Intrinsic Sphincter Deficiency Research Articles

Volume at First Leak Is Associated With Sling Failure Among Women With Stress Urinary Incontinence.

Stress urinary incontinence at a low bladder volume is a clinically observed phenomenon that is not well studied with regard to treatment outcomes. The primary aim of our study was to determine if the volume at first leak is associated with sling outcome. This is a retrospective cohort study evaluating whether urodynamic stress urinary incontinence observed at low volumes is associated with sling failure using the Synthetic Derivative database. Sling failure was defined as (1) undergoing a subsequent surgery for stress incontinence (eg, urethral bulking agent, repeat sling) or (2) leakage that was subjectively worse or unchanged from baseline. Sling success was defined as subjective improvement in incontinence or being dry. Intrinsic sphincter deficiency was defined as maximum urethral closure pressure 20 cm H20 or less or abdominal leak point pressure less than 60 cm H20. Outcome data were available for 168 of 206 women who underwent a sling after urodynamic testing from 2006 to 2014. Of the 168 women, 80 were transobturator, 79 were retropubic, 8 lacked data regarding the approach to the midurethral sling, and 1 was an autologous pubovaginal sling. Similar failure rates were seen for transobturator (10%) and retropubic slings (7.6%). Preoperative urodynamic parameters, such as cystometric capacity and intrinsic sphincter deficiency, were similar among failed and successful slings. For every additional 50 mL in bladder volume at first leak (SUIvol), there was a 1.6 increased odds of having a successful sling (odds ratio, 1.576; 95% confidence interval, 1.014-2.450; P = 0.04). There was no statistically significant association between maximum urethral closure pressure, abdominal leak point pressure, body mass index, age, sling type, or whether a prior anti-incontinence procedure had been performed and sling success. Bladder volume at first leak is a strong predictor of sling failure.

Surgical Management of Stress Urinary Incontinence

Stress urinary incontinence (SUI) is a prevalent and distressing condition that affects up to 50% of women over their lifetime. If nonsurgical treatments are not effective, surgery is highly successful. Preoperative evaluation includes at minimum a thorough history and physical examination, urinalysis, demonstration of SUI, assessment of urethral mobility, and measurement of postvoid residual urine volume. The midurethral sling is the most studied surgical procedure for urinary incontinence and is safe and highly effective. With the recent concern about permanent mesh in urogynecologic surgery, many patients might choose a laparoscopy- or robot-assisted Burch colposuspension or fascial sling. This review contains 5 figures, 5 tables and 38 references Key words: intrinsic sphincter deficiency, mesh, midurethral sling, minimally invasive surgery, preoperative evaluation, retropubic colposuspension, stress urinary incontinence, urethral bulking, urodynamic testing

Do urodynamics provide a better understanding of voiding disorders in women over 80?

Population ageing has as consequence an increasing number of women older than 80 years with lower urinary tract symptoms (LUTS). Despite old age, urodynamic study is often performed to diagnose the cause of LUTS. Our purpose is to discuss the contribution of urodynamics to manage that population. Urodynamic studies of 169 consecutive women older than 80 years, respectively 124 non-neurological (non-N) and 45 neurological (N), were retrospectively analysed. Number of co-morbidities was lower in non-N (2.5 vs. 3.1) with predominance of cardiovascular and endocrinology while musculo-skeletal, cognitive and previous pelvic surgery predominated in N. Among main complaint, incomplete retention or dysuria was more frequent in N while incontinence and frequency were predominant in non-N. More frequent urodynamic diagnosis (UD) was "normal" i.e. non contributive (25.0%) and intrinsic sphincter deficiency (ISD=21.7%) in non-N, detrusor overactivity (DO=42.2%) and detrusor underactivity (DU=38.8%) in N. In non-N, there were 94 treatment proposals based on the complaint when UD was "normal" and on UD for DO, DU and ISD. In N, treatment proposals were mainly prompted voiding or self-catheterization based on DU diagnosis. Usefulness of urodynamics to manage LUT dysfunction in women older than 80 y is greatly dependent on their neurological status. In non-neurological women this is non debatable but proposed treatment needs to take into account existing co-morbidities. In neurological women the main usefulness is to unmask DU and to propose the best management in order to avoid complete retention. 4.

Sonographic evaluation of bladder wall thickness in women with lower urinary tract dysfunction.

ObjectiveTo investigate the correlation between bladder wall thickness (BWT) measured by ultrasonography and lower urinary tract dysfunction (LUTD) in patients with lower urinary tract symptoms (LUTS).MethodsForty-eight women with LUTS who underwent urodynamic study and BWT by ultrasonography as outpatients were studied. We assessed LUTS during a medical examination by interview. The thinnest part of the bladder wall was measured by a transabdominal ultrasonography. We excluded patients who had visited another hospital previously because we did not know what treatment they had received, including medications, behavioral therapy, or other treatments. We constructed receiver operating characteristic (ROC) curves for diagnosis of LUTD and also determined reliable BWT criteria by calculating the area under the curve. Statistical analyses were performed using the Kolmogorov-Smirnov method and Student's t-test.ResultsThe mean age, body mass index, and duration of symptoms were 59.9±9.7 years, 26.06±3.4 kg/m2, and 53.4±38.2 months, respectively. Urodynamic study parameters (Valsalva leak point pressure, maximal urethral closure pressure, functional length, and postvoid residual volume) were lower in patients with BWT <3 mm; however, these differences were not significant. Patients with BWT ≥3 mm developed a hypoactive bladder (P=0.009) and intrinsic sphincter deficiency (ISD) (P=0.001) at a significantly higher rate. According to the ROC analysis, the best BWT cut-off value was 3 mm for overactive bladder diagnosis.ConclusionsWomen with LUTD showed higher BWT values (≥3 mm), especially patients with hypoactive bladder and ISD. Sonographic evaluation of BWT is an easy, fast, and noninvasive method for possible diagnostic tool for LUTD.

The Urological Society of India survey on urinary incontinence practice patterns among urologists.

Introduction:The Urological Society of India guidelines panel on urinary incontinence (UI) conducted a survey among its members to determine their practice patterns in the management of UI. The results of this survey are reported in this manuscript.Methods:An anonymous online survey was carried out among members of the USI to determine their practice patterns regarding UI using a predeveloped questionnaire on using SurveyMonkey®. A second 4-question randomized telephonic survey of the nonresponders was performed after closure of the online survey. Data were analyzed by R software 3.1.3 (P < 0.05 significant).Results:A total of 468 of 2109 (22.2%) members responded to the online survey. Nearly 97% were urologists, 74.8% were working at a private, and 39.4% were in an academic institution. Almost all were managing UI. 84.2% had local access to a urodynamics (UDS) facility. 85.8% would check postvoid residual urine for all the patients. Voiding diary, symptom scores, quality of life scores, pad test, Q-tip test, stress test, uroflow, and cystoscopy were ordered as part of evaluation by 86.0%, 49.8%, 24.4%, 22.0%, 6.0%, 71.8%, 69.2%, and 34.7%, respectively. 47.6% would order a UDS for patients with urgency UI who fail conservative treatment. 36.9% would get UDS prior to all stress UI surgery. Seventy-five percent would make a diagnosis of intrinsic sphincter deficiency. Solifenacin was the first choice for urgency UI in general and darifenacin was preferred in elderly. Botulinum was the first choice for refractory urgency UI. Midurethral sling was the commonest procedure for surgical management of SUI (95.1%). 147 of the 1641 non responders were randomly sampled telephonically. Telephonic respondents had similar access to UDS facility but had performed fewer lifetime number of post-prostatectomy incontinence (PPI) surgeries. Combining data from both surveys, total number of artificial sphincters and PPI surgeries ever performed by USI members was estimated at 375 and 718 respectively.Conclusion:This survey provides important new data and elicits critical differences in management practices based on demographics.

A re-adjustable sling for female recurrent stress incontinence and intrinsic sphincteric deficiency: Long-term results in 205 patients using the Remeex sling system.

To evaluate the outcomes and complications at long-term follow-up after a Remeex re-adjustable sling for recurrent stress urinary incontinence (rSUI) and intrinsic sphincteric deficiency (ISD) in women. Two hundred thirty women with SUI were evaluated after undergoing a re-adjustable sling operation. Twenty-five patients were lost to follow-up, 205 were classified by Q-tip, urodynamic, and clinical criteria into ISD (109) and rSUI (96). Outcome measures included number of pads, 1 h pad-test, urodynamics and subjective satisfaction index with the procedure. After a mean follow-up of 89 months (26-159), 165 patients were cured of SUI (71.7% in the intention to treat analysis (itt), 80.5% in per protocol analysis (pp)). Forty patients remained incontinent (17.4% in itt, 19.5 in pp). Thirty-one patients (15.1%) had detrusor overactivity (DH) incontinence, 21 (10.2%) with de-novo DH and 10 with previous urodynamic mixed incontinence. Eighty-eight patients required re-adjustment of the sling during the follow-up. The tension was increased in 82 cases due to recurrence of SUI and reduced in six due to outlet obstruction. The overall complications rate was 28.8%, (3.4% clavien III). The Remeex re-adjustable sling provides a good cure rate for rSUI and ISD at long-term follow-up. The complications rate is acceptable since most complications are clavien II. The ability to re-adjust the sling tension during the follow-up allowed us to achieve cure for recurrence after the initial procedure, and to relieve obstruction in every case attempted.

Efficacy of the inside-out tramsobturator tension-free vaginal tape (TVT-ABBREVO) for the treatment of stress urinary incontinence after a 12-month follow-up

The aim of this study was to evaluate the efficacy of the inside-out tension-free vaginal tape transobturator approach or TVT-Obturator system (TVT-ABBREVO) in women with stress urinary incontinence (SUI). This is a prospective single arm study of women with SUI who underwent a TVT-ABBREVO procedure. The inclusion criterion was a diagnosis of SUI urodynamically proven without detrusor over activity. SUI was defined as involuntary urine leakage with stress in the absence of detrusor over activity with or without intrinsic sphincter deficiency. Before, and 12 months after surgery women received urodynamic test, pelvic examination, and a personal interview using the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). The primary outcome was the incidence of incontinency through cough stress test during the urodynamic exam. A total of 90 women were included in the analysis. Our analysis showed that the incidence of incontinence through cough stress test during the urodynamic exam was significantly less 12 months after the intervention (100% vs 3%; P-value =0.001). Moreover, we found a significantly improvement of the quality of life measured by UDI score (13±4.5 vs 7.3±2.2 points; P-value 0.01) and IIQ score (14±5.7 vs 8.1 vs 3.1 points; P-value 0.02). No intraoperative complications were noticed. TVT-ABBREVO significantly reduced the incidence of stress urinary incontinence. In the authors’ experience, this technique resulted technically simple and provided high objective and subjective long-term efficacy, a clinically meaningful improvement in patient quality of life, and an excellent safety profile.

Decreased Urethral Volume Is Comparable to Funneling as a Predictor of Intrinsic Sphincter Deficiency.

The aims of this study were to determine the association between x-ray funneling and ultrasound urethral sphincter complex measurements and to compare the reliability of funneling versus urethral volume measurement in the detection of intrinsic sphincter deficiency (ISD). This was a retrospective analysis, which included 54 stress incontinent women dichotomized into those with (1) ISD and (2) no ISD. The presence of bladder neck funneling was diagnosed by fluoroscopic images obtained at the time of video-urodynamics testing. Measurements of the urethral sphincter complex were obtained from ultrasound volumes. Reliability measures were obtained for both funneling and urethral volume measurements. Rhabdomyosphincter length and area were found to be smaller in patients with funneling compared with those with no funneling (P = 0.0161, P = 0.0359). The urethral volume was significantly smaller in the ISD versus no-ISD group (P = 0.0002). For those who had funneling, the ISD group had smaller urethral volume compared with the no-ISD group (P = 0.0019). For those who did not have funneling, the ISD group still had a smaller urethral volume compared with the no-ISD group (P = 0.0054). An ultrasound urethral volume of less than 3.5 cm had a sensitivity of 81% and a specificity of 64% for the presence of ISD, whereas x-ray funneling had a sensitivity of 76% and a specificity of 73%. Smaller rhabdomyosphincter length and area on ultrasound are associated with x-ray funneling. Ultrasound urethral volume of 3.5 cm as a cutoff provides the same reliability as x-ray funneling for the diagnosis of ISD.

Efficacy and Initial Safety Profile of CXCL12 Treatment in a Rodent Model of Urinary Sphincter Deficiency.

Disappointing results of skeletal muscle precursor cell (skMPC) therapy for women with intrinsic urinary sphincter deficiency (ISD) associated urinary incontinence has increased interest in alternative sphincter regenerative approaches. This study was to measure the safety and efficacy of the cell homing chemokine CXCL12 versus skMPCs in a rat model of ISD. Thirty‐six adult female Sprague Dawley rats were divided into 6 treatment (Tx) conditions: (a) no ISD/noTx [Control]; (b) ISD/noTx; (c) ISD + skMPCs; (d) ISD + 3.5 mg CXCL12; (e) ISD + 7mg CXCL12; and (f) ISD + 14 mg CXCL12. Tx's were injected directly into the sphincter complex 30 days post ISD and rats euthanized 30 days post Tx. Blood samples for measurements of kidney and liver function, white and red blood cell counts, were taken at baseline and at euthanasia. Leak point pressures (LPP) were measured prior to, and sphincter collagen/muscle content measured after, euthanasia. There were no effects of treatments on white or red/white blood cell counts, kidney/liver function tests or histopathology of the urinary sphincter complex or surrounding tissues. ISD lowered LPP 35% and sphincter muscle content by 17% versus control rats. CXCL12, but not skMPC injections, restored both LPP to control values in a dose‐dependent fashion. Both skMPCs and CXCL12 restored sphincter muscle content to control values. This chemokine approach may represent a novel therapeutic option for ISD and appears, at least short‐term, to produce little clinical or tissue pathology. Stem Cells Translational Medicine 2017;6:1740–1746

Editorial Comment to Retropubic tissue fixation system tensioned mini-sling carried out under local anesthesia cures stress urinary incontinence and intrinsic sphincter deficiency: 1-year data.

Editorial Comment to Retropubic tissue fixation system tensioned mini-sling carried out under local anesthesia cures stress urinary incontinence and intrinsic sphincter deficiency: 1-year data.

A Study of Clinical Predictors Associated With Intrinsic Sphincter Deficiency in Women With Stress Urinary Incontinence.

PurposeRecently, intrinsic sphincter deficiency (ISD) has been identified as one important factor in the outcome of stress urinary incontinence (SUI) related surgery. Clinical factors that can predict ISD are uncommon. The aim of this study was to determine predictive clinical factors for ISD in female patients with SUI.MethodsThe patients were classified into 3 groups according to the value of Valsalva leak point pressure (VLPP)>90 cm H2O (anatomical incontinence, AI), between 61 and 90 cm H2O (equivocal, EV), and <60 cm H2O (ISD). All groups underwent a full examination, history evaluation, physical examination, uroflowmetry, and complete urodynamic study. Univariate analysis was performed by chi-square or t-test for categorical variables, respectively. A multivariate study was performed by Pearson correlation analysis in order to get clinical predictors of VLPP<60 cm H2O. Statistical significance was set at P<0.05.ResultsThere were 3 groups with a total of 189 patients: 56 patients (AI, 29.7%), 64 patients (EV, 33.8%), and 69 patients (ISD, 36.5%). The univariate analysis revealed a significant difference associated with maximal urethral closing pressure (P=0.03) and Stamey classification (P=0.006) between ISD and AI. The more severe the urinary symptom grade, the higher the frequency of ISD. However, the multivariate analysis showed the independent predictor of ISD is only present in grades II and III symptoms in the Stamey classification (P=0.001).ConclusionsIt was found that the more severe the symptoms of urinary incontinence, the higher the possibility of ISD. In other words, the degree of urinary incontinence was found to be one relevant clinical factor in predicting ISD. This finding may help in evaluating and identifying the appropriate surgical technique for EV. Currently, absolute cutoff value to diagnose ISD has not yet been determined. More research is needed to identify clinical factors that can predict ISD.

Choosing the right sling for your patient.

Recent data has demonstrated a one in five lifetime risk of a woman requiring stress urinary incontinence (SUI) surgery. Currently, most women opt for a synthetic midurethral sling (MUS), with over 3.6 million placed worldwide. This article attempts to identify whether a gold standard exists with regards to surgical correction of female SUI. When considering which sling type to use for which incontinent woman, the published data demonstrates excellent results for both synthetic mesh (retropubic or transobturator routes) and fascial pubovaginal slings for most patients. Intrinsic sphincter deficiency does appear to be better treated with the use of a retropubic approach, although still with less than stellar results. With little to differentiate, the treatment of most female SUI may be solely based on which sling the surgeon feels most comfortable performing. Currently, most urologists and gynecologists favour synthetic MUS over fascial slings in surgical-naïve patients; however, recent U.S Food and Drug Administration (FDA) warnings concerning the use of mesh in transvaginal surgery have patients questioning the safety of synthetic MUS for the treatment of SUI.

Efficacy of the Artificial Urinary Sphincter ZSI 375 for Treatment of Post-Radical Prostatectomy Incontinence in Patients with Intrinsic Sphincter Deficiency: A Preliminary Study

Objectives: To evaluate the efficacy of the ZSI 375 artificial urinary sphincter (AUS) (Zephyr Artificial Sphincter, Geneva, Switzerland) for the treatment of patients with post-radical prostatectomy urinary incontinence. Methods: This was a retrospective, non-randomised, multicentre study open to patients with moderate-to-severe urinary incontinence due to intrinsic sphincter deficiency after radical prostatectomy. Efficacy and safety was evaluated on continence status, complications, and surgical revision. Results: Twenty-seven patients were recruited between September 2013 and April 2016 and followed up to April 2017. Mean age was 67.70 years old (range: 55–78). Twenty-six patients (96.30%) presented with incontinence post-radical prostatectomy and one patient (3.70%) after post-radical prostatectomy plus adjuvant radiotherapy. Follow-up ranged from 12 months–42 months (mean: 27.11). The success rate was 88.90% after 12 months follow-up, 94.12% after 24 months follow-up and 83.33% after 36 months follow-up. Three patients (11.11%) presented with a scrotal infection, two patients (7.41%) suffered a urethral erosion, and two patients (7.41%) had a mechanical failure. The revision rate was 22.22% (six patients). Conclusion: The follow-up time of this preliminary clinical study was long enough to demonstrate that the ZSI 375 AUS offers a good rate of continence to patients with urinary stress incontinence.

Retropubic tissue fixation system tensioned mini-sling carried out under local anesthesia cures stress urinary incontinence and intrinsic sphincter deficiency: 1-year data.

To assess the outcomes of the tissue fixation system midurethral sling for the treatment of intrinsic sphincter deficiency. We retrospectively studied a total of 96 intrinsic sphincter deficiency patients treated with the tissue fixation system midurethral sling at Yokohama Motomachi Women's Clinic from 2006 to 2015. We evaluated intraoperative and 1-year postoperative results. Regarding the cure rate, we divided patients into three groups: (i) patients with maximum urethral closure pressure <20 and Valsalva leak point pressure <65 combined (n = 17); (ii) patients with maximum urethral closure pressure <20 (n = 55); and (iii) patients with Valsalva leak point pressure <65 (n = 47). The median age was 63 years (range 38-89 years). The median operating time including local anesthesia was 24 min (range 12-55 min) and median blood loss was 5.0 mL (range 3-69 mL). All operations were day surgery under local anesthesia. Postoperative pain was minimal. All patients were discharged the same day. There were no intraoperative complications except one bladder perforation. There were no tape rejections. The 1-year postoperative cure rates were: 88.2% among patients with maximum urethral closure pressure <20 and Valsalva leak point pressure <65, 90.9% for patients with maximum urethral closure pressure <20, and 85.1% among patients with Valsalva leak point pressure <65. The tissue fixation system midurethral sling operation is a simple, safe and effective operation for older women with intrinsic sphincter deficiency, and it can be carried out under local anesthesia.

Long-term outcomes of autologous fascia lata sling for stress incontinence secondary to intrinsic sphincter deficiency in women

ObjectiveTo report our long-term pubovaginal sling (PVS) outcomes using fascia lata for stress urinary incontinence (SUI) secondary to intrinsic sphincteric deficiency (ISD). Methodology and methodsFollowing Institute Review Board approval, charts from women undergoing PVS with fascia lata, with at least 6 months of follow up, were reviewed. Preoperative and postoperative data collected included demographics, validated questionnaires, prior anti-incontinence procedures, associated repairs, urodynamic findings, and reoperation procedures for SUI. Success was defined as cure of SUI (no pad, UDI-6 Question 3 related to SUI at ≤ 1, and no SUI reoperation). ResultsBetween 1997 and 2013, 22 women met the inclusion criteria with mean age of 73 (52–88) years, mean BMI 29 (17–38) and mean parity 2.7 (1–4). Mean follow up was 96 months (8–190). Indication for fascia lata sling included obesity (13) and prior abdominal procedures (9), including abdominoplasty. Fifteen women had received one or more prior antiincontinence procedures and five a prior injectable agent. No perioperative complications were noted. Overall, 14 of 22 women met success criteria [UDI-6 Question 3 at 0 (10) and at 1 (4)]. Three women underwent a subsequent procedure for residual SUI with periurethral bulking agent and one is awaiting an artificial urinary sphincter. ConclusionAt long-term follow-up of over 8 years after fascia lata sling, women who underwent fascia lata sling had acceptable continence outcomes with minimal complications.

IJU this issue

Treatment of advanced renal cell carcinoma has progressed significantly in the past decade. Pal et al. (Duarte, CA, USA) reported a large retrospective review of advanced renal cell carcinoma in the USA. They reviewed the medical charts of 1173 patients from 318 physicians, and indicated that sunitinib and everolimus remain the most commonly used first and second targeted therapies, respectively. This article shed light on real-world practice in the USA. Cancer-related death is rare for men with biopsy-confirmed prostate cancer and a Gleason score of ≤6. This seems to be partly explained by undergrading of biopsies. Alberts et al. (Rotterdam, the Netherlands) retrospectively reviewed the biopsy specimens of 98 men with a Gleason score of ≤6 or 3 + 4 = 7. This review included 15 men who died, and had a clinical T 1/2 Gleason score of ≤6 at prevalence screening in the European Randomized study of Screening for Prostate Cancer Rotterdam cohort. They also confirmed that the International Society of Urological Pathology 2014 grading system was more accurate for prognostic assessment than the classic Gleason score. This issue includes two interesting Original Articles focusing on prostate biopsy. Shoji et al. (Tokyo, Japan) reported the accuracy of a new technique, real-time magnetic resonance imaging-transrectal ultrasound fusion transperineal target biopsy for biopsy-naïve men. They concluded that targeted biopsy is superior to conventional systemic biopsy. However, a systemic biopsy is still important, because although targeted biopsy alone diagnosed 79% of significant cancers, combined targeted + systematic biopsies diagnosed 95% of significant cancers. Kamei et al. (Tokyo, Japan) reported the prevalence and characteristics of fecal antimicrobial-resistant Escherichia coli in Japanese men undergoing transrectal prostate biopsy. Transrectal biopsy is a common procedure for the diagnosis of prostate cancer, but it has a risk of life-threatening infectious complications. Current guidelines recommend prophylactic use of fluoroquinolone. However, the results of the study revealed fecal carriage rates of fluoroquinolone-resistant E. coli and extended-spectrum b-lactamase-producing E. coli at 9.8% and 5.9%, respectively. An important article in functional urology, Ferreira et al. (Le Mans, France) reported the midterm outcomes of laparoscopic implantation of artificial urinary sphincters in women with intrinsic sphincter deficiency. They reported that 76% of patients experienced resolution, and 16% reported improvement of incontinence. The report was one of the largest series with the longest follow up for this patient population. This issue included two interesting Case Reports. The first report by Fahmy et al. (Selangor, Malaysia) described a unique ureteral substitution technique using buccal mucosa for a 64-year-old woman with a long proximal ureteral stricture after multiple bowel surgeries. Postoperative renal function was improved. The second report by Sugino et al. (Nagoya, Japan) presented a case of the successful treatment of an impacted ureteral stone in a 2-year-old girl with a single session of combined percutaneous nephrostomy and ureteroscopy using a holmium laser.

PD25-07 DURASPHERE AS NEW AGENT FOR THE TREATMENT OF HYPERMOBILE GLANS

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy III1 Apr 2017PD25-07 DURASPHERE AS NEW AGENT FOR THE TREATMENT OF HYPERMOBILE GLANS Jared J. Wallen, SK Madiraju, KG Tayon, MS Gross, RE Carrion, and PE Perito Jared J. WallenJared J. Wallen More articles by this author , SK MadirajuSK Madiraju More articles by this author , KG TayonKG Tayon More articles by this author , MS GrossMS Gross More articles by this author , RE CarrionRE Carrion More articles by this author , and PE PeritoPE Perito More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1202AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite proper sizing and placement of a penile implant, a subset of patients present postoperatively with glanular hypermobility. This is characterized by sensation of a soft glans penis, pain during intercourse associated with cylinder tip pressure, or the appearance of droopy glans with maximal inflation. Previous studies have discussed the use of PDE5 inhibitors and/or intraurethral alprostadil to treat the hypermobile glans. In this study we present our results of subcoronal Coloplast (Minneapolis, MN) Durasphere® injections as a surgical treatment for the hypermobile glans. METHODS Durasphere is a safe, sterile bulking agent composed of carbon-coated zirconium beads suspended in a water based beta-glucan gel. It has long been used as a bulking agent in the treatment of urinary incontinence caused by intrinsic sphincter deficiency (ISD). This is a retrospective review of 16 patients who underwent glanular bulking with Durasphere by a single surgeon from 2014-16. Patient data were compiled after extensive review of operative reports, inpatient notes, consult notes, and follow-up visits. RESULTS Sixteen patients underwent a total of 61 subcoronal Durasphere injections (mean 3.6, range 2-8). Fifteen of these patients have been seen in follow-up on average 50.5 weeks since their injections. 86.6% reported satisfaction with their treatment regimen quoting reduced or absent pain during intercourse and subjectively improved stability of their glans penis as reasons for satisfaction. 3 adverse events have been noted but all have healed with conservative management and no patients have lost their implant. CONCLUSIONS Durasphere has a safe and effective history in ISD treatment and our initial data suggests that similarly successful results are obtainable for glanular hypermobility treatment in experienced hands. We believe subcoronal Durasphere injections should be a viable option in the armamentarium of treatments for true glanular hypermobility due to high patient satisfaction, ease of intervention, and low adverse events. Proper diagnosis requires expert evaluation to ensure that the penile implant is appropriately sized and positioned in order to rule out floppy glans syndrome and SST deformity. As opposed to true glanular hypermobility, these conditions are caused by an undersized implant and require surgical revision. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e504 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jared J. Wallen More articles by this author SK Madiraju More articles by this author KG Tayon More articles by this author MS Gross More articles by this author RE Carrion More articles by this author PE Perito More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP63-13 DOES VIDEOURODYNAMIC CLASSIFICATION DEPEND ON PATIENT POSITIONING IN PATIENTS WITH STRESS URINARY INCONTINENCE?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2017MP63-13 DOES VIDEOURODYNAMIC CLASSIFICATION DEPEND ON PATIENT POSITIONING IN PATIENTS WITH STRESS URINARY INCONTINENCE? Hazel Ecclestone, Eskinder Solomon, Rizwan Hamid, Mahreen Paksad, Daniel Wood, Tamsin Greenwell, and Jeremy Ockrim Hazel EcclestoneHazel Ecclestone More articles by this author , Eskinder SolomonEskinder Solomon More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , Mahreen PaksadMahreen Paksad More articles by this author , Daniel WoodDaniel Wood More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , and Jeremy OckrimJeremy Ockrim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1965AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Videourodynamic studies (VUDS) are often used to assess stress urinary incontinence (SUI). Treatment options are based on the degree of hypermobility and intrinsic sphincter deficiency. The most common classification on VUDS of SUI by Blaivas-Olsson is described in the semi-oblique position. However, most urodynamics are performed supine or standing with advocates of standing position suggesting that this stance permits gravity to enhance prolapse and aid diagnosis. We assessed the difference in Blaivas-Olsson grading in either positions. METHODS 121 consecutive women with SUI underwent videourodynamic study prior to operative intervention. SUI was assessed in both supine and standing positions and the extent of descent was classified according to Blaivas-Olsson criteria. Differences between the positions was assessed using Fisher's exact test with p <0.05 being significant. RESULTS 72 of 121 SUI classifications remained the same in both lying and standing positions. 49 gradings were upgraded with position (40%); no patients were downgraded. Of the 49 patients whose grading changed, 20 (16.5%) had non-demonstrable SUI converted to demonstrable (i.e. grade 0 converted to I, IIa, IIb or III); 22 patients with SUI in the supine position were upgraded by one grade (I -IIa (10) and IIa-IIb (12)) and 7 were upgraded by two grades from I to IIb (Figure). The difference in the distribution of SUI grading between supine and standing positions was statistically significant (p < 0.01) CONCLUSIONS 16.5% of patients only had SUI demonstrable in the standing position. 40% Blaivas-Olsson classifications were upgraded with patients in the standing position. This has important implications for practice. To best replicate symptoms, and minimise the chance of underestimating both incontinence and the degree of descent, we suggest that videourodynamics are performed using standardised methodology in both lying and standing positions. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e840 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Hazel Ecclestone More articles by this author Eskinder Solomon More articles by this author Rizwan Hamid More articles by this author Mahreen Paksad More articles by this author Daniel Wood More articles by this author Tamsin Greenwell More articles by this author Jeremy Ockrim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Therapeutic Efficacy of a New Procedure for Male Urinary Incontinence Combining a Suburethral Polypropylene Mesh and Cardiovascular Patch.

PurposeStress urinary incontinence (SUI) in men is a complication secondary to prostatectomy or resulting from neurological lesions. This study presents our experiences with male suburethral slings over the past decade.MethodsIn this study, we considered patients who presented with SUI and were diagnosed with an intrinsic sphincteric deficiency due to postprostatectomy incontinence (PPI) or other causes (non-PPI). Patients who underwent the suburethral sling procedure using a polypropylene mesh and a cardiovascular patch were retrospectively included. An urodynamic study was performed before and after the operation. Global response assessment (GRA) and SUI grading were used for surgical outcome. The revision rate and the infection rate were also evaluated.ResultsA total 31 patients were enrolled in this study; the mean patient age was 59.5±18.9 years, and the mean follow-up period was 36.9±29.4 months. Fourteen patients comprised the non-PPI group and 17 were in the PPI group. The preoperative SUI of all patients were categorized as a moderate to severe problem according to the SUI grade, with a mean score of 2.32±0.48 before the operation and 0.48±0.57 after the operation. With a mean score of 2.35±0.71, GRA showed that the patients were satisfied with the treatment. After the sling procedure, 4 patients (13%) reported a mild improvement, 12 (38.7%) a moderate improvement, while 15 (48.4%) reported an excellent improvement. Six patients (19.4%), including 5 from the non-PPI group (35.7%) and 1 (5.9%) from the PPI group (P=0.037), underwent sling removal because of infection.ConclusionsThe male suburethral sling procedure using a polypropylene mesh and a cardiovascular patch is a safe, efficacious, and inexpensive surgical procedure for PPI. In cases of neurological incontinence, however, the higher infection rate in non-PPI patients means that they should be carefully managed.

865 - Effectiveness of adjustable slings (Remeex system™) in women with stress urinary incontinence due to intrinsic sphincter deficiency

865 - Effectiveness of adjustable slings (Remeex system™) in women with stress urinary incontinence due to intrinsic sphincter deficiency