Incontinence Outcomes Research Articles

A study of the effects of home administered transcutaneous electrical nerve stimulation on quality of life, psychosocial and incontinence outcomes in children with overactive bladder syndrome

A study of the effects of home administered transcutaneous electrical nerve stimulation on quality of life, psychosocial and incontinence outcomes in children with overactive bladder syndrome

Evolution of stress urinary incontinence (SUI) outcomes assessment: a narrative review

Evolution of stress urinary incontinence (SUI) outcomes assessment: a narrative review

Estimating Surgical Urethral Length on Intraoperative Robot-Assisted Prostatectomy Images Using Artificial Intelligence Anatomy Recognition.

Objective: To construct a convolutional neural network (CNN) model that can recognize and delineate anatomic structures on intraoperative video frames of robot-assisted radical prostatectomy (RARP) and to use these annotations to predict the surgical urethral length (SUL). Background: Urethral dissection during RARP impacts patient urinary incontinence (UI) outcomes, and requires extensive training. Large differences exist between incontinence outcomes of different urologists and hospitals. Also, surgeon experience and education are critical toward optimal outcomes. Therefore, new approaches are warranted. SUL is associated with UI. Artificial intelligence (AI) surgical image segmentation using a CNN could automate SUL estimation and contribute toward future AI-assisted RARP and surgeon guidance. Methods: Eighty-eight intraoperative RARP videos between June 2009 and September 2014 were collected from a single center. Two hundred sixty-four frames were annotated according to prostate, urethra, ligated plexus, and catheter. Thirty annotated images from different RARP videos were used as a test data set. The dice (similarity) coefficient (DSC) and 95th percentile Hausdorff distance (Hd95) were used to determine model performance. SUL was calculated using the catheter as a reference. Results: The DSC of the best performing model were 0.735 and 0.755 for the catheter and urethra classes, respectively, with a Hd95 of 29.27 and 72.62, respectively. The model performed moderately on the ligated plexus and prostate. The predicted SUL showed a mean difference of 0.64 to 1.86 mm difference vs human annotators, but with significant deviation (standard deviation = 3.28-3.56). Conclusion: This study shows that an AI image segmentation model can predict vital structures during RARP urethral dissection with moderate to fair accuracy. SUL estimation derived from it showed large deviations and outliers when compared with human annotators, but with a small mean difference (<2 mm). This is a promising development for further research on AI-assisted RARP.

Recommendations of the SUFU/AUGS/ICS Female Stress Urinary Incontinence Surgical Publication Working Group: A Common Standard Minimum Data Set for the Literature.

Relevant, meaningful, and achievable data points are critical in objectively assessing quality, utility, and outcomes in female stress urinary incontinence (SUI) surgery. A minimum data set female SUI surgery studies was proposed by the first American Urological Association guidelines on the surgical management of female SUI in 1997, but recommendation adherence has been suboptimal. The Female Stress Urinary Incontinence Surgical Publication Working Group (WG) was created from members of several prominent organizations to formulate a recommended standard of study structure, description, and minimum outcome data set to be utilized in designing and publishing future SUI studies. The goal of this WG was to create a body of evidence better able to assess the outcomes of female SUI surgery. The WG reviewed the minimum data set proposed in the 1997 AUA SUI Guideline document, and other relevant literature. The body of literature was examined in the context of the profound changes in the field over the past 25 years. Through a DELPHI process, a standard study structure and minimum data set were generated. Care was taken to balance the value of several meaningful and relevant data points against the burden of creating an excessively difficult or restrictive standard that would disincentivize widespread adoption and negatively impact manuscript production and acceptance. The WG outlined standardization in four major areas: 1) study design, 2) pretreatment demographics and characterization of the study population, 3) intraoperative events, and 4) post-treatment evaluation, and complications. Forty-two items were evaluated and graded as: STANDARD - must be included; ADDITIONAL - may be included for a specific study and is inclusive of the Standard items; OPTIMAL - may be included for a comprehensive study and is inclusive of the Standard and Additional items; UNNECESSARY/LEGACY - not relevant. A reasonable, achievable, and clinically meaningful minimum data set has been constructed. A structured framework will allow future surgical interventions for female SUI to be objectively scrutinized and compared in a clinically significant manner. Ultimately, such a data set, if adopted by the academic community, will enhance the quality of the scientific literature, and ultimately improve short and long-term outcomes for female patients undergoing surgery to correct SUI.

Recommendations of the SUFU/AUGS/ICS Female Stress Urinary Incontinence Surgical Publication Working Group: A common standard minimum data set for the literature.

Relevant, meaningful, and achievable data points are critical in objectively assessing quality, utility, and outcomes in female stress urinary incontinence (SUI) surgery. A minimum data set female SUI surgery studies was proposed by the first American Urological Association guidelines on the surgical management of female SUI in 1997, but recommendation adherence has been suboptimal. The Female Stress Urinary Incontinence Surgical Publication Working Group (WG) was created from members of several prominent organizations to formulate a recommended standard of study structure, description, and minimum outcome data set to be utilized in designing and publishing future SUI studies. The goal of this WG was to create a body of evidence better able to assess the outcomes of female SUI surgery. The WG reviewed the minimum data set proposed in the 1997 AUA SUI Guideline document, and other relevant literature. The body of literature was examined in the context of the profound changes in the field over the past 25 years. Through a DELPHI process, a standard study structure and minimum data set were generated. Care was taken to balance the value of several meaningful and relevant data points against the burden of creating an excessively difficult or restrictive standard that would disincentivize widespread adoption and negatively impact manuscript production and acceptance. The WG outlined standardization in four major areas: (1) study design, (2) pretreatment demographics and characterization of the study population, (3) intraoperative events, and (4) posttreatment evaluation, and complications. Forty-two items were evaluated and graded as: STANDARD-must be included; ADDITIONAL-may be included for a specific study and is inclusive of the Standard items; OPTIMAL-may be included for a comprehensive study and is inclusive of the Standard and Additional items; UNNECESSARY/LEGACY-not relevant. A reasonable, achievable, and clinically meaningful minimum data set has been constructed. A structured framework will allow future surgical interventions for female SUI to be objectively scrutinized and compared in a clinically significant manner. Ultimately, such a data set, if adopted by the academic community, will enhance the quality of the scientific literature, and ultimately improve short and long-term outcomes for female patients undergoing surgery to correct SUI.

Recommendations of the SUFU/AUGS/ICS female stress urinary incontinence surgical publication working group: A common standard minimum data set for the literature

Introduction and ObjectivesRelevant, meaningful, and achievable data points are critical in objectively assessing quality, utility, and outcomes in female stress urinary incontinence (SUI) surgery. A minimum data set female SUI surgery studies was proposed by the first American Urological Association guidelines on the surgical management of female SUI in 1997, but recommendation adherence has been suboptimal The Female Stress Urinary Incontinence Surgical Publication Working Group (WG) was created from members of several prominent organizations to formulate a recommended standard of study structure, description, and minimum outcome data set to be utilized in designing and publishing future SUI studies. The goal of this WG was to create a body of evidence better able to assess the outcomes of female SUI surgery. MethodsThe WG reviewed the minimum data set proposed in the 1997 AUA SUI Guideline document, and other relevant literature. The body of literature was examined in the context of the profound changes in the field over the past 25 years. Through a DELPHI process, a standard study structure and minimum data set were generated. Care was taken to balance the value of several meaningful and relevant data points against the burden of creating an excessively difficult or restrictive standard that would disincentivize widespread adoption and negatively impact manuscript production and acceptance. Results:The WG outlined standardization in four major areas: (1) study design, (2) pretreatment demographics and characterization of the study population, (3) intraoperative events, and (4) post-treatment evaluation, and complications. Forty-two items were evaluated and graded as: STANDARD — must be included; ADDITIONAL — may be included for a specific study and is inclusive of the Standard items; OPTIMAL — may be included for a comprehensive study and is inclusive of the Standard and Additional items; UNNECESSARY/LEGACY — not relevant. Conclusion:A reasonable, achievable, and clinically meaningful minimum data set has been constructed. A structured framework will allow future surgical interventions for female SUI to be objectively scrutinized and compared in a clinically significant manner. Ultimately, such a data set, if adopted by the academic community, will enhance the quality of the scientific literature, and ultimately improve short and long-term outcomes for female patients undergoing surgery to correct SUI.

Faster both in operative time and functional recovery by the extraperitoneal daVinci SP-based robot-assisted radical prostatectomy: a propensity score matching analysis compared to transperitoneal multiport counterpart.

We aim to investigate the peri-operative outcomes after extraperitoneal single-port based robot-assisted radical prostatectomy (eSP-RARP) utilizing the da Vinci SP system compared to conventional transperitoneal multi-port counterparts (tMP-RARP), in an era when pelvic lymph node dissection (PNLD) was omitted for the node-negative case. With exclusion criteria of volume + 50g, suspicious rectal invasion, and node-positive disease given relatively weak grasping power and limited range of motion from the current SP system, 50 consecutive patients (Since December 2021) with localized prostate cancer underwent eSP-RARP by a single urologist maintaining identical surgical technique for 100 consecutive tMP-RARP cases (Since December 2020). Given initial selection criteria, each group was matched to a 1:1 ratio based on the risk-stratification parameters and the prostate volume. The operative time, which was maintained in each group during the study period, was significantly faster in eSP-RARP groups than in tMP-RARP (149.2 vs. 163.2min, p = 0.025), while the weight of the removed specimen (27.1 vs. 29.0g, p = 0.420) and margin positivity (14.7% vs. 11.7% in pT2, p = 0.812) were similar. The gas-out (1.5 vs. 1.88days, p = 0.003) and solid diet dates (2.26 vs. 3.22days, p < 0.001) were faster in the eSP-RARP group. The single-pad continence dates (30.5 vs. 51.9days, p = 0.145) and zero-pad continence dates (105.5 vs. 146.2days, p = 0.210) were identical. 90-day single-pad continence rate was 92% vs. 82% (p = 0.142, 52% vs. 56% in zero-pad continence). Based on these, daVinci SP-based RARP restored bowel function faster with shorter operative time through an extraperitoneal approach than the conventional transperitoneal multi-port counterpart while maintaining similar incontinence outcomes in cases without a routine PNLD.

Patient Preferences for Benefit and Risk Associated With High Intensity Focused Ultrasound for the Ablation of Prostate Tissue in Men With Localized Prostate Cancer

IntroductionFood and Drug Administration must make decisions about emerging high intensity focused ultrasound (HIFU) devices that may lack relevant clinical oncologic data but present with known side effects. This study aims to capture patients’ perspective by quantifying their preferences regarding the available benefit and important side effects associated with HIFU for localized prostate cancer. Materials and methodsPreferences for HIFU outcomes were examined using a discrete choice experiment survey. Participants were asked to choose a preferred treatment option in 9 choice questions. Each included a pair of hypothetical treatment profiles that have similar attributes/outcomes with varying levels. Outcomes included prostate biopsy outcome and treatment-related risks of erectile dysfunction (ED) and urinary incontinence (UI). We calculated the maximum risk of side effect patients were willing to tolerate in exchange for increased benefit. Preferences were further explored via clinical and demographic data. ResultsAbout 223 subjects with a mean age of 64.8 years completed the survey. Respondents were willing to accept a 1.51%-point increase in new ED risk for a 1%-point increase in favorable biopsy outcome. They were also willing to accept a 0.93%-point increase in new UI risk for a 1%-point increase in biopsy outcome. Subjects who perceived their cancer to be more aggressive had higher risk tolerance for UI. Younger men were willing to tolerate less ED risk than older men. Respondents with greater than college level of education had a lower risk tolerance for ED or UI. ConclusionsResults may inform development and regulatory evaluation for future HIFU ablation devices by providing supplemental information from the patient perspective.

The minimal important difference of patient-reported outcome measures related to female urinary incontinence: a systematic review

BackgroundThe minimal important difference is a valuable metric in ascertaining the clinical relevance of a treatment, offering valuable guidance in patient management. There is a lack of available evidence concerning this metric in the context of outcomes related to female urinary incontinence, which might negatively impact clinical decision-making.ObjectivesTo summarize the minimal important difference of patient-reported outcome measures associated with urinary incontinence, calculated according to both distribution- and anchor-based methods.MethodsThis is a systematic review conducted according to the PRISMA guidelines. The search strategy including the main terms for urinary incontinence and minimal important difference were used in five different databases (Medline, Embase, CINAHL, Web of Science, and Scopus) in 09 June 2021 and were updated in January 09, 2024 with no limits for date, language or publication status. Studies that provided minimal important difference (distribution- or anchor-based methods) for patient-reported outcome measures related to female urinary incontinence outcomes were included. The study selection and data extraction were performed independently by two different researchers. Only studies that reported the minimal important difference according to anchor-based methods were assessed by credibility and certainty of the evidence. When possible, absolute minimal important differences were calculated for each study separately according to the mean change of the group of participants that slightly improved.ResultsTwelve studies were included. Thirteen questionnaires with their respective minimal important differences reported according to distribution (effect size, standard error of measurement, standardized response mean) and anchor-based methods were found. Most of the measures for anchor methods did not consider the smallest difference identified by the participants to calculate the minimal important difference. All reports related to anchor-based methods presented low credibility and very low certainty of the evidence. We pooled 20 different estimates of minimal important differences using data from primary studies, considering different anchors and questionnaires.ConclusionsThere is a high variability around the minimal important difference related to patient-reported outcome measures for urinary incontinence outcomes according to the method of analysis, questionnaires, and anchors used, however, the credibility and certainty of the evidence to support these is still limited.

Improved urinary incontinence outcomes following vaginal erbium laser treatment

Improved urinary incontinence outcomes following vaginal erbium laser treatment

Systematic review of quality-of-life outcomes following radical prostatectomy versus radiation therapy for prostate cancer

Localized prostate cancer presents a therapeutic challenge with various treatment options, including radical prostatectomy (RP) and radiation therapy (RT). Understanding the comparative effectiveness of these interventions is crucial for informed decision-making. A systematic review was conducted following PRISMA guidelines to identify studies comparing outcomes between RP and RT for localized prostate cancer. PubMed, Embase, and Cochrane Library were searched for relevant articles published up to date. Eligible studies included comparative trials reporting outcomes such as urinary incontinence, sexual function, bowel function, hormonal function, general quality of life, and biochemical failure (BF). Quality assessment and data synthesis were performed using established tools. Sixteen studies met the inclusion criteria, encompassing diverse study designs, patient populations, and follow-up durations. RP was associated with worse urinary incontinence outcomes as compared to RT in several studies, while sexual function outcomes favored RT. Bowel function outcomes varied across studies, with some favoring RP and others RT. Hormonal function outcomes were mixed, with some studies indicating worse outcomes with RT plus androgen deprivation therapy. The BF rates were lower with RT plus adjuvant therapy as compared to RP in some studies. The choice between RP and RT for localized prostate cancer should consider patient-specific factors and preferences. RP might offer advantages in terms of urinary continence, while RT might be preferred for preserving sexual function. Bowel function and hormonal outcomes varied, highlighting the need for individualized treatment decisions. Further research is needed to elucidate long-term outcomes and optimize treatment strategies for localized prostate cancer.

Is Surgical Treatment for Obesity Able to Cure Urinary Incontinence in Women?-A Prospective Single-Center Study.

There is enough evidence to support weight loss in order to improve urinary incontinence. Nevertheless, weight loss and maintaining a lower weight are not easy to achieve in the general population. Our study aims to evaluate whether bariatric surgery has a positive effect on the symptoms of urinary incontinence in female patients. We performed a prospective study on obese female patients before and after bariatric surgery, over a period of 9 years. Patients with a BMI ≥ 33 kg/m2 were included if they described involuntary loss of urine and no previous surgery for urinary incontinence was performed. The patients underwent laparoscopic surgery, either gastric sleeve, bypass or banding, performed by four surgeons in our hospital. The type of incontinence was not assessed at the initial visit carried out by the surgeon. All patients who declared being incontinent were referred to the urologist where they received the ICIQ-UI-SF questionnaire before their bariatric surgery and during follow -up visits. The sum of points obtained at questions 3, 4 and 5 was used to evaluate the severity of incontinence, as well as the impact on the quality of life. Our evaluation collected data on age, time since onset of symptoms, pad usage, number and type of deliveries, concomitant conditions and medications. The type of incontinence was assessed by the urologist before bariatric surgery as urge, stress or mixed incontinence. At follow-up visits, the patients were also asked to fill out a 10-point VAS questionnaire evaluating their perception on the evolution of incontinence symptoms. Data were analyzed using t-test statistical analysis. Our objective defined changes in incontinence as cure, improved, no change and worse. We included 54 women from whom initial data and at least 18 months of follow-up were available. We observed that about 50% of all women undergoing bariatric surgery have some degree of urinary incontinence. The ICIQ score improved from 13.31 ± 5.18 before surgery to 8.30 ± 4.49 points after surgery (p < 0.0001). Before surgery, 38 patients (70%) described severe incontinence compared to only 20 patients (37%) after surgery. A total of 16 women (31%) reported complete cure of urinary incontinence after bariatric surgery. Data from the VAS questionnaire show improvement in 46 cases (85%). Pad usage improved from 7.04 ± 2.79 to 3.42 ± 2.77 (p < 0.001) per day. The number of patients using more than one pad per day decreased from 35 (65%) to 9 (17%). The type of incontinence did not seem to be relevant, but our sample size was too small to lead to statistically significant results. There was no impact on the outcome of incontinence of number/type of delivery, age or BMI. Our data show that bariatric surgery is able to cure urinary incontinence in one of three obese women. A significant improvement was obtained in more than two-thirds of the patients, regardless of the type of incontinence. For an obese female with urinary incontinence, treatment for obesity should prevail and incontinence should be treated only if symptoms remain.

A matched-analysis on short-term and long-term (up to 5 years of follow-up) urinary incontinence outcomes after robot-assisted radical prostatectomy with and without anterior and posterior reconstruction: data on 1358 patients

PurposeWe report a comparative monocentric study with a short and long-term follow-up with the aim to assess differences about urinary continence outcomes in patients treated with Robot-Assisted Radical Prostatectomy (RARP) with two different techniques: with anterior and posterior reconstruction and without any kind of reconstruction.Materials and methodsFrom January 2016 to September 2021, at the Department of Urology of the “F. Miulli” Hospital of Acquaviva delle Fonti, in Italy, 850 eligible patients underwent extraperitoneal RARP with anterior and posterior reconstruction and 508 without reconstructions.ResultsIn patients undergoing RARP with reconstructions 1 month after surgery the urinary continence was preserved in 287/850 patients (33.8%), 3 months after surgery in 688/850 (81%), 6 months in 721/850 (84.8%), 12 months in 734/850 (86.3%), 18 months in 671/754 (89%), 24 months in 696/754 (92.3%), 36 months in 596/662 (90%), 48 months in 394/421 (93.6%), 60 months in 207/212 (97.6%). In patients undergoing RARP without reconstruction 1 month after surgery urinary continence was preserved in 99/508 (19.4%), after 3 months in 276/508 (54.3%), 6 months in 305/508 (60%), 12 months in 329/508 (64.7%), 18 months in 300/456 (65.7%), 24 months in 295/456 (64.7%), 36 months in 268/371 (72.3%), 48 months in 181/224 (81%), 60 months in 93/103 (90.3%).ConclusionIn our case study, the RARP with anterior and posterior reconstruction technique is associated with a statistically significant higher rate (up to 48 months of follow-up) and a faster recovery of urinary continence compared to the technique without reconstructions.

Long-Term Male Sexual Function and Fecal Incontinence Outcomes for Adult Patients with Hirschsprung Disease or Anorectal Malformation

BackgroundThis study sought to characterize sexual function and fecal incontinence related quality of life (QOL) outcomes for adult males with anorectal malformation (ARM) or Hirschsprung's Disease (HD). MethodsWe conducted a cross-sectional survey study of male patients ≥18 years with ARM or HD. Patients were identified from our institutional database, contacted and consented by telephone, and sent a REDCap survey via email. The International Index of Erectile Function (IIEF-5) and Male Sexual Health Questionnaire (MSHQ) evaluated erectile dysfunction (ED) and ejaculatory dysfunction (EjD), respectively. The Cleveland Clinic Incontinence Score (CCIS) and the Fecal Incontinence Quality of Life Scale (FIQLS) assessed fecal incontinence-related outcomes. A linear regression analysis of IIEF-5 scores compared to CCIS scores was used to evaluate for an association between ED and incontinence. ResultsOf 63 patients contacted, 48 completed the survey. The median age for respondents was 22.5 years (IQR 20–25). There were 19 patients with HD and 29 patients with ARM. On the IIEF-5 survey, 35.3% report some level of ED. On the MSHQ-EjD survey, the median score was 14 out of 15 (IQR 10.75–15), indicating few EjD concerns. The median CCIS was 5 (IQR 2.25–7.75) and the median FIQL scores ranged from 2.7 to 3.5 depending on the domain assessed, demonstrating some QOL challenges secondary to fecal incontinence. On linear regression analysis, IIEF-5 and CCIS scores were weakly associated (B = −0.55, p = 0.045). ConclusionsMale adult patients with ARM or HD may have ongoing concerns with sexual function and fecal incontinence. Level of EvidenceLevel 4. Type of StudyCross-Sectional Survey Study.

MP37-12 SURGICAL TREATMENT OF OBESITY IS ABLE TO CURE URINARY INCONTINENCE - 9 YEARS EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP37-12 SURGICAL TREATMENT OF OBESITY IS ABLE TO CURE URINARY INCONTINENCE - 9 YEARS EXPERIENCE Cristian Persu, Narcis Chirca, Bogdan Gabriel Buzescu, Irina Ciofu, and Viorel Jinga Cristian PersuCristian Persu More articles by this author , Narcis ChircaNarcis Chirca More articles by this author , Bogdan Gabriel BuzescuBogdan Gabriel Buzescu More articles by this author , Irina CiofuIrina Ciofu More articles by this author , and Viorel JingaViorel Jinga More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is enough evidence to support weight loss in order to improve urinary incontinence. Nevertheless, weight loss and maintaining a lower weight are not easy to achieve in general population. Our study aims to evaluate whether bariatric surgery has a positive effect on the symptoms of urinary incontinence in female patients. METHODS: We performed a prospective study on obese female patients before and after bariatric surgery, over a period of 9 years. Patients with a BMI≥33 kg/m2 were included if they described involuntary loss of urine and no previous surgery for urinary incontinence was performed. The patients underwent laparoscopic surgery: gastric sleeve, bypass or banding, performed by four surgeons in our hospital. The type of incontinence was not assessed at the initial visit done by the surgeon. All patients who declared being incontinent were referred to the urologist where they received the ICIQ – UI -SF questionnaire before their bariatric surgery and during follow up visits. The sum of points obtained at questions 3,4 and 5 was used to evaluate the severity of incontinence as well as the impact on the quality of life. Our evaluation collected data on age, time since onset of symptoms, pad usage, number and way of deliveries, concomitant conditions and medications. The type of incontinence was assessed by the urologist before bariatric surgery, as urge, stress or mixed incontinence. At follow up visits, the patients were also asked to fill in a 10 point VAS questionnaire evaluating their perception on the improvement of incontinence symptoms. Data was analyzed using the t-test statistical analysis. Our objective defined change in incontinence as cure, improved, no change and worse. RESULTS: Our study included 54 women in which initial data and at least 18 months of follow up were available. We observed that about 50% of all women undergoing bariatric surgery have some degree of urinary incontinence. The ICIQ score improved from 13,31±5,18 before to 8,30±4,49 points after surgery (p<0.0001). Before surgery, 38 patients (70%) described severe incontinence, compared to only 20 patients (37%) after surgery. 16 women (31%) report complete cure of urinary incontinence after bariatric surgery. Data from the VAS questionnaire shows improvement in 46 cases (85%). Pad usage improved from 7,04±2,79 to 3,42±2,77 (p<0.001) per day. The number of patients using more than one pad per day decreased from 35 (65%) to 9 (17%). The type of incontinence doesn’t seem to be relevant, but our sample size was too small to lead to statistically significant results. There is no impact on the outcome of incontinence of number/type of delivery, age or BMI. CONCLUSIONS: Our data shows that bariatric surgery is able to cure urinary incontinence in one of three obese women. Significant improvement is obtained in more than two thirds of the patients, regardless the type of incontinence. For an obese female with urinary incontinence, the treatment for obesity should prevail and incontinence should be treated only if symptoms remain. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e519 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cristian Persu More articles by this author Narcis Chirca More articles by this author Bogdan Gabriel Buzescu More articles by this author Irina Ciofu More articles by this author Viorel Jinga More articles by this author Expand All Advertisement PDF downloadLoading ...

Genitourinary Quality-of-Life Comparison Between Urethral Sparing Prostate Stereotactic Body Radiation Therapy Monotherapy and Virtual High-Dose-Rate Brachytherapy Boost

Although radiation dose escalation improves prostate cancer disease control, it can cause increased toxicity. Genitourinary (GU) symptoms after prostate radiation therapy affect patient health-related quality of life (QoL). We compared patient-reported GU QoL outcomes following 2 alternative urethral sparing stereotactic body radiation therapy regimens. Expanded Prostate Cancer Index Composite (EPIC)-26 GU scores were compared between 2 urethral sparing stereotactic body radiation therapy trials. The SPARK trial prescribed a "Monotherapy" dose of 36.25 Gy in 5 fractions to the prostate. The PROMETHEUS trial prescribed 2 phases: a 19- to 21-Gy in 2 fractions "Boost" to the prostate, followed by 46 Gy in 23 fractions or 36 Gy in 12 fractions. The biological effective dose (BED) for urethral toxicity was 123.9 Gy for Monotherapy and 155.8 to 171.2 Gy for Boost. Mixed effects logistic regression models were utilized to estimate the difference in the odds of a minimal clinically important change from baseline EPIC-26 GU score between regimens at each follow-up. 46 Monotherapy and 149 Boost patients completed baseline EPIC-26 scoring. Mean EPIC-26 GU scores revealed statistically superior urinary incontinence outcomes for Monotherapy at 12 months (mean difference, 6.9; 95% confidence interval [CI], 1.6-12.1; P=.01) and 36 months (mean difference, 9.6; 95% CI, 4.1-15.1; P < .01). Monotherapy also revealed superior mean urinary irritative/obstructive outcomes at 12 months (mean difference, 6.9; 95% CI, 2.0-12.9; P < .01) and 36 months (mean difference, 6.3; 95% CI, 1.9-10.8; P < .01). For both domains and at all time points, the absolute differences were <10%. There were no significant differences in the odds of reporting a minimal clinically important change between regimens at any time point. Even in the presence of urethral sparing, the higher BED delivered in the Boost schedule may have a small adverse effect on GU QoL compared with Monotherapy. However, this did not translate to statistically significant differences in minimal clinically important changes. Whether the higher BED of the boost arm offers an efficacy advantage is being investigated in the Trans Tasman Radiation Oncology Group 18.01 NINJA randomized trial.

Incontinence outcomes in women undergoing retropubic mid-urethral sling: a retrospective cohort study comparing Safyre™ and handmade sling.

ABSTRACTPurpose This study examined and compared efficacy, safety, satisfaction, and complications of the retropubic Safyre™ sling and a retropubic hand-made synthetic sling (HMS) in a short-, mid- and long-term follow-up.Methods We retrospectively reviewed a prospectively maintained database of women who underwent Safyre™ or HMS between March 7ths 2005 and December 27ths, 2017. Patients had first assessment (7-10 days), second (40-45 days), and third (sixth month) postoperatively. Between September and December 2018, patients who completed at least one year of surgery, received a telephone call. Follow-up compared quartiles of follow-up time to determine complications (Clavien-Dindo), success rates (International Consultation on Incontinence Modular Questionnaire for Urinary Incontinence Short Form – ICIQ-UI SF), and patient satisfaction.Results Three hundred fifty-one patients underwent surgery and 221 (63%) were evaluated after a median of 78.47 (± 38.69) months, 125 (55%) in the HMS, and 96 (45%) in the Safyre™ group. Higher intraoperative bladder injury was observed with Safyre™ (0% vs. 4.2%, p=0.034), and a tendency for urinary retention, requiring indwelling urinary catheter over 24 hours (2.4% vs. 8.3%, p=0.061). Both HMS (p<0.001) and Safyre™ (p<0.001) presented improvements on ICIQ-UI SF. There were no differences in satisfaction, subjective cure rates, ICIQ-UI SF, or complications between groups.Conclusions Both HMS and Safyre™ have similar satisfaction and subjective cure rates, with marked ICIQ-UI SF score improvement. Higher rates of intraoperative bladder injury were seen in patients who received Safyre™ retropubic sling.

PD27-11 PREREHABILITATION CAN IMPROVE URINARY CONTINENCE IN PATIENTS AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 May 2022PD27-11 PREREHABILITATION CAN IMPROVE URINARY CONTINENCE IN PATIENTS AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY Aleksandra Juszczak, Tomasz Konecki, Piotr Kutwin, Łowicki Roman, Marcin Cichocki, and Zbigniew Jabłonowski Aleksandra JuszczakAleksandra Juszczak More articles by this author , Tomasz KoneckiTomasz Konecki More articles by this author , Piotr KutwinPiotr Kutwin More articles by this author , Łowicki RomanŁowicki Roman More articles by this author , Marcin CichockiMarcin Cichocki More articles by this author , and Zbigniew JabłonowskiZbigniew Jabłonowski More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002575.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stress urinary incontinence (SUI) is still one of the major complications after laparoscopic radical prostatectomy (LPR). This is a big problem for patients and physiotherapists. This may happen to most patients soon after surgery. The aim of the study was to assess whether the use of pre-rehabilitation before LRP would reduce the symptoms of SUI. METHODS: 70 patients were included. They were randomly divided into two groups. In group I (n = 36), patients underwent pelvic floor muscle rehabilitation 1 month before surgery and continued rehabilitation after surgery, group II (n = 34) began rehabilitation one month after surgery. Postoperative therapy was the same in both groups. Ultrasound, biofeedback therapy and pelvic floor muscle training were used. Urinary incontinence results were compared between the groups at 1st and 6th months after the procedure. RESULTS: CONCLUSIONS: The implementation of pre-rehabilitation significantly accelerated the results in terms of return to continence in patients after radical prostatectomy in the 1st and 6th month after the surgery. The use of pre-rehabilitation should be considered as a way to improve pelvic floor muscle activity and incontinence outcomes in patients undergoing LRP. Source of Funding: Own © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e497 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aleksandra Juszczak More articles by this author Tomasz Konecki More articles by this author Piotr Kutwin More articles by this author Łowicki Roman More articles by this author Marcin Cichocki More articles by this author Zbigniew Jabłonowski More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP22-06 THE IMPACT OF PROSTATE CANCER DISEASE PROGRESSION AND SALVAGE OR ADJUVANT TREATMENT ON ARTIFICIAL URINARY SPHINCTER DEVICE OUTCOMES

You have accessJournal of UrologyCME1 May 2022MP22-06 THE IMPACT OF PROSTATE CANCER DISEASE PROGRESSION AND SALVAGE OR ADJUVANT TREATMENT ON ARTIFICIAL URINARY SPHINCTER DEVICE OUTCOMES Shree Agrawal, Hanson Zhao, Joao Pedro Emrich Accioly, Hadley Wood, and Kenneth Angermeier Shree AgrawalShree Agrawal More articles by this author , Hanson ZhaoHanson Zhao More articles by this author , Joao Pedro Emrich AcciolyJoao Pedro Emrich Accioly More articles by this author , Hadley WoodHadley Wood More articles by this author , and Kenneth AngermeierKenneth Angermeier More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While utilization of artificial urinary sphincter (AUS) for post prostate cancer intervention incontinence can improve quality of life, AUS placement in men with prostate cancer (CaP) progression to biochemical recurrence (BR) or distant metastatic disease (DM) with respect to AUS outcomes has yet to be characterized. METHODS: Retrospective review of patients who underwent AUS implantation from 1/2009-8/2021 was performed. Demographics, comorbidities, CaP treatment, pathology, progression, timing of AUS following primary intervention, surgical characteristics, incontinence outcomes and device revisions were assessed by chi-square and Pearson’s t-test analyses. Multivariable Cox proportional hazards and Kaplan Meier models were used to assess time to AUS device revision by CaP progression. RESULTS: We identified 526 patients who underwent AUS implantation, 255 had complete CaP and AUS characteristics as summarized in the table. Mean follow up from AUS and primary CaP treatment was 56 and 118 months, respectively. Among 134 patients treated with radiation, 40 developed AUS complications with 11 erosions and 11 with recurrent incontinence (p=0.21). In 78 patients treated with androgen deprivation therapy (ADT), AUS complications were noted in 22 with 7 erosions and 6 with recurrent incontinence, prompting revision (p=0.77). BR occurred in 101 patients (40%), with 16% requiring AUS revision (p=0.92). DM developed in 28 patients (11%), with 8 undergoing AUS after DM diagnosis. On univariate analysis, only transcorporal cuff use [HR 3.6 (95% CI 1.7-7.3), p=0.001] significantly correlated with AUS revision.There was no significant difference in continence rates following AUS for patients who underwent prostatectomy, radiation therapy, ADT, or who developed BR or DM. A majority (76%) reported 0-1 pads/day at last follow up. AUS durability for those with BR, by 2 years was 92%, 5 years 85%, and by 10 years 60% (p=0.55). In DM, this was 96% by 2 years, 90% by 5 years, and 71% by 10 years (p=0.26). CONCLUSIONS: There were no significant differences in AUS outcomes between patients without CaP disease progression and those with BR, local recurrence, or DM. Based on this data, AUS implantation in patients undergoing salvage or adjuvant therapy may still be an effective procedure. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e373 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shree Agrawal More articles by this author Hanson Zhao More articles by this author Joao Pedro Emrich Accioly More articles by this author Hadley Wood More articles by this author Kenneth Angermeier More articles by this author Expand All Advertisement PDF DownloadLoading ...

Artificial urinary sphincter outcomes for post-radical prostatectomy urinary incontinence. A narrative review

Urinary incontinence post-radical prostatectomy is a common complication that might negatively impact patients’ quality of life. Treatments include medical and surgical options, being the insertion of an artificial urethral sphincter (AUS) the gold standard. The aim of this narrative review is to evaluate the outcomes of artificial urinary sphincter implantation for urinary incontinence developed post-radical prostatectomy with and without radiation, in terms of urinary continence and complications. The MEDLINE and Scopus search returned 477 articles. A total of eleven articles were included for qualitative analysis. A total of 707 men that met the inclusion criteria were included. The 22.6% of the men (160 patients) received pelvic external beam radiotherapy prior to the implantation of the artificial urinary sphincter. The overall continence success rate was defined by the use of pads. Some authors reported a success rate of 0 pads per day (PPD) or ≤ 1 PPD in the last follow-up. The complications included urethral atrophy, mechanical failure, revision and/or removal of the device, infection and erosion. Further prospective studies should be done to clarify continence concepts after the placement of an AUS and long-term complications.