Perfect Continence Research Articles

PE030 Perfect continence vs occasional dribbling in pad-free men: Assessing urinary continence post RP

PE030 Perfect continence vs occasional dribbling in pad-free men: Assessing urinary continence post RP

Bowel function after anterior rectal resection for cancer: short and long-term prospective evaluation with low anterior rectal syndrome (LARS) score in a cohort of Cameroonian patients.

bowel dysfunction is the most common and disabling complication after anterior rectal resection (ARR) for cancer. We aimed to evaluate these complications in a cohort of Cameroonian patients, using the low anterior rectal syndrome (LARS) score. we conducted a descriptive and analytical cross-sectional study, in two university hospitals of Yaoundé (Cameroon). Prospectively, we collected the records of all patients aged at least 18 years who had an ARR indicated for rectal cancer from January 2015 to March 2018. Alive patients among them were subsequently received in consultation at 1 and 3 years after surgery, for short and long-term assessment of their digestive function using the LARS score. during the study period, 28 patients underwent anterior rectal resection for rectal cancers. Short-term bowel function was evaluated in 23 patients. Their mean age was 48.42 ± 12.2 years and 14 were males. LARS was present in 10 of them (43.47%) and classified as "minor" in the majority of cases (n=6). The commonest bowel dysfunction at this term was splitting of stool (56.53%). Long-term digestive function was evaluated in 11 patients; LARS was found in 3 of them (27,27%) and classified as minor in all cases. Perfect continence was significantly improved (p=0.003) in the long term compared to the short-term status. Continence (p=0.049) and urgency (p=0.048) were better in patients who had a low colorectal anastomosis compared to those who had a colo supra-anal anastomosis. after ARR for cancer, there is a high prevalence of LARS in the short term with an improvement in the long term.

A magnetic endourethral sphincter against stress urinary incontinence: preliminary pilot study in humans.

Urinary incontinence (UI) is a common and frustrating condition that affects patients' quality of life as well as the Healthcare systems. Currently, the most severe cases of UI are treated using implanted, invasive artificial sphincters. We propose an innovative, minimally invasive magnetic endourethral sphincter for the treatment of stress UI (SUI) in patients for whom previous medical and surgical treatments have failed. Six patients with severe SUI were enrolled at a single center and underwent cystoscopic sphincter implantation. After 10 days, correct device position was confirmed by ultrasonography. The sphincter was explanted after 28 days. In all patients, the sphincter was successfully implanted using an endoscopic approach. One patient reached the end of the pilot test (28 days) with the sphincter correctly placed. Patients' responses on the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire improved from a score of 18 out of 21 at the screening visit (UI without reasons) to a score of 3 out of 21 (almost perfect continence). No major pain and discomfort were reported. This study showed the feasibility of sphincter implantation, explantation, and overall tolerability, although a redesign of the sphincter distal part is needed.

Multicenter clinical trial for the resection of rectal polyps using a new laparoendoscopic hybrid transanal access device

IntroductionComplex polyps require the use of advanced endoscopic techniques or minimally invasive surgery for their approach. In rectal polyps it is of special relevance to reach a consensus on the best approach to avoid under- or overtreatment that increases unnecessary morbidity and mortality. MethodsWe describe a prospective, multicenter, pilot clinical trial with a first-in-human medical device. It is hypothesized that UNI-VEC® facilitates transanal laparoendoscopic surgery for the removal of early rectal tumors. The primary objective is to evaluate that it is safe and meets the established functional requirements. Secondary objectives are to evaluate results, complications and level of satisfaction. Results16 patients were recruited in 12 months with a minimum follow-up of 2 months. The mean size was 3.4 cm with the largest polyp being 6 cm. Regarding location, the mean was 6.6 cm from the anal margin. Endoscopic Mucosal Resection (EMR) (6.3%), Endoscopic Submucosal Dissection ESD (43.8%), REC (6.3%) and TAMIS (43.8%) were performed. The mean time was 73.25 min. The 56.3% used a 30° camera and 43.8% used the flexible endoscope as a viewing instrument. The 56.3% were benign lesions and 43.8% malignant. Complete resection is achieved in 87.5%. Regarding complications, mild bleeding (Clavien I) occurred in 25%, 6.3% and 21.4% at 24 h, 48 h and 7 days respectively. Continence was assessed according to the Wexner scale. At 7 days, 60% showed perfect continence, 26.7% mild FI and 13.3% moderate FI. At 30 days, 66.7% had perfect continence, 20% mild FI and 13.3% moderate FI. At 2 months, 4 patients were reviewed who at 30 days had a Wexner's degree higher than preoperative and perfect continence was demonstrated in 25% of the patients, 50% mild and 25% moderate. In no case did rectal perforation or major complications requiring urgent reintervention occur. As for the level of reproducibility, safety, level of satisfaction with the device and evaluation of the blister, the evaluation on a scale of 0–10 (9.43, 9.71, 9.29 and 9.50 respectively). All the investigators have previous experience with transanal devices. ConclusionsThe study demonstrates the efficacy and safety of UNI-VEC® for the treatment of rectal lesions. It will facilitate the implementation of hybrid procedures that seek to solve the limitations of pure endoscopic techniques by allowing the concomitant use of conventional laparoscopic and robotic instrumentation with the flexible endoscope.

Ensayo clínico multicéntrico para la resección de pólipos rectales mediante un nuevo dispositivo de acceso transanal híbrido laparoendoscópico

IntroductionComplex polyps require the use of advanced endoscopic techniques or minimally invasive surgery for their approach. In rectal polyps it is of special relevance to reach a consensus on the best approach to avoid under- or overtreatment that increases unnecessary morbidity and mortality. MethodsWe describe a prospective, multicenter, pilot clinical trial with a first-in-human medical device. It is hypothesized that UNI-VEC® facilitates transanal laparoendoscopic surgery for the removal of early rectal tumors. The primary objective is to evaluate that it is safe and meets the established functional requirements. Secondary objectives are to evaluate results, complications and level of satisfaction. ResultsSixteen patients were recruited in 12 months with a minimum follow-up of 2 months. The mean size was 3.4 cm with the largest polyp being 6 cm. Regarding location, the mean was 6.6 cm from the anal margin. Endoscopic mucosal resection (EMR) (6.3%), endoscopic submucosal dissection (ESD) (43.8%), REC (6.3%) and TAMIS (43.8%) were performed. The mean time was 73.25 min. The 56.3% used a 30° camera and 43.8% used the flexible endoscope as a viewing instrument. The 56.3% were benign lesions and 43.8% malignant. Complete resection is achieved in 87.5%. Regarding complications, mild bleeding (Clavien I) occurred in 25%, 6.3% and 21.4% at 24 h, 48 h and 7 days, respectively. Continence was assessed according to the Wexner scale. At 7 days, 60% showed perfect continence, 26.7% mild FI and 13.3% moderate FI. At 30 days, 66.7% had perfect continence, 20% mild FI and 13.3% moderate FI. At 2 months, 4 patients were reviewed who at 30 days had a Wexner's degree higher than preoperative and perfect continence was demonstrated in 25% of the patients, 50% mild and 25% moderate. In no case did rectal perforation or major complications requiring urgent reintervention occur. As for the level of reproducibility, safety, level of satisfaction with the device and evaluation of the blister, the evaluation on a scale of 0–10 (9.43, 9.71, 9.29 and 9.50, respectively). All the investigators have previous experience with transanal devices. ConclusionsThe study demonstrates the efficacy and safety of UNI-VEC® for the treatment of rectal lesions. It will facilitate the implementation of hybrid procedures that seek to solve the limitations of pure endoscopic techniques by allowing the concomitant use of conventional laparoscopic and robotic instrumentation with the flexible endoscope.

MP15-14 PRESERVATION OF ENDOPELVIC FASCIA, PUBOPROSTATIC LIGAMENTS, DORSAL VENOUS COMPLEX AND HYDRODISSECTION OF THE NEUROVASCULAR BUNDLES IMPROVE RATES AND TIME TO CONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: A PROPENSITY-SCORE MATCHED ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP15-14 PRESERVATION OF ENDOPELVIC FASCIA, PUBOPROSTATIC LIGAMENTS, DORSAL VENOUS COMPLEX AND HYDRODISSECTION OF THE NEUROVASCULAR BUNDLES IMPROVE RATES AND TIME TO CONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: A PROPENSITY-SCORE MATCHED ANALYSIS Ahmed S. Elsayed, Yousuf Ramahi, Ayat A. Shah, Hannah B. Ely, Zhe Jing, Holly Houenstein, Julian Joseph, Sharifeh Almasaid, Gaybrielle James, James O. Peabody, Ahmed A. Hussein, and Khurshid A. Guru Ahmed S. ElsayedAhmed S. Elsayed More articles by this author , Yousuf RamahiYousuf Ramahi More articles by this author , Ayat A. ShahAyat A. Shah More articles by this author , Hannah B. ElyHannah B. Ely More articles by this author , Zhe JingZhe Jing More articles by this author , Holly HouensteinHolly Houenstein More articles by this author , Julian JosephJulian Joseph More articles by this author , Sharifeh AlmasaidSharifeh Almasaid More articles by this author , Gaybrielle JamesGaybrielle James More articles by this author , James O. PeabodyJames O. Peabody More articles by this author , Ahmed A. HusseinAhmed A. Hussein More articles by this author , and Khurshid A. GuruKhurshid A. Guru More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002544.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We sought to report the oncologic and functional outcomes of endopelvic fascia (EPF), puboprostatic ligament (PPL), and dorsal venous complex (DVC) preservation with hydrodissection of the neurovascular bundles (NVB) during robot-assisted radical prostatectomy (RARP). METHODS: A retrospective review of our prostate cancer database was performed. Patients who underwent either bilateral or unilateral nerve sparing-RARP were identified. Propensity score matching was performed between new surgical technique (Group 1) and a historical group (Group 2). Data was reviewed for perioperative, oncologic and functional outcomes. Kaplan Meier curves were used to depict biochemical recurrence-free survival (BRFS). Cumulative incidence curves were used to depict perfect continence (0 pads), social continence (0-1 pad) and potency (SHIM ≥17). Multivariate analyses (MVA) were used to depict variables associated with continence and potency. RESULTS: 202 patients were included in the study (76 in Group 1 and 126 in Group 2) with a median follow up of 17 months. Kaplan Meier curves showed similar BRFS (p=0.98). Group 1 showed higher perfect continence rates at 1 months (9% vs 3%), 3 months (24% vs 19%), and 6 months (54% vs 34%) compared to Group 2. Group 1 showed higher social continence rates at 1 month (15% vs 3%), 3 months (67% vs 32%), and 6 months (87% vs 53%) compared to Group 2 (Figure 1a-c). MVA showed that Group 1 was associated with perfect (HR 1.82, 95%CI 1.29–2.58, p<0.01) and social continence (HR 2.54, 95%CI 1.83 – 3.52, p<0.01), but not potency (Table 1). CONCLUSIONS: EPF, PPL, and DVC preservation with hydrodissection of the NVB offered similar oncological outcomes, but earlier and improved urinary continence rates compared to standard dissection. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e247 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed S. Elsayed More articles by this author Yousuf Ramahi More articles by this author Ayat A. Shah More articles by this author Hannah B. Ely More articles by this author Zhe Jing More articles by this author Holly Houenstein More articles by this author Julian Joseph More articles by this author Sharifeh Almasaid More articles by this author Gaybrielle James More articles by this author James O. Peabody More articles by this author Ahmed A. Hussein More articles by this author Khurshid A. Guru More articles by this author Expand All Advertisement PDF DownloadLoading ...

Prediction of Incontinence after Robot-Assisted Radical Prostatectomy: Development and Validation of a 24-Month Incontinence Nomogram.

Simple SummaryMany men fear urinary leakage after radical surgery for prostate cancer and may even choose against operation for unrealistic fears of leakage. Many urologists are unaware of their own results, and some urologists who collect their results do so in different ways. We collected urinary leakage data from 680 men in a uniform and simple way at 6, 12, and 24 months after operation: no pads, 1–2 pads, or ≥3 pads required daily. We used many patient characteristics to identify the key factors that predict recovery of urinary control after operation: age, race, height and weight, and preoperative erectile function. Easy-to-use nomograms were constructed that should be tested by other urologists to make sure they perform equally well in their patients. Nomograms like these allow men and the urologists counseling them to share patient-specific information about the timeline for, and the chance of, recovery of urinary control after operation.Incontinence after robot-assisted radical prostatectomy (RARP) is feared by most patients with prostate cancer. Many risk factors for incontinence after RARP are known, but a paucity of data integrates them. Prospectively acquired data from 680 men who underwent RARP January 2008–December 2015 and met inclusion/exclusion criteria were queried retrospectively and then divided into model development (80%) and validation (20%) cohorts. The UCLA-PCI-Short Form-v2 Urinary Function questionnaire was used to categorize perfect continence (0 pads), social continence (1–2 pads), or incontinence (≥3 pads). The observed incontinence rates were 26% at 6 months, 7% at 12 months, and 3% at 24 months. Logistic regression was used for model development, with variables identified using a backward selection process. Variables found predictive included age, race, body mass index, and preoperative erectile function. Internal validation and calibration were performed using standard bootstrap methodology. Calibration plots and receiver operating curves were used to evaluate model performance. The initial model had 6-, 12-, and 24-month areas under the curves (AUCs) of 0.64, 0.66, and 0.80, respectively. The recalibrated model had 6-, 12-, and 24-month AUCs of 0.52, 0.52, and 0.76, respectively. The final model was superior to any single clinical variable for predicting the risk of incontinence after RARP.

Surgical repair and follow-up of chronic 4th degree obstetric perineal tear (total perineal defect) in 2 centres in eastern Africa.

Introduction and hypothesisFourth-degree perineal tear occurs in up to 0.2% of vaginal deliveries. In limited resource communities, women often deliver in local villages without facilities to repair obstetric anal sphincter injuries. These fourth-degree tears heal by secondary intention and result in total perineal defects. The aim of the study is to present medium-term follow-up of a large number of women following repair of chronic fourth-degree tear.MethodsRepairs of chronic obstetric fourth-degree tears were undertaken during surgical camps at Kagando Hospital, Uganda and Selian Hospital, Tanzania, from December 2013 to October 2019. Women completed Cleveland Clinic Incontinence Scores (CCIS) on admission (face to face) and during the 7-year follow-up period (via telephone).ResultsTwo hundred fourteen women had medical history and CCIS completed on admission. The mean age at presentation was 33.9 years and mean duration of the condition was 8.9 years. Over a third of women stated they suffered social abandonment because of the unrepaired fourth-degree tear. Nearly 45% of women suffered the tear during the first vaginal delivery. At 1-year follow-up, 87% of 101 women scored 0 (perfect continence) and 94% of 66 women had perfect continence at 2 years. Forty-one births occurred during the follow-up period (32 vaginal deliveries) with two recurrences of fourth-degree tear.ConclusionsFollow-up in limited resource communities is challenging. Short- to medium-term results of women who had repair of total perineal defect (unrepaired fourth-degree obstetric tears) are encouraging.

Retrospective Analysis of Primary Suturing of the Internal Orifice of Perianal Fistula During FiLaC Procedure.

We aimed to evaluate the results of the fistula-tract laser closure associated with primary closure of internal orifice. The surgical objective was to seal the fistula tract using laser energy and closing internal orifice with purse-string suture. Between January 2017 and December 2018, 35 consecutive patients who underwent the laser closure plus internal orifice suturing included. In all 35 patients, the laser procedure was applied then internal orifice was primarily closed with 2-0 polyglactin suture after the debridement of necrotic tissue. Among 35 patients (11 female, 24 male), mean age was 43.9±12.9 years. Median follow-up was 11 months (6.0 to 17.6 mo). According to the Park classification; 21 patients (60%) had intersphincteric fistula, 12 (34%) had transsphincteric fistula, 2 (6%) had suprasphincteric or extrasphincteric fistula. There were low/simple and high/complex fistula in 21 (60%) and 14 patients (40%), respectively. Overall, 15/35 (42.9%) patients showed complete healing, 12/35 (34%) had slight drainage with minimal symptoms, 8/35 (22%) patients had persistent symptomatic drainage, and there was no patient with painful symptomatic drainage. On the basis of the Jorge-Wexner continence score, there was no significant difference in patients before and after the procedure. The perfect continence rate was achieved in 32 patients (91%). Although the absence of major and minor complications after Fistula Laser Closure (FiLaC) procedure seemed to be a major advantage, we thought that closure of the internal opening by primary suturing has no positive effect on the healing of the perianal fistula.

Transanal total mesorectal excision for locally advanced middle–low rectal cancers

BackgroundThis study investigated the results of transanal total mesorectal excision (TaTME) combined with laparoscopy for locally advanced mid–low rectal cancer.MethodsPatients with mid–low locally advanced rectal cancer (T3 category or above and/or N+) who underwent rectal resection with TaTME technique were enrolled prospectively. Patients who had distant metastasis, multiple malignancies, intestinal obstruction or perforation, or a clinical complete response to chemoradiotherapy were excluded. Postoperative results, including morbidity, circumferential resection margin (CRM) assessment, short‐term survival and functional outcomes, were analysed.ResultsThirty‐eight patients, with 25 mid and 13 low rectal tumours, who had elective resection by TaTME from March 2015 to September 2018 were included. There were 25 men and 13 women. Mean(s.d.) age was 58·2(16·4) years and mean(s.d.) BMI was 24·2(2·5) kg/m2. Tumours were 3–9 cm from the anal verge. Mean(s.d.) duration of surgery was 210(42) min. All patients had hand‐sewn anastomoses and protective ileostomies. There were no conversions, abdominal perineal resections or postoperative deaths. Four patients had a complication, including three presacral abscesses, all managed by transanastomotic drainage. At 3 months after ileostomy closure, all patients had perfect continence. Apart from a greater tumour diameter in patients with low rectal cancers (6·0 cm versus 4·6 cm in those with mid rectal tumours; P = 0·035), clinical features were similar in the two groups. CRM positivity was greater for low than for mid rectal tumours (3 of 13 versus 0 of 25 respectively; P = 0·034), and more patients with a low tumour had TME grade 2 (4 of 13 versus 1 of 25; P = 0·038). There was no difference in oncological outcomes at 17 months.ConclusionAlthough this study cohort was small, special attention should be paid to bulky low rectal tumours to reduce the rate of CRM positivity.

External validation of prostatectomy incontinence nomogram (PIN).

106 Background: Using previously developed prostatectomy incontinence nomogram (PIN) we sought to externally validate the nomogram that predicts probability of incontinence at 6-, 12-, and 24-months after robot assisted radical prostatectomy (RARP). Methods: Prospective data from 663 men with prostate cancer that underwent RARP from 2010 to 2014 at two comprehensive cancer centers and three large group practices was queried. The performance of the previously developed model was evaluated using calibration plots (predicted continence rates versus observed continence rates with 95% CI obtained using Jeffrey’s prior method) and receiver operating curves (ROC). Using Expanded Prostate Cancer Index Composite (EPIC-50) Urinary Function questionnaire, perfect continence was defined as 0 pads, social continence was defined as 1 or 2 pads, and incontinence was defined as ≥ 3 pads used after RARP. Results: The 6-, 12-, and 24- month social continence rates were 77%, 88%, and 93%, respectively. Similar to the 6- and 12-month model development cohort, the external validation cohort has modest predictability with a 6- and 12- month AUC of 0.61, and 0.62, respectively. The 24-month AUC of 0.62 in the external validation cohort is worse than what was reported in the development cohort (AUC 0.80). Conclusions: The externally validated prostatectomy incontinence nomogram is generalizable but has modest 6-, 12-, and 12-month predictability in risk of incontinence after RARP.

Treatment for anal fissure: Is there a safe option?

BackgroundSurgeons often approach anal fissure with chemical denervation (Botulinum toxin, BT) instead of initial lateral internal sphincterotomy (LIS) due to concerns for long-term incontinence. We evaluated the characteristics and outcomes of patients who received BT or LIS. MethodsWe performed a retrospective chart review of patients undergoing LIS and BT for anal fissure between 2009 and 2015. In 2015, a telephone survey was performed to evaluate durability, long-term incontinence and patient satisfaction. ResultsNinety-four patients met criteria: 73 LIS and 21 BT. Age (BT 49 vs. LIS 52) was similar between groups (p = 1.0). Cleveland Clinic Fecal Incontinence (CCFI) score pre-intervention was higher in BT than LIS patients (2.1 vs. 0.4, p = 0.007) with fewer BT patients with perfect continence (50% vs. 88%). Telephone survey response was 61%. Fissure recurrence was significantly higher for BT than LIS patients (36% vs. 9%, p = 0.03). ConclusionPatients undergoing LIS were less likely to recur. Both LIS and BT patients had some durable changes in continence raising the question of whether there is a safe technique.

Long-term Outcome of an Organ Preservation Program After Neoadjuvant Treatment for Rectal Cancer.

The aim of this study was to establish the oncological and functional results of organ preservation with a watch-and-wait approach (W&W) and selective transanal endoscopic microsurgery (TEM) in patients with a clinical complete or near-complete response (cCR) after neoadjuvant chemoradiation for rectal cancer. Between 2004 and 2014, organ preservation was offered if response assessment with digital rectal examination, endoscopy, and MRI showed (near) cCR. Watch-and-wait was offered for cCR, and two options were offered for near cCR: TEM or reassessment after three months. Follow-up included endoscopy and MRIs every three months during the first year, and every six months thereafter. Long-term outcome was assessed with Kaplan-Meier curves. Functional outcome was assessed with colostomy-free survival and Vaizey incontinence score (0 = perfect continence, 24 = totally incontinent). One hundred patients were included, with median follow-up of 41.1 months. Sixty-one had cCR at initial response assessment. Thirty-nine had near cCR, of whom 24 developed cCR at the second assessment and 15 patients underwent TEM (9 ypT0, 1 ypT1, 5 ypT2). Fifteen patients developed a local regrowth (12 luminal, 3 nodal), all salvageable and within 25 months. Five patients developed metastases, and five patients died. Three-year overall survival was 96.6% (95% confidence interval [CI] = 89.9% to 98.9%), distant metastasis-free survival was 96.8% (95% CI = 90.4% to 99.0%), local regrowth-free survival was 84.6% (95% CI = 75.8% to 90.5%), and disease-free survival was 80.6% (95% CI = 70.9% to 87.4%). Colostomy-free survival was 94.8% (95% CI = 88.0% to 97.8%), with a good continence after watch-and-wait (Vaizey = 3.4, SD = 3.9) and moderate after TEM (Vaizey = 9.7, SD = 5.1). Organ preservation appears oncologically safe for selected rectal cancer patients with a cCR or near cCR after neoadjuvant chemoradiation when applying strict selection criteria and frequent follow-up, including endoscopy and MRI. The low colostomy rate and the good long-term functional outcome warrant discussing this option with the patient as an alternative to major surgery.

Quality of life with anal fistula.

Anal fistula affects people of working age. Symptoms include abscess, pain, discharge of pus and blood. Treatment of this benign disease can affect faecal continence, which may, in turn, impair quality of life (QOL). We assessed the QOL of patients with cryptoglandular anal fistula. Newly referred patients with anal fistula completed the St Mark's Incontinence Score, which ranges from 0 (perfect continence) to 24 (totally incontinent), and Short form 36 (SF-36) questionnaire at two institutions with an interest in anal fistula. The data were examined to identify factors affecting QOL. Data were available for 146 patients (47 women), with a median age of 44 years (range 18-82 years) and a median continence score of 0 (range 0-23). Versus population norms, patients had an overall reduction in QOL. While those with recurrent disease had no difference on continence scores, QOL was worse on two of eight SF-36 domains (p<0.05). Patients with secondary extensions had reduced QOL in two domains (p<0.05), while urgency was associated with reduced QOL on five domains (p<0.05). Patients with loose seton had the same QOL as those without seton. No difference in urgency was found between patients with and without loose seton. In primary fistula patients, 19.4% of patients experienced urgency versus 36.3% of those with recurrent fistulas. Patients with anal fistula had a reduced QOL, which was worse in those with recurrent disease, secondary extensions and urgency. Loose seton had no impact on QOL.

Outcomes following surgical repair using layered closure of unrepaired 4th degree perineal tear in rural western Uganda.

In many rural low-income countries, perineal tears at time of vaginal birth are not repaired at time of delivery. The aims of this study are to describe the surgical technique for management of the unrepaired 4th degree tear, performed without flaps, and short-term follow up on anal incontinence symptoms using a validated questionnaire. Women presenting to fistula camps in western Uganda with unrepaired 4th degree tears were interviewed using the Cleveland Clinic Continence Score. Interviews were undertaken pre-operatively, at 4-6weeks post-operatively and 12months following surgery. Repair of the 4th degree tear was performed in layers, with an overlapping anal sphincter repair and reconstruction of the perineal body, without flaps. All women were examined prior to discharge. 68 women completed pre-operative Cleveland Clinic Continence Scores. Prior to surgery, 59% of women complained of daily incontinence to solid stools. Over 70% of women complained of restriction to lifestyle due to the unrepaired 4th degree tear. About 50% of the women are rejected by their husbands because of the condition. Only 1 woman had wound breakdown on Day 2. At 4 to 6weeks follow-up, 61 women were contacted and all reported perfect continence. This study highlights the hidden problem of unrepaired 4th degree tears in rural areas of low-income countries where most deliveries are undertaken in the village without professional health care workers. These tears have significant impact on quality of life and anal incontinence. Short-term outcomes following surgical repair using a layered closure are promising.

PD18-01 IMPROVEMENT IN CONTINENCE AND QUALITY OF LIFE IN MEN WITH SEVERE LUTS VIA HYPOTHERMIC COOLING

INTRODUCTION AND OBJECTIVES: Men with Severe lower urinary tract symptoms (LUTS) have been shown to have immediate improvement in urinary symptoms and quality of life (QOL) after robotic-assisted radical prostatectomy (RARP) persisting long term (Urology 84(4): 826-831,2014). However, men with Severe LUTS had lower postoperative continence rates when compared to men with Moderate/Mild LUTS (71% vs 89%). We studied continence rates, AUAss and urinary QOL in men with severe LUTS before and after RARP comparing men receiving intraoperative cooling to men who did not. METHODS: RARP was performed on 1,385 patients by 1 surgeon from 2002 to 2013. Men with preoperative severe LUTS (AUAss 20) were compared based on hypothermic cooling (n1⁄445) versus control (n1⁄453). Men returned preoperative and postoperative self-reported American Urological Association Symptom Score (AUAss) and urinary QOL questionnaires at 3 Months, 9 Mo, 15 Mo, and > 2 Years. Continence was defined as completely pad free and was recorded by continence cards. ‘Perfect continence’ was defined as: 0 pads, total urinary control, and no leakage. RESULTS: There was no significant difference in the baseline demographics (Age, BMI, Preop PSA, Prostate Weight) of the cooling versus control cohorts (all p>.27). Average follow up time in both groups was 1.8 Years. Continence rates at 3, 9 and 12 Mo postoperatively in the cooling vs control group was 73% vs 53% (p1⁄4.06), 87% vs 71% (p1⁄4.07), 89% vs 71% (p1⁄4.05), Figure 1. The cooling cohort trended toward higher rates of perfect continence compared to control at 3 Mo (29% vs 11%) and 9 Mo (61% vs 32%), all p<.09. AUAss significantly improved in both cohorts by a mean of 15.8 points (24.5 to 8.7, p<.001) as soon as 3 months and remained durable 15þ months postop (p1⁄4.28), but not between groups. Mean QOL scores declined at 3 Mo from 4.0 to 1.9 for the cooling group and from 4.0 to 2.6 for the non-cooling group (p<.001), both persisting long term. CONCLUSIONS: In men with severe LUTS undergoing RARP, intraoperative hypothermic cooling significantly improved the mean time to continence, overall 12 month pad-free continence (89% versus 71%), and also trended towards total contol or ‘perfect’ continence. QOL scores significantly improved as well. AUAss dynamically improved with cooling, as did controls, but pad free continence was not compromised as reported in non-cooled men. Source of Funding: none

Long-term outcome of low perianal fistulas treated by fistulotomy: a multicenter study.

Fistulotomy is considered to be the golden standard for the treatment of low perianal fistula but might have more influence on continence status than believed. This study was performed to evaluate the healing rate after a fistulotomy and to show results for continence status. A retrospective database study was performed in one university medical center and its six affiliated hospitals. All patients treated with a fistulotomy for a low perianal fistula were identified. Healing and recurrence of the fistula were identified. Questionnaires on continence status and quality of life were mailed to all patients. In total, 537 patients were identified. The primary etiology of the fistulas was cryptoglandular (66.5%). Recurrence was seen in 88 patients (16.4%) resulting in a primary healing rate of 83.6%. After secondary treatment for the recurrence, another 40 patients healed. This resulted in a secondary healing rate of 90.3%. The Kaplan-Meier analysis showed that at 5 years, the healing rate was 0.81 (95% confidence interval (95% CI) 0.71-0.85). The mean Vaizey score was 4.67 (SD 4.80). Major incontinence, defined as a Vaizey score of >6, was seen in 95 (28.0%) patients. Only 26.3% of the patients had a perfect continence status (Vaizey score 0). Quality of life was not different from the general population. Fistulotomy seems to be associated with a healing rate of 0.81 (95% CI 0.71-0.85) after 5 years. However, major incontinence is still reported by 26.8% of patients and only 26.3% of patients had a perfect continence status.

1265 POSTOPERATIVE ANATOMIC MEASUREMENTS WITH DYNAMIC MAGNETIC RESONANCE IMAGING: ASSOCIATION WITH URINARY CONTINENCE IN ORTHOTOPIC ILEAL NEOBLADDER AFTER RADICAL CYSTOPROSTATECTOMY FOR BLADDER CANCER

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion (I)1 Apr 20131265 POSTOPERATIVE ANATOMIC MEASUREMENTS WITH DYNAMIC MAGNETIC RESONANCE IMAGING: ASSOCIATION WITH URINARY CONTINENCE IN ORTHOTOPIC ILEAL NEOBLADDER AFTER RADICAL CYSTOPROSTATECTOMY FOR BLADDER CANCER Jonathan Lopater, Antoine Scherrer, Servane Gey, Vincent Delmas, Yann Neuzillet, and Thierry Lebret Jonathan LopaterJonathan Lopater Suresnes, France More articles by this author , Antoine ScherrerAntoine Scherrer Suresnes, France More articles by this author , Servane GeyServane Gey Paris, France More articles by this author , Vincent DelmasVincent Delmas Paris, France More articles by this author , Yann NeuzilletYann Neuzillet Suresnes, France More articles by this author , and Thierry LebretThierry Lebret Suresnes, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2619AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The objective of this study is to use dynamic magnetic resonance (MR) imaging to evaluate the roles of post-operative anatomic measurements in the recovery of urinary continence in orthotopic ileal neobladder after radical cystoprostatectomy for bladder cancer. METHODS Five case patients requiring clean intermittent self-catheterization (CISC), and thirty eight control patients who received a dynamic MR imaging with an orthotopic ileal neobladder after radical cystoprostatectomy for bladder cancer were evaluated in a prospective study at a single institution. Day-time and noctunal urinary continence was categorized as mode according to CISC requirement, perfect and not perfect continence, as incontinence severity according to pad count and as time to continence. Dynamic MR imaging anatomic measurements of pelvic bone and soft tissue were performed. Multivariate age-adjusted polytomus and ordinal logistic regressions after univariate mean and repartition comparison were performed to assess variables associated with urinary continence mode and incontinence severity. Univariate and multivariate age-adjusted cox regressions were performed to assess variables with time to continence recovery. RESULTS Day-time continence of control patients was perfect in 73.7% and satisfying in 94.7%. Univariate analyses selected 3 variables, but only levator ani thickness at the pouch-urethral anastomosis level predicted day-time urinary continence mode (relative risk ratio [RRR] = 2.14 per mm, perfect against not perfect, 95% CI [1.16, 3.97], p = 0.015), incontinence severity (Ordinal odds ratio = 2.08 per mm, 95% CI [1.27, 3.93], p = 0.007) and time to day-time recovery (Hazard ratio [HR]= 0.82 per mm, 95% CI [0.68, 1.00], p = 0.046). Levator ani muscle at the level of the urethra had a teardrop coronal shape, thicker at the bottom than at the top. Also, levator ani thickness at the pouch-urethral anastomosis level represented postoperative lack of membranous urethral support. CONCLUSIONS Data suggest that lack of membranous urethral support impacts on daytime urinary continence recovery of orthotopic ileoplasty after cystoprostatectomy for bladder cancer. Prognostic value on urinary continence recovery of post-operative peri-sphincteric structures establishes a pathophysiological role to membranous urethral support in men besides innervation. Therefore, preservation of peri-sphincteric structures during surgery is recommended. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e518 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Lopater Suresnes, France More articles by this author Antoine Scherrer Suresnes, France More articles by this author Servane Gey Paris, France More articles by this author Vincent Delmas Paris, France More articles by this author Yann Neuzillet Suresnes, France More articles by this author Thierry Lebret Suresnes, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1036 PRIMARY ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR MALE NON-NEUROGENIC STRESS URINARY INCONTINENCE: EARLY AND MIDTERM RESULTS OF A MULTICENTER CONTEMPORARY SERIES

1036 PRIMARY ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR MALE NON-NEUROGENIC STRESS URINARY INCONTINENCE: EARLY AND MIDTERM RESULTS OF A MULTICENTER CONTEMPORARY SERIES

165 LIVE BETTER: THE EFFECT OF LIFESTYLE BEHAVIORS ON POST-PROSTATECTOMY HEALTH RELATED QUALITY OF LIFE OUTCOMES

You have accessJournal of UrologyProstate Cancer: Epidemiology and Natural History I1 Apr 2012165 LIVE BETTER: THE EFFECT OF LIFESTYLE BEHAVIORS ON POST-PROSTATECTOMY HEALTH RELATED QUALITY OF LIFE OUTCOMES Michael A. Poch, Diana C. Mehedint, Rebecca L. O'Malley, Chi-Chen Hong, Levi Ross, Khurshid A. Guru, and Willie Underwood Michael A. PochMichael A. Poch Buffalo, NY More articles by this author , Diana C. MehedintDiana C. Mehedint Buffalo, NY More articles by this author , Rebecca L. O'MalleyRebecca L. O'Malley Buffalo, NY More articles by this author , Chi-Chen HongChi-Chen Hong Buffalo, NY More articles by this author , Levi RossLevi Ross Buffalo, NY More articles by this author , Khurshid A. GuruKhurshid A. Guru Buffalo, NY More articles by this author , and Willie UnderwoodWillie Underwood Buffalo, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.216AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Modifiable lifestyle behaviors, including tobacco use, alcohol consumption, and physical activity, have been shown to affect genitourinary health in men. The goal of this study was to assess the impact of lifestyle behaviors on health-related quality of life (HRQL) outcomes for patients undergoing robotic radical prostatectomy (RARP) using a novel composite index: Lifestyle Index of Vascular and Erectile health (LIVE score). METHODS The prospective IRB approved localized prostate cancer database at Roswell Park Cancer Institute was queried for patients who underwent RARP from 2004 to 2009. HRQL outcomes were measured using the UCLA-PCI at standard postoperative time points. Lifestyle behavior data were obtained from the Institutional Data Bank and BioRepository which collects extensive epidemiological information regarding dietary, social, and health practices at the time of cancer diagnosis. LIVE scores were generated by assigning values to smoking status, pack year history, physical activity level and body mass index (BMI). Patients with LIVE scores ≤ 2 were categorized as low, 3-4 average, and >4 high. The relationship between LIVE scores and HRQOL outcomes was assessed using ANOVA and multivariable regression analysis. RESULTS 409 patients were included in the study. Mean age at operation was 60 (SD ± 6 years) with mean pre-operative PSA 6.5 ng/ml (SD ± 5.1). 130 (32%) patients reported adequate sexual function by 12 months postoperatively. 179(44%) patients returned to baseline sexual bother score by 12 months. At 6 months 359 (88%) patients were using ≤2 pads per day and (217) 53% had perfect continence. Urinary bother scores returned to baseline in 219 (53%) patients by 12 months. 77 (19%), 246 (60%) and 73 (18%) patients had high, average and low LIVE scores, respectively. Patients with average and high LIVE scores had higher sexual function scores than patients with low LIVE scores preoperatively (p <0.001), at 6 (p = 0.01), 12 (p = 0.013) and 24 months (p = 0.036). Better erection quality (p = 0.02) and orgasmic function (p = 0.01) were positively associated with LIVE scores after adjustments for age, preoperative sexual function, and receipt of nerve sparing technique. There was no difference in pad count between LIVE groups at 6 and 12 months after adjustment for age and nerve-sparing technique. CONCLUSIONS As demonstrated by the LIVE index, healthy lifestyle behaviors are associated with improved postoperative sexual function for patients undergoing RARP. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e68-e69 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael A. Poch Buffalo, NY More articles by this author Diana C. Mehedint Buffalo, NY More articles by this author Rebecca L. O'Malley Buffalo, NY More articles by this author Chi-Chen Hong Buffalo, NY More articles by this author Levi Ross Buffalo, NY More articles by this author Khurshid A. Guru Buffalo, NY More articles by this author Willie Underwood Buffalo, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...