Functional Profile Length Research Articles

Predictors of the efficacy of CO2 laser therapy for female stress urinary incontinence

Background: Predictors of the efficacy of a single-session of CO2 laser therapy for female stress urinary incontinence are important for pretreatment consultation. Thus, the objective of this study was to evaluate these predictors. Methods: All consecutive women who underwent vaginal CO2 laser therapy for stress urinary incontinence were prospectively enrolled. Results: The median duration of subjective improvement (defined as ≥1 on the global response assessment) was 18.3 months (95% confidence interval (CI): 12.1 to 18.3 months, n = 75). Multivariable analysis revealed that low voided volume (dL, hazard ratio [HR] = 0.707; area under the curve [AUC] = 0.66, cutoff value of voided volume ≤4.0 dL), high postvoid residual volume (dL, HR = 2.714; AUC = 0.60, cutoff value of postvoid residual volume ≥1.0 dL), and low functional profile length (HR = 0.956; AUC = 0.58, cutoff value of functional profile length ≤2.8 cm) were predictors of subjective failure. A logit(p) = 1.0 - 0.5 x (voided volume) + 0.9 x (postvoid residual volume) can be used to predict failure (HR = 1.775; AUC = 0.71, cutoff value of logit(p) ≥0.0). Pad weights decreased at 3 and 6-month follow-up visits. At 6 months, 8 women (21%) were cured (<1 g pad weight), and 16 women (42%) showed improvement (>50% decrease in pad weight). Overactive bladder symptoms improved at 3 and 6 months. However, there was no change in female sexual function from baseline. Conclusion: A low voided volume and high postvoid residual volume can be used to predict subjective failure after one session of transvaginal CO2 laser therapy. However, the subjective therapeutic effect may diminish within a median duration of 18 months.

Age-specific prevalence, clinical and urodynamic findings of detrusor underactivity and bladder outlet obstruction in female voiding dysfunction.

Female voiding dysfunction with cystocele have been widely studied, but there are no data regarding women without cystoceles. The present study aimed to evaluate the prevalence of detrusor underactivity (DU) and bladder outlet obstruction (BOO) without cystoceles in a large sample size. This was a retrospective cohort study. Between April 1996 and September 2018, 602 neurologically intact women with voiding dysfunction without cystoceles were enrolled. Detrusor pressure (DU) at the maximum flow rate (PdetQmax) <20 cmH2O, maximum flow rate (Qmax) <15 mL/s, and a bladder voiding efficiency <90% and BOO (PdetQmax ≥40 cmH2O and Qmax <12 mL/s) were diagnosed by urodynamic study. Otherwise, a non-DU/BOO diagnosis was made. The prevalence of DU and BOO was the primary outcome. The secondary outcomes were the analyses of the differences between these three groups in objective UDS parameters and subjective questionnaires and bladder diary parameters. This study included 100 (17%) women with DU, 60 (10%) with BOO, and 442 (73%) with a non-DU/BOO diagnosis. DU increased with age, but BOO decreased as age increased. The women in the DU group were older, had higher parity and pad weights, and lower PdetQmax, maximum urethral closure pressure, and functional profile length than the BOO group. The urodynamic findings did not correlate well to subjective questionnaire parameters. None of the symptoms revealed a significant difference between the groups. The retrospective design was the limitation of the study. The prevalence of DU increased with age in women with voiding dysfunction without advanced cystoceles. Conversely, BOO decreased with age. Prevalence intersected in the fourth decade. Diagnosis requires urodynamic evaluation, as subjective symptoms are inconclusive.

Modified Urethral Graciloplasty Cross-Innervated by the Pudendal Nerve for Postprostatectomy Urinary Incontinence: Cadaveric Simulation Surgery and a Clinical Case Report.

An artificial sphincter implanted in the bulbous urethra to treat severe postprostatectomy urinary incontinence is effective, but embedding-associated complications can occur. We assessed the feasibility, efficacy, and safety of urethral graciloplasty cross-innervated by the pudendal nerve. A simulation surgery on three male fresh cadavers was performed. Both ends of the gracilis muscle were isolated only on its vascular pedicle with proximal end of the obturator nerve severed and transferred to the perineum. We examined whether the gracilis muscle could be wrapped around the bulbous urethra and whether the obturator nerve was long enough to suture with the pudendal nerve. In addition, surgery was performed on a 71-year-old male patient with severe urinary incontinence. The postoperative 12-month outcomes were assessed using a 24-hour pad test and urodynamic study. In all cadaveric simulations, the gracilis muscles could be wrapped around the bulbous urethra in a γ-loop configuration. The length of the obturator nerve was sufficient for neurorrhaphy with the pudendal nerve. In the clinical case, the postoperative course was uneventful. The mean maximum urethral closure pressure and functional profile length increased from 40.7 to 70 cm H 2 O and from 40.1 to 45.3 mm, respectively. Although urinary incontinence was not completely cured, the patient was able to maintain urinary continence at night. Urethral graciloplasty cross-innervated by the pudendal nerve is effective in raising the urethral pressure and reducing urinary incontinence.

Influence of background characteristics in responders of regenerative therapy by periurethral injection of adipose-derived regenerative cells for male stress urinary incontinence.

To determine if the male responders with post-prostatectomy incontinence in the ADRESU study, which is a clinical trial of regenerative therapy by periurethral injection of adipose-derived regenerative cells, are influenced by any background characteristics. Briefly, autologous adipose-derived regenerative cells isolated from abdominal adipose tissue and a mixture of adipose-derived regenerative cells with fat tissue were transurethrally injected into the rhabdosphincter and submucosal space of the urethra, respectively. Sixteen out of 43 patients (37.2%) responded to treatment (responders) and exhibited improvement in the urine leakage volume, defined as >50% reduction from baseline determined by the 24-hour pad test at 52 weeks of treatment (or last visit within 52 weeks). Background data such as age, body weight, method of prostatectomy, baseline frequency of leaks, number of leaks, number of pad changes, International Consultation on Incontinence Questionnaire-Short Form, King's Health Questionnaire, urodynamic urethral function including functional profile length and maximum urethral closure pressure, and abdominal leak point pressure were collected and compared between responders and nonresponders. None of the background factors influenced improvement in the responders as compared with the nonresponders. However, a significant between-group difference in the rates of decrease in urine leakage volume was noted in patients of younger age (<70 years), compared with those of older age (≥70 years) from 2 to 26 weeks of treatment. A greater decrease in urine leakage volume was noted in the younger patient group than in the older patient group.

Predictive urodynamic factors for de novo stress urinary incontinence after laparoscopic sacrocolpopexy for pelvic organ prolapse.

Laparoscopic sacrocolpopexy is often performed to treat pelvic organ prolapse. Preoperative stress urinary incontinence (SUI) can improve after laparoscopic sacrocolpopexy. In contrast, some patients without incontinence preoperatively develop SUI after pelvic organ prolapse repair (ie, de novo SUI). This study aimed to identify the preoperative predictive factors of de novo SUI after laparoscopic sacrocolpopexy. A total of 858 patients underwent laparoscopic sacrocolpopexy between January 2013 and November 2017 at Kameda Medical Center. Urodynamic studies were performed pre- and postoperatively on 75 patients. This retrospective study included 43 of 75 patients who did not have SUI preoperatively. We assessed urethral function according to functional profile length and maximum urethral closure pressure. We evaluated voiding function in terms of maximum flow rate, detrusor pressure at maximum flow rate, and postvoid residual volume. Furthermore, each factor was compared between de novo SUI-positive and SUI-negative groups. After laparoscopic sacrocolpopexy, 30 (69.8%) patients presented with SUI. The preoperative maximum urethral closure pressure was significantly lower in the de novo SUI-positive group (36.0 cmH2 O) than in the de novo SUI-negative group (50.5 cmH2 O, P= .020). More patients with maximum urethral closure pressure <40 cmH2 O had de novo SUI than patients with maximum urethral closure pressure ≥40 cmH2 O (P= .004). There were no significant differences between preoperative maximum urethral closure pressure and postoperative maximum urethral closure pressure in either group. Low preoperative maximum urethral closure pressure, particularly maximum urethral closure pressure <40 cmH2 O, is a predictor of de novo SUI after laparoscopic sacrocolpopexy.

Prevalence of detrusor underactivity and bladder outlet obstruction in women with cystocele and changes in voiding function after cystocele repair

To evaluate the prevalence of detrusor underactivity (DU) and bladder outlet obstruction (BOO) in women with high-grade cystocele and the impacts of cystocele repair. Between November 2010 and September 2018, women with ≥stage II cystocele were included. DU (detrusor pressure at maximum flow rate (PdetQmax)<20 cmH2O, maximum flow rate (Qmax)<15mL/s, and bladder voiding efficiency<90%) and BOO (PdetQmax≥40 cmH2O and Qmax<12mL/s) were diagnosed by urodynamic study (UDS). Women who underwent cystocele repair were further analyzed with preoperative and postoperative comparisons. A total of 623 women were included. Forty-four (7%) and 17 (3%) women were diagnosed with DU and BOO, respectively. Among the 314 operatively treated women, a significant increase in DU (7% vs. 15%, p=0.0007), especially in those with stage III cystocele, and a slightly decreased rate of BOO were noted postoperatively. UDS revealed that the postvoid residual volume, functional profile length, maximum urethral closure pressure (MUCP), and pressure transmission ratio at the MUCP decreased significantly, as did the pad weight. Nearly all lower urinary tract symptoms (LUTS) improved significantly, except nocturnal enuresis. Among bladder diary parameters, nocturia episodes, daytime frequency, urgency episodes, and incontinence episodes decreased significantly after the operation. The prevalence rates of DU and BOO in women with high-grade cystocele were 7% and 3%, respectively. After cystocele repair, the rate of DU increased. Most LUTS improved subjectively on questionnaires and objectively on UDS and bladder diary parameters after operation.

Predictors of an improvement in the severity of concomitant urodynamic stress incontinence after transvaginal mesh surgery for pelvic organ prolapse

Factors affecting the anti-incontinence efficacy of a tailored anterior transvaginal mesh (ATVM) surgery are undetermined. Thus, our aim was to investigate predictors for anti-incontinence efficacy of this ATVM surgery. Medical records of women with pelvic organ prolapse and concomitant evident or occult urodynamic stress incontinence, who underwent the ATVM surgery but without concomitant anti-incontinence surgery, were reviewed. A total of 134 women were reviewed, including those who underwent ATVM only (n=45), ATVM and posterior transvaginal mesh surgery (n=88), and ATVM with total vaginal hysterectomy (n=1). Multivariable analysis revealed that stage of cystocele (coefficient=56.4), functional profile length (cm, coefficient=61.1) and the score of general health perceptions in the King's Health Questionnaire (coefficient=-3.3) were independent predictors of the percentage change in pad weight from baseline. Seven (5.2%) women were found to have recurrent or persistent stress urinary incontinence, and 6 of the above 7 women underwent transobturator mid-urethral sling procedure. Free of further anti-incontinence surgery probabilities were 94.7% and 89.2% at 3 and 6 years after surgery, respectively. Functional profile length (hazard ratio=2.61) was also identified as a predictor for further anti-incontinence surgery. Lesser degree of cystocele, shorter functional profile length and poorer general health perceptions were predictors of greater anti-incontinence effect after the tailored ATVM surgery. Besides, longer functional profile length was also a predictor for further anti-incontinence surgery after the ATVM surgery.

Possible predictor of early recovery on urinary continence after laparoscopic radical prostatectomy - Bladder neck level and urodynamic parameters.

To investigate the relationship between post-operative bladder neck levels and urodynamic parameters and their effect on urinary incontinence after laparoscopic radical prostatectomy (LRP). Forty-eight consecutive patients undergoing LRP were retrospectively reviewed. All patients were assessed using retrograde cystography after LRP and were grouped according to their bladder neck position: Level 0: at or above the superior margin of the symphysis pubis (SMSP); Level -1: at <2cm below SMSP; and Level -2: at >2cm below SMSP. Urodynamic studies were conducted at baseline as well as at 1 and 3 months post-operatively. Early recovery of urinary continence was defined as no urine leakage or only one pad/day used within 3 months after surgery. Demographic characteristics, changes in urodynamic parameters, and continence outcomes were analyzed. Overall rate of early recovery of urinary continence was 33.3%. Patients with higher bladder neck levels experienced a significantly earlier recovery of urinary continence in univariate analysis (77.8%, 29.2%, and 13.3% for bladder neck levels 0, -1, and -2, respectively, p=0.004). Patients with early recovery of urinary continence had significantly longer functional profile lengths (FPLs) 1 month post-surgery (21.0mm vs 14.8mm, p=0.019). Higher bladder neck levels were significantly associated with longer FPLs at 1 month (p=0.032). Bladder neck level is associated with FPLs at 1 month post-surgery, which is the possible predictor of early recovery of urinary continence after LRP. Patients with longer FPL at 1 month after LRP have a higher rate of early recovery of urine continence.

De novo overactive bladder after robot-assisted laparoscopic radical prostatectomy.

To investigate storage symptoms following robot-assisted laparoscopic radical prostatectomy (RARP), focused on de novo overactive bladder (OAB), and to evaluate the factors related to de novo OAB occurrence. We prospectively examined 245 patients without OAB who underwent RARP for localized prostate cancer. Subjective and objective symptoms in the lower urinary tract were evaluated before and after surgery. At 3 months after RARP, the patients were divided into two groups: patients with de novo OAB (de novo OAB group) and those without OAB (OAB-free group). We compared the operative and urodynamic parameters between both groups and evaluated the factors related to OAB. De novo OAB was observed in 37.8% (87/230) of patients. Post-operative continence rate was significantly higher in the OAB-free group (79.7%) than in the de novo OAB group (8.0%). Although the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) in the de novo OAB group significantly deteriorated from 9.7 to 14.1 and from 2.4 to 8.3, respectively, no corresponding significant changes occurred in the OAB-free group. Additionally, there was a significant difference in pre-operative IPSS-QOL score, continence rate, pre-and post-operative maximum urethral closing pressure (MUCP), and post-operative functional profile length (FPL) between both groups. Multivariable logistic regression analysis showed pre-operative IPSS-QOL score and post-operative MUCP were significant predictive factors for de novo OAB. The incidence rate of de novo OAB after RARP was about 40%, and seemed unexpectedly high. Decreased urethral function was significantly related to de novo OAB after surgery.

Changes in cognitive load and effects on parameters of gait

AbstractReading or texting with a mobile phone while walking requires cognitive resource allocation and consequently induces changes in gait. Fifty-six young adults walked along the GAITRite© walkway under baseline, low-, and high-cognitive loads. Participants’ Functional Ambulation Profile (FAP), velocity, and stride length decreased while double-support time increased under higher cognitive load. This result shows that during cognitively loaded multitasking conditions participants are unable to stabilize their gait. In addition, lower FAP scores across the conditions suggest an increased risk for future injurious falls. This study demonstrates that distracted walking using a mobile phone can affect several parameters of gait and it would be prudent to not read or text on a mobile phone while walking.

MP47-18 CONTRIBUTORS TO THE OCCURRENCE OF INGUINAL HERNIA AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV1 Apr 2017MP47-18 CONTRIBUTORS TO THE OCCURRENCE OF INGUINAL HERNIA AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY. Tsuyoshi Majima, Yasushi Yoshino, Yoshihisa Matsukawa, Yasuhito Funahashi, Naoto Sassa, Masashi Kato, Tokunori Yamamoto, and Momokazu Gotoh Tsuyoshi MajimaTsuyoshi Majima More articles by this author , Yasushi YoshinoYasushi Yoshino More articles by this author , Yoshihisa MatsukawaYoshihisa Matsukawa More articles by this author , Yasuhito FunahashiYasuhito Funahashi More articles by this author , Naoto SassaNaoto Sassa More articles by this author , Masashi KatoMasashi Kato More articles by this author , Tokunori YamamotoTokunori Yamamoto More articles by this author , and Momokazu GotohMomokazu Gotoh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1478AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies reported that about 10% of patients who underwent retropubic radical prostatectomy developed inguinal hernia (IH) after surgery. However, few studies have evaluated IH following robot-assisted radical prostatectomy (RARP). We retrospectively investigated the incidence and risk factors for IH after RARP. METHODS Subjects included patients who underwent RARP for prostate cancer in our institution from February 2012 to January 2015. Those with previous/concomitant IH history, concurrent IH-prophylaxis surgery, and follow-up < 1 year were excluded. Demographic and clinical profiles were collected from medical records. Every RARP video record was reviewed by a blinded urologist to verify the existence of a patent processus vaginalis (PPV). Univariate and multivariate Cox proportional hazards models were used to determine relationships between post-RARP IH and age, body mass index (BMI), previous lower abdominal surgery, total International Prostate Symptom Score (IPSS), IPSS voiding score, IPSS storage score, IPSS question 5 (weak stream) and 6 (straining) score, maximum urethral closing pressure (MUCP) and functional profile length (FPL) on urethral pressure profile, prostate weight, and PPV. Pre- and postoperative IPSS, MUCP, and FPL were included. RESULTS Of 284 patients in the study, 41 (14.4%) developed IH at a median 8 months after RARP. On univariate analysis, BMI ≥ 23, IPSS question 5 score ≥ 3, and PPV were significantly correlated with post-RARP IH (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.24 - 0.89, p = 0.02; HR 2.20, 95% CI 1.12 - 4.3, p = 0.02; HR 3.59, 95% CI 2.39 - 5.40, p < 0.001, respectively). On multivariate analysis, IPSS question 5 score ≥ 3, and PPV were significantly correlated with post-RARP IH (HR 2.77, 95% CI 1.40 - 5.51, p = 0.003; HR 3.87, 95% CI 2.46 - 6.07, p < 0.001). PPV was detected on the right (51 patients, 17.9%), left (23, 8.0%), and both (15, 5.2%) sides. Twenty-three of 51 patients (45.0%) with right-side PPV, 5 of 23 (26.0%) with left-side PPV, and 5 of 15 (33.3%) with bilateral PPV developed IH after RARP. Thirty-seven of 41 post-RARP IH cases (95.1%) were indirect, but only 4 cases (4.8%) were combined IH. CONCLUSIONS Weak stream and PPV were predictive of IH after RARP. Prophylactic surgery should be performed during RARP in patients at high risk for post-RARP IH. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e635 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Tsuyoshi Majima More articles by this author Yasushi Yoshino More articles by this author Yoshihisa Matsukawa More articles by this author Yasuhito Funahashi More articles by this author Naoto Sassa More articles by this author Masashi Kato More articles by this author Tokunori Yamamoto More articles by this author Momokazu Gotoh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD18-12 DE NOVO OVERACTIVE BLADDER AFTER ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III1 Apr 2017PD18-12 DE NOVO OVERACTIVE BLADDER AFTER ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY Yoshihisa Matsukawa, Yasuhi Yoshino, Yasuhito Funahashi, Tsuyoshi Majima, Tokunori Yamamoto, and Momokazu Gotoh Yoshihisa MatsukawaYoshihisa Matsukawa More articles by this author , Yasuhi YoshinoYasuhi Yoshino More articles by this author , Yasuhito FunahashiYasuhito Funahashi More articles by this author , Tsuyoshi MajimaTsuyoshi Majima More articles by this author , Tokunori YamamotoTokunori Yamamoto More articles by this author , and Momokazu GotohMomokazu Gotoh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.872AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robot-assisted laparoscopic radical prostatectomy (RALP) is becoming a popular treatment option for localized prostate cancer. Although the potency and stress urinary incontinence after RALP have been assessed in detail, few studies have described the storage dysfunctions such as overactive bladder (OAB) that occur after RALP. In the present study, we investigated the storage function following RALP, with a focus on de novo OAB, and evaluated the factors related to the occurrence of de novo OAB after RALP. METHODS We prospectively examined 150 patients without OAB who underwent RALP for localized prostate cancer, and the pre- and postoperative (3 months) urodynamic studies.The evaluated urodynamic parameters were maximum urethral closing pressure (MUCP) and functional profile length (FPL). At the evaluation after 3 months of RALP, we divided the patients into two groups: patients with de novo OAB (de novo OAB group) and patients without OAB after surgery (OAB-free group). We compared the operative and urodynamic parameters between the groups and evaluated the factors related to the occurrence of de novo OAB. In the present study, OAB was defined as a score of 2 or more on the urgency component of the overactive bladder symptom score (OABSS), and a total OABSS of 3 or more. RESULTS De novo OAB after RALP was observed in 43 patients (28.7%). The International Prostate Symptom Score (IPSS) and OABSS in the de novo OAB group deteriorated significantly from 8.4 to 17 and from 2.1 to 9.3, respectively, whereas those in the OAB-free group improved significantly from 8.2 to 7.4, and from 2.8 to 2.7, respectively. Additionally, there was a significant difference in the incontinence rate, preoperative MUCP, postoperative MUCP, and postoperative FPL, as observed from the univariate comparison of operative and urodynamic parameters between the groups (Table). Multivariable logistic regression analysis performed using factors related to de novo OAB showed that postoperative MUCP was the only significant factor for predicting de novo OAB. CONCLUSIONS The incidence rate of de novo OAB after RALP was about 30%, which was thought to be unexpectedly high. The decrease in urethral function was related to de novo OAB after surgery, and it was attributed to the increased reflex response of the urethral afferent pathway. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e364 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yoshihisa Matsukawa More articles by this author Yasuhi Yoshino More articles by this author Yasuhito Funahashi More articles by this author Tsuyoshi Majima More articles by this author Tokunori Yamamoto More articles by this author Momokazu Gotoh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD01-03 VIDEOURODYNAMIC CHANGES AND THE PREDICTORS OF EARLY RECOVERY ON URINARY CONTINENCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2016PD01-03 VIDEOURODYNAMIC CHANGES AND THE PREDICTORS OF EARLY RECOVERY ON URINARY CONTINENCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY Hsu-Che Huang, Yuan-Hong Jiang, and Hann-Chorng Kuo Hsu-Che HuangHsu-Che Huang More articles by this author , Yuan-Hong JiangYuan-Hong Jiang More articles by this author , and Hann-Chorng KuoHann-Chorng Kuo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2023AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although laparoscopic radical prostatectomy (LRP) is effective in treatment of localized prostate cancer, patients might suffer from stress urinary incontinence (SUI) after LRP. This study investigated the changes of videourodynamic parameters after LRP and impact on urinary incontinence METHODS A total of 48 male patients underwent LRP received videourodynamic study (VUDS) at baseline, 3 months and 6 months after operation. The changes of urodynamic parameters including detrusor pressure (Pdet), voided volume, cystometric bladder capacity (CBC), maximum flow rate (Qmax), postvoid residual (PVR), maximal urethral closure pressure (MUCP) and functional profile length (FPL) were measured at 3 and 6 months after opeation. The bladder neck (BN) level to the superior margin of the symphysis pubis (SMSP) after LRP was also measured 7 to 10 days after opeartion by retrigrade cystography. The BN level at or above SMSP was defined as 0, and BN level below SMSP more than 2 cm was defined as -2, otherwise, the BN level was -1. The SUI condition was evaluated by questionare during out-patient clinic follow up. RESULTS The overall SUI rate was 66.7%,47.9%, and 16.7% at 3,6,12 months after LRP, respectively. MUCP, FPL and Pdet significantly declined from 62.6cmH2O, 48.7mm and 41.8cmH2O, which was measured at baseline, to 46.4cmH2O,16.8mm and 25.4cmH2O at 6 months, respectively. Among patients with SUI at 3 months and 6 months after operation, the MUCP level at 3 months and bladder neck level were significantly lower than patients without SUI. For patients with prolonged SUI (12 months postoperatively), the MUCP at 3 months showed significant association. (Table.1 and Table. 2) CONCLUSIONS BN level and MUCP can strongly predict the early continence recovery after LRP. The BN level not below the symphysis pubis and higher MUCP level at 3 months after operation are associated with an early recovery of SUI after LRP © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e46 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Hsu-Che Huang More articles by this author Yuan-Hong Jiang More articles by this author Hann-Chorng Kuo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

CHARACTERISTICS OF STRESS URINARY INCONTINENCE AFTER PELVIC ORGAN PROLAPSE SURGERY.

(Objective) We examined the morphology and function of lower urinary tract in order to know characteristics of stress urinary incontinence after pelvic organ prolapse (POP) surgery. (Methods) One hundred twenty-five female patients (mean age 64.9 years, mean parity 2.2, mean body mass index (BMI) 24.4) were performed anti-incontinence surgery for stress urinary incontinence. Sixty-one of 125 patients underwent POP surgery before anti-incontinence surgery. They were divided into groups as follows: post-POP surgery group and non-POP surgery group. All patients underwent one-hour pad test, chain cystourethrography (chain CG), Urodynamic studies (UDS) as preoperative assessment. Midurethral sling procedure was performed as an anti-incontinence surgery. Preoperative assessment criteria and postoperative treatment results were compared between two groups. (Results) Post-POP surgery group showed a significantly greater amount of urinary leakage per 1-hour pad test than non-POP surgery group (65.2±74.3 g vs 14.3±25.2 g, p<0.05). The diagnosis of type III urinary stress incontinence (Blaivas' classification) was more frequently diagnosed in post-POP surgery group than non-POP surgery group (50.0% vs 25.0%, p<0.05). Maximum urethral closure pressure (MUCP) and functional profile length (FPL) of post-POP surgery group were lower than those of non-POP surgery group (27.4±9.2 vs 35.7±14.7, p<0.05, 27.3±4.7 vs 29.9±5.0, p<0.05). Postoperative treatment results of post-POP surgery group were worse than those of non-POP surgery group (78.7% vs 92.2%, p<0.05). (Conclusions) Post-POP surgery group showed more severe urinary incontinence, lower urinary function and lower cure rate. Therefore we should keep in mind when approaching urinary stress incontinence.

Regenerative treatment of male stress urinary incontinence by periurethral injection of autologous adipose‐derived regenerative cells: 1‐year outcomes in 11 patients

To assess the efficacy and safety of a novel cell therapy for male stress urinary incontinence consisting of periurethral injection of autologous adipose-derived regenerative cells, and to determine the 1-year outcomes. A total of 11 male patients with persistent stress urinary incontinence after prostate surgery were included in the study. The Celution system was used to isolate adipose-derived regenerative cells from abdominal adipose tissue obtained by liposuction. Subsequently, these regenerative cells, and a mixture of regenerative cells and adipose tissue were transurethrally injected into the rhabdosphincter and submucosal space of the urethra, respectively. The 1-year outcomes were assessed using a 24-h pad test, a validated patient questionnaire, urethral pressure profile, transrectal ultrasonography and magnetic resonance imaging. Stress urinary incontinence improved progressively in eight patients during the 1-year follow up, as determined by a 59.8% decrease in the leakage volume in the 24-h pad test, decreased frequency and amount of incontinence, and improved quality of life. One patient achieved total continence. The mean maximum urethral closing pressure and functional profile length increased from 35.5 to 44.7 cmH₂O, and from 20.4 to 26.0 mm, respectively. Magnetic resonance imaging showed the sustained presence of the injected adipose tissue, and enhanced ultrasonography showed a progressive increase in blood flow to the injected area in all patients. No significant adverse events were observed peri- or postoperatively. Periurethral injection of autologous adipose-derived regenerative cells might represent a safe and feasible treatment modality for male stress urinary incontinence.

The Effects of Thoracic Epidurally Administered Drugs on Urethral Sphincter Function in Women: A Pooled Analysis

Thoracic epidural analgesia (TEA) has been shown to inhibit detrusor activity in patients undergoing open renal surgery, resulting in clinically relevant post-void residuals. However, the impact of different epidural drug mixtures on urethral sphincter function is not completely elucidated. Pooled analysis of an open observational study and a double-blind randomized trial. Single tertiary centre. Twenty-eight women without lower urinary tract symptoms and post-void residual <100 mL, who underwent open renal surgery with TEA. Pooling results in three groups with different epidural regimens (7 with bupivacaine 0.125%, 8 with bupivacaine 0.125% and fentanyl 2 μg/mL, and 13 with bupivacaine 0.1% plus fentanyl 2 μg/mL and epinephrine 2 μg/mL). All women underwent urethral pressure measurements before TEA and during TEA 2-3 days postoperatively. All patients received a TEA placed at the insertion site interspace T 8-9. Maximum urethral closure pressure at rest decreased significantly during TEA with bupivacaine alone (median 70 cm H2 O [interquartile range 66-76] to 43 [43-65], P = 0.031) and with bupivacaine/fentanyl/epinephrine (75 cm H2 O [68-78] to 56 [52-75], P = 0.028), whereas with bupivacaine/fentanyl, no significant change could be detected (74 [51-88] vs 67 [46-70], P = 0.156). In all groups, functional profile length at rest was not influenced during TEA. TEA with bupivacaine and the addition of fentanyl and epinephrine appears to decrease maximum urethral closure pressure at rest in women. The addition of fentanyl alone to bupivacaine may reduce this effect. Thus, the TEA effect on urethral sphincter function seems to depend on the drug mixture administered.

1578 URETHRAL SPHINCTER FUNCTION IN WOMEN DURING THORACIC EPIDURALLY ANALGESIA: A POOLED ANALYSIS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology (I)1 Apr 20131578 URETHRAL SPHINCTER FUNCTION IN WOMEN DURING THORACIC EPIDURALLY ANALGESIA: A POOLED ANALYSIS Livio Mordasini, Tobias Metzger, Thomas M. Kessler, Fiona C. Burkhard, and Patrick Y. Wuethrich Livio MordasiniLivio Mordasini Bern, Switzerland More articles by this author , Tobias MetzgerTobias Metzger Bern, Switzerland More articles by this author , Thomas M. KesslerThomas M. Kessler Zuerich, Switzerland More articles by this author , Fiona C. BurkhardFiona C. Burkhard Bern, Switzerland More articles by this author , and Patrick Y. WuethrichPatrick Y. Wuethrich Bern, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3128AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Thoracic epidural analgesia (TEA) has been shown to inhibit detrusor activity in patients undergoing open renal surgery, resulting in relevant postvoid residuals. However, the impact of different epidural drug mixtures on urethral sphincter function is still unknown. METHODS The present study is a pooled analysis of an open observational study and a double-blind randomized trial. Twenty-eight women without lower urinary tract symptoms, who underwent open renal surgery with TEA, were pooled and categorized into three groups with different epidural mixtures (7 with bupivacaine 0.125%, 8 with bupivacaine 0.125% and fentanyl 2 μg/ml and 13 with bupivacaine 0.1% plus fentanyl 2 μg/ml and epinephrine 2 μg/ml). All women underwent urethral pressure measurements at rest before TEA and during TEA 2-3 days postoperatively. All patients received a TEA placed at the insertion site interspace T 8-9. RESULTS Maximum urethral closure pressure (MUCP) at rest decreased significantly during TEA with bupivacaine alone (median 70 cmH2O [range: 60-80] to 43 [19-68], P=0.031) and with bupivacaine/fentanyl/epinephrine (75 cmH2O [range: 33-115] to 56 [24-105], P=0.028), whereas with bupivacaine/fentanyl no significant change could be detected (74 [49-95] vs 67 [38-86], P=0.156). In all groups functional profile length at rest was not influenced during TEA. CONCLUSIONS TEA with bupivacaine decrease MUCP at rest in women. The addition of fentanyl counteracts this effect. If epinephrine, which reduces the fentanyl plasma concentration by half is also added, MUCP is again significantly decreased. The effect of fentanyl is most likely systemic. The observed increase of MUCP may further explain the negative effect of systemic opiods on voiding function. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e648 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Livio Mordasini Bern, Switzerland More articles by this author Tobias Metzger Bern, Switzerland More articles by this author Thomas M. Kessler Zuerich, Switzerland More articles by this author Fiona C. Burkhard Bern, Switzerland More articles by this author Patrick Y. Wuethrich Bern, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urethral sphincter function before and after radical prostatectomy: Systematic review of the prognostic value of various assessment techniques

Urethral sphincter incompetence is generally considered to be the most important contributing factor to post-radical prostatectomy incontinence (PRPI). The value of various assessment techniques used to objectify urethral sphincter function before and/or after RP is unclear. Our review addresses the following questions: In men having to undergo RP, which measurement techniques that assess pre-operative and post-operative urethral sphincter function have predictive value for the post-operative continence status or correlate with the post-operative continence status. A systematic and comprehensive search was performed using the terms: urethral sphincter, radical prostatectomy (RP), and urinary incontinence. Results were restricted to English-language papers published between 1980 and March 2012. Only techniques described by at least two studies were included. Several assessment techniques for urethral sphincter function and anatomy were identified: sphincter electromyography, magnetic resonance imaging (MRI), perfusion sphincterometry and urethral pressure profilometry (UPP). A shorter urethral sphincter length on preoperative endorectal MRI might be associated with an increased risk of PRPI as well as longer time to achieve continence. UPP showed that both maximum urethral closure pressure (MUCP) and functional profile length (FPL) decrease significantly after RRP. Low preoperative MUCP and FPL are associated with an increased risk of PRPI. The other mentioned assessment techniques are not usable as preoperative diagnostic tools. MRI and UPP might be valuable preoperative diagnostic tools in patients waiting for RRP. However, more and larger studies are needed to show the exact role of MRI and UPP in the preoperative management of patients waiting for RRP and for whom post-operative incontinence is a big concern.

Urodynamic quantification of decrease in sphincter function after radical prostatectomy: Relation to postoperative continence status and the effect of intensive pelvic floor muscle exercises

We analyzed the impact of radical retropubic prostatectomy (RRP) on the urethral sphincter function as assessed by urethral pressure profilometry (UPP) and its relation to post-radical prostatectomy continence status. Furthermore, we analyzed the effect of intensive pelvic floor muscle exercises (PFME) on the urethral sphincter function. Sixty-six patients were included in the study. UPP was performed before RRP and 26 weeks after catheter removal. All patients were instructed in PFME, however, the intensity of PFME varied between instructions based on an information folder only (F-PFME) and intensive guidance by a physiotherapist, in addition to the folder (PG-PFME). In 66 patients, pre- as well as postoperative UPP was evaluable. After surgery, the functional profile length and the maximum urethral closure pressure (MUCP) showed a median decrease of 64% and 41%, respectively. For men who had regained continence after 6 months the median MUCP was significantly higher both before and after operation as compared to men who were still incontinent. In multivariate analysis, non-nerve sparing approach was a prognostic factors for a higher relative decrease of the MUCP after RRP. Comparing the PG-PFME group with the F-PFME group there were no significant differences in changes in UPP parameters. A poor preoperative MUCP seems to be an important prognostic factor for persistent incontinence after RRP. Non-nerve sparing approach seems to be an important prognostic factor for impairment of the urethral sphincter function as measured by UPP. More intensive physiotherapy seems to have no additional effect on the postoperative urethral sphincter function as measured by UPP.

210 PERIURETHRAL INJECTION OF AUTOLOGOUS ADIPOSE-DERIVED STEM CELLS FOR THE TREATMENT OF MALE STRESS URINARY INCONTINENCE: OUTCOME OF A PRELIMINARY CLINICAL TRIAL

You have accessJournal of UrologyStem Cell Research1 Apr 2012210 PERIURETHRAL INJECTION OF AUTOLOGOUS ADIPOSE-DERIVED STEM CELLS FOR THE TREATMENT OF MALE STRESS URINARY INCONTINENCE: OUTCOME OF A PRELIMINARY CLINICAL TRIAL Momokazu Gotoh, Tokunori Yamamoto, Yoshihisa Matsukawa, and Ryohei Hattori Momokazu GotohMomokazu Gotoh Nagoya, Japan More articles by this author , Tokunori YamamotoTokunori Yamamoto Nagoya, Japan More articles by this author , Yoshihisa MatsukawaYoshihisa Matsukawa Nagoya, Japan More articles by this author , and Ryohei HattoriRyohei Hattori Nagoya, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.263AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To report a novel cell therapy using autologous adipose-derived stem cells (ADSCs) for stress urinary incontinence caused by urethral sphincter deficiency and the early outcomes in 2 initial male patients undergoing periurethral injection of ADSCs. METHODS Two male patients with persistent stress urinary incontinence after prostate surgery (radical prostatectomy and holmium laser enucleation of the prostate) received treatment. After liposuction of 250 mL of adipose tissue from the abdomen, we isolated ADSCs from this tissue using the CelutionTM system. Subsequently, the isolated ADSCs and a mixture of stem cells and adipose tissue were transurethrally injected into the rhabdosphincter and submucosal space of the urethra, respectively. Unlike other cell therapy, this treatment is entirely autologous, requires no cell culture, and is performed in the context of a single surgical procedure. Outcomes during a 3-month follow-up were assessed by a 24-hour pad test, a validated patient questionnaire, urethral pressure profile, contrast-enhanced transrectal ultrasonography, and magnetic resonance imaging. The present study was approved by the Ethics Committee of the Nagoya University Graduate School of Medicine and by the Japanese government. RESULTS After injection, urinary incontinence progressively improved during the 3-month follow-up, i.e., decreased leakage volume in a 24-hour pad test. One patient with moderate incontinence (mean leakage amount per day during 4 consecutive days in a 24-hour pad test: 113.3 g) achieved total continence 14 weeks after injection. In another patient, the mean leakage amount per day has been improving from 49.5 to 12.3 g at 12 weeks after injection. In the urethral pressure profile, both maximum urethral closing pressure and functional profile length increased in both patients. Magnetic resonance imaging demonstrated sustained presence of the injected adipose tissue. Enhanced ultrasonography revealed a progressive increase in blood flow to the injected area. No significant adverse events were observed peri- and postoperatively. CONCLUSIONS This preliminary study demonstrated that periurethral injection of autologous ADSCs is a safe and feasible treatment modality for patients with stress urinary incontinence caused by urethral sphincter deficiency. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e87-e88 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Momokazu Gotoh Nagoya, Japan More articles by this author Tokunori Yamamoto Nagoya, Japan More articles by this author Yoshihisa Matsukawa Nagoya, Japan More articles by this author Ryohei Hattori Nagoya, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...