Dry Pad Research Articles

STUDY THERMAL OF COMPRESSOR POWER REDUCTION ON USING SOLID DRY PAD PRE-AIR COOLING SYSTEM

AbstractThe uses of compressor based air conditioning system has rapidly increased the consumption of fossil fuel energy resources and the degradation of environment quality. Massive study has been done worldwide to reduce energy consumption for compressor based air conditioning (AC) system. This study is subjected to investigate the use of solid dry pad as pre-air cooling for AC system. In this study, solid dry pad would be placed in the evaporator and condenser inlet air side. This placement was objected to give a pre-cooling effect for evaporator and condenser inlet air, so then the compressor could be operated with a lower power consumption. The experiment would be carried out within three level air mass flowrate of 0.293 kg/s; 0.319 kg/s; and 0.359 kg/s, for air velocity of 2.2; 2.4; and 2.7 m/s respectively, the cooling cabin is set into 30oC using a heater as a cooling load. As a results, it could be revealed that at the highest air mass flowrate of 0.359 kg/s, it could achieved the lowest compressor power consumption of 0.44 kW, within a higher cooling capacity of 2.625 kW, a higher condenser heat rejection of 3.622 kW and also higher COP of 5.9. Referring to those results, it can be concluded that when employing solid dry pad pre-air cooling for evaporator and condenser AC system, it could reduced compressor power consumption by 12.2%; 21.9% and 20% for air velocity of 2.2; 2.4; and 2.7 m/s respectively.Keywords : solid dry pad, pre-air cooling, compressor power reduction.

Effect of Inlet Air Humidity Control on a Novel Indirect Condensative Cooling Performances in Achieving Air Thermal Comfort

The objective of this research is to investigate the effect of controlling inlet air relative humidity on the performance of solid dry pad based indirect condensative cooling (SDP-ICC) system, in an effort to have a better air thermal comfort. The main evaporative cooling parameter such as cooling efficiency, cooling capacity, and temperature drop, condensation rate and energy efficiency ratio would be observed, together with the final dry and wet bulb air temperature and relative humidity in respect to reach the standard air thermal comfort. During the experiment test, the inlet air would be heated respectively using 1.0 kW, 1.5 kW and 2.0 kW heater in a climate chamber before it passed through to the solid dry pad, to be cooled indirect condensatively. The air velocity would be set on 11.3 m3/. The test results indicate that to achieve an air thermal comfort significantly in the evaporative and or condensative cooling system, the air should need to be treated with more than one thermal process, rather than cooling only. In this research, the SDP-ICC has only achieved the air thermal comfort in respect to its relative humidity of 67.3%, 55.65% and 44.3% respectively for heating capacity of 1.0 kW, 1.5 kW and 2.0 kW. The highest SDP-ICC cooling performance has been achieved on 1.5 kW heating capacity, in which it has reached 1.9 kW, 1.83, 3.4oC and 0.237 m3/hr respectively for cooling capacity, energy efficiency ratio, temperature drop and condensation rate. It can be concluded that by heating the inlet air relative humidity in evaporative and or condensative cooling system, it can be resulted the product air which has met the standard air thermal comfort.

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.

PD45-09 LONG TERM OUTCOME OF A RANDOMIZED CLINICAL TRIAL COMPARING THULIUM VAPORIZATION OF THE PROSTATE VERSUS MONOPOLAR TURP, THE TEST OF TIME

You have accessJournal of UrologyCME1 May 2022PD45-09 LONG TERM OUTCOME OF A RANDOMIZED CLINICAL TRIAL COMPARING THULIUM VAPORIZATION OF THE PROSTATE VERSUS MONOPOLAR TURP, THE TEST OF TIME Osama Ezzat, Ahmed M. Elshal, Mahmoud Laymon, Ahmed El-Assmy, and Ahmed Shoma Osama EzzatOsama Ezzat More articles by this author , Ahmed M. ElshalAhmed M. Elshal More articles by this author , Mahmoud LaymonMahmoud Laymon More articles by this author , Ahmed El-AssmyAhmed El-Assmy More articles by this author , and Ahmed ShomaAhmed Shoma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To report the long term outcome of a randomized trial comparing high power thulium laser vaporization of the prostate (ThuVap) to Monopolar transurethral resection of the prostate (M-TURP) for treatment of mild to moderate benign prostatic obstruction (BPO). METHODS: Between May 2017 and December 2018, 110 patients (prostate size 30-80ml) were randomly allocated to ThuVap (54) and M-TURP (56). Patients were followed up at 1, 3, 6, 12 months then annually. In this analysis, retreatment rate will be our main concern. Patients with recurring LUTs will be examined by flexible cystoscopy and treatment will be planned accordingly. Urinary outcome measures (change in IPSS, Qmax, PVR, QOL score), percent PSA reduction, sexual function changes and late postoperative complications will be reported and compared between both groups. RESULTS: After a median of 43.5 months (range 31- 52.6 months), 46 ThuVap and 45 M-TURP patients were evaluable with comparable significant improvement of urinary outcome measures from baseline at different follow up visits in both groups (P>0.05). (Figure1) Recurrent LUTs due to Bladder Outlet Obstruction (BOO) was reported in 9 (19.5%) and 8 (17.8%) after ThuVap and M-TURP respectively (P=0.83). Reuse of alpha blockers was reported in 5 (10.9%) and 4 (8.9%) of ThuVap and M-TURP patients respectively (P=0.75). Reintervention was reported in 8.7% and 8.9% after ThuVap and M-TURP respectively (P=0.51) including prostate re-resection in 3 ThuVap and 2 M-TURP patients. Median percent of PSA reduction at last follow-up was 59% and 57% in the ThuVap and M-TURP respectively (P=0.98). Six (13%) ThuVap patients and single (2.2%) M-TURP patient reported stress urine incontinence (SUI) subjectively (P= 0.243). Using one-hour pad test, G0 (dry pad) was reported in 3 ThuVap patients and GI (<10gm) SUI in the remaining patients. Among sexually active men, there were no statistically significant difference at last follow up neither total IIEF-15 score nor its EF subdomain (P>0.05) (Figure1). Ejaculatory dysfunction was reported in 59.1% and 57.1% in ThuVap and M-TURP groups respectively (P= 1). CONCLUSIONS: ThuVap could achieve durable control of LUTs secondary to small and moderate sized BPO comparable to M-TURP maintaining all safety advantages of laser. Source of Funding: no funds received © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e785 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Osama Ezzat More articles by this author Ahmed M. Elshal More articles by this author Mahmoud Laymon More articles by this author Ahmed El-Assmy More articles by this author Ahmed Shoma More articles by this author Expand All Advertisement PDF DownloadLoading ...

Green Synthesis Using Klebsiella pneumoniae as well as its Execution onto Textiles for Microbe Resistance

Microorganisms like bacteria and yeast and their use in the combination of nanoparticles is a basically a recent phenomenon. These microorganisms lessen the toxicity by decreasing the ions of metal or through the creation of complexes which are insoluble along with the metal’s ions (as metal sulfides) as colloidal elements. The present study focuses on bio-synthesis of silver nanoparticles by the bacterium Klebsiella pneumoniae. The reduction of AgNO3 to Ag nanoparticles was due to the extracellular production of the enzyme nitrate reductase by the K. pneumoniae into the medium. The particles were characterized by SEM. The biosynthesized Ag nanoparticles were padded on the fabrics of cotton by cure method of dry pad. The preliminary antimicrobial activity was performed by disc diffusion method against Escherichia coli and Staphylococcus aureus. The antimicrobial property of the treated fabrics were confirmed qualitatively and quantitatively by parallel streak (AATCC- 147) and challenge test (AATCC -100) respectively. SEM results revealed the form of the nano particles were in range of 50 - 60 nm. An area of inhibition of 7 mm as well as 5 mm were found against S.aureus and E.coli respectively by disc diffusion test. Parallel streak method also confirmed the anjinicrobial activity. The results of the challenge test revealed the fabrics treated with biosynthesized nanoparticles depicted 100% minimum point in comparision with S.aureus and 99% reduction against E.coli.

A model identifying characteristics predictive of successful pelvic floor muscle training outcomes among women with stress urinary incontinence

Introduction and hypothesisThe aim of this study was to prospectively identify aspects of baseline demographic, clinical, and pelvic morphology of women with stress urinary incontinence (SUI) that are predictive of cure with physiotherapist-supervised pelvic floor muscle training (PFMT).MethodsWomen ≥18 years old with SUI were recruited from urogynecology and pelvic health physiotherapy clinics. Participants completed a 3-day bladder diary, the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF), a standardized pad test, manual assessment of pelvic floor muscle (PFM) strength and tone, and transperineal ultrasound (TPUS) assessment of their urogenital structures at rest while in a supine position and standing, and during contraction, straining, and coughing. Participants attended six physiotherapy sessions over 12 weeks and performed a home PFMT program. The assessment was repeated after the intervention; cure was defined as a dry (≤2 g) pad test.ResultsSeventy-seven women aged 50 (±10) years completed the protocol; 38 (49%) were deemed cured. Based on univariate testing, four predictors were entered into a binary logistic regression model: ICIQ-UI-SF, PFM tone, bladder neck (BN) height in a quiet standing position, and BN height during a cough in a standing position. The model was significant (p < 0.001), accurately classifying outcome in 74% of participants. The model, validated through bootstrapping, performed moderately, with the area under the receiver operating characteristic curve = 0.80 (95% CI: 0.69–0.90; p = 0.00), and with 70% sensitivity and 75% specificity.ConclusionsWomen with better bladder support in a standing position and less severe symptoms were most likely to be cured with PFMT.Clinical trial registration#NCT01602107.

Application of Response Surface Methodology to Optimize Ammonia Volatilization Determination by Enclosure Method

ABSTRACT In the enclosure method, ammonia volatilization from an enclosed soil is commonly estimated by hanging acid-soaked polyfoam pads over the soil sample in an enclosed bottle. Response surface methodology (RSM) was used to optimize polyfoam density (D), pad height (H) and pad saturation with an acid solution (S) to maximize ammonia collection in the polyfoam pads. Three central composite design (CCD) experiments with three polyfoams having low (0.013 g cm−3), medium (0.026 g cm−3), and high (0.037 g cm−3) D were conducted. The pads utilized had heights of 1.25, 2.50, and 3.75 cm saturated with an acid solution (9.8% H3PO3 plus 2% glycerol) to a weight of 5, 9, and 13 times that of the dry pad weight. Models developed for medium and high-density polyfoams were sufficiently reliable to predict ammonia collection response in terms of H and S. The response increased linearly with H and quadratically with S. High D pads collected about 13% more ammonia than that of low or medium D pads. The models predicted maximum ammonia collection in polyfoam pads of density 0.037 g cm−3, height 3.75 cm, and at acid saturation of 10.58 times of the dry pad weight.

Transvesical robot-assisted radical prostatectomy: initial experience and surgical outcomes.

ObjectivesTo describe in detail the techniques for transvesical robot‐assisted radical prostatectomy (RARP) using the da Vinci Si/Xi system (Intuitive Surgical, Sunnyvale, CA, USA) and to evaluate functional and oncological outcomes in 35 patients with prostate cancer.Patients and MethodsThirty‐five patients with localized prostate cancer were enrolled for transvesical RARP. The patients' preoperative data (mean ± sd age 63.4 ± 8.1 years, body mass index 28.6 ± 5.3 kg/m2, total prostate‐specific antigen 10.8 ± 4.9 ng/mL and prostate volume 30.6 ± 14.4 mL, and median [interquartile range {IQR}] biopsy Gleason score 6 [6–7], and International Index of Erectile Function [IIEF]‐5 score 18 [16–20]) were collected. Preoperative assessment revealed 28 cases of cT2a and seven cases of cT2b disease. All patients were continent preoperatively (defined as no pad required or one dry pad per day as a precaution). Surgical results and peri‐operative complications were assessed. All patients were followed up for at least 12 months postoperatively.ResultsThe mean operating time was 150 ± 35 min. Estimated blood loss was 100 ± 45 mL. Urinary infection was noted in one patient and managed with levofloxacin. Another patient complained of nocturia on postoperative day 14, which was relieved with solifenacin succinate. Urethral catheters were removed on postoperative day 7. Thirty‐two patients achieved immediate urinary continence, with three patients returning to full continence on postoperative day 14. Postoperative pathology confirmed 24 pT2a cases, nine pT2b cases and two pT2c cases (median [IQR] Gleason score 6 [6–7]). Positive surgical margins were found in four patients (11.4%). No urethral stricture or urinary leakage was noted on urethrocystography taken 3 months after surgery. Urodynamic studies were performed preoperatively and 6 months after surgery: median (IQR) maximum urinary flow 12.2 (10.2–14.9) vs 13.7 (10.1–15.0) mL/s; bladder capacity 385.3 (351.3–410.2) vs 370.2 (330.1–395.4) mL; and voiding phase detrusor contractility 38.5 (27.8–42.3) vs 35.6 (28.3–41.3) mmH2O, respectively. During a minimum of 12 months of follow‐up, no biochemical recurrence was noted in any patient. The median (IQR) IIEF‐5 score was 17 (16–19).ConclusionsThe transvesical approach is a valid alternative to RARP in selected patients, providing promising postoperative urinary continence. Long‐term functional and oncological results require further investigation.

MP19-01 SHOULD WE CHANGE HOW TO ASSESS EARLY CONTINENCE AFTER RHABDOSPHINCTER RECONSTRUCTION IN PATIENTS UNDERGOING ROBOTIC PROSTATECTOMY: RESULTS OF A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP19)1 Apr 2020MP19-01 SHOULD WE CHANGE HOW TO ASSESS EARLY CONTINENCE AFTER RHABDOSPHINCTER RECONSTRUCTION IN PATIENTS UNDERGOING ROBOTIC PROSTATECTOMY: RESULTS OF A RANDOMIZED CONTROLLED TRIAL Lucas Regis*, Aina Salazar, Jacques Planas, Ana Celma, Enric Miret, Merce Cuadras, Alonso Narvaez, David Lorente, Jose Placer, Enrique Trilla, and Juan Morote Lucas Regis*Lucas Regis* More articles by this author , Aina SalazarAina Salazar More articles by this author , Jacques PlanasJacques Planas More articles by this author , Ana CelmaAna Celma More articles by this author , Enric MiretEnric Miret More articles by this author , Merce CuadrasMerce Cuadras More articles by this author , Alonso NarvaezAlonso Narvaez More articles by this author , David LorenteDavid Lorente More articles by this author , Jose PlacerJose Placer More articles by this author , Enrique TrillaEnrique Trilla More articles by this author , and Juan MoroteJuan Morote More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000852.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Posterior rhabdosphincter reconstruction (PRRS) following radical prostatectomy was designed to improve early urinary continence. We executed a randomized clinical trial comparing early continence rates in patients undergoing urethrovesical anastomosis with or without periprostatic reconstruction. METHODS: We conducted a randomized clinical trial (NCT03302169) intended to detect a 20% difference in 1-month continence defined by a patient response of 0 to question 3 of the EPIC26 questionnaire urinary domain, comparing standard running vesicourethral anastomosis (controls) to PRRS followed by standard running vesicourethral anastomosis (PRRS treated). Further continence outcomes were assessed by time to have no leakage (dry pad first date), 24-hour pad weights and time until stop using pad/any protection (Pad 0 first date), ICIQ-SF and IPSS questionnaires. Patients had clinically localized prostate cancer and were blinded. Surgeons were notified of computer randomization (random.org) after prostate excision. Patients and data gatherers were blinded to treatment allocation. RESULTS: A total of 158 patients were randomized between January 2017 and September 2018. 153 patients completed the 6 months study first analysis. Preoperative clinical and functional variables were equivalent between study arms. 50th percentile of patients with dry pad and patients without any protection in the PRRS group was 23 and 34 days, respectively. While 49 and 81 were the equivalent distribution of the control group. Univariate analyses showed that the type of reconstruction was related with absence of any protection 1 month after the surgery (p=0.012) but it wasn’t associate with the dry pad status. No differences were found at 6 months or using the questionnaires specific domains. We performed a multivariate analysis including PSA, BMI, age, prostate volume, lymphadenectomy, nerve-sparing technique and the reconstruction type. PRRS was the only independent predictor of dry pad status and use of any protection at 1 month (Pad 0). The Kaplan-Meier curve demonstrated the statistically significant difference between both techniques in time to recovery early urinary continence. CONCLUSIONS: In this randomized clinical trial posterior rhabdosphincter showed a clear benefit in early urinary continence. To determine the date of dry pad and Pad 0 seems to be more reliable than apply validated questionnaires in established timeframes in order to assess continence status after radical prostatectomy. Source of Funding: no © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e298-e298 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lucas Regis* More articles by this author Aina Salazar More articles by this author Jacques Planas More articles by this author Ana Celma More articles by this author Enric Miret More articles by this author Merce Cuadras More articles by this author Alonso Narvaez More articles by this author David Lorente More articles by this author Jose Placer More articles by this author Enrique Trilla More articles by this author Juan Morote More articles by this author Expand All Advertisement PDF downloadLoading ...

MP41-01 EVALUATION OF URINARY CONTINENCE FOLLOWING OPEN RADICAL CYSTECTOMY WITH ORTHOTOPIC NEOBLADDER IN FEMALES USING A VALIDATED QUESTIONNAIRE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-01 EVALUATION OF URINARY CONTINENCE FOLLOWING OPEN RADICAL CYSTECTOMY WITH ORTHOTOPIC NEOBLADDER IN FEMALES USING A VALIDATED QUESTIONNAIRE Seyedeh-Sanam Ladi Seyedian*, Wesley Yip, Zhoobin Bateni, Saum Ghodoussipour, Jie Cai, Gus Miranda, Sumeet Bhanvadia, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Seyedeh-Sanam Ladi Seyedian*Seyedeh-Sanam Ladi Seyedian* More articles by this author , Wesley YipWesley Yip More articles by this author , Zhoobin BateniZhoobin Bateni More articles by this author , Saum GhodoussipourSaum Ghodoussipour More articles by this author , Jie CaiJie Cai More articles by this author , Gus MirandaGus Miranda More articles by this author , Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Orthotopic neobladder (ONB) following radical cystectomy (RC) is less frequent in female patients compared to males, due to unclear functional outcomes. We prospectively evaluated the continence outcomes in female patients undergoing open RC and ONB with a validated pad usage questionnaire. METHODS: From May 2012 onwards, we prospectively followed patients after open RC with ONB with a validated, pictorial, pad usage questionnaire that assesses the number, size, and wetness of pads, as well as catheter use, at follow-up clinic visits. In our IRB approved database, 42 ONB were performed for female patients after open RC from May 2012 to May 2018 (38% of all urinary diversions in female patients). 32 patients had complete data from interval clinic visits with at least 1 year of follow-up. Daytime continence was defined as no pad usage or an almost dry pad. RESULTS: A total of 32 female ONB patients with median age of 65 years (range: 42-81) and BMI of 25.6 (range: 18-35) were included. Median follow-up was 3 years (range: 1-7). The need to catheterize was noted in 10 patients (36%), either due to complete retention (7%), high post-void residuals (25%), or to empty their neobladder prior to sleeping (4%). Neobladder-vaginal fistulae developed in 4 patients (14%), with 1 ultimately converting to a continent cutaneous diversion after failed conservative management and the other 3 undergoing primary repairs. Daytime continence rates with and without intermittent catheterization increased from 64% and 36% at 4 months post-operatively, to 90% and 60% at 4 years, respectively. Nighttime continence rates with and without catheterization increased from 57% and 24% at 4 months, to 90% and 60% at 4 years, respectively (Figure1). Daytime continence rate was significantly less in females compared to males (P=0.024), while there was no significant difference in nighttime continence rate between them (P=0.58). CONCLUSIONS: Open RC and ONB in selected female patients can have good functional outcomes. Day and nighttime continence improve over time and majority of patients achieve continence by 2 years. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e595-e595 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seyedeh-Sanam Ladi Seyedian* More articles by this author Wesley Yip More articles by this author Zhoobin Bateni More articles by this author Saum Ghodoussipour More articles by this author Jie Cai More articles by this author Gus Miranda More articles by this author Sumeet Bhanvadia More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...

PD63-06 MRI CONFIRMS DIFFERENT POSITION OF THE VESICOURETHRAL ANASTOMOSIS AFTER RHABDOSPHINCTER RECONSTRUCTION IN ROBOTIC PROSTATECTOMY: COHORT ANALYSES FROM A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V (PD63)1 Apr 2020PD63-06 MRI CONFIRMS DIFFERENT POSITION OF THE VESICOURETHRAL ANASTOMOSIS AFTER RHABDOSPHINCTER RECONSTRUCTION IN ROBOTIC PROSTATECTOMY: COHORT ANALYSES FROM A RANDOMIZED CONTROLLED TRIAL Lucas Regis*, Aina Salazar, Jacques Planas, Ana Celma, Sarai Roche, Richard Mast, David Lorente, Jose Placer, Merce Cuadras, Enric Miret, Mario Alonso Narvaez, Enrique Trilla, and Juan Morote Lucas Regis*Lucas Regis* More articles by this author , Aina SalazarAina Salazar More articles by this author , Jacques PlanasJacques Planas More articles by this author , Ana CelmaAna Celma More articles by this author , Sarai RocheSarai Roche More articles by this author , Richard MastRichard Mast More articles by this author , David LorenteDavid Lorente More articles by this author , Jose PlacerJose Placer More articles by this author , Merce CuadrasMerce Cuadras More articles by this author , Enric MiretEnric Miret More articles by this author , Mario Alonso NarvaezMario Alonso Narvaez More articles by this author , Enrique TrillaEnrique Trilla More articles by this author , and Juan MoroteJuan Morote More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000980.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Posterior rhabdosphincter reconstruction (PRRS) following radical prostatectomy (RP) was designed to improve early urinary continence. The aim of our study was to determine anatomical features of the urethrovesical anastomosis using MRI to compare the differences depending on the reconstruction technique and continence outcomes. METHODS: We selected 40 patients from a randomized clinical trial (NCT03302169) with 158 men designed to compare early continence rates in patients undergoing urethrovesical anastomosis with or without PRRS. All patients had clinically localized prostate cancer and underwent MRI between 2-4m after RP. They were selected according to the reconstruction technique (PRRS vs non PRRS) and functional outcome (early vs late continence recovery) and 4 groups were made. Continence outcomes were assessed by time to have no leakage (day of dry pad), 24h PADtest 30d after RP and EPIC 26 questionnaires. Good early outcomes in continence recovery were defined as <=1pad/24h and PADtest <150 mL/24h 30d after RP. 2 independent blinded radiologists (1 and 2) assessed predetermined anatomical MRI benchmarks in order to determine the situation of the anastomosis in the pelvis: the vertical situation assessed as distance to the line coccyx-inferior pubic margin (ACPv) and antero-posterior situation as distance from the pubis to the line from coccyx-pubis through the anastomosis (AAP). Patients and data gatherers were blinded to treatment allocation. RESULTS: According to both radiologists, urethrovesical anastomosis was significantly superior in the pelvis situation (higher ACPv) in patients with PRRS when analyzing the group with good early outcome recovery, p=0.021 and p=0.01 reader 1 and 2, respectively. Reader 1 found that the anastomosis after PRRS was more anterior (lower AAP) in the same group, p=0.017; reader 2 didn’t find significant differences. Globally, PRRS group patients with better early recovery had a more anterior and superior position of the anastomosis (higher ACPv and lower AAP), according to both readers, p<0.05. The Pearson correlation between readers of ACPv and AAP were 0.975 (p<0.001) and 0.333 (p<0.046), respectively. No differences were found in the group using >1 pad/24h 30d after RP. CONCLUSIONS: This is the first study that confirms positional differences according to the type of reconstruction in RP. It seems that the early continence improvement of PRRS is due to more superior and anterior situation of the urethrovesical anastomosis. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1294-e1295 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lucas Regis* More articles by this author Aina Salazar More articles by this author Jacques Planas More articles by this author Ana Celma More articles by this author Sarai Roche More articles by this author Richard Mast More articles by this author David Lorente More articles by this author Jose Placer More articles by this author Merce Cuadras More articles by this author Enric Miret More articles by this author Mario Alonso Narvaez More articles by this author Enrique Trilla More articles by this author Juan Morote More articles by this author Expand All Advertisement PDF downloadLoading ...

Temporary Renal Artery Clamping With Hemostatic Materials in Diffuse Type of Spontaneous Renal Allograft Rupture: A Case Report

BackgroundSeveral surgical strategies have been introduced for spontaneous kidney rupture. Herein, we report on a case in which temporary artery clamping with hemostatic materials was performed. Case PresentationA 52-year-old man underwent renal transplant from a living donor (his 20-year-old son). Spontaneous allograft rupture occurred 6 days after transplant. He developed severe abdominal pain, hypotension, and mental changes. His blood hemoglobin level was 3.6 g/dL, which was indicative of severe hemorrhage. Immediate re-exploration revealed a large hematoma in the iliac fossa and that the renal allograft had ruptured, with multiple fracture lines on the entire surface. Because of diffuse surface rupture, surgical suture was not attempted. For manual compressive hemostasis, temporary artery clamping with hemostatic materials was performed. First, we identified the graft artery for temporary clamping, similar to the method in partial nephrectomy. Second, at the time of temporary clamping, the hemostatic matrix was sprayed on the surface of the renal graft. Third, we compressed the whole renal parenchyma with both hands and a dry pad for 5 minutes. After removing the clamp, successful bleeding control was confirmed. Finally, the graft was wrapped with oxidized cellulose. Renal biopsy in the operating room revealed the cause of rupture as acute rejection type IIB. ConclusionSpontaneous renal allograft rupture is a rare but serious complication. When surgical suture is not appropriate for the repair of the ruptured allograft, temporary artery clamping with hemostatic materials can be considered an alternative.

The Effects of Halofuginone on Wound Healing in the Rat Nasal Mucosa.

Background Halofuginone is an alkaloid febrifugine analogue and bioactive molecule that was isolated incidentally from the Dichroa febrifuga plant. The therapeutic efficacy of halofuginone in parasitic infections, scleroderma, inflammation, and fibrosis-related diseases, as well as in some types of cancer, has been previously reported. The effects of halofuginone on nasal mucosal damage are not yet known. Objective The aim of this study was to investigate the potential effect of topically applied halofuginone on wound healing in the mechanically injured nasal mucosa of rats. Methods A unilateral mucosal wound was created in the nasal cavity of 32 rats (aged 4 weeks) using the brushing technique. These rats were randomly divided into 4 groups. Although the control group did not receive an intervention, a dry pad, a saline-impregnated pad, or a pad impregnated with halofuginone were placed in the rats of the other 3 groups and left for 5 minutes. Rats were sacrificed on the 14th day, and a histological examination was performed. The nasal mucosa was assessed via hematoxylin-eosin and Masson’s trichrome staining. Results There were no statistically significant differences in epithelial thickness, inflammation, goblet cell formation, and epithelial disarray values between the halofuginone group and the control group ( P &gt; .05). The subepithelial thickness was significantly decreased in the saline-treated group and the halofuginone-treated group ( P &lt; .05), but a significantly lower level of subepithelial fibrosis was only observed in the halofuginone group compared to the other groups ( P &lt; .05). Conclusions Topical halofuginone administration reduces the development of fibrosis and subepithelial edema after experimentally induced nasal mucosal injury, but it does not exert therapeutic or preventive effects on epithelial damage, inflammation, and goblet cell hyperplasia.

The influence of incontinence pads moisture at the loaded skin interface

AimProlonged mechanical loading on soft tissues adjacent to bony prominences can lead to pressure ulcers. The presence of moisture at the skin interface will lower the tolerance to load. Absorbent pads manage moisture in individuals with incontinence, although their role in maintaining skin health is unknown. The present study investigated the effects of moist incontinence pads on skin physiology after periods of mechanical loading. Material and methodsTwelve healthy participants were recruited to evaluate a single incontinence pad design under three moisture conditions: 0% (dry), 50% and 100% fluid capacity. For each pad condition, pressure (9 kPa) or pressure in combination with shear (3 N) was applied to the sacrum, followed by a period of off-loading. Measures included trans-epidermal water loss (TEWL) and inflammatory biomarkers sampled at the skin interface. ResultsResults revealed no change in TEWL in the loaded dry pad condition. By contrast, when the pads contained moisture, significant increases in TEWL were observed. These increases were reversed during off-loading. Inflammatory biomarkers, specifically IL-1α/total protein ratio, were up-regulated during dry pad loading, which recovered during off-loading. Loaded moist pads caused a significant increase in biomarkers, which remained elevated throughout the test period. ConclusionThe study revealed a marked compromise to stratum corneum integrity when the skin was exposed to moist incontinence pads in combination with mechanical loads. These physiological changes were largely reversed during off-loading. Incontinence pads provided some protection in the dry state, although more research is required to determine optimal clinical guidance for their use.

Experimental setup of stretchable arid dry pad sensors for the signal acquisition fir filter design using Vedic approach

At present in Medical Image processing a hard point to settle any issue with the assistance of Computer collaborator using Arid-dry pad sensor plays a prominent role. Specialist is to investigate the medical diagnosis with the assistance of imaging system such as The CT scan, MRI scan, EEG, Ultrasound technique or any kind of medical images analyzing the system of the patient with the help of images. Design of low power and low delay digital finite-impulse response (FIR) which plays a vital role in medical image applications along with Arid-dry pad sensors. These days, there are numerous versatile applications requiring low power and high throughput than any time in recent memory. In this research the FIR channel framework configuration has turned into a huge execution objective. The Finite Impulse Response (FIR) Filter is the vital segment for planning a medical image processing. The adders and multipliers play an important role in FIR filter while considering these, not only the fast response but also the number of component, area and path delay. The proposed FIR filter is designed by using adder and Wave pipelined Vedic multiplier from the analysis of various adders and multipliers. The Wave pipelined Vedic multiplier performs multiplication process in a hierarchical manner. The work has demonstrated the effectiveness of Urdhva Triyagbhyam– Vedic technique for multiplication which strikes a distinction in the real procedure of increase itself. It empowers parallel age of moderate items, wipes out undesirable increase ventures with zeros and scaled to higher bit levels. Thus, the proposed method can minimize the setup time violation and path delay of the FIR filter with pad sensors. The proposed FIR Filter is simulated, synthesized, calculating power consumption using ISE simulator, Xilinx and Altera Quartus II.

2446 Feasibility, acceptability, and appropriateness of the menstrual cup for short-term non-surgical management of vesicovaginal fistula (VVF) among potential users and stakeholders

OBJECTIVES/SPECIFIC AIMS: To examine how women with OF in Ghana develop strategies for coping in the absence of access to successful surgical repair. To assess the feasibility, acceptability, and appropriateness of an innovation to support coping among women with OF seeking care in a health facility in Ghana. To examine the perceived facilitators and barriers to implementation among additional OF stakeholders regarding the innovation. METHODS/STUDY POPULATION: This study uses a sequential exploratory mixed methods design. The population of study is women in Ghana living with obstetric fistula, as well as additional fistula stakeholders (programmers, policy makers, community leaders). To get an understanding of usual leakage, women carried out at baseline a pad test, where they wore a sanitary pad for 2 hours and leaked freely. We subtracted the dry pad weight from the wet pad weight to estimate urine leakage in mL. Then women inserted the cup for 2 hours and again wore a pad and urine leakage was estimated. Acceptability among women with vesicovaginal fistula was measured by questionnaire. Acceptability among additional stakeholders was examined by semistructured interview. Appropriateness was assessed among the user, additional stakeholders, and organizational setting. RESULTS/ANTICIPATED RESULTS: We observed a 61% mean reduction in leakage with the cup which was also perceived by cup users as a reduction in wetness. Notably, one participant who had 4 previous surgical attempts, experienced a 78% reduction in leakage. No adverse events attributable to use of the cup were observed, unlike some of the strategies women currently use to manage leakage. Acceptability was high as most women could easily insert, remove, and wear the cup over the 2-hour period and fistula stakeholders indicated the innovation content and complexity were acceptable. In community interviews, women shared various coping and self-care strategies to manage their leaking, other related impairments, and stigma. Women using the cup in the health facility expressed that it was useful. Additional stakeholders found the cup a low-cost, low-tech solution to supplement existing programs. Within the stakeholder interviews we heard that the cultural norms and existing activities of the potential implementation partners align with the innovation approach. Stakeholders revealed various implementation facilitators and barriers. The facilitators to implementation reported in the interviews were related to the intervention and organization characteristics in particular. Stakeholders perceived a relative advantage to self-management. Stakeholders had concerns regarding whether women would find the insertable device acceptable and appropriate—questioning whether potential users would have access to water, soap, and safe space to empty cup. DISCUSSION/SIGNIFICANCE OF IMPACT: The innovation is efficacious, acceptable, adds to current coping strategies, and fits within existing fistula programs. Stakeholders pre-implementation perceptions highlight the importance of partnerships and the need for an evidence base related to effectiveness, acceptability, and cost. Challenges to address include access to resources within these contexts (water, soap, and safe space) and development appropriate counseling message.

A prospective randomized trial comparing the use of tolterodine or weighted vaginal cones in women with overactive bladder syndrome

ObjectiveTo compare the efficacy of pelvic floor muscle exercises (PFME) using weighted vaginal cones (WVC) on the symptoms, clinical findings, urodynamic findings and quality of life (QoL) in overactive bladder (OAB) patients with tolterodine. Study designThirty-nine patients with urinary frequency (≥8/day), nocturia (≥2/night), urgency and a total score of ≥8 to the overactive bladder-awareness tool (OAB-V8) were diagnosed as OAB and were randomized into two treatment groups; WVC and extended release tolterodine (tolterodine ER) 4mg/day for 8 weeks. Results of the clinical findings, 3-day urinary diary, validated questionnaires for symptom bother and QoL (Urinary distress inventory (UDI-6), incontinence impact questionnaire (IIQ-7), OAB-V8, Wagner questionnaire) and urodynamic examination before and after treatment were compared. ResultsA reduction of frequency, nocturia and urinary incontinence was observed in WVC group (p=0.006, p=0.034 and p=0.008, respectively) and in tolterodine group (p<0.001, p=0.002 and p=0.035, respectively). 24-h dry pad test results were improved significantly in both groups (p=0.003 and p=0.001, respectively). Pelvic muscle strength was significantly improved in WVC group but not in tolterodine group (p=0.010 and p=0.180, respectively). UDI-6, IIQ-7, OAB-V8 scores were improved significantly in both groups. Improvements in Wagner questionnaire were observed in WVC group but not in tolterodine group (p=0.002 and p=0.591, respectively). First sensation of bladder filling was significantly improved after WVC treatment but not in tolterodine group (p=0.035 and p=0.550, respectively). After treatment, detrusor overactivity (DO) resolved in 8 patients in the WVC group (p=0.003) and in 2 patients in the tolterodine group (p=0.426). ConclusionsWVC treatment seems to be an efficacious therapeutic option for the improvement of overactive bladder syndrome (OABS).

A Paper-Based Reagent Storage Approach for Point-of-Care Electrochemical Sensing

In this work, we report on a paper-based reagent storage approach for electrochemical sensing applications. We use a paper pad to store dry reagents. Once re-hydrated, the pad provides proper aqueous environment for electrochemical measurement. This approach offers several advantages including low cost, no need for on-site sample preparation, ease of fabrication, operation, storage, and disposal. We expect this approach to be highly beneficial in point-of-care electrochemical sensing applications. We fabricated the three-electrode electrochemical sensor on a flexible polyethylene terephthalate (PET) film by evaporation of metal (Au or Cu) followed by standard photolithography and wet etching. Our electrochemical sensor consists of two shorted interdigitated array (IDA) working electrode (WE) with finger width/spacing of 10µm/5µm, an auxiliary electrode (AE) and a reference electrode (RE) (Fig. 1a). We arranged the electrode layout into USB style for convenient connection with a potentiostat. We fabricated paper-based reagent-storage pads by shaping Whatman No.1 filter paper with a paper puncher or a pair of scissors. We designed paper pads with a size of 12mm×10mm to cover the entire area of the three electrodes (Fig. 1b). We first demonstrate cyclic voltammetry by rehydrating a paper pad containing dry ferricyanide on gold IDA sensor. A 10mM ferricyanide solution was first dried on a paper pad. After contacting with the sensor surface, 50µL DI water was dispensed on the pad followed by cyclic voltammetry (CV) scanning from -0.5V to 0.3V with a scan rate of 100mV/s. As shown in Fig. 2a, the CV spectra exhibites two redox peaks as expected, while the CV spectra using a control paper pad without ferricyanide is flat. This indicates that the dry-form of ferricyanide in the paper pad can be dissolved into aqueous solution during re-hydration process supporting electrochemical reaction on the sensor surface. The paper-based dry-reagent platform can be used in anodic stripping voltammetry (ASV) for detection of lead (Pd) [1]. Reagents containing pH 5.5 acetate buffer with 50, 100 and 200ppb Pd were dispensed and dried on three different paper pads. After aligning a paper pad with a Cu-based sensor [2], 50µL liquid sample was introduced on the paper pad followed by ASV scanning. The experimental parameters were selected after optimization: -0.8 V and 300 s for preconcentration; 50 ms period, 50 mV amplitude, and 8 mV increment for square wave. As shown in Fig. 2b, the peak amplitude of ASV spectra increases with the concentration of Pd within the paper pad. This approach can provide supporting electrolyte for electrochemical impedimetric sensing. We first dried 10mM ferricyanide on a paper pad. After aligning the paper pad with a gold IDA sensor and rehydrating with PBS, electrochemical impedance scanning was conducted from 0.1Hz to 1MHz under a DC bias of -0.15V with an AC bias of 10mV. The Nyquist plot (Fig. 2c) appears as a semicircle indicating the background charge transfer resistance through bare Au electrode surface to be ~4000ohm. This result suggests the paper pad with dry ferricyanide can provide Fe2+/Fe3+to the sensor surface for electrochemical impedance spectroscopy without disrupting the measurement. In conclusion, we developed a paper-based platform capable of storing dry reagents for electrochemical sensing applications. Paper pads containing dry reagents can be easily re-hydrated to provide adequate aqueous environment for different types of electrochemical sensing techniques. We envision this platform can be valuable for low-cost, point-of-care electrochemical sensing applications. Reference [1] W. Kang, X. Pei, A. Bange, E. Haynes, W. R. Heineman, and I. Papautsky, Anal. Chem. 2014, in press. [2] X. Pei, W. Kang, W. Yue, A. Bange, W. R. Heineman, and I. Papautsky, Anal. Chem. 2014, 86, 4893-4900. Acknowledgements This work was supported in part by funds provided by the NIEHS award R01ES022933. Figure captions: Fig. 1 (a) Photography of IDA sensor fabricated on a flexible PET film. (b) Aligning a paper pad containing dry reagent on sensor surface. (c) Conventional way of dispensing samples for EC detection. (d) Operation of dry-reagent pad including (1) dispensing reagent on a paper pad, (2) drying reagent, (3) Aligning reagent pad with sensor, and (4) rehydrate dry pad with aqueous sample for EC measurements. Fig. 2 (a) Paper pad platform for CV scanning. (b) Paper pad platform for detection of Pd using ASV. (c) Paper pad platform for EIS measurement. Figure 1

Pad weighing for reduction of indwelling urinary use and catheter-associated urinary tract infection: a quality improvement project.

Catheter-associated urinary tract infections pose a significant risk to hospitalized patients. Measuring accurate urinary output is a common reason for indwelling catheterizations in acutely ill patients. The risk of catheter-associated infections may be eliminated while maintaining ability to measure urinary output of incontinent patients through the use of a highly absorbent pad and weighing postincontinence. The dry pad weight is subtracted from the wet pad weight and the resulting difference (expressed in grams) equals the volume of urine leaked into the pad in milliliters. We found that using this system of improved measurement of urine output when compared to documenting the number of incontinent episodes while allowing removal of indwelling urethral catheters as soon as possible.

Retrospective evaluation of male slings for patients with urinary incontinence after radical prostatectomy - one surgeon’s experience

Stress urinary incontinence is one of the main complications after radical prostatectomy (RP) with a significant percentage of patients reporting bothersome incontinence > 1 year after surgery. Assessment of one surgeon's results in surgical treatment of urinary stress incontinence of patients with radical prostatectomy applying transobturator and suprapubic slings. From February 2010-February 2014, 20 patients, age 57-76, with moderate and severe stress urinary incontinence (SUI) were treated surgically. All patients previously had radical prostatectomy due to prostate cancer. All 20 patients with stress urinary incontinence (PRPUI) had Argus slings placement after radical prostatectomy. Patients were followed for a longer period of time, 6 months minimum, 48 months maximum.18 patients (90%) had negative, dry PAD test after surgery, one patient (5%) had positive PAD test, and one patient (5%) who previously had Advance transobturator sling placement with no positive results, had sling removed due to an infection. 6 patients (30%) needed additional sling adjustment, performed between 9-21st day after the surgery. We concluded that Argus sligs, suprapubic or transobturatory are an effective and safe treatment for PRPUI. This procedure is minimal invasive and our results clearly demonstrate that both heavy and moderate incontinence responds well.