Postoperative Pad Use Research Articles

PD37-11 MULTI-CENTERED ASSESSMENT OF CLINICAL OUTCOMES AND FACTORS ASSOCIATED WITH FAILURE OF THE ADJUSTABLE TRANSOBTURATOR MALE SYSTEM (ATOMS)

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy II (PD37)1 Apr 2020PD37-11 MULTI-CENTERED ASSESSMENT OF CLINICAL OUTCOMES AND FACTORS ASSOCIATED WITH FAILURE OF THE ADJUSTABLE TRANSOBTURATOR MALE SYSTEM (ATOMS) Elaine Redmond*, Genevieve Nadeau, Le-Mai Tu, Christopher Doiron, Stephen Steele, Dean Elterman, Jennifer Locke, Sender Herschorn, Conrad Maciejewski, Neil Dwyer, Lysanne Campeau, Kevin Carlson, and Keith Rourke Elaine Redmond*Elaine Redmond* More articles by this author , Genevieve NadeauGenevieve Nadeau More articles by this author , Le-Mai TuLe-Mai Tu More articles by this author , Christopher DoironChristopher Doiron More articles by this author , Stephen SteeleStephen Steele More articles by this author , Dean EltermanDean Elterman More articles by this author , Jennifer LockeJennifer Locke More articles by this author , Sender HerschornSender Herschorn More articles by this author , Conrad MaciejewskiConrad Maciejewski More articles by this author , Neil DwyerNeil Dwyer More articles by this author , Lysanne CampeauLysanne Campeau More articles by this author , Kevin CarlsonKevin Carlson More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000908.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The adjustable transobturator male system (ATOMS) is a trans-obturator device with a non-circumferential adjustable hydraulic cushion used to treat sphincteric incontinence after prostate cancer treatment. The aim of this multicentre study was to assess postoperative outcomes from the ATOMS device and to identify factors influencing failure to achieve continence. METHODS: Men who underwent insertion of ATOMS for the treatment post prostatectomy incontinence between September 2015 and August 2019 at 9 Canadian centres were reviewed. The primary outcome was continence; defined as requiring ≤1 pad postoperatively for patients requiring ≥2 pads preoperatively and 0 pads for those requiring 1 pad preoperatively. Secondary outcomes included improvement (>50% change in pad use), patient satisfaction, explantation and 90-day complications. Other patient demographics included age, obesity (BMI≥35), comorbidities, concurrent radiotherapy, prior incontinence surgery, previous urethral stenosis, type of prostatectomy and pads per day (ppd). RESULTS: 295 patients with a mean age of 69.9 years were analyzed. Pre-operatively mean pad use was 4.2 ppd (1-12), 32.5% of patients reported severe incontinence (≥5 pads/day), 34.2% had concurrent radiotherapy and 20.0% had failed previous incontinence surgery. Initial post-operative pad use was 1.4 ppd before cushion adjustment (p<0.0001) and 0.9 ppd following adjustments (p<0.0001). 71.2% (n=210) patients underwent adjustment a mean of 2.1 (0-9) times for a mean total volume of 12.0mL. Overall continence rate was 72.9% (n=215) at a mean follow-up of 19.7 months. 89.2% (n=263) of patients experienced >50% improvement, 84.4% (n=249) of patients were satisfied with the results of surgery. 8.1% (n=24) required device explantation. On multivariate Cox regression analysis, concurrent radiotherapy (HR 2.5, p<0.0001), diabetes (HR 2.2, p=0.006) and increased pre-operative pad usage (HR 1.1, p=0.03) were associated with failure to achieve continence, while patient age (p=0.51), obesity (p=0.08), prior urethral stenosis (p=0.66) and prior incontinence surgery (p=0.17) were not. Radiation therapy was also associated with device explantation (HR 3.1, p=0.007). CONCLUSIONS: In the largest cohort study to date, ATOMS is a safe and efficacious device for the treatment of a broad spectrum of patients with post prostatectomy incontinence. Our study found a durable response on continued follow-up, with high rates of continence, improvement and patient satisfaction. Patients with prior radiation, increased pre-operative pad use and diabetes are less likely to achieve continence. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e732-e732 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elaine Redmond* More articles by this author Genevieve Nadeau More articles by this author Le-Mai Tu More articles by this author Christopher Doiron More articles by this author Stephen Steele More articles by this author Dean Elterman More articles by this author Jennifer Locke More articles by this author Sender Herschorn More articles by this author Conrad Maciejewski More articles by this author Neil Dwyer More articles by this author Lysanne Campeau More articles by this author Kevin Carlson More articles by this author Keith Rourke More articles by this author Expand All Advertisement PDF downloadLoading ...

Canadian Experience with the Adjustable Transobturator Male System for Post-Prostatectomy Incontinence: A Multicenter Study.

We assessed the efficacy and safety profile of the ATOMS® (Adjustable Transobturator Male System) for post-prostatectomy incontinence in a multicenter North American setting. We reviewed outcomes from 8 centers in men who underwent treatment of post-prostatectomy incontinence with an ATOMS. Primary study outcomes were pad changes and continence, defined as requiring 1.0 or 0 pad postoperatively in patients who required 2.0 or more pads preoperatively and 0 pad in those who required more than 1.0 or 2.0 pads preoperatively. Secondary outcomes included improvement, 90-day complications and patient satisfaction. A total of 160 patients were enrolled in study with a median followup of 9.0 months. Preoperative median pad use was 4 per day (IQR 3-5). Of the patients 36.3% reported severe preoperative incontinence, 31.3% received prior radiotherapy and 16.3% underwent previous incontinence surgery. Median postoperative pad use after adjustments was 0.5 per day (IQR 0-1, p <0.001). The overall continence rate was 80.0% with improvement in 87.8% of cases. Of the patients 70.1% underwent a mean ± SD of 2.4 ± 2.7 adjustments (IQR 0-16). The patient satisfaction rate was 86.3%, 22.3% experienced 90-day complications of any grade and 7 (4.4%) experienced Clavien III complications primarily related to the injection port. Patients with a history of radiotherapy were less likely to be continent (62.5% vs 87.9%, p=0.002), improved (77.1% vs 92.6%, p=0.02) or satisfied (69.8% vs 93.2%, p=0.001). Similarly patients with previous incontinence surgery had lower rates of continence, improvement and satisfaction (57.7%, 73.1% and 69.6%, respectively). In the short term the ATOMS is a safe and efficacious device to treat post-prostatectomy incontinence. Patients with concurrent radiotherapy and previous incontinence surgery respond to treatment but are less likely to be continent, improved or satisfied.

Lower urinary tract symptoms (LUTS) before and after robotic-assisted laparoscopic prostatectomy: does improvement of LUTS mitigate worsened incontinence after robotic prostatectomy?

Urinary incontinence is a major concern for patients scheduled for radical prostatectomy. However, after prostatectomy lower urinary tract symptoms (LUTS) may improve and thus mitigate this concern. We assessed LUTS and its interference with the quality of life (QoL) using the short form of the international continence society male questionnaire (ICSMALESF-Q) in patients before and after robot-assisted radical prostatectomy (RARP). Furthermore, we aimed to identify risk factors for postoperative urinary incontinence. Data of all patients who underwent RARP from 2009 to 2014 were prospectively collected in our customized database. We identified 453 eligible patients for whom a preoperative and at least two postoperative datasets including ICSMALESF-Q were available. Both the ICSMALESF-Q at 6 months (P<0.001) and the related QoL at 12 months (P<0.01) have significantly improved after RARP (P<0.001). Two years after RARP ICSMALESF-Q and thus LUTS have improved in 64%, remained unchanged in 18% and worsened in 18% of patients. The daily pad use was 0 in 79% and 0 or 1 pad in 95.6%, respectively. Increased patient age (P<0.05) was significantly associated with an increased average number of pads used per day (multiplicative effect: +2.1% pads for each year). Being in the D'Amico low-risk group reduced the average number of pads used by 22% (P<0.05, multiplicative effect 0.780). The prostate volume, planned nerve sparing, adjuvant or salvage radiotherapy, body mass index (BMI), or a history of transurethral resection of the prostate (TUR-P) before radical prostatectomy were not associated with the postoperative pad use or changes in LUTS. The ICSMALESF-Q and thus LUTS have significantly improved in a majority of patients after RARP and hence the associated QoL improved as well. Preoperative D'Amico low-risk group significantly reduced pad use after RARP, whereas increased age significantly increased postoperative pad use. These results will help providers counsel their patients more appropriately before prostatectomy by focusing not only on pad use and incontinence after RARP, but also on changes of the bothersomeness of LUTS and risk factors in general.

PD02-08 PREVENTATIVE CONCOMITANT SLING FOR DE-NOVO STRESS URINARY INCONTINENCE AFTER ROBOTIC SACRAL COLPOPEXY DOES NOT IMPROVE LONG TERM CONTINENCE OR SATISFACTION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse I1 Apr 2017PD02-08 PREVENTATIVE CONCOMITANT SLING FOR DE-NOVO STRESS URINARY INCONTINENCE AFTER ROBOTIC SACRAL COLPOPEXY DOES NOT IMPROVE LONG TERM CONTINENCE OR SATISFACTION Charles Powell, Bridget Eckrich, Jeffrey Rothenberg, and Thomas Gardner Charles PowellCharles Powell More articles by this author , Bridget EckrichBridget Eckrich More articles by this author , Jeffrey RothenbergJeffrey Rothenberg More articles by this author , and Thomas GardnerThomas Gardner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.201AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a 44% risk of stress urinary incontinence (SUI) following sacral colpopexy and some advocate a concomitant sling to prevent this. Robotic Sacral Colpopexy (RSC) may carry a different risk of de-novo SUI and women may be just as satisfied with a delayed mid-urethral sling (MUS). This would reduce unnecessary MUS. We sought to determine this risk and evaluate the hypothesis that delayed MUS following RSC will have similar long term pad use, Quality of Life (QoL), Distress (UDI-6), and Impact scores (IIQ-7) compared to concomitant MUS. METHODS Retrospective review was undertaken and subjects were grouped based on continence status at the time of RSC. Incontinence was defined by self-report at any follow up visit, SUI on the supine stress test, or decision for MUS. RESULTS A retrospective review of the Indiana University RSC database between 2009 and 2015 identified 135 women who underwent RSC. 79 had no preoperative SUI and 29/79 (36.7%) of patients had at least one episode of de-novo SUI following RSC over a follow up of 17.9 months. 98 patients were evaluable post-operatively. 47/57 (82%) initially dry patients elected no concomitant MUS, and ultimately 5/47 (11%) of those chose a delayed sling at an average follow up time of 23.9 months. 10/57 (18%) preoperatively dry women elected to undergo a concomitant MUS at the time of RSC. Those undergoing delayed sling reported similar post-operative pad use, UDI-6, QoL, and IIQ-7 scores (Table 1) compared with those not undergoing a sling, suggesting that a delayed sling did not have a negative impact on QoL. Those choosing to undergo concomitant MUS reported more pads per day preoperatively (2.6 vs. 0.4) including pad use from urge incontinence. With regard to satisfaction the patients who were dry pre-operatively and chose no sling scored better (2.25 vs. 6.2, p<0.01) on the IIQ-7 compared with those choosing a concomitant sling. CONCLUSIONS Patients undergoing RSC without concomitant MUS have similar de-novo SUI rates to those undergoing open colpopexy. There appears to be no advantage to concomitant MUS at the time of RSC for women exhibiting no preoperative SUI. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e53-e54 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Charles Powell More articles by this author Bridget Eckrich More articles by this author Jeffrey Rothenberg More articles by this author Thomas Gardner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP88-20 SUCCESS RATES OF ARTIFICIAL URINARY SPHINCTER PLACEMENT FOLLOWING URETHROPLASTY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-20 SUCCESS RATES OF ARTIFICIAL URINARY SPHINCTER PLACEMENT FOLLOWING URETHROPLASTY Christopher Powell, Travis Dum, William Brant, and Joshua Broghammer Christopher PowellChristopher Powell More articles by this author , Travis DumTravis Dum More articles by this author , William BrantWilliam Brant More articles by this author , and Joshua BroghammerJoshua Broghammer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1853AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients undergoing artificial urinary sphincter (AUS) following urethroplasty are often categorized as high-risk due to previous urethral instrumentation and theoretical altered urethral vascular supply. Limited data exist regarding outcomes in these patients making appropriate patient counseling difficult at best. We compare outcomes of AUS placement at two tertiary care centers to determine outcomes of AUS placement in patients who had undergone previous urethroplasty. METHODS A retrospective analysis of patients treated with AUS placement from November 2008 to December 2013 was performed at two tertiary care centers. All patients receiving AUS placement were included regardless of urinary incontinence etiology. Patients were divided into “average risk” (AR) and previous urethroplasty (PU) cohorts. Patients with a history of radiation therapy, multiple treatments for bladder neck contracture or urethral stricture, urethral stent placement, or a history of erosion or infection in a previous AUS and were excluded from the AR cohort. Charts were analyzed for pre-operative risk factors as well as post-operative complications, revisions, and pad usage. RESULTS 141 patients underwent AUS placement during the study period. 13 patients undergoing AUS placement had a history of previous urethroplasty (PU). Patients were included regardless of indication for urethroplasty. Indications for urethroplasty included urethral stricture, AUS erosion, and bladder neck contracture in 9, 3, and 1 patient respectively. 63 patients were considered average risk (AR). Post-operative complication rate was 15.4% (n=2, RR 1.38, p=0.66) in the PU group and 11.1% (n=7) in the AR group. Complications in the PU group included persistent bothersome incontinence and erosion each in a single patient. Mean postoperative pad use was 0.96 (n=53) in AR group vs 2.1 in PU group (n=8). Mean follow-up time was 10.9 months (range 1-35) for AR group and 4 months (range 1-9) for PU group. CONCLUSIONS Patients who had previously undergone a urethroplasty for any indication were not statistically more likely to develop a postoperative complication than “average risk” patients. Post-operative pad usage was twice that of the AR group. While longer follow-up is necessary, these data suggest that patients undergoing AUS placement following urethroplasty may have a similar complication rate to that of the general population. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1099 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Powell More articles by this author Travis Dum More articles by this author William Brant More articles by this author Joshua Broghammer More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

MP38-09 THE VALUE OF RETROPUBIC SLINGS FOLLOWING FAILED PRIOR ANTI-INCONTINENCE PROCEDURES

INTRODUCTION AND OBJECTIVES: Mid-urethral slings (MUS) are considered first-line surgical treatment of stress urinary incontinence (SUI). However, there is a paucity of data regarding the use of retropubic slings for patients who failed a prior sling. This study compares the outcomes of retropubic mid-urethral slings (SPARC) to autologous pubovaginal rectus fascial slings (pvs) for sling refractory incontinence. METHODS: A retrospective review of 213 consecutive patients undergoing placement of SPARC (n1⁄4152) or pvs (n1⁄461) by two fellowship trained urologists for prior failed sling surgery was conducted over an eight-year time span. Mean follow-up was 29 months (range 3 to 93). Preand post-operative pad use was recorded for all patients in addition to completion of four validated questionnaires preand postoperatively: Stress-related leak, Emptying ability, Anatomy, Protection, Inhibition, Quality of life, Mobility and Mental status Incontinence Classification System (SEAPI-QMM), Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6) and Visual Analog Score (VAS). RESULTS: The overall subjective cure rate was 61.1%. 27 total patients (12.7%) required additional anti-incontinence procedures and the incidence of de novo urgency was 9.9% (21 patients). Short-term (<30days) urinary retention was the most common complication recorded (4.04% of all patients). The number of pads used per day reduced from a mean of 3.26 to a mean of 0.77 (p<0.0001) postoperatively. A statistically significant improvement between preand post-operative SEAPI total, IIQ-7, UDI-6 and VAS was demonstrated (p<0.0001). Sub-analysis comparing the SPARC to the rectus pvs used for secondary repair demonstrated no significant differences in subjective cure rates, post-operative pad use, SEAPI total, IIQ-7, UDI-6 or VAS between groups (Table 1). CONCLUSIONS: The widespread use of surgical slings for SUI has led to an increase in the absolute number of patients who fail their primary procedures. Secondary repair with a retropubic MUS is as durable and effective in improving QoL as the rectus pvs. This provides invaluable information for patient education and surgical planning for refractory stress incontinence.

MP33-18 A COMPARISON OF OUTCOMES AFTER RETROPUBIC MID-URETHRAL SLING, DOES VALSALVA VOIDING AFFECT SUCCESS RATE?

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy I1 Apr 2014MP33-18 A COMPARISON OF OUTCOMES AFTER RETROPUBIC MID-URETHRAL SLING, DOES VALSALVA VOIDING AFFECT SUCCESS RATE? Blake Anderson, David Hatcher, Rena Malik, Jessica Volsky, Gregory Bales, and Doreen Chung Blake AndersonBlake Anderson More articles by this author , David HatcherDavid Hatcher More articles by this author , Rena MalikRena Malik More articles by this author , Jessica VolskyJessica Volsky More articles by this author , Gregory BalesGregory Bales More articles by this author , and Doreen ChungDoreen Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.969AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is known that many women void via valsalva and that retropubic slings (RPS) may cause voiding dysfunction. The aim of this study was to compare outcomes after RPS in women with and without valsalva voiding. METHODS 95 women had RPS placed for stress urinary incontinence (SUI) from 2011 to 2013. Baseline demographics, urodynamic findings, operative parameters, and post-operative course were examined retrospectively. Valsalva voiding was defined as abdominal straining witnessed while voiding during urodynamics. Standardized follow-up was at 1, 3, 6, and 12 months. The primary outcome was subjective success rate (absence of SUI with physical activity, coughing, or sneezing). We also looked at Urogenital Distress Inventory (UDI-6) score, Incontinence Impact Questionnaire (IIQ-7) score, post-void residual (PVR), pad use, complications, and revision rate. Tests of significance were done using Fisher’s exact tests and Student’s t-tests. RESULTS Subjects included 45 (47%) valsalva voiders (VV) and 50 (53%) non-valsalva voiders (NV). No differences were seen between groups in mean age, PVR, or capacity. Abdominal leak point pressure without a catheter was significantly lower in VV (56 vs. 70 cm H2O, p=0.045), yet VV had less severe IIQ-7 at baseline compared to NV, (9 ± 6 vs. 13±7, p=0.01). Catheter time was significantly shorter in VV compared to NV (2.5 vs. 4.1 days, p=0.03). No differences were seen between groups in the rate of passing initial void trial (71% VV vs. 61% NV, p=0.1). In the perioperative period, 4.7% of VV and 11.9% of NV required clean intermittent catheterization (CIC) (p=0.16). No patients required CIC beyond 4 weeks. Complication rates (11.4% VV vs. 9.3% NV, p=0.3) and revision rates (7.1% VV vs. 9.5% NV, p=0.28) were similar. In total, 7 (7%) patients required revisions. Reasons were pain (1 VV, 2 NV), erosion (1 NV), voiding dysfunction (1VV, 1 NV), and sling failure (1 VV). Subjective success rates were similar with no significant differences at 1, 3, 6, and 12 months (91%, 94%, 100%, and 100 % for VV and 88%, 88%, 100%, and 93% for NV). At one month, VV had smaller change in postoperative pad use (-1.2 vs. -2.8, p=0.04), IIQ-7 (-5 vs. -12, p=0.0001), and UDI-6 (-4 vs. -8, p=0.01), but there were no significant differences in these parameters between VV and NV at 3, 6, and 12 months. CONCLUSIONS In women with valsalva voiding, RPS appear to be a safe and effective treatment for SUI. Between VV and NV, no differences were seen in success rate, postoperative voiding dysfunction, complication rate, or revision rate. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e345 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Blake Anderson More articles by this author David Hatcher More articles by this author Rena Malik More articles by this author Jessica Volsky More articles by this author Gregory Bales More articles by this author Doreen Chung More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urethral Buttressing in Patients Undergoing Artificial Urinary Sphincter Surgery

We evaluated the safety and feasibility of what we believe to be a novel technique of buttressing the urethra with a fibrin coated collagen fleece in patients undergoing artificial urinary sphincter surgery in the presence of urethral atrophy. A total of 17 consecutive men were treated with urethral buttressing for urethral atrophy during artificial urinary sphincter surgery. Continence, complications and patient reported outcomes were assessed by preoperative and postoperative pad use, chart review, patient interview and validated questionnaires. Mean ± SD followup was 38 ± 3.0 months (median 34, range 23 to 71). One patient was excluded from further evaluation due to accidental iatrogenic urethral injury elsewhere. At 3-month followup the mean improvement in pad use was 5 ± 0.5 pads (median 5, range 2 to 9). Of 16 patients 9 (56%) and 2 (13%) used 1 and 0 pad per day, respectively. According to the Patient Global Impression of Improvement questionnaire, 12 of 16 patients (75%) described their condition as much or very much better after surgery. Mean ± SD postoperative Incontinence Impact Questionnaire and Urogenital Distress Index scores were 2 ± 0.8 (median 1, range 0 to 11) and 4 ± 1.0 (median 3, range 0 to 11), respectively. No intraoperative complications were observed. During followup 2 of 16 patients (13%) underwent placement of a second cuff due to unsatisfactory postoperative continence, 1 (6%) underwent artificial urinary sphincter revision for clean urethral erosion and 1 (6%) underwent revision for pump malfunction. Urethral buttressing with a collagen fleece appears to be a safe, feasible option for urethral atrophy in patients treated with artificial urinary sphincter implantation or revision.

Comparison of oncological and functional outcomes of pure versus robotic-assisted laparoscopic radical prostatectomy performed by a single surgeon

Objective. The aim of this study was to compare oncological and functional outcomes of pure laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALRP) performed by a single surgeon. Material and methods. In total, 327 consecutive patients with prostate cancer who underwent radical prostatectomy (144 with LRP and 183 with RALRP) were enrolled. No significant differences were found in prostate-specific antigen level, biopsy Gleason score, clinical T stage or D'Amico risk stratification between the two groups. The operating time was longer in the LRP group (p < 0.001). The RALRP group patients had significantly lower postoperative pain numerical rating scale (NRS) (p = 0.016) and catheter duration (p < 0.001). There were no differences in pathological Gleason score, pathological T stage or positive surgical margin rate. No differences were found in biochemical recurrence-free survival. Postoperative pad-free continence rates revealed a more rapid recovery in the RALRP group, but rates at 12 months were not significantly different. Multivariate analysis showed that the type of surgery was a strong independent factor to predict early postoperative pad use. Postoperative potency rates were not significantly different at 3, 6 and 12 months in patients who underwent nerve-sparing procedures. Conclusions. LRP and RALRP performed by a single surgeon yielded similar results in terms of safety and oncological outcomes. More favorable outcomes were noted in operating time, pain NRS and catheter duration, as well as urinary continence recovery time. Therefore, RALRP showed more favorable components in terms of postoperative quality of life than LRP.

Adjustable continence balloons: Clinical results of a new minimally invasive treatment for male urinary incontinence

This study aimed to evaluate the results of the Danish experience with the ProACT urinary continence device inserted in men with stress urinary incontinence. The ProACT was inserted in 114 patients. Data were registered prospectively. The main endpoints were complications, pad use per day and 24 h urinary leakage. A questionnaire evaluating symptoms and satisfaction was sent to the patients. Data including preoperative and postoperative pad use and urinary leakage were available for 92 and 90 patients, respectively. A decrease in the median 24 h urinary leakage (352.5 vs 11 ml, p < 0.001) and in the median number of pads used per day (4.75 vs 2.25, p = 0.001) was demonstrated. Forty-six patients had a pad use of 0-1 pads per day and/or a daily urinary leakage less than 8 g, corresponding to an overall dry rate of 50%. A decrease in urinary leakage > 50% was seen in 72 patients (80%). Complications were seen in 23 patients. All of these were treated successfully by removal of the device in the outpatient setting followed by replacement of the device. Another eight patients had a third balloon inserted to improve continence further. Fourteen patients (12%) ended up with an artificial sphincter or a urethral sling. Sixty patients (63%) experienced no discomfort and 58 (61%) reported being dry or markedly improved. Overall, 50 patients (53%) reported being very or predominantly satisfied. Adjustable continence balloons seem to be a good alternative in the treatment of male urinary incontinence. Complications are mild and easily treated.

Pre- and Postoperative Urodynamic Findings in Patients After a Bulbourethral Composite Suspension with Intraoperative Urodynamically Controlled Sling Tension Adjustment for Postprostatectomy Incontinence

To compare pre- and postoperative urodynamic findings in patients with a bulbourethral composite suspension and intraoperative urodynamically controlled sling tension adjustment. All data were prospectively collected from 10 patients (mean age 66 years) who successfully underwent bulbourethral composite suspension for moderate to severe postprostatectomy incontinence. Patients were evaluated preoperatively and 3-6 months postoperatively by urodynamic measurements, including urethra pressure profiles (UPPs) and pressure flow studies (PFSs). Clinical outcome was evaluated by patient-reported pad use and questionnaires (ICIQ-UI SF and I-QOL). Intraoperatively sling tension was adjusted under repeated urodynamic measurements of abdominal leak point pressure. Data were evaluated using the Kruskal-Wallis Wilcoxon test. Sling implantation was successful in all patients. Pre- to postoperative pad use decreased significantly (P < .005). Five patients were pad-free, 3 used 1 pad, and 2 used 2 pads per day. Continence and quality of life improved significantly (ICIQ-UI SF: pre-op 17 vs post-op 4.9; I-QOL: pre-op 66 vs post-op 91; P < .05 for both). Urodynamic parameters during the filling phase remained unchanged. UPPs revealed a significant increase of the maximal urethral closure pressure (pre-op 40 cm H(2)O vs post-op 58 cm H(2)O) and functional length (pre-op 31 mm vs post-op 40 mm; P < .05 for both). Postoperatively, urodynamic maximal flow rates were slightly reduced from 16 mL/s to 12 mL/s (P = .4). PFSs revealed an unobstructed voiding in all patients. According to the present evaluation, a bulbourethral composite suspension with intraoperative urodynamically controlled sling tension adjustment improves continence without causing prolonged clinically or urodynamically significant voiding obstruction.

Single Incision Mid-urethral Sling for Treatment of Female Stress Urinary Incontinence

To present the longitudinal outcomes in an observational cohort of patients who had undergone treatment of stress urinary incontinence with a single incision mid-urethral sling (MUS). A prospective, observational study of all female patients who had undergone surgical intervention with the MiniArc MUS was performed. The surgical candidates underwent history and physical examination and urodynamic testing, as indicated. Quality of life questionnaires (Urogenital Distress Inventory [UDI-6] and Incontinence Impact Questionnaire [IIQ-7]) were administered preoperatively. The salient operative data were recorded. The patients were followed up postoperatively for evidence of treatment success and adverse events. The patients completed the UDI-6, IIQ-7, and Female Sexual Function Index questionnaires at 1 and 12 months after treatment. From September 2007 to October 2008, 120 patients underwent placement of the MiniArc MUS for the treatment of stress urinary incontinence. The mean patient age was 58.4 years. The mean body mass index was 27.2 kg/m(2). The mean preoperative daily pad use was 2.4. The mean preoperative IIQ-7 and UDI-6 score was 86.58 and 62.5, respectively. Of the 120 patients, 108 (90%) completed a minimum follow-up period of 12 months. Of these 108 patients, 101 (94%) were cured/dry. The mean postoperative pad use was 0.2 (P < .001). The mean IIQ-7 and UDI-6 score was 13.32 (P < .001) and 12.5 (P < .001), respectively. The Female Sexual Function Index results demonstrated no discomfort with intercourse in 49%, occasional discomfort in 9%, and frequent discomfort in 2%. The remaining 40% of our patients were not sexually active. Our results have shown that the MiniArc MUS offers excellent outcomes that are durable at 1 year after treatment.

Comparison of outcomes after single or DOUBLE-CUFF artificial urinary sphincter insertion

Objectives To assess the effectiveness and complications associated with single and double-cuff artificial urinary sphincter (AUS) implantation for postprostatectomy stress urinary incontinence. Methods A retrospective study of 56 men with postprostatectomy stress urinary incontinence who underwent either single (28 patients) or double (28 patients) cuff AUS placement was performed. Patients in each cohort were matched on the basis of preoperative pad use, risk factors for complications, and age. Patient selection was blinded relative to outcome. Continence, quality of life, and complications were assessed using the Incontinence Impact Questionnaire Short Form (IIQ-7), postoperative pad use, and chart review. Results The mean age was 67 years for each group. Daily pad use decreased from 7.7 to 1.1 in patients treated with a single-cuff AUS and from 7.8 to 0.7 in patients with a double-cuff AUS ( P = 0.25). Complete continence (0 pads daily) was reported in 3 (11%) of 28 men with single-cuff and 12 (43%) of 28 men with double-cuff sphincters ( P = 0.008). The IIQ-7 scores improved from 14.8 to 3.1 after single-cuff placement and from 16.3 to 2.5 after double-cuff placement ( P = 0.03). With an average follow-up of 41.3 and 21.2 months for the single and double-cuff cohorts, respectively, five complications were reported in the single-cuff recipients and four in the double-cuff patients. Conclusions A significantly greater rate of complete continence and improvement in the IIQ-7 were seen in men with double-cuff AUS compared with single-cuff devices. Additional study is needed to confirm the relative advantages of double-cuff insertion.

Success Rate of Modified Pereyra Bladder Neck Suspension Determined by Outcomes Analysis

The reported success rates of the modified Pereyra bladder neck suspension vary from 51 to 90%. Retrospective chart review studies have reported cure rates of 77 to 90%. In contrast, a questionnaire based outcomes analysis, using a strict definition of cure, reported 51% of the patients to be cured of stress urinary incontinence after modified Pereyra bladder neck suspension. We conducted a questionnaire based outcomes analysis of the modified Pereyra bladder neck suspension at our institution. The objectives of the study were to determine the success rates of this procedure using strict criteria in an outcomes analysis format, assess the overall satisfaction of patients postoperatively and identify historical factors that may be predictive of outcome.Between September 1988 and December 1991, 151 patients underwent a modified Pereyra bladder neck suspension for urodynamically documented genuine stress urinary incontinence. Mean patient age was 56 years (range 19 to 82 years) and mean followup was 25 months (range 9 to 45). All patients had type 2 incontinence (anatomical) based on history (severity of symptoms), physical examination, and fluoroscopic assessment of the bladder neck and urethra. Preoperative pad use, and irritative and obstructive symptoms were retrospectively assessed, and a preoperative Stamey incontinence score was assigned. A standardized questionnaire was used to compare preoperative and postoperative voiding symptoms, perception of urinary control and satisfaction with the decision to undergo an operation. Followup telephone calls were made by a trained registered nurse not associated with the original procedure. Postoperative pad use also was quantified and a postoperative Stamey score was assigned.A total of 106 patients (70%) returned the questionnaires. Cure was strictly defined as no urine leakage under any circumstance. While 78% of the patients required no to minimal protection postoperatively, 50 (47%) reported cure of the stress urinary incontinence, 68 (64%) reported subjective improvement, 27 (26%) were the same and 11 (10%) were subjectively worse after modified Pereyra bladder neck suspension. Of the patients 77% were satisfied with the decision to undergo the operation. Patients subjectively worse were significantly older than those subjectively improved (66 versus 54 years, p = 0.05). Postoperative failures had significantly higher obstructive and irritative symptom scores.Questionnaire based outcomes analysis has consistently demonstrated success rates less than those reported in retrospective chart review studies. Outcomes analysis, based on patient assessment of satisfaction, may more accurately reflect the expected surgical outcome after a modified Pereyra bladder neck suspension. We emphasize the need for standardized questionnaires and outcomes analysis to evaluate patient satisfaction with surgery designed to improve quality of life.