Good Urinary Function Research Articles

A study of outcomes in patients undergoing nerve preserving surgery in colorectal cancers

Background: Colorectal cancers are third most commonly diagnosed cancer globally. Its management consist mainly of surgical intervention to achieve an oncologic cure but also to preserve function. Introduction of nerve-preserving TME technique, spares the nerve and plexus pivotal for urinary and sexual function. The study assessed the urinary and sexual function after nerve sparing colorectal surgery. Aims and objective were to check functional outcomes after nerve preservation in patient undergoing colorectal cancer surgery, in terms of urinary and sexual function.Methods: A prospective observational study conducted from January 2019 to July 2020, in the department of surgery and oncosurgery, Dr. BRAM Hospital, Raipur, Chhattisgarh.Results: According to IPSS score, post-operatively, 57.5% showed fair urinary function, 22.5% showed good urinary function and 20% showed poor urinary function at 1 month. At 3 months, 80% showed good urinary function, 15% showed fair urinary function and 5% showed poor urinary function. According to IIEF score in males, post-operatively, at 1 month, 52% had a fair score, 40% had a poor score and 8% had a good score. At 3 months, 68% had a good score, 24% had a fair score and 8% had a poor score. According to FSFI score in females, post-operatively, at 1 month, 40% had a good score, 26.6% had fair score and 33.33% had a poor score. At 3 months, 66.67% had a good score, 13.33% had a fair score and 20% had a poor score.Conclusions: Nerve preserving surgery in colorectal cancer significantly preserves urinary and sexual function.

Have urinary function outcomes after radical prostatectomy improved over the past decade?

Changes in surgical technique and postoperative care that target improvements in functional outcomes are widespread in the literature. Radical prostatectomy (RP) is one such procedure that has seen multiple advances over the past decade. The objective of this study was to leverage RP as an index case to determine whether practice changes over time produced observable improvements in patient-reported outcomes. This study analyzed patients undergoing RP by experienced surgeons at a tertiary care center with prospectively maintained patient-reported outcome data from 2008 to 2019. Four patient-reported urinary function outcomes at 6 and 12 months after RP were defined with a validated instrument: good urinary function (domain score ≥ 17), no incontinence (0 pads per day), social continence (≤1 pad per day), and severe incontinence (≥3 pads per day). Multivariable logistic regressions evaluated changes in outcomes based on the surgical date. Among 3945 patients meeting the inclusion criteria, excellent urinary outcomes were reported throughout the decade but without consistent observable improvements over time. Specifically, there were no improvements in good urinary function at 12 months (P = .087) based on the surgical date, and there were countervailing effects on no incontinence (worsening; P = .005) versus severe incontinence (improving; P = .003). Neither approach (open, laparoscopic, or robotic), nor nerve sparing, nor membranous urethral length mediated changes in outcomes. In a decade with multiple advances in surgical and postoperative care, there was evidence of improvements in severe incontinence, but no measurable improvements across 3 other urinary outcomes. Although worsening disease factors could contribute to the stable observed outcomes, a more systematic approach to evaluating techniques and implementing patient selection and postoperative care advances is needed. Although there have been advances in radical prostatectomy over the past decade, consistent observable improvements in postoperative incontinence were not reported by patients. To improve urinary function outcomes beyond the current high standard, the approach to studying innovations in surgical technique needs to be changed, and further development of other aspects of prostatectomy care is needed.

Evaluation of Patient- and Surgeon-Specific Variations in Patient-Reported Urinary Outcomes 3 Months After Radical Prostatectomy From a Statewide Improvement Collaborative

Understanding variation in patient-reported outcomes following radical prostatectomy may inform efforts to reduce morbidity after this procedure. To describe patient-reported urinary outcomes following radical prostatectomy in the diverse practice settings of a statewide quality improvement program and to explore whether surgeon-specific variations in observed outcomes persist after accounting for patient-level factors. This prospective population-based cohort study included 4582 men in the Michigan Urological Surgery Improvement Collaborative who underwent radical prostatectomy as primary management of localized prostate cancer between April 2014 and July 2018 and who agreed to complete validated questionnaires prior to surgery and at 3, 6, and 12 months after surgery. Data were analyzed from 2019 to June 2019. Radical prostatectomy. Patient- and surgeon-level analyses of patient-reported urinary function 3 months after radical prostatectomy. Outcomes were measured using validated questionnaires with results standardized using previously published methods. Urinary function survey scores are reported on a scale from 0 to 100 with good function established as a score of 74 or higher. For the 4582 men undergoing radical prostatectomy within the Michigan Urological Surgery Improvement Collaborative who agreed to complete surveys, mean (SD) age was 63.3 (7.1) years. Survey response rates varied: 3791 of 4582 (83%) responded at baseline, 3282 of 4137 (79%) at 3 months, 2975 of 3770 (79%) at 6 months, and 2213 of 2882 (77%) at 12 months. Mean (SD) urinary function scores were 88.5 (14.3) at baseline, 53.6 (27.5) at 3 months, 68.0 (25.1) at 6 months, and 73.7 (23.0) at 12 months. Regression analysis demonstrated that older age, lower baseline urinary function score, body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 or higher, clinical stage T2 or higher, and lack of bilateral nerve-sparing surgery were associated with a lower probability of reporting good urinary function 3 months after surgery. When evaluating patients with good baseline function, the rate at which individual surgeons' patients reported good urinary function 3 months after surgery varied broadly (0% to 54.5%; P < .001). Patients receiving surgery from top-performing surgeons were more likely to report good 3-month function. This finding persisted after accounting for patient risk factors. In this study, patient- and surgeon-level urinary outcomes following prostatectomy varied substantially. Documenting surgeon-specific variations after accounting for patient factors may facilitate identification of surgical factors associated with superior outcomes.

Recovery of urinary function after robotic-assisted laparoscopic prostatectomy versus radical perineal prostatectomy for early-stage prostate cancer

Robotic-assisted laparoscopic prostatectomy (RALP) has largely replaced open radical prostatectomy in many centers. Radical perineal prostatectomy (RPP) is another less invasive approach that has not been widely adopted. RPP offers excellent exposure of the urinary sphincter and bladder neck that may provide good urinary function outcomes. We evaluate urinary function after RALP and RPP. Retrospective review of a prospective radical prostatectomy database was performed. Urinary modules from the Expanded Prostate Cancer Index Composite-Urinary Function (EPIC-UF) questionnaire were used to determine urinary symptoms at baseline and at 6, 12, 18, and 24months after surgery. 753 men underwent RALP (n = 623) or RPP (n = 130). Of these, 558 had complete data and were included in our study (RALP: n = 458, RPP: n = 100). A higher number of patients undergoing RALP than RPP had pelvic lymph node dissection (20.2% vs. 0%, p < 0.0001) and cavernosal neurovascular bundle sparing (79.2% vs. 68.4%, p < 0.0001). 558 patients had complete EPIC-UF data. Overall urinary recovery was greater for RALP than RPP at 6 months (p = 0.028). Urinary incontinence and function were also more improved after RALP compared to RPP at 6 months (p = 0.021, p = 0.006). However, no differences in overall, urinary incontinence, or urinary function scores were seen at 12, 18, or 24months. There was no difference between groups in urinary bother or irritative/obstructive symptoms at any time point. RALP had more rapid recovery of urinary function at 6 months vs. RPP; at 12-24months, however, RALP and RPP had similar urinary function recovery in all urinary subdomains.

Uterovaginal prolapse with multiple Vesical calculi: A rare case report

Uterine prolase is a common gynaecological disease .It is usually associated with cystocele and or rectocele as well as enterocele. Recurrent urinary tract infections may occur in chronically unreduced cystocele leading to calculus formation,cystitis,pyelitis,pyelonephritis and renal failure.We report a case of a 70 years old multiparous lady with third degree uterovaginal prolapse for twenty years, presence of multiple vesical calculus in the cystocele was noted on X-ray pelvis while undergoing investigation.Suprapubic cystolithotomy followed by vaginal hysterectomy with pelvic floor repair was done. Multiple vesical calculus were removed. Postoperative course was uneventful and she was discharged on 10th post-operative day. Patient is still on follow up with good urinary function and no recurrent UTI.J Dhaka Medical College, Vol. 25, No.1, April, 2016, Page 77-79

Unexpected Long-term Improvements in Urinary and Erectile Function in a Large Cohort of Men with Self-reported Outcomes Following Radical Prostatectomy

BackgroundIt is generally assumed that if a man does not regain urinary continence or erectile function within 12 mo of radical prostatectomy (RP), then the chance of subsequent recovery is low. ObjectiveTo determine the probability of achieving good urinary function (UF) or erectile function (EF) up to 48 mo postoperatively in men who reported poor UF or EF at 12 mo after RP. Design, setting, and participantsWe identified 3187 patients who underwent RP from 2007 through 2013 at a tertiary institution and had extended multidisciplinary follow-up with patient-reported UF and EF scores at ≥12 mo. InterventionOpen or minimally invasive RP. Outcome measurements and statistical analysisPrimary outcome was good UF as defined by a urinary score ≥17 (range: 0–21) or good EF as defined by a modified International Index of Erectile Function-6 score ≥22 (range: 1–30). The probability of functional recovery beyond 12 mo was determined by Kaplan-Meier analyses. Results and limitationsAmong patients incontinent at 12 mo, the probability of achieving good UF at 24, 36, and 48 mo was 30%, 49%, and 59%. In patients experiencing erectile dysfunction at 12 mo, the probability of recovering EF at 24, 36, and 48 mo was 22%, 32%, and 40%. On multivariable analyses, 12-mo functional score and age were associated with recovery, but only score was consistently significant. ConclusionsMen with incontinence or erectile dysfunction at 12 mo have higher than anticipated rates of subsequent functional improvement. Probability of recovery is strongly influenced by score at 12 mo. Further research should address the impact of ongoing multidisciplinary follow-up care on our observed rates of recovery. Patient summaryMany prostate cancer patients continue to recover urinary and erectile function after 12 mo. The level of functional recovery by 12 mo is associated with long-term recovery and should be discussed by the physician and patient when deciding on rehabilitative interventions.

Penile amputation and successful reattachment and the role of winter shunt in postoperative viability: A case report and literature review

Traumatic self-amputation of the penis by a psychotic patient is rare. Microvascular replantation is the favored management approach. There are no known cases of self-amputation followed by ingestion of the stump and subsequent replantation. A 51-year-old patient with paranoid schizophrenia presented 2 hours following penile amputation. He had swallowed the excised portion, which was endoscopically retrieved from the stomach in the emergency department. Successful reattachment was achieved including microvascular repair of the dorsal penile arteries without cavernosal arterial anastamoses. A Winter's shunt was performed to improve venous circulation. The patient has been followed for 3 years from the date of repair. He has adequate erection for intercourse and good urinary function, but has experienced sensory loss over the dorsal aspect and glans and urethral stricture dilation. This is the first report of replantation following ingestion of an amputated penis.

IgG4-Related Prostatitis Impairs Objective Urinary Function as with Benign Prostate Hyperplasia: A Case Report Successfully Treated with Transurethral Resection.

We report a case of IgG4-related prostatitis successfully treated with transurethral resection of the prostate (TUR-P). A 47-year-old man with a history of autoimmune pancreatitis and sclerosing cholangitis presented with lower urinary tract symptoms. Because ultrasonography revealed a mildly enlarged prostate and uroflowmetry showed a severely diminished flow curve, benign prostatic hyperplasia was diagnosed. Despite the administration of α1-blockers, the patient's condition did not improve, and TUR-P was performed in accordance with his wish. Pathological examination showed dense lymphoplasmacytic inflammation with no evidence of synchronous malignancy. On immunohistochemical staining, a large number (>40/high-power field) of IgG4-positive cells were observed in the lesions showing the inflammation, confirming the diagnosis of IgG4-related prostatitis. The patient's urinary function dramatically improved postoperatively, and good urinary function has been maintained for 3 years without additional treatment. Recognition of the impact of IgG4-related prostatitis on objective urinary function will help in appropriately treating patients with this condition.

Rectal leiomyosarcoma, three-year follow-up

Rectal leiomyosarcomas are rare tumors originated from smooth muscle cells. Differential diagnosis includes gastrointestinal stromal tumors (GIST), leiomyomas or schwannomas, and the differentiation of these tumors is usually made through immunohistochemistry. Due to its rarity, the standard treatment has not been defined. The purpose of this study was to present the follow-up of a patient with leiomyosarcoma of medium rectum submitted to exclusive operative treatment. The tumor size was 6 cm and it had a high mitotic index. The patient remains with good urinary function and good sphincter function, and free of the disease after a three-year follow-up.

A New Use of Scrotal Septal Skin Flap in Repairing Hypospadias

In our study, we introduce the use of a scrotal septal skin flaps in repair of hypospadias. Between June 2006 and October 2008, 30 patients were treated by using a penile local flap to reconstruct the urethra, and a scrotal septal skin flap to cover the wound located on the ventral side of the penis. Of 30 patients, 4 presented with urine leakage, but this condition healed spontaneously after 2 to 4 weeks. Urine leakage healed without problem in the remaining patients, and they had unobstructed urinary flow. Additionally, they all were satisfied with genital appearance after the reconstruction. We conclude that our method is a convenient means to cover the wound at the ventral side of the reconstructed urethra by using a scrotal septal skin flap during hypospadias repair. This procedure provides good urinary function and satisfactory appearance to the patients. In addition, this method solves the problem of very limited local tissue for urethral reconstruction in the hypospadias patient.

Curiethérapie de prostate par iode 125 : facteurs pronostiques de longue durée de toxicité urinaire, digestive et sexuelle

Purpose For patients with good urinary function and presenting with a low risk prostate cancer, prostate brachytherapy using iodine implants represents one of the techniques of reference. This retrospective analysis investigates urinary (U), digestive (D) and sexual (S) toxicities and their prognostic factors of duration. Material and methods From August 2000 to November 2007, 176 patients presenting with prostate adenocarcinoma underwent interstitial brachytherapy. Urinary, digestive and sexual toxicities were classified according to Common toxicities criteria for adverse events, version 3.0 (CTCAE V3.0). For each toxicity (U, D, S), the number of complications U (dysuria, nicturia…), D (proctitis, diarrhea…) and S (sexual dysfunction, loss of libido, …) was listed and analyzed according to criteria related to the patient, implant, dosimetric data and characteristics of the toxicity. Prognostic factors identified in univariate analysis (UVA) (Log Rank) were further analyzed in multivariate analysis (MVA) (Cox model). Results With a median follow-up of 26 months (1–87), 147 patients (83.5 %) presented urinary toxicities. Among them, 29.5 % (86 patients) and 2.4 % (seven patients) presented grade 2 and 3 U toxicity respectively. In UVA, urinary grade toxicity greater than or equal to 2 ( p = 0.037), the presence of initial U symptoms ( p = 0.027) and more than two urinary toxicities ( p = 0.00032) were recognized as prognostic factors. The number of U toxicities was the only prognostic factor in MVA ( p = 0.04). D toxicity accounted for 40.6 % (71 patients). Among them, 3 % (six patients) were grade 2. None were grade 3. Two factors were identified as prognostic factors either in UVA and MVA: the number of D toxicities greater than or equal to 2 (univariate analysis: p = 0,00129, multivariate analysis: p = 0,002) and age less than or equal to 65 years (univariate analysis: p = 0,004, multivariate analysis: p = 0,007). Eighty-three patients (47.4 %) presented a sexual toxicity; 26.9 % (49 patients) and 5 % (nine patients) were scored as grade 2 and 3 respectively. A number of seeds greater than 75 ( p = 0.032) and S grade greater than or equal to 2 ( p < 0.0001) were recognized as prognostic factors in UVA. S grade was the only prognostic factor in MVA ( p = 0.0015). Conclusion The duration of U, D and S toxicity is strongly correlated with a high number of toxicities and the grade of toxicity. This analysis allows for better information given to the patient regarding the duration of the post-treatment complications.

Real-time MRI of Orthotopic Ileal Neobladder Voiding: Preliminary Findings

ObjectivesThe purpose of this preliminary study was to analyze the dynamic changes in the configuration of the neobladder and naïve bladder during voiding using real-time MRI. MethodsThis study included 10 male patients who had a radical cystectomy and an ileal orthotopic neobladder due to organ-confined bladder cancer and had good urinary function, and 5 male control volunteers. With the subjects in the lateral decubitus position, real-time MRI was performed during micturition. A sagittal slice orientation was used to depict the bladder and the entire length of the urethra; individual movements along the X-axis and Y-axis of the bottom and top of the neobladder and the naïve bladder were recorded and analyzed. Urodynamic studies (UDS) and video voiding cystourethrography were performed in patients. ResultsFive of the 10 neobladder patients could void in the lateral decubitus position. In normal controls and patients who could void, the bladder outlet bladder moved ventrocranially during micturition. The ileal bladder outlet moved a significantly longer distance than the naïve bladder during micturition (X-axis, −13.4±1.5 vs. −3.6±4.3cm, p=0.0014; Y-axis, −10.6±0.5 vs. −2.0±6.5cm, p=0.0187). The distance that the bladder top moved between the naïve bladders and the neobladder did not differ. UDS did not show a difference between patients who could and could not void at lateral position. ConclusionsDuring micturition, the neobladder was found to rotate and move more dynamically than the naïve bladder. Real-time MRI is useful for assessing dynamic voiding function of orthotopic neobladders.