystoscopy, and video urodynamic assessment. The technique starts with a midline incision performed in the anterior vaginal wall approximately 1 cm away from the urethral meatus and carried down to the proximal urethra. The surgical procedure requires a circumferential dissection of the proximal urethra prior to sling placement. All the slings measured 1 x 16 cm. All the synthetic spiral slings (SSS) were polypropylene mesh with a zero polyglactin suture applied at each end. Slings were wrapped around the urethra to provide 360 degrees of compression prior to securing without tension. Patients were followed with number of pads, Stamey score, and quality of life questionnaires. RESULTS Twenty-nine patients were followed for a minimum of 15 months (15-18 months). Mean age was 60 years (36-84 years). At presentation, the mean number of prior vaginal procedures and pads used was 3.5 (1-6) and 7 (3-12), respectively. 21 had a synthetic spiral sling (SSS), 5 had an autologous spiral sling (AUSS)(3 rectus fascia and 2 fascia lata), and 3 underwent a lateral spiral sling (LSS). Mean daily pad use decreased to 0.9 (0-2) (p<0.05). Postoperative mean Stamey score decreased from 2.6 to 0.3 (p<0.05). Complications included 3 unilateral vesical perforations, in which the contralateral LSS was used. Overall success rate was 72%. CONCLUSIONS Salvage spiral sling techniques represent a satisfactory alternative for the treatment of refractory urinary incontinence. When synthetic material can not be used, autologous tissue can provide similar results. When the bladder is unilaterally perforated an LSS can be used on the contralateral side. Tampa, FL© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e69 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alejandro R. Rodriguez More articles by this author Tariq Hakki More articles by this author Jorge Caso More articles by this author Raul Ordorica More articles by this author Jorge Lockhart More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Continence Definition After Radical Prostatectomy Using Urinary Quality of Life: Evaluation of Patient Reported Validated Questionnaires

After radical prostatectomy continence is commonly defined as no pads except a security pad or 0 to 1 pad. We evaluated the association of pad status and urinary quality of life to determine whether security and 1 pad status differ from pad-free status to better define 0 pads as the post-prostatectomy standard. A total of 500 consecutive men underwent robot assisted radical prostatectomy from October 2003 to July 2007. Data were collected prospectively and entered into an electronic database. Postoperatively men completed self-administered validated questionnaires including questions on 1) daily pad use (0, security, 1, or 2 or more), 2) urine leakage (daily, about once weekly, less than once weekly or not at all), 3) urinary control (none, frequent dribbling, occasional dribbling or total control), 4) American Urological Association symptom score and 5) urinary quality of life. Postoperatively men who indicated 0 pad use had a mean +/- SE symptom score of 5.8 +/- 0.3 and pleased quality of life (1.16 +/- 0.08). In contrast, men with a security pad and 1 pad had a symptom score of 7.6 +/- 0.7 and 9.2 +/- 0.6 but mixed quality of life (2.78 +/- 0.18 and 3.41 +/- 0.15, respectively, p <0.0005). Results show a significant decrease in quality of life between no pads (1.16 or pleased), a security pad and 0 or 1 pad (2.78 and 3.41 or mixed, respectively). Findings do not support defining continence with a security pad or 0 to 1 pad. Continence should be strictly defined as 0 pads.

Complications of the AdVance Transobturator Male Sling in the Treatment of Male Stress Urinary Incontinence

To evaluate prospectively the complication rate of the retrourethral transobturator sling (AdVance sling) for the functional treatment of male stress urinary incontinence (SUI). In 230 patients with SUI due to nonintrinsic sphincter deficiency (without direct sphincter lesion) after radical prostatectomy (n=213), radical cystoprostatectomy with ileal neobladder (n=2) and transurethral resection of the prostate (n=15) a retrourethral transobturator sling was implanted. Patients were followed up for a median of 17 months (range, 4-42 months) with regard to intraoperative, early postoperative, and midterm postoperative complications. Overall complication rate of the AdVance sling was 23.9%. Despite one accidental sling misplacement, no intraoperative complication occurred. Forty-nine patients (21.3%) experienced urinary retention postsurgery. Two slings were explanted (0.9%), 1 due to initial wrong placement and the other due to a symphysitis, attributed to a Guillain-Barré syndrome and not to a sling infection. One sling was transected (0.4%) due to slippage of the sling with obstruction of the urethra. Further complications were local wound infection (0.4%), urinary infection with fever (0.4%), and persistent moderate perineal pain (0.4%). There was no correlation between postoperative acute urinary retention and age at sling implantation, time of incontinence before sling implantation, preoperative daily pad use, or prior invasive incontinence treatment, respectively. The retrourethral transobturator AdVance sling is a safe treatment option for male nonintrinsic sphincter deficiency SUI, with the main postoperative complication being transient acute urinary retention. Severe intra- and postoperative complications are rare and sling explantation rate is very low.

Patient Perceived Effectiveness of a New Male Sling as Treatment for Post-Prostatectomy Incontinence

Objective measures show the AdVance() sling provides some benefit in post-prostatectomy incontinence. To our knowledge no validated, patient determined outcomes have been used to assess this procedure. We described the patient perceived effectiveness and postoperative complications. A retrospective chart review was followed by a telephone survey consisting of the Patient Global Impression of Improvement, Patient Global Impression of Severity, and questions about recommending the surgery, daily pad use and complications. Successful outcomes were Patient Global Impression of Improvement responses of very much better or much better without further incontinence treatment. Objective success is defined as pad-free or a reduction to 2 or less pads daily. A total of 35 patients received the sling a median of 25 months after prostatectomy. Telephone surveys were administered a mean of 35 weeks after the sling procedure and 33 patients were contacted. Of the cases 18 (51.4%) and 21 (60%) were patient determined and objective successes, respectively. Of the patients with subjective treatment failure 3 would recommend the surgery to a friend and 12 were undecided or would not. Furthermore, no patients with subjective treatment failure were pad-free and 10 (58.8%) had pads that were mostly wet on changing. For the entire population a reduction in median daily pad use from 2.5 to 1 was observed as well as a strong association (p <0.01) between Patient Global Impression of Improvement and Patient Global Impression of Severity responses. Three individuals pursued further treatment with bulking agents and 3 had retention that resolved. The AdVance sling is safe, and demonstrates similar subjective and objective outcomes. The procedure can benefit some individuals with post-prostatectomy incontinence and, therefore, may be another treatment option for this condition.

Long-term effects of extracorporeal magnetic innervations in the treatment of women with urinary incontinence: results of 3-year follow-up

This study is designed to evaluate the long-term efficacy of extracorporeal magnetic innervation (ExMI) in the treatment of women with urinary incontinence. Our prospective study included a period of 3 years between May 2005 and October 2008. A total of 137 consequent women with stress and urge incontinence were included in the study. Of the patients, 68 had stress incontinence and others had urge incontinence. All of the patients with stress incontinence were successfully followed up and 32 (47%) were totally dry in negative stress test at the 6 months after ExMI therapy. In the same group, 27(39%) showed improvement in the frequency of daily leak episodes from 3.2 times to 1.2 times. In the urge incontinence group, all of the patients completed the treatment and they were successfully followed up. While 40 (58%) patients were dry and 18 (26%) significantly improved the average number of incontinence episodes decreased from 3.7 times to 1.7 times per day, treatment failed in the remaining 11 (16%) patients at the 6 months. At 6 months, the recurrence rate was 53%. At the 6 months after 16 sessions of ExMI had a significant QOL, parallel to decrease in daily pad use and leakage episodes. Only 16 sessions are not effective definitive therapy. The beneficial effects are temporary and there is high recurrence.

Validating the Incontinence Symptom Severity Index: A Self-Assessment Instrument for Voiding Symptom Severity in Women

Most voiding symptom self-assessment instruments assess either symptom bother or effect on quality of life. The Incontinence Symptom Severity Index is an instrument for self-assessment of severity of female urinary storage and voiding symptoms, rather than symptom bother or effects of symptoms on quality of life. We assessed the validity of the Incontinence Symptom Severity Index for female voiding symptom self-assessment. The Incontinence Symptom Severity Index assesses 8 symptom domains, including emptying, urgency, urge incontinence, nocturia, daytime frequency, stress incontinence, leakage with physical activity and pad use. Three separate cohorts of women with a mean age of 59, 60 and 63 years, respectively, who underwent evaluation for urinary complaints associated with incontinence and vaginal prolapse were analyzed. Internal consistency was assessed via item-total correlations and Cronbach's alpha. Concurrent validity against the Urogenital Distress Inventory and Pelvic Floor Distress Inventory-Short Form were studied by correlating similar symptom domains of the Incontinence Symptom Severity Index with both instruments. We assessed criterion validity by comparison with the objective measures of post-void residual urine, voiding logs and self-reported pad use. Response to change was assessed by comparing pretreatment and posttreatment Incontinence Symptom Severity Index scores. Significant item total correlations were seen for each Incontinence Symptom Severity Index item and Cronbach's alpha was 0.69. All Incontinence Symptom Severity Index items significantly correlated with similar items of the Urogenital Distress Inventory and Pelvic Floor Distress Inventory-Short Form. Significant posttreatment reductions were also observed for all 8 Incontinence Symptom Severity Index items. Progressively higher post-void residual urine was noted for the 4 severity scores of Incontinence Symptom Severity Index item 1 (emptying) (p = 0.07). Incontinence Symptom Severity Index items 3 (nocturia) and 4 (daytime frequency) showed significantly increasing nighttime and daytime voids with worsening severity scores for each (p <0.0001 and <0.0041, respectively). Incontinence Symptom Severity Index items 5 to 8 (stress incontinence, urge incontinence, leakage with activity and pad use) showed significantly increasing trends in mean daily pad use (p <0.0001, 0.022, <0.0001 and <0.0001, respectively) among the 4 severity scores for each. The Incontinence Symptom Severity Index demonstrates good reliability and validity. It is a useful instrument for assessment of female incontinence and voiding symptom severity in clinical and research settings.

Prospective Evaluation of the Functional Sling Suspension for Male Postprostatectomy Stress Urinary Incontinence: Results after 1 Year

BackgroundAlthough surgical techniques for radical prostatectomy (RP) have been refined significantly, a significant number of patients still suffer from persisting postprostatectomy stress urinary incontinence (SUI). In recent years, various minimally invasive sling systems have been investigated as treatment options for such incontinence. ObjectiveThe aim of the study was the prospective evaluation of the efficacy of the retrourethral transobturator sling for the functional treatment of male SUI after RP. Design, setting, and participantsThe study documents a single-centre prospective evaluation of the outcome of 124 patients with mild to severe SUI following RP in whom an AdVance sling was implanted between February 2006 and September 2008. MeasurementsAll patients were comprehensively evaluated preoperatively and after 6 mo and 1 yr regarding daily pad use, 1-h and 24-h pad tests, residual urine, uroflowmetry, Incontinence Quality of Life Scale (I-QOL) score, and Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF) score. Data were collected prospectively. Results and limitationsAfter 6 mo, a cure rate (no pads or one dry security pad) of 55.8%, an improved rate (one to two pads or pad reduction ≥50%) of 27.4%, and a failure rate of 16.8% were observed. After 1 yr, the cure rate was 51.4%, the improved rate was 25.7%, and the failure rate was 22.9%. Daily pad use and pad weight decreased significantly postoperatively. No significant changes were seen in residual urine and flow rate. Quality-of-life scores improved significantly. Postoperative acute urinary retention was seen in 12.9% of patients. One patient had a local wound infection that was cured with antibiotics. One patient had the sling removed due to misplacement. ConclusionsThe retrourethral transobturator sling is an effective and attractive treatment option for male SUI resulting from RP after 1 yr of implantation.

STATIN AND NON-STEROIDAL ANTI-INFLAMMATORY DRUG USE AND DEVELOPMENT OF UROLOGIC OUTCOMES

significantly. Also the daily pad use decreased significantly. No severe intraoperative complication like bleeding or injury of the bladder occurred. 6.5% of the patients had an acute urinary retention after postoperative catheter removal and were treated by suprapubic catheter or intermittent self catheterization for a maximum of 6 weeks. CONCLUSIONS: The Advance sling is also in a longer followup a save and non-invasive treatment for male incontinence with reproducible and stable results. The cure and improvement rates are after one year still significant and without big changes to prior published three month results.

Efficacy and Safety of Artificial Urinary Sphincter for Stress Urinary Incontinence after Prostate Surgery

Purpose: To evaluate the efficacy and safety of artificial urinary sphincter (AUS) for the treatment of stress urinary incontinence (UI) after prostate surgery. Materials and Methods: We performed a retrospective chart review of 19 patients who underwent AUS implantation from July 2003 to November 2008. Efficacy was evaluated in terms of the postoperative changes in daily pad use, incontinence visual analogue scale (I-VAS), International Continence Society male-Short Form questionnaire (ICS-male SF), Incontinence Quality of Life questionnaire (I-QoL), and patients’ satisfaction postoperatively. No pad use was defined as cure, and use of 1 pad or fewer per day as improvement. Cure and improvement were regarded as success. Complications and durability of the AUS were evaluated. Results: The median age of the patients was 70.0 years (range, 47-76 years). With a median follow-up period of 11.8 months (range, 6.2-48.1 months), the success rate was 68.4% (13/19; cure in 12 and improvement in 1). I-VAS, subscale scores of ICS-male SF (incontinence and QoL), and total and subscale scores of I-QoL (psychosocial impact, social embarrassment, avoidance, and limiting behaviors) were significantly improved. Fifteen (78.9%) patients reported being satisfied. Six (31.5%) patients required revision: volume adjustment for 2, second cuff implantation for 2, pump reposition for 1, and pump reposition, volume adjustment, and second cuff implantation for 1. One of the patients who had a second cuff implantation had the sphincter explanted for infection. Conclusions: Despite the high rate of revision, the satisfaction rate was high and the quality of life was significantly improved after AUS implantation for urinary incontinence after prostate surgery. (Korean J Urol 2009;50:854-858) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Long-Term Durability and Functional Outcomes Among Patients With Artificial Urinary Sphincters: A 10-Year Retrospective Review From the University of Michigan

The artificial urinary sphincter continues to be one of the most effective and commonly used surgical treatments for severe urinary incontinence. The long-term durability and functional outcome remains unclear. This study sought to report the artificial urinary sphincter complication rates, associated risk factors with complications, and long-term quality of life and durability. This single institution study reports the outcomes of 124 consecutive index cases of artificial urinary sphincter from 1996 to 2006 for complications (infection, erosion, and mechanical failure). Bivariate statistics and multivariable logistic models were used to identify patient and artificial urinary sphincter characteristics associated with complications. Functional outcomes and long-term durability were assessed using a cross sectional analysis of a validated health related quality of life survey and a product limit estimates, respectively. Among the 124 male patients median followup was 6.8 years. The overall complication rate for patients undergoing an artificial urinary sphincter was 37.0%, with mechanical failure the most common cause (29), followed by erosion (10) and then infection (7). Significant differences between complications and specific patient and artificial urinary sphincter characteristics risk factors were not found. Functional outcomes appeared stable with similar mild-moderate urinary incontinence severity and 0 to 1 daily pad use at intervals of 0 to 4 years, 4 to 8 years and more than 8 years. Long-term durability was notable with 36% having complications (requiring surgical revision or removal) within 10 years and most events occurring within the first 48 months. Long-term durability and functional outcomes are achievable for the AMS 800, but there are appreciable complication rates for erosion, mechanical failure and infection in the first 48 months from implantation.

Laparoscopic radical prostatectomy: Surgical, oncological and functional outcomes

To report the first results of laparoscopic radical prostatectomy (LRP) at our institution. The surgical, functional and oncological outcomes of all patients who underwent LRP at Helsinki University Central Hospital between May 2002 and May 2006 were prospectively evaluated. The first eight patients were operated transperitoneally and the next 72 extraperitoneally. The mean operative time was 328+/-73 min (range 210-510 min). The mean estimated blood loss was 769+/-906 ml (range 50-5500 ml), and 18 patients (22.5%) had transfusions. The mean catheterization time was 13.2+/-4.0 days (range 9-35 days). Mean hospital stay was 5.7+/-3.1 days (range 3-15 days). Nineteen patients (23.8%) had perioperative complications. The conversion rate to open surgery was 11.3% and 6.3% required an immediate re-operation. Three anastomotic strictures (5.7%) and two cases of ileus (3.8%) were observed. The cancer was intracapsular (pT1-2) in 68 patients (85.0%) and extracapsular (pT3-4) in 12 (15.0%). Positive surgical margins were noted in 20 patients (25.0%) in total: 17.6% of pT1-2 cases and 66.7% of pT3-4 cases. Prostate-specific antigen recurrence (> or =0.2 ng/ml) was noted in 5/53 patients (9.4%), who were followed for >12 months. The continence rate (no daily pad use) was 86.8% and the potency rate was 34.6% at 12 months. The surgical, functional and oncological results of our first LRPs compare fairly well with the early experience of others. LRP is feasible outside high-volume centers but the learning curve is expected to be long.

Spiral Sling Salvage Anti-Incontinence Surgery in Female Patients With a Nonfunctional Urethra: Technique and Initial Results

Female patients with severe urethral incompetence are a unique surgical challenge. Urethral closure and continent diversion are often the next step in the treatment of these patients. We present a technique that provides circumferential coaptation of the urethra as a salvage procedure in this severe subset of patients. We prospectively evaluated 47 patients who had a spiral sling. A 1 x 15 cm piece of soft polypropylene mesh was prepared with a zero polyglactin suture applied at each end. A clamp was used to pass the mesh between the urethra and pubis. The ends of the mesh were crossed at the ventral aspect of the urethra, creating a complete circle around the urethra. The sutures were transferred to the suprapubic area and tied without tension. The surgical outcome was determined by patient self-assessment, including symptom, bother and quality of life questionnaires. Mean patient age was 59 years. At presentation patients had undergone a mean of 2.6 incontinence procedures and wore a mean of 6 pads daily. Mean daily pad use decreased to 0.9 (p <0.005). Preoperatively mean SUI symptom severity and bother scores were 2.8 and 2.9, respectively, on a scale of 0--none to 3--severe. Postoperatively these values decreased to 0.6 and 0.4, respectively (each p <0.005). There was a mean 87% overall improvement in symptoms. The spiral sling is an effective salvage transvaginal procedure that may be considered in a small subset of female patients with a nonfunctional urethra as a last resort before urethral closure procedures.

TRANSURETHRAL INJECTION OF BULKING AGENTS FOR STRESS URINARY INCONTINENCE FOLLOWING ORTHOTOPIC NEOBLADDER RECONSTRUCTION IN WOMEN

The clinical efficacy of transurethral bulking agents for the treatment of new onset urinary incontinence following radical cystectomy and orthotopic lower urinary tract reconstruction in women was evaluated. Between 1990 and 2002, 101 female patients with primary transitional cell carcinoma of the bladder were treated with radical cystectomy and orthotopic ileal neobladder reconstruction. Of the 101 patients 12 (12%) underwent treatment for new onset urinary incontinence following exenterative surgery with transurethral injection of bulking agents, including collagen in 11 and nonabsorbable pyrolytic carbon coated beads in 1. A total of 25 injections were administered to 12 female patients with a mean age of 75.4 years following orthotopic neobladder reconstruction. Mean followup was 22.5 months (range 2 to 51). Two of the 12 patients (16.7%) reported complete continence and were considered cured, although subjective complaints of urinary frequency persisted. Four patients (33%) had decreased objective average daily pad use (6.75 to 2.25) and 6 (50%) showed no subjective or objective improvement in symptomatology. Although injection of urethral bulking agents is a minimally invasive treatment for stress urinary incontinence following orthotopic neobladder reconstruction, long-term results in patients with severe disease show a less than optimal durable response.