Leak Point Research Articles

Combined Treatment With CCR1-Overexpressing Mesenchymal Stem Cells and CCL7 Enhances Engraftment and Promotes the Recovery of Simulated Birth Injury-Induced Stress Urinary Incontinence in Rats.

Objective: To observe whether urethral injection of chemokine (c-c motif) ligand 7 (CCL7) and overexpressing CC receptor 1 (CCR1) in mesenchymal stem cells (MSCs) can promote their homing and engraftment to the injured tissue, and improve the recovery of simulated birth injury-induced stress urinary incontinence (SUI) in rats.Methods: Female rats underwent a dual injury consisting of vaginal distension (VD) and pudendal nerve crush (PNC) to induce SUI. Bone marrow-derived MSCs were transduced with lentivirus carrying CCR1 (MSC-CCR1) and green fluorescent protein (GFP). Forty virgin Sprague–Dawley rats were evenly distributed into four groups: sham SUI + MSC-CCR1+CCL7, SUI + MSCs, SUI + MSC-CCR1, and SUI + MSC-CCR1+CCL7 group. The engrafted MSCs in urethra were quantified. Another three groups of rats, including sham SUI + sham MSC-CCR1+CCL7 treatment, SUI + sham MSC-CCR1+CCL7 treatment, and SUI + MSC-CCR1+CCL7 treatment group, were used to evaluate the functional recovery by testing external urethral sphincter electromyography (EUS EMG), pudendal nerve motor branch potentials (PNMBP), and leak point pressure (LPP) 1 week after injury and injection. Urethra and vagina were harvested for histological examination.Results: The SUI + MSC-CCR1+CCL7 group received intravenous injection of CCR1-overexpressing MSCs and local injection of CCL7 after simulated birth injury had the most engraftment of MSCs to the injured tissues and best functional recovery from SUI compared to other groups. Histological examination showed a partial repair in the SUI + MSC-CCR1+CCL7 group.Conclusions: Our study demonstrated combined treatment with CCR1-overexpressing MSCs and CCL7 can increase engraftment of MSCs and promote the functional recovery of simulated birth trauma-induced SUI in rats, which could be a new therapeutic strategy for SUI.

Therapeutic potential of muscle growth promoters in a stress urinary incontinence model.

Weakness of urinary sphincter and pelvic floor muscles can cause insufficient urethral closure and lead to stress urinary incontinence. Bimagrumab is a novel myostatin inhibitor that blocks activin type II receptors, inducing skeletal muscle hypertrophy and attenuating muscle weakness. β2-Adrenergic agonists, such as 5-hydroxybenzothiazolone derivative (5-HOB) and clenbuterol, can enhance muscle growth. We hypothesized that promoting muscle growth would increase leak point pressure (LPP) by facilitating muscle recovery in a dual-injury (DI) stress urinary incontinence model. Rats underwent pudendal nerve crush (PNC) followed by vaginal distension (VD). One week after injury, each rat began subcutaneous (0.3 mL/rat) treatment daily in a blinded fashion with either bimagrumab (DI + Bim), clenbuterol (DI + Clen), 5-HOB (DI + 5-HOB), or PBS (DI + PBS). Sham-injured rats underwent sham PNC + VD and received PBS (sham + PBS). After 2 wk of treatment, rats were anesthetized for LPP and external urethral sphincter electromyography recordings. Hindlimb skeletal muscles and pelvic floor muscles were dissected and stained. At the end of 2 wk of treatment, all three treatment groups had a significant increase in body weight and individual muscle weight compared with both sham-treated and sham-injured rats. LPP in DI + Bim rats was significantly higher than LPP of DI + PBS and DI + Clen rats. There were more consistent urethral striated muscle fibers, elastin fibers in the urethra, and pelvic muscle recovery in DI + Bim rats compared with DI + PBS rats. In conclusion, bimagrumab was the most effective for increasing urethral pressure and continence by promoting injured external urethral sphincter and pelvic floor muscle recovery.

SCF/c-kit signaling pathway participates in ICC damage in neurogenic bladder

ABSTRACT Neurogenic bladder (NB) is a type of double renal dysfunction caused by nerve lesions. The interstitial cells of Cajal (ICC) damage are involved in bladder dysfunction. The aim of this study is to investigate the effect of stem cell factor (SCF)/c-kit signaling pathway on ICC damage in NB model rats. Maximum cystometric capacity (MCC), bladder leak point pressures (BLPP), and bladder compliance (BC) were measured in sham-operated and NB model rats. Immunofluorescent staining for c-kit was performed to determine ICC count in rat bladder trigone. The morphology and ultrastructure changes of ICCs were observed under an electron microscope. The mRNA levels of c-kit and SCF in bladder tissues were determined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The protein levels of c-kit, SCF, p-JAK, p-STAT1, and p-STAT3 in bladder tissues were determined by western blot. ICC proliferation was detected by CCK-8 assay. NB resulted in changes in ultrastructure changes of ICCs and a decrease in the number of ICCs and in expression of c-kit, SCF, p-JAK, p-STAT1, and p-STAT3 in NB tissues. Inhibition of SCF/c-kit signaling pathway suppressed ICC proliferation by inhibiting JAK/STAT3 pathway. Moreover, inhibition of SCF/c-kit signaling pathway impaired the SCF-induced attenuation of ICC damage in NB model rats. Collectively, our data indicate that SCF/c-kit signaling pathway participates in ICC damage in NB.

Numerical simulation of CO2 leakage in a shallow subsurface layer from a CO2 geological storage site

In an effort to detect and quantify potential CO2 leakage from geologic storage sites, this work investigates the migration process of CO2 leaked in a shallow subsurface associated with the CO2 sequestration project at Shaanxi, China. A shallow subsurface model with aquifer and soil layers was established, and the sensitivities of leakage rate and geological conditions were analysed. The results show that the distribution morphology of the CO2 plume is generally mushroom-shaped when the leaked CO2 enters the formation as a point source. Maximum leakage occurs at the soil surface due to the comprehensive effects of pressure, concentration, and density differences between CO2 and soil gas. The mass fraction of CO2 in gas is approximately 0.38–0.48 near the surface leak point, and leaked CO2 moves laterally along the bottom of the soil vadose zone. The leakage rate of CO2 significantly affects the pressure build-up as observed for an increase in the CO2 leakage rate from 0.0002 to 0.02 kg/s. In addition to the loess beam area, the migration process of CO2 leakage in the valley terrace area was also studied. The results show that the CO2 concentration in the leakage centre area of the valley terrace is not much different from that in the loess beam. Moreover, the surface leakage range in the valley terrace is much smaller than that in the loess beam, which is because of the differences in the formation composition and thickness. Heterogeneity has limited effect on leakage.

Verification and Defined Dosage of Sodium Pentobarbital for a Urodynamic Study in the Possibility of Survival Experiments in Female Rat.

Objectives To evaluate the effects of pentobarbital dosages on lower urinary tract function and to define an appropriate dosage of sodium pentobarbital that would be suitable for urodynamic studies in which recovery from anesthesia and long term survive were needed for subsequent experiment. Methods Twenty-four 8-week-old, female, virgin, Sprague-Dawley rats (200-250 g) were used in this study. Rats in study groups received gradient doses of pentobarbital intraperitoneally, and those in the control group received urethane intraperitoneally. External urethral sphincter electromyography (EUS-EMG) was recorded simultaneously during cystometry and leak point pressure tests. The toe-pinch reflex was used to determine the level of anesthesia. Results Micturition was normally induced in both the urethane group and 32 mg/kg pentobarbital group. However, in groups of 40 mg/kg or 36 mg/kg pentobarbital, micturition failed to be induced; instead, nonvoiding contractions accompanied by EUS-EMG tonic activity were observed. There were no significant differences in leak point pressure or EUS-EMG amplitude or frequency between the urethane and 32 mg/kg pentobarbital groups. Conclusions This study confirmed significant dose-dependent effects of pentobarbital on lower urinary tract function and 32 mg/kg pentobarbital as an appropriate dosage for recovery urodynamic testing, which enable the achievement of expected essential micturition under satisfactory anesthesia in female rats.

Is pre-operative urodynamic bladder function the true predictor of outcome of male sling for post prostatectomy incontinence?

PurposeTo investigate pre-operative urodynamic parameters in male sling patients to ascertain whether this might better predict surgical outcomes and facilitate patient selection.MethodsWe performed a retrospective, case notes and video-urodynamics, review of men who underwent AdVanceXP male sling in three London hospitals between 2012 and 2019. Urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was performed in one centre.ResultsSuccessful outcome was seen in 99/130 (76%) of men who required one pad or less per day. The dry rate was 51%. Pad usage was linked to worse surgical outcomes, mean 2.6 (range 1–6.5) for success vs 3.6 (range 1–10) although the ranges were wide (p = 0.002). 24 h pad weight also reached statistical significance (p = 0.05), with a mean of 181 g for success group versus 475 g for the non-successful group. The incidence of DO in the non-successful group was significantly higher than in successful group (55% versus 29%, p = 0.0009). Bladder capacity less than 250 ml was also associated with worse outcomes (p = 0.003). Reduced compliance was not correlated with outcomes (31% for success groups vs 45% for non-successful group, p = 0.15). Preoperative RLPP was performed in 60/130 patients but did not independently reach statistical significance (p = 0.25).ConclusionUrodynamic parameters related to bladder function—detrusor overactivity and reduced maximum cystometric capacity predict male sling outcomes and may help in patient selection for male sling (or sphincter) surgery; whereas urodynamic parameters of sphincter incompetency (RLPP) were not predictive. Further larger scale studies are required to confirm these findings.

Predicting Upper Urinary Tract Risk in the Neurogenic Bladder Patient

In this review, we explore if risk factors for developing renal deterioration can be identified in a timely fashion, thereby preventing or delaying the progression of renal injury in the neurogenic bladder patient. Historically detrusor leak point pressure (DLPP) > 40 cm H2O has been used to identify risk of upper urinary tract dysfunction (UUTD). Recent studies suggest that DLPP should not be the only decision-making parameter to predict the risk of UUTD and that patients with DLPP > 20 cm H2O should be followed closely for upper tract assessment. Furthermore, a variety of urinary biomarkers can be used markers of UUTD to guide management of neurogenic patients. Urodynamic studies represent a valuable tool in the evaluation and monitoring of urinary tract function. Multiple sources have emphasized the early identification and regular follow-up of these patients to not only have a baseline urinary tract function but also to monitor renal function and evaluate for upper tract damage.

Diagnosis of the single leakage in the fluid pipeline through experimental study and CFD simulation

The pipeline safety management system is crucial to transfer oil and gas because the phenomena of leakage commonly occurs in the long-distant pipelines. Hidden safety hazards can be caused by design and construction defects, affected by natural disasters, or corroded by the transmission fluid. Therefore, quick detection will not only reduce the loss of transported oil and gas but also can protect the local environment. In this study, we develop a new method to detect the pipeline leak by analyzing pressure distribution through the leak. Pipeline leak detection tests are operated using a flow loop. Through the experiments, four parameters which are pressures and flow rates of pipeline inlet and outlet are recorded. Then the specific location of the leak is determined by dimensionless analysis of flow parameters. To generate the solution to locate the leak, we introduce three dimensionless variables, which are dimensionless leak location, dimensionless leak rate, and dimensionless pressure drop. Then the relationship of pressure distribution and leak parameters is built through the simulation models. After running 3D computational fluid dynamics (CFD) simulations with commercial software (FLUENT), the pressure distribution in the pipeline with leakage in the experiments will be verified by the experimental data. Finally, the mathematical models are developed to detect and evaluate the leakage through the pipeline. CFD simulation results show that both the leak rate and location have significant effects on the pressure distribution through the pipe, which is identical to the outcome from the experiments. When the dimensionless leak location is smaller or the dimensionless leak rate is larger, the dimensionless pressure drop is smaller. The mathematical model which is based on these dimensionless variables can be applied in locating the leak point in the real accident.

Comparison of Time Delay Estimation Methods Used for Fast Pipeline Leak Localization in High-Noise Environment

Pipeline networks are one of the most efficient and extensively used means for transporting fluid products. However, they suffer from a serious problem that threatens their normal and secure operation, which is the occurrence of leaks. In this article, an acoustic technique for the localization of leaks in pipelines placed in the high-noise environment of an oil refinery is described. This technique is based on the estimation of the time delay between the moments at which an acoustic signal produced by a leak reaches two sensors mounted on the external surface of the pipeline at a certain distance between them. For this reason, three different time delay estimation methods, based on the cross-correlation procedure, are studied in this article. These methods are tested for their accuracy in the estimation of the leak position, as well as for their ability to work with measurements of short duration and the results are compared. This is important because the acquisition duration affects directly the response time of the leak localization system, which is a crucial parameter for the targeted applications. Finally, an algorithm for fast and accurate identification of the leak point is proposed.

Fatigue failure analysis of dented pipeline and simulation calculation

Natural gas pipeline leaks may cause considerable damage to people, properties, and the surrounding environment. This study investigates a dent leak in a gas pipeline in China that has operated for six years. The failure pipe section meets American Petroleum Institute (API) specification 5L-2012 standard for carbon steel pipelines. The cause of leakage is evaluated not only through visual examination, micromorphology observation, structural deformation analysis, and residual stress measure of the dented region near the leak point of the pipe body, but also through finite element analysis on the deformation and stress of the pipe under different loads. The dent formation is related to rocks during pipeline laying. Under the combined effect of external load and internal pressure, the maximum equivalent stresses of the dented edge at the outer wall, bulge top of the inner wall, and dented edge of the inner wall are greater than the yield stress of the material. Moreover, micro-crack formation occurs due to the maximum deformation at the bottom of the dent and the maximum equivalent stress on top of the inner surface bulge. Under alternating stress, microcracks gradually expand until they penetrate the wall thickness, and thereby cause pipeline leakages.

The influence of bowel management on urodynamic findings in spina bifida children with detrusor overactivity and detrusor sphincter dyssynergia

To examine the effects of bowel management on urodynamic findings in spina bifida children with detrusor overactivity (DO) and detrusor sphincter dyssynergia (DSD). Between 2014 and 2019 we prospectively evaluated 39 consecutive spina bifida children with DO and DSD (18 (46.2%) boys and 21 (53.8%) girls, aged 4-16 years; mean age 9.5±3.7 years) who received bowel management and we treated their bowel dysfunction with an aim of alleviating the symptoms of constipation, preventing constant overdistension of the rectosigmoid, providing regular emptying of the colon and faecal continence. Bowel management included daily enema, laxative application and a special diet who was performed during 12 months. All children had undergone urodynamic studies before and after starting bowel management, with no changes in their urological treatment. Bowel management caused an increase in maximum bladder capacity from 183.0 (112.0-234.0) to 237.0 (165.0-298.0) (p<0.001). When maximal bladder capacity adjusted for age there was also significant increment (adjusted before 0.54 (0.47-0.64), adjusted after 0.75 (0.70-0.82), p<0.001). In addition, we observed a decrease in maximal detrusor pressure from 64.3 (49.0-77.0) to 46.4 (32.0-59.0) cm H2O (p<0.001) and an increase in bladder compliance from 3.0 (2.0-3.3) to 5.6 (3.9-6.6) ml/cm H2O (p<0.001). There was also significant reductions in leak point pressure from 62.0 (48.0-69.0) to 39.0 (30.0-43.0) cm H2O (p=0.001), and significant reductions in post-void residual volume (PVR) from 165.0 (128.0-187.0) to 98.0 (68.0-136.0) ml in our 13 patients who could achieve spontaneous voiding (p=0.001). Administering bowel management may be useful for bladder function and urodynamic findings in spina bifida children with DO and DSD. Therefore, bowel management should form an integral part of the treatment in spina bifida children with DO and DSD.

Delayed Treatment With Low-intensity Extracorporeal Shock Wave Therapy in an Irreversible Rat Model of Stress Urinary Incontinence

OBJECTIVETo determine the outcomes and mechanisms of delayed low-intensity extracorporeal shock wave therapy (Li-ESWT) in a rat model of irreversible stress urinary incontinence (SUI). MATERIALS AND METHODSTwenty-four female Sprague-Dawley rats were randomly assigned into 3 groups: sham control, vaginal balloon dilation + β-aminopropionitrile (BAPN; SUI group), and vaginal balloon dilation + BAPN + treatment with Li-ESWT (SUI–Li-ESWT group). An irreversible SUI model was developed by inhibiting the urethral structural recovery with BAPN daily for 5 weeks. Thereafter, in the SUI–Li-ESWT group, Li-ESWT was administered twice per week for 2 weeks. After a 1-week washout, all 24 rats were evaluated with functional and histologic studies at 17 weeks of age. Endogenous progenitor cells were detected via the EdU-labeling method. RESULTSFunctional analysis with leak point pressure testing showed that the SUI–Li-ESWT group had significantly higher leak point pressures compared with untreated rats. Increased urethral and vaginal smooth and striated muscle content and increased thickness of the vaginal wall were noted in the SUI–Li-ESWT group. The SUI group had significantly decreased neuronal nitric oxide /tyrosine hydroxylase positive nerves ratio in the smooth muscle layers of the urethra, while the SUI–Li-ESWT group had neuronal nitric oxide/tyrosine hydroxylase+ nerves ratio similar to that of the control group. The continuality of urothelial cell lining was also improved in the SUI–Li-ESWT group. In addition, there were significantly increased EdU-positive cells in the SUI–Li-ESWT group. CONCLUSIONLi-ESWT appears to increase smooth muscle content in the urethra and the vagina, increase the thickness of urethral wall, improve striated muscle content and neuromuscular junctions, restore the integrity of the urothelium, and increase the number of EdU-retaining progenitor cells in the urethral wall.

Adjustable bulbourethral male sling: Experience after 30 cases of moderate to severe male stress urinary incontinence.

To report our experience using the Argus perineal sling from July 2015 to April 2018 for male stress urinary incontinence (SUI) after prostatic surgery. To evaluate the safety, efficacy and healthrelated quality of life in patients undergoing this procedure. The positioning of an adjustable bulbourethral male sling provides a perineal incision, exposure of the bulbospongiosus muscle and the application of the sling bearing on it with transobturator passage of the two extremities with out-in technique. To modulate the bearing tension on the urethra, with a rigid cystoscope the Retrogade Leak Point Pressure is measured, increasing it by 10-15 cm of H20 from baseline. We retrospectively evaluated the results of this implant performed by the same operator on 30 patients who presented post-operative SUI from medium to severe (> = 2 pads/day, pad test at one hour > = 11 g). Mean operative time and possible intra and postoperative complications were evaluated. Postoperatively each patient was reassessed according to the following parameters: number of pads consumed/ die, pad tesy at one hour, ICQS-F, any related side effects. After the intervention, 21 of 30 patients (70% of the total) were totally continent (< 1 pad / day, pad test at 1 h < 1-2 g, ICQS-F < 11), out of them 4 required a single adjustment at 3 months in order to achieve this result. 9 of 30 patients (30 %) achieved a clinically significant improvement without obtaining total continence (mean reduction of the n° pads/day: -2.5 ± 1 DS; average reduction of the pad test at 1 h: -20 g ± 4 DS; ICQS-F average reduction: -6 points ± 2 DS), out of them 5 required a 3 month adjustment to obtain these improvements resulting, 4 needed 2 adjustments resulting because the first adjustment was not satisfactory and one who ameliorated from severe to moderate incontinence decided to live in this clinical condition. The results of our study show that the positioning of this sling represents a valid treatment for the moderate and severe post-surgical male SUI. The possibility of adjusting the tension of the sleeve in a "second look" makes the intervention adaptable according to the results obtained. Only multicentric clinical trials on larger series would clarify and eventually confirm the clinical benefits of this sling in post-surgical male SUI.

Epidural Stimulation Targeting Lower Urinary Tract Function in Spinally Intact and Transected Urethane‐Anesthetized Rats

Bladder management for conditions such as spinal cord injury (SCI) includes a combination of catheterization (either self‐intermittent or suprapubic) and pharmacological approaches, which targets maintenance but does not promote recovery of function. We have exciting data from multiple individuals receiving spinal cord epidural stimulation (scES) that is optimized for stepping and standing, in combination with task‐specific training, that shows improvements in lower urinary tract function. The objective of our current functional mapping pre‐clinical animal studies is to identify scES configurations (electrode location, amplitude and frequency) that can promote optimal neural control of urine storage (adequate bladder capacity at safe pressures without incontinence) and sufficient controlled emptying (high voiding efficiency at safe leak point pressures). Initial mapping was done in acute anesthetized terminal preparations during cystometry (bladder filling) using a modified Medtronic Specify 5‐6‐5 epidural array that is being used by our group in parallel human scES studies. The current data compares the response to scES in spinally intact and transected male and female rats 6 weeks post‐injury at T13‐L1 (level of sympathetic supply), L3‐4 (region with circuits related to external urethral sphincter control) and L6‐S1 (level of parasympathetic supply) spinal segments. Results indicate that scES storage effects and voiding efficiency were dependent upon presence/absence of spinal transection, frequency and intensity stimulation patterns, electrode location, and sex of the animals. Taken together these results suggest that the circuitry is dissociable and amenable to stimulation that seeks to promote either storage or voiding. Furthermore, our innovative approach and novel application of this Medtronic Specify 5‐6‐5 epidural device will generate functional maps that will lay the groundwork for expedient translation of this promising technology to individuals with SCI as well as provide a powerful tool for elucidating underlying circuits present in the lumbosacral cord that are involved in urogenital function.Support or Funding InformationNIH SPARC OT2OD024898

PD41-01 URODYNAMIC EVALUATION IN WOMEN UNDERGOING RADICAL CYSTECTOMY AND ORTHOTOPIC NEOBLADDER: PRE- AND POSTOPERATIVE ROLES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (PD41)1 Apr 2020PD41-01 URODYNAMIC EVALUATION IN WOMEN UNDERGOING RADICAL CYSTECTOMY AND ORTHOTOPIC NEOBLADDER: PRE- AND POSTOPERATIVE ROLES Bedeir Ali-El-Dein*, Ahmed Elhefnawy, Mohamed H Zahran, Atallah A Shaaban, and Mohamed A Ghoneim Bedeir Ali-El-Dein*Bedeir Ali-El-Dein* More articles by this author , Ahmed ElhefnawyAhmed Elhefnawy More articles by this author , Mohamed H ZahranMohamed H Zahran More articles by this author , Atallah A ShaabanAtallah A Shaaban More articles by this author , and Mohamed A GhoneimMohamed A Ghoneim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000921.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To investigate the role of urodynamic evaluation preoperatively and postoperatively to characterize and plan treatment of voiding and continence problems in women undergoing radical cystectomy (RC) and orthotopic neobladder (ONB). METHODS: Between January 1995 and December 2018, RC and ONB were performed in 395 women with bladder cancer (BC) and a mean age of 53 + 10 years. Of these, genitalia sparing cystectomy was performed in 25. Preoperatively, only urethral pressure profile (UPP) was conducted. Postoperatively, evaluation included voiding and continence outcome using UPP, water cystometry of the pouch, voiding pouchometry, leak point pressure (LPP) and pelvic floor electromyography (EMG). Preoperative UPP was correlated with postoperative voiding and continence outcome and we used urodynamic data to plan treatment of postoperative voiding and continence problems. RESULTS: 125 urodynamically evaluated patients were eligible with a median followup of 93 months. The mean preoperative maximal urethral closing pressure (MUCP) was 70 ± 19 cm.water, mean functional urethral length (FUL) was 30.2 ± 4.5 mm and mean continence product (CP) was 2114 cm.water mm. There was no correlation between these values and postoperative continence and voiding status. Of these patients, 64 (51%) were totally continent, 3 (2.4%) had total incontinence (TI), 9 stress urinary incontinence (SUI), 30 (24%) isolated nighttime incontinence (NI), and 7 (5.6%) had NI on top of chronic urinary retention (CUR). CUR developed in 38 patients (30%), including 7 with NI and 2 with TI. Among NI patients, 18 had pouch hyperactivity, 7 had CUR, 6 had incompetent urethral closure mechanism (IUCM), 19 had UTI, while 6 had no reason. Patients with NI and IUCM (6) and those with TI (3) had marked decrease of the mean MUCP (69 vs 38.4), mean FUL (30 vs 22) and mean CP (2070 vs 845) compared with preoperative values (p<0.001). Changes of the UPP values over time (at 6 and 60 months) in 50 patients were not predictive of changes of the continence or voiding status. On filling cystometry, pouch hyperactivity was noted in 18 women with NI, 5 with NI on top of CUR and 16 (13%) continent women (p = 0.038). EMG on 16 patients with CUR showed silent pelvic floor. Based on these data, NI was treated by imipramine hydrochloride 50 mg at bed time, anticholinergics and antimicrobial treatment for positive cultures with improvement in 22 patients. CUR was successfully treated by CIC and anticholinergics (pouch hyperactivity). CONCLUSIONS: UPP is a helpful objective tool to assess the urethral closure mechanism before and after RC and ONB in women. In the studied cohort, postoperative changes of the UPP parameters over time were not predictive of changes of the voiding or continence status. Urodynamic evaluation helps characterize and plan treatment of voiding and continence problems after ONB. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e821-e821 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bedeir Ali-El-Dein* More articles by this author Ahmed Elhefnawy More articles by this author Mohamed H Zahran More articles by this author Atallah A Shaaban More articles by this author Mohamed A Ghoneim More articles by this author Expand All Advertisement PDF downloadLoading ...

PD27-07 ROBOT-ASSISTED ARTIFICIAL URINARY SPHINCTER IMPLANTATION IN FEMALE PATIENTS: AN INTERNATIONAL MULTICENTER STUDY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (PD27)1 Apr 2020PD27-07 ROBOT-ASSISTED ARTIFICIAL URINARY SPHINCTER IMPLANTATION IN FEMALE PATIENTS: AN INTERNATIONAL MULTICENTER STUDY Benoit Peyronnet*, Frank Van der Aa, Vincent Cardot, Grégoire Capon, Xavier Biardeau, Olivier Belas, Frederic Dubois, Juliette Hascoet, Vincent Cardot, Frederic Dubois, Vidart Adrien, Aurelien Descazeaud, Andrea Manunta, Luis Castro-Sader, Marta Allue, Frederic Thibault, Rainer Hein, Pierre Lecoanet, and Georges Fournier Benoit Peyronnet*Benoit Peyronnet* More articles by this author , Frank Van der AaFrank Van der Aa More articles by this author , Vincent CardotVincent Cardot More articles by this author , Grégoire CaponGrégoire Capon More articles by this author , Xavier BiardeauXavier Biardeau More articles by this author , Olivier BelasOlivier Belas More articles by this author , Frederic DuboisFrederic Dubois More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Vincent CardotVincent Cardot More articles by this author , Frederic DuboisFrederic Dubois More articles by this author , Vidart AdrienVidart Adrien More articles by this author , Aurelien DescazeaudAurelien Descazeaud More articles by this author , Andrea ManuntaAndrea Manunta More articles by this author , Luis Castro-SaderLuis Castro-Sader More articles by this author , Marta AllueMarta Allue More articles by this author , Frederic ThibaultFrederic Thibault More articles by this author , Rainer HeinRainer Hein More articles by this author , Pierre LecoanetPierre Lecoanet More articles by this author , and Georges FournierGeorges Fournier More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000884.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The morbidity related to artificial urinary sphincter (AUS) implantation in women is usually considered as the drawback which has limited its widespread. In order to decrease this morbidity, several teams have recently reported the use of a robotic approach to implant the AUS in female patients. The aim of this study was to report the perioperative and functional outcomes of robotic AUS implantation in women. METHODS: All female patients who underwent robotic AUS implantation using a standardized technique (anterior approach) between 2013 and 2019 at fourteen european institutions were included in a retrospective study. The indication for AUS implantation was type III stress urinary incontinence and intrinsic sphincter deficiency defined as a combination of a low urethral closure pressure/Valsalva leak point pressure and loss of urethral mobility. The primary endpoint was the functional outcome categorized as dry (0 pads), improved or unchanged. RESULTS: One hundred and twenty-three patients underwent robotic AUS implantation. Patients’ characteristics are summarized in table 1. There were 20 intraoperative complications (16.3%): 12 bladder neck injuries and 8 vaginal injuries. Surgeons carried on with AUS implantation in all cases. Twenty-two patients experienced postoperative complications (18%) but only four were Clavien ≥3 (3.3%): three early AUS explantations (2 due to vaginal erosion, 1 due to infection) and one reoperation for bladder fistula. After a mean follow-up of 13 months, there were 5 AUS explantations performed in total (4.1%): the 3 early explantations reported above, one for chronic urinary retention and one for urethral erosion. At the latest follow-up visit, 99 patients were dry (80.5%), 12 were improved (6.9%) and 12 were unchanged (9.8%). CONCLUSIONS: This study is the first international multicenter series assessing the outcomes of robotic AUS implantation in women using a standardized technique. This series confirm the promising perioperative and functional outcomes reported in previous studies. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e551-e552 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benoit Peyronnet* More articles by this author Frank Van der Aa More articles by this author Vincent Cardot More articles by this author Grégoire Capon More articles by this author Xavier Biardeau More articles by this author Olivier Belas More articles by this author Frederic Dubois More articles by this author Juliette Hascoet More articles by this author Vincent Cardot More articles by this author Frederic Dubois More articles by this author Vidart Adrien More articles by this author Aurelien Descazeaud More articles by this author Andrea Manunta More articles by this author Luis Castro-Sader More articles by this author Marta Allue More articles by this author Frederic Thibault More articles by this author Rainer Hein More articles by this author Pierre Lecoanet More articles by this author Georges Fournier More articles by this author Expand All Advertisement PDF downloadLoading ...

PD37-12 URODYNAMIC PREDICTORS OF SURGICAL OUTCOMES FOLLOWING MALE SLING IMPLANTATION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy II (PD37)1 Apr 2020PD37-12 URODYNAMIC PREDICTORS OF SURGICAL OUTCOMES FOLLOWING MALE SLING IMPLANTATION Bogdan Toia*, Lap Yan Leung, Raveen Saigal, Eskinder Solomon, Sachin Malde, Claire Taylor, Arun Sahai, Rizwan Hamid, Tamsin Greenwell, Jai Seth, Davendra Sharma, and Jeremy Ockrim Bogdan Toia*Bogdan Toia* More articles by this author , Lap Yan LeungLap Yan Leung More articles by this author , Raveen SaigalRaveen Saigal More articles by this author , Eskinder SolomonEskinder Solomon More articles by this author , Sachin MaldeSachin Malde More articles by this author , Claire TaylorClaire Taylor More articles by this author , Arun SahaiArun Sahai More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , Jai SethJai Seth More articles by this author , Davendra SharmaDavendra Sharma More articles by this author , and Jeremy OckrimJeremy Ockrim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000908.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The surgical options for post prostatectomy incontinence are implantation of an artificial sphincter or male sling. Outcomes for artificial sphincters, and predictive values for good outcome have been documented. However, the criteria for patient selection and the likelihood of a good outcome for male slings are limited. Most authors have relied on pad number/weight as their primary parameter, despite poor correlation with success rates. It remains unclear whether pre-operative urodynamic parameters might better predict surgical outcomes and facilitate patient selection. METHODS: We performed a retrospective case notes and video-urodynamics review of men who underwent AdVanceXP male mid-urethral sling insertion in three London hospitals between 2012 and 2019. Collected data included demographics, postoperative continence and urodynamic parameters. Video-urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was only performed in one centre. Analysis was performed using chi-squared and independent t tests, with p<0.05 is considered significant. RESULTS: 114 men were identified. 89/114 (78%) patients were cured of their incontinence requiring 1 pad per day or less for reassurance (59/114 (52%) did not use any pads), whilst 25/114 (22%) patients remained significantly wet. Success by urodynamic parameters is shown in Figure 1. 43/114 (38%) had detrusor overactivity (DO) on preoperative urodynamics, with a mean pressure of 41cmH2O (range 15-78). The rate of DO demonstrated in the wet group was significantly higher than in dry group (60% vs 31%, p=0.009), but the peak DO pressure did not correlate with outcomes (p = 0.778). 31/114 (27%) had abnormal compliance, with higher incidence in the wet group (48% vs. 21%, p= 0.008). Having a bladder capacity less than 400ml was also associated with worse outcomes (p=0.001). Preoperative RLPP did not correlate with surgical outcomes (p=0.495), but was only was performed in 55 men (48%). CONCLUSIONS: Urodynamic parameters can be used to predict outcome for male sling. The predictors of significance are detrusor overactivity, reduced compliance and reduced bladder capacity (<400mls). Further study is required to accurately define urodynamic parameters that will differentiate outcomes and criteria for sling (and sphincter) selection. Source of Funding: No funding required © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e732-e733 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bogdan Toia* More articles by this author Lap Yan Leung More articles by this author Raveen Saigal More articles by this author Eskinder Solomon More articles by this author Sachin Malde More articles by this author Claire Taylor More articles by this author Arun Sahai More articles by this author Rizwan Hamid More articles by this author Tamsin Greenwell More articles by this author Jai Seth More articles by this author Davendra Sharma More articles by this author Jeremy Ockrim More articles by this author Expand All Advertisement PDF downloadLoading ...

Which procedure for stress urinary incontinence? Injectable.

Which procedure for stress urinary incontinence? Injectable.

Tunable Q-factor wavelet transform of acoustic emission signals and its application on leak location in pipelines

The tunable Q-factor wavelet transform (TQWT) is a discrete wavelet transform realized by the iterative two-channel filter group and the discrete Fourier transform (DFT). In this paper, the TQWT is applied to the extraction of leakage signals of the water pipeline network. By using the maximum principle of kurtosis, the Q-factor and the number of decomposition layer were determined to overcome the disadvantages of prefixed Q-factor and number of decomposition layers. The combination of kurtosis and envelope entropy was used to select the subband with abundant information. And then, correlation analysis was conducted further to locate the leakage point. Furthermore, a laboratory water pipe and an outdoor actual water pipe system were built to study the leakage signal. By analyzing the leakage signal from both experimental system, it can be found that the leakage signal characteristics of different leakage points for actual water pipe are all in the first layer, and the positioning error of each leakage point is within 1%. It indicates that TQWT can effectively extract the leakage components from the leakage signal of low SNR and has a higher location accuracy of the leak point.

Evaluation of transperineal ultrasound in diagnosis and grading of female genuine urinary stress incontinence

Stress urinary incontinence (SUI) has an observed prevalence of between 4%and 35%. Purpose: To determine the role of transperineal ultrasound in diagnosing stress incontinence, its degree and the possible cause by: Measuring the BN descent, urethral hypermobility, funneling of BN or proximal urethra, urethral diameter, posterior urethra vesical angle, associated cystocele Using color Doppler to detect escape of urine through the urethra. Methods: 52 female patients diagnosed to have genuine stress incontinence using 3 day voiding diary, simple questionnaire and confirmed by standard urodynamics. Classification of stress incontinence into mild, moderate and severe using Valsalva leak point pressure during urodynamic study. Transperineal ultrasound for evaluation of the anterior pelvic compartment regarding: bladder neck descent, urethralhy permobility, Funneling of the BN, posterior urethrovesical angle ,urethral diameter, associatedcystocele, and finally the Doppler detection of urinary escape both at rest and with Valsalva maneuvers. Results: 28/52 cases (53.8%) of SUI didn’t show clinical evidence of cystocele; 11 cases (21.2%) showed grade 1 cystocele and 13cases (25%) showed grade 2 cystocele. The presence or absence of cystocele and also the grade of cystocele did not show a statistically significant relation to the degree of SUI; p=0.089 and 0.086 respectively Conclusion: We came to conclusion that transperineal ultrasound can be used in accurate diagnosis and grading of female urinary stress incontinence with our given cutoff values for bladder displacement, α angle, β angle and urethral diameters and from this grading by transperineal ultrasound comes the novelity of our research.