Postoperative Urinary Function Research Articles

Early-stage voiding function following uni- versus bilateral inferior vesical vessel resection during therapeutic lateral lymph node dissection with autonomic nerve sparing for advanced low rectal cancer (with video).

Lateral lymph node dissection (LLND) has now been widely accepted as the optimal procedure to minimize lateral local recurrence (LLR) for selected cases with advanced lower rectal cancer in Asian countries. However, there is still controversy over the preservation or resection of the inferior vesical vessels (IVVs) during LLND due to concerns of impaired post-operative urinary function. Moreover, the standardized procedure for autonomic nerve preservation has not yet been established. To evaluate the early-stage postoperative voiding function in patients who underwent LLND with uni- versus bilateral resection of the IVVs and to introduce an autonomic nerve sparing technique with a fascial space priority approach (FSPA). LLND was performed in 106 consecutive patients with advanced low rectal cancer at Tianjin Union Medical Center from May 2017 to October 2022. Prospectively collected clinical data were retrospectively compared between patients who received uni-lateral and bilateral LLND. A video with narration was provided to introduce the stepwise procedure of autonomic nerve preservation during IVV resection. The unilateral lymph node dissection (LND) group and the bilateral LND group included 75 and 31 cases, respectively. All LLNDs were performed with FSPA with IVV resection as a standard procedure. No significant differences were observed in overall catheterization days (p = 0.336) and re-catheterization rate (p = 0.575) between groups. No patients in either group suffered from long-term (≥ 30 days) voiding dysfunction. Autonomic nerve sparing is achievable with resection of IVVs during LLND. Satisfactory early-stage voiding function could be obtained with IVV resection on both sides.

Individualized center-based analysis of urinary and sexual functional outcome after radical prostatectomy based on the prostate cancer outcome study: a post hoc pathway to patient outcome measurement analysis for quality improvement.

We evaluate differences of patient-reported outcome measurements (PROM) based urinary continence and sexual function 12 months after radical prostatectomy (RPE) based on perioperative, surgical, and patient-specific characteristics in a large European academic urology center. All men enrolled in the Prostate Cancer Outcome Study (PCO) study who were treated with RPE between 2017 and 2021 completed EPIC-26 information surveys before and 12 months after RPE. Survey data were linked to clinical data of our institution. Logistic regression analyses were performed to examine the correlation between individual surgeons, patient characteristics, patient clinical data, and their urinary continence and sexual function. In total, data of 429 men were analyzed: unstratified mean (SD) EPIC-26 domain score for urinary function decreased from 93.3 (0.7) to 60.4 (1.5) one year after RPE, respectively for sexual function from 64.95 (1.6) to 23.24 (1.1). Patients with preoperative adequate urinary function (EPIC-26 score > 80) reported significantly different mean urinary function scores between 53.35 (28.88) and 66.25 (25.15), p= 0.001, stratified by surgeons experience. On binary logistic regression analyses, only nerve sparing techniques (OR: 1,83, 95% CI: 1.01;3.21; p = 0.045) and low body mass index (OR: 0.91, CI: 0.85;0.99, p= 0.032) predicted adequate postoperative urinary function. The results show how using provider-specific data from a larger cohort study enables to develop institution-specific analysis for functional outcomes after RPE. These models can be used for internal quality improvement as well as enhanced and provider-specific patient communication and shared decision making.

Effect of transcutaneous electrical acupoint stimulation on postoperative urinary function in elderly patients undergoing total hip arthroplasty.

To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative urinary function in elderly patients undergoing total hip arthroplasty (THA). One hundred and eighty elderly patients undergoing unilateral THA without indwelling urinary catheters were randomly assigned to a TEAS group (90 cases, 3 cases dropped out, 4 cases were eliminated) and a sham TEAS group (90 cases, 1 case dropped out, 4 cases were eliminated). Both groups received fascia iliac block and subarachnoid block anesthesia under ultrasound guidance. The patients in the TEAS group were treated with TEAS at Zhongji (CV 3), Guanyuan (CV 4), and bilateral Huiyang (BL 35), Ciliao (BL 32) 30 minutes before anesthesia initiation, with dissperse-dense wave, frequency of 2 Hz/100 Hz, until 30 minutes after surgery. The patients in the sham TEAS group underwent the same procedure with the device applied at the same acupoints but without electrical stimulation. The incidence of postoperative urinary retention (POUR), time to first void, voiding threshold, urinary adenosine triphosphate (ATP) level, postoperative abnormal voiding status (bladder residual volume, re-catheterization rate, nocturia occurrence), and postoperative incidence of urinary tract infection (UTI) and prosthetic joint infection (PJI) were observed in both groups. The incidence of POUR in the TEAS group was lower than that in the sham TEAS group (P<0.05); the time to first void in the TEAS group was shorter than that in the sham TEAS group (P<0.05); the voiding threshold in the TEAS group was lower than that in the sham TEAS group (P<0.05); the urinary ATP level in the TEAS group was higher than that in the sham TEAS group (P<0.05); the bladder residual volume in the TEAS group was lower than that in the sham TEAS group (P<0.05); the nocturia occurrence in the TEAS group was lower than that in the sham TEAS group (P<0.05). However, there was no statistically significant difference in re-catheterization rate, incidence of UTI, and incidence of PJI between the two groups (P>0.05). TEAS could effectively reduce the occurrence of postoperative urinary retention and improve the postoperative urinary function in elderly patients undergoing THA, which might be related with increasing the urinary ATP level.

Long-term survival and functional outcomes of laparoscopic surgery for clinical stage I ultra-low rectal cancers located within 5 cm of the anal verge: A prospective phase II trial (Ultimate trial).

To clarify the long-term oncological outcomes and postoperative anal, urinary, and sexual functions after laparoscopic surgery for clinical stage I very low rectal carcinoma located near the anal canal. Laparoscopic surgery is widely applied for rectal cancer; however, concerns remain, with some studies showing poorer outcomes compared to open surgery. This single-arm, phase II trial included patients registered preoperatively from 47 institutions in Japan. The planned sample size was 300. The primary endpoint was the 3-year local recurrence rate. Anal, urinary, and sexual functions were evaluated using a prospective questionnaire. Three-hundred patients were registered between January 2014 and March 2017. Anus-preserving surgery was performed in 278 (93%), including 172 who underwent intersphincteric resection (58%) and 106 (36%) who underwent low anterior resection. The 3-year cumulative local recurrence rate was 6.3%. At 3 years postoperatively, 87% of patients used their own anus, and the median incontinence score improved from 12 at 3 months to 8 at 3 years. Only 5% of patients had severe incontinence (incontinence score of 16 points). Postoperative urinary function evaluation showed that International Prostate Symptom Score and Overactive Bladder Symptom Score decreased 1 week after surgery, but recovered to preoperative level 1 month after surgery. International Consultation on Incontinence Questionnaire-Sort Form remained almost stable after surgery. Sexual function evaluation using the International Index of Erectile Function-5 and International Index of Erectile Function-15 revealed that the patients had deteriorated 3 months after surgery but had recovered only slightly by 6 months. Laparoscopic surgery achieves feasible long-term oncological outcomes and a high rate of anus preservation with moderate anal function, and an acceptable incontinence score. While urinary function recovered rapidly, sexual function showed poor recovery.

Research progress of robot and laparoscope in postoperative complications of rectal cancer.

Rectal cancer is one of the most common malignant tumours worldwide, and it is also one of the major diseases that seriously threatens human life and health. At present, the main treatment for rectal cancer is still surgical treatment. The surgical methods have been rapidly developed from the previous open surgery to the current minimally invasive surgery. At present, there are two main minimally invasive surgeries: robotic surgery and laparoscopic surgery. Due to the particularity of rectal cancer surgery, more and more studies have shown that robotic rectal cancer surgery has more advantages than laparoscopic rectal cancer surgery. However, whether the incidence of postoperative complications after robotic rectal cancer surgery is lower than that after laparoscopy is not uniformly conclusive in the current study. Therefore, in this paper, we searched Pubmed, Cochrane Library, Embase and other databases, collected the latest published meta-analysis on postoperative complications of robots and laparoscopy in rectal cancer, and assessed the quality of the included meta-analysis by AMSTAR-2 evaluation tool, so as to explore the current research status and research quality of postoperative complications of robots and laparoscopy in rectal cancer. The results showed that compared with laparoscopic rectal cancer surgery, robotic rectal cancer surgery could improve the postoperative urinary and reproductive function of male patients, but it could not be proved that robotic rectal cancer surgery could reduce the incidence of postoperative complications, anastomotic leakage, urinary retention, intestinal obstruction, anastomotic bleeding, incision infection, pulmonary infection, venous thrombosis and abdominal abscess; however, the overall quality of meta-analysis of the results of each complication was low or very low. Therefore, multicenter, large-sample, high-quality prospective randomised controlled studies and high-quality meta-analysis are still needed to prove the advantages of robotic rectal cancer surgery in postoperative complications in the future.

Applications of Near-Infrared Fluorescence Imaging and Angiography of Inferior Vesical Artery in Laparoscopic Lateral Lymph Node Dissection: A Prospective Nonrandomized Controlled Study

BACKGROUND: Near-infrared imaging with indocyanine green has been used to guide lateral lymph node dissection, yet its efficacy and benefits need further investigation. OBJECTIVE: To investigate the efficacy and feasibility of near-infrared fluorescence imaging and angiography of the inferior vesical artery in laparoscopic lateral lymph node dissection. DESIGN: A prospective nonrandomized controlled study. SETTINGS: Single-center study. PATIENTS: Patients with lower rectal cancer who underwent total mesorectal excision plus lateral lymph node dissection. MAIN OUTCOME MEASURES: A cohort of 108 patients was enrolled. After propensity score matching, 29 patients in the near-infrared group and 50 patients in the non–near-infrared group were matched. The total number of harvested lateral lymph nodes, positive lateral lymph nodes, inferior vesical artery preservation, and postoperative urinary function were compared. RESULTS: After propensity score matching, both groups had similar baseline characteristics. The total number of harvested lateral lymph nodes in the near-infrared group was significantly higher (12 vs 9, p = 0.013), but positive lateral lymph nodes were similar between the 2 groups (1 vs 1, p = 0.439). The inferior vesical artery preservation ratio was significantly increased with the aid of indocyanine green angiography (93.1% vs 56.0%, p &lt; 0.001). The non–near-infrared group required more days for urinary catheter removal than the near-infrared group (5 vs 4, p = 0.046). Urinary recatheterization tended to occur more frequently in the non–near-infrared group, with a marginally significant trend (16% vs 0%, p = 0.059). The non–near-infrared group tended to have more cases with residual urine volume ≥50 mL than the near-infrared group (20.0% vs 3.4%, p = 0.087), especially in the bilateral dissection subgroup (41.2% vs 0%, p = 0.041). LIMITATIONS: Small sample size. CONCLUSIONS: Near-infrared imaging increased the number of harvested lateral lymph nodes, whereas real-time indocyanine green fluorescence angiography ensured the preservation of the inferior vesical artery and tended to improve postoperative urinary function.

Urinary outcomes of new ultra-minimally invasive treatments for prostate cancers.

The aim of this narrative review is to evaluate the current available literature on urinary outcomes following cryotherapy and high-intensity focused ultrasound (HIFU) for localized prostate cancer (PCa). The available literature is heterogeneous in terms of intervention modalities and assessment of urinary outcome measures. Nevertheless, ultra-minimally invasive treatments seem to provide good urinary outcomes. Technological advancement and the adoption of more conservative ablation templates allow for a further reduction of toxicity and better preservation of urinary function. Urinary incontinence occurs in 0-10% of the patients and, is mostly transient. Voiding and storage lower urinary tract symptoms (LUTS) mostly occur in the early postoperative period and rarely require surgical treatment. Focal therapies performed with a salvage intent after external beam radiotherapy have a significantly higher impact on patient's urinary function. Ultra-minimally invasive treatment for PCa show a good safety profile concerning urinary function, but consensus on when and how best to assess this is still lacking. Efforts should be made to standardize the report of preoperative and postoperative urinary function to provide higher level of evidence.

Erectile function evaluation in patients after urethroplasty: systematic review and meta-analysis

Background. The success of surgical treatment of urethral strictures is often assessed in terms of the quality of urination and the patency of the urethral lumen. Despite the fact that this assessment is carried out according to the above parameters, it seems important to take into account such a possible complication as erectile dysfunction, which can significantly impair the patient’s quality of life. This is the difference in the perception of the success of the surgical intervention by the clinician and the patient.Aim. To determine the relationship between urethroplasty and the likelihood of erectile dysfunction in the postoperative period according to world literature.Materials and methods. The PubMed database was analyzed using the keywords: anterior urethroplasty, posterior urethroplasty, urethroplasty, sexual dysfunction, erectile dysfunction. All articles were reviewed by two independent authors for inclusion based on predetermined criteria. Among the included scientific papers are randomized controlled trials, systematic reviews.Results. Sixteen scientific papers with a total of 1476 patients were included in the final study. The decrease in erectile function after surgery in this meta-analysis is 3 %. The main factors influencing postoperative parameters were age and erectile function at the time of surgery.Conclusion. Most studies state that urethroplasty does not imply a significant impact on erectile function, however, they acknowledge that the occurrence of this complication affects the assessment of treatment outcomes among patients and the further impact on their quality of life, regardless of postoperative urinary function.

The progress of dorsal vascular complex control strategy in radical prostatectomy.

Radical prostatectomy has undergone a development from open to laparoscopic surgery to a surgical robotic approach. With improved surgical equipment and the continuous development of surgical techniques, various surgical strategies for controlling the dorsal vascular complex (DVC) during RP have been investigated, which affect intraoperative blood loss, postoperative tumour control and postoperative urinary and sexual function. The present narrative review summarizes the latest anatomical information about the prostatic apex and DVC and then describes the three types of DVC control. More detailed anatomy of the DVC is required and the optimal DVC control under different situations needs further research.

Surgical outcomes of low-power thulium laser enucleation of prostates >80 g. One-year of follow-up.

The aim of this study was to assess the effectiveness of low-power thulium (30 W) and the duration necessary to eliminate adenomas at the level of the surgical capsule, as well as its impact on postoperative urinary and sexual function. Patients with symptomatic benign prostatic hyperplasia (BPH), who had ThuLEP between December 2019 and March 2022 and had a prostate size >80 mL and had not responded to the medication therapy, were included. The prostate size, prostate-specific antigen (PSA), enucleation and morcellation times, postoperative International Prostate Symptom Score (IPSS), and International Index of Erectile Function-5 (IEFF-5) records at 1, 3, 6, and 12 months were among the information gathered. The average age of the 80 patients who received ThuLEP was 66.7 ±6.4 years, with a mean prostate volume of 112.65 ±19.3 mL. The mean duration for enucleation was 71 ±11 min. At the initial follow-up after one month, the mean IPSS was 8.012 ±1.78 mL and the mean Qmax enhancement was 30.16 ±4 mL s-1. In contrast to baseline, our findings demonstrated a substantial improvement in postoperative urgency and urgency urinary incontinence (UUI) (p = 0.005) but no meaningful variation in IIEF-5 score at the 12-month follow-up. Low-power ThuLEP is worthwhile for therapeutic use because it effectively treats patients with large prostates with satisfactory urinary and sexual effects.Clinical trials .gov ID: NCT05494944.

Retracted: Clinical Efficacy of LSC and TVT-O for Stress Urinary Incontinence Complicated with Pelvic Organ Prolapse and Factors Influencing Postoperative Urinary Function Recovery.

[This retracts the article DOI: 10.1155/2022/1557256.].

Oral 13 - The Transobturator Sub-urethral Sling: A Safe and Effective Option for all Degrees of Post Prostatectomy Urinary Incontinence

Male stress urinary incontinence (SUI) after radical prostatectomy (RP) is common. The surgical standard of care traditionally has been placement of an artificial urinary sphincter (AUS) but since its introduction the transobturator male sling has been shown to have particular unique advantages. Our aim was to assess outcomes of a consecutive series of suburethral sling insertions in men presenting with all degrees of post RP SUI.A consecutive cohort of men undergoing AdVance sling insertion following RP were studied. Parameters assessed included pre and postoperative urinary function, 24 hour pad use, quality of life (QoL) outcomes, complications and further treatments. Degree of incontinence was categorized as mild (1-2), moderate (3-5) or severe (≥ 6) depending on daily pad use. Patients were reviewed at 1, 4 and 6 months. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess symptom severity and QoL outcomes.Seventy-seven patients were included, mean age 68 and mean time to sling post RP 34 (8-113) months. Preoperative degree of incontinence: mild 22%, moderate 58%, severe 20%. Fourteen percent had undergone post RP radiation therapy (RT). In total 73% experienced complete resolution of symptoms post sling, 12% significant improvement, 15% no reduction in pad use. Sixty percent with severe incontinence were classified as cured (no pad or 1 dry pad for security reasons). When patients with preoperative RT were excluded, cure rate rose to 82%. On follow up survey at 30 months (mean), the ICIQ-SF score decreased from baseline 17.7 (9-21.0) to 8.0 (0-20) (p < 0.0001), CI 95% (8-12).Suburethral slings are effective and safe for all degrees of post RP incontinence, are associated with improved QoL parameters and with appropriate selection and counseling are a viable option for more severe degrees of post RP SUI.

MP57-12 PATIENT REPORTED SEXUAL AND URINARY FUNCTIONAL OUTCOMES IN MEN WITH INTERMEDIATE RISK PROSTATE CANCER UNDERGOING RADICAL PROSTATECTOMY: ANALYSIS OF THE MUSIC REGISTRY

You have accessJournal of UrologyCME1 May 2022MP57-12 PATIENT REPORTED SEXUAL AND URINARY FUNCTIONAL OUTCOMES IN MEN WITH INTERMEDIATE RISK PROSTATE CANCER UNDERGOING RADICAL PROSTATECTOMY: ANALYSIS OF THE MUSIC REGISTRY Roshan Paudel, John Cochrane, Ji Qi, Michael Cher, Richard Sarle, James Peabody, S. Mohammad Jafri, Brian Lane, Alice Semerjian, Arvin George, and Kevin Ginsburg Roshan PaudelRoshan Paudel More articles by this author , John CochraneJohn Cochrane More articles by this author , Ji QiJi Qi More articles by this author , Michael CherMichael Cher More articles by this author , Richard SarleRichard Sarle More articles by this author , James PeabodyJames Peabody More articles by this author , S. Mohammad JafriS. Mohammad Jafri More articles by this author , Brian LaneBrian Lane More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Arvin GeorgeArvin George More articles by this author , and Kevin GinsburgKevin Ginsburg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002640.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess patient reported continence and sexual function outcomes among men with intermediate risk prostate cancer (IRPC) undergoing radical prostatectomy (RP) in MUSIC. METHODS: We reviewed the Patient Reported Outcome program in the MUSIC prostate cancer registry for men with IRPC undergoing RP from May 2014-- to June 2021. EPIC-26 surveys are administered at baseline and 1, 3, 6, 12, and 24 month postoperatively. To quantify deterioration in function resulting from surgery, patients were included in this analysis if they report good urinary and/or sexual function at baseline. Social continence (SC) was defined as self-reported use of 0-1 pad per day and assessed at 3 and 6 months postoperatively. Good sexual function (SF) was defined as erections firm enough for penetration and assessed at 12 and 24 months postoperatively. Proportions of patients with social continence and good sexual function were compared between favorable (F-IRPC) and unfavorable (U-IRPC) with the Chi-squared test. Surgeon level variation was assessed graphically. RESULTS: Among 3967 patients undergoing RP for IRPC, 2911 and 2614 patients with good baseline urinary function completed the 3m and 6m surveys and 984 and 666 patients with good baseline sexual function completed the 12m and 24m surveys. Post-operative SC was reported in 67% and 86% of patients at 3m and 6m. We noted similar SC for men with F-IRPC and U-IRPC at 3m (68% vs. 67%, p=0.61) and 6m (86% vs. 85%, p=0.74) postoperatively. Recovery of SF was less robust, with 26% and 30% of men reporting good SF at 12m and 24m postoperatively. Men with F-IRPC had improved SF at 12m compared with men with U-IRPC (30% vs. 24%, p=0.031), although this difference was not statistically significant at 24m (34% vs. 28%, p=0.064). There was notable variability in recovery of SC and SF by contributing surgeon for both men with F-IRPC and U-IRPC (Figure). CONCLUSIONS: As reported in MUSIC PRO, men with IRPC had reasonable urinary continence recovery postoperatively overall, but generally poor recovery of erectile function, with notable variation in postoperative urinary and sexual function by surgeon. These data may inform patients and surgeons regarding the range of expected outcomes as well as drive future quality improvement efforts. Source of Funding: Funding from Blue Cross Blue Shield of Michigan © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e986 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roshan Paudel More articles by this author John Cochrane More articles by this author Ji Qi More articles by this author Michael Cher More articles by this author Richard Sarle More articles by this author James Peabody More articles by this author S. Mohammad Jafri More articles by this author Brian Lane More articles by this author Alice Semerjian More articles by this author Arvin George More articles by this author Kevin Ginsburg More articles by this author Expand All Advertisement PDF DownloadLoading ...

Clinical Efficacy of LSC and TVT-O for Stress Urinary Incontinence Complicated with Pelvic Organ Prolapse and Factors Influencing Postoperative Urinary Function Recovery.

Pelvic organ prolapse is caused by various causes, which leads to the weakness of the tissue supporting the pelvic floor and then causes the downward displacement of female reproductive organs and adjacent organs. Clinical studies have shown that pop is often associated with stress urinary incontinence. This research project aimed to clarify the clinical effect of laparoscopic sacrocolpopexy (LSC) and tension-free vaginal tape obturator (TVT-O) for stress urinary incontinence (SUI) complicated with pelvic organ prolapse (POP) and the influencing factors of postoperative urinary function (UF) recovery. The clinical data of 125 patients with SUI complicated with POP treated in Wenzhou Central Hospital and Beidahuang Industry Group General Hospital between March 2018 and December 2019 were retrospectively analyzed. Patients were assigned to the following two arms based on different treatment methods: the combination group (n = 65, treated with LSC plus TVT-O) and the control group (n = 60, treated with LSC). The alterations of perioperative clinical and urodynamic indexes were analyzed. The objective and subjective response rates were observed and compared. The degree of POP before and after surgery was evaluated. According to the urinary function recovery time, the patients were divided into the fast and non-fast recovery groups, and then, the factors influencing postoperative UF recovery were analyzed between groups. The combination group showed statistically longer operation time (OT) and postoperative indwelling catheter and higher intraoperative blood loss (IBL) than the control group (all P < 0.05), but the anal exhaust time and postoperative length of stay (LOS) differed insignificantly between the two arms. The combination group outperformed the control group in the objective response rate, as well as the scores of illness, quality of life (QOL), and sexual life (all P < 0.05). Menopause, maximum flow rate (MFR), and preoperative residual urine volume were identified as the influencing factors for normal urination. For patients with SUI complicated with POP, the efficacy of laparoscopic sacrocolpopexy was limited, while combining with TVT-O would obtain more significant short-term and long-term efficacy, which can significantly improve patients' urination and long-term quality of life, with higher safety and clinical promotion value.

A simplified procedure of nerve-sparing radical hysterectomy.

We devised a simplified nerve-sparing radical hysterectomy that is simpler than commonly used procedures. We retrospectively examined 16 cases of classical non-nerve-sparing radical hysterectomy (non-nerve-sparing group) and 16 cases of simplified nerve-sparing radical hysterectomy (nerve-sparing group) performed between 2019 and 2020. We examined and compared the duration of surgery, blood loss, perioperative complications, postoperative urinary function (presence or absence of urinary sensation, number of days with residual urine measurement, and frequency and duration of oral sustained release urapidil capsules and self-catheterization), and short-term prognosis between the two groups. Compared to conventional non-nerve-sparing radical hysterectomy, the duration of surgery for nerve-sparing radical hysterectomy was significantly shorter (407 [339-555] min vs. 212 [180-356] min; p < 0.001), and blood loss was significantly less. Compared to the nerve-sparing group, the non-nerve-sparing group had more cases of oral urapidil use and a higher frequency of clean intermittent catheterization. Clean intermittent catheterization was required in two cases in the nerve-sparing group; however, it was withdrawn at 180 and 240 days. Conversely, clean intermittent catheterization was still required in three cases in the non-nerve-sparing group. There were no statistically significant differences in progression-free survival and overall survival between the two groups. The simple nerve-sparing radical hysterectomy resulted in shorter duration of surgery and less blood loss as well as in a clear improvement in the postoperative urinary status and short-term prognosis. This technique simplifies nerve-sparing radical hysterectomy, which is commonly thought to be complicated, making it easier to understand.

Impact of nerve-sparing posterolateral parametrial excision for deep infiltrating endometriosis on postoperative bowel, urinary, and sexual function.

ObjectiveTo evaluate the functional outcomes of nerve‐sparing surgery for deep infiltrating endometriosis (DIE) with or without posterolateral parametrectomy.MethodsA multicenter, observational, retrospective, cohort study was performed including all symptomatic women who underwent nerve‐sparing laparoscopic excision of DIE and preoperative and postoperative assessment of functional outcomes through validated questionnaires between April 2019 and March 2020. Women with posterolateral parametrial DIE (P‐group) and women with no parametrial involvement (NP‐group) were compared in terms of preoperative and postoperative functional outcomes related to pelvic organs assessed through validated questionnaires (KESS and GIQLI for bowel function, BFLUTS for urinary function, and FSFI for sexual function); pain symptoms at 3‐month follow up assessed through an 11‐point visual analogue scale (VAS) for dyschezia, dysmenorrhea, dyspareunia and chronic pelvic pain; surgical outcomes; and rate of urinary voiding dysfunction at 3‐month follow up.ResultsOne‐hundred patients were included: 69 in the P‐group and 31 in the NP‐group. Preoperative and postoperative values of questionnaires, pain symptoms, and postoperative complication rates were comparable between the two groups, except for postoperative dyspareunia and sexual dysfunction, which were statistically higher in the P‐group. Only patients in the P‐group experienced urinary voiding dysfunction, but no statistical significance was reached (P = 0.173).ConclusionPosterolateral parametrectomy for DIE appears to be associated with a higher risk of postoperative dyspareunia and sexual dysfunction.

Analysis of Related Risk Factors for Deep Vein Thrombosis after Urology Surgery

Eighty patients undergoing urological surgery were chosen for the study, and the risk variables for deep vein thrombosis (DVT) were evaluated. The univariate analysis revealed no significant difference between the two groups in terms of gender, age, hypertension, diabetes, smoking, or drinking; operation time, postoperative hospital stay, lithotomy position, postoperative urinary tract infection, or high blood pressure. Blood lipids and coagulation function indices (prothrombin time (PT) and activated partial thrombin time (a PTT)) showed statistically significant differences. In patients undergoing urological surgery, logistic multivariate analysis revealed that operation time, postoperative hospital stay, lithotomy position, postoperative urinary tract infection, PT, aPTT, and hyperlipidemia were all independent risk factors for postoperative DVT. Thus, the primary risk factors for DVT after urological surgery include the duration of the operation, the length of the postoperative hospital stay, the location of the lithotomy, the presence of a postoperative urinary tract infection, hyperlipidemia, and abnormal coagulation function indicators.

Evaluating the result of sphincteric-preserving surgery (Parks procedure) for low rectal cancer

Sphincter-preserving surgery for low rectal cancer improved the quality of life while maintaining the oncologic outcomes. A retrospective, descriptive study was conducted with 45 patients who underwent sphincter-preserving surgery for low rectal cancer at the National Cancer Hospital and Hanoi Medical University Hospital between January 2016 and April 2020. The mean age was 55.6 years old. Male: female ratio = 0.7:1. Nearly all patients presented with hematochezia (95.6%). 75.6% of the tumors are located within 4-6 cm from the anal verge. The anastomotic leak rate was 4.4%. All patients had a normal postoperative urinary function. The sexual dysfunction rate was low (15.8%) and reversible. None had erectile or ejaculation dysfunction. 97.8% satisfied with sphincter function after one year. Tumors located &gt; 4 cm and the anastomosis sites located &gt; 2 cm from the anal verge were good prognostic factors for the recovery of sphincter function (p &lt; 0.05). The Parks procedure had optimistic postoperative outcomes with a low complication rate, minimal sexual dysfunction, and good sphincter function in long-term follow-up.

Magnetic resonance neuroimaging promotes the preservation of pelvic autonomic nerves in laparoscopic total mesorectal excision: a comparative study.

BackgroundHow to preserve pelvic autonomic nerves system (PANS) in total mesorectal excision (TME) is still a technical challenge for gastrointestinal surgeons, and nerve preservation according to preoperative magnetic resonance imaging (MRI) is a hot topic in pelvic surgery. The purpose of this study was to assess the postoperative urogenital function of patients with rectal cancer (RC) who underwent preoperative and postoperative neuroimaging of PANS vs. patients who did not.MethodsPatients meeting the inclusion criteria were prospectively enrolled in a magnetic resonance neuroimaging (MRN) group from June 2018, while primary RC patients from January 2016 to May 2018 who met the inclusion criteria were enrolled in a non-MRN group. Patients in the MRN group underwent MRN examination before operation and 6 months after operation, while those in the non-MRN group were collected and analyzed retrospectively.ResultsBased on International Prostate Symptom Score (IPSS) and International Index of Erectile Function 5 (IIEF5) scores at 6 months, the postoperative urinary and sexual function of male patients in the MRN group were significantly better than that in the non-MRN group (P<0.05). In addition, based on International Consultation on Incontinence modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Female Sexual Function Index (FSFI) scores at 6 months, the postoperative sexual function of female patients in the MRN group was significantly better than that in the non-MRN group (P<0.05).ConclusionsIn the present study, we constructed a three-dimensional (3D) presentation of PANS based on preoperative MRN which showed in vivo pelvic autonomous innervation. This may promote the preservation of PANS during TME and reduce the postoperative urogenital dysfunction rate.

Surgical management and outcomes in spinal intradural arachnoid cysts: the experience from two tertiary neurosurgical centres.

Evaluation of the presentation and outcomes of different surgical treatment approaches for spinal intradural arachnoid cysts (SIAC). Cases were identified from electronic records of two major neurosurgical centres in London over the last 10years (October 2009-October 2019) that have been surgically treated in both institutions. Clinical findings, surgical technique, and recurrence by procedure were statistically analysed. Statistical analysis was performed with STATA 13.1 Software. A total of 42 patients with SIAC were identified for this study with a mean age at the time of surgery of 53.6years and a male:female ratio of 8:13. There were 31 patients with primary SIACs and 11 with secondary SIACs. The most common presenting symptom was paraesthesia (n = 27). The most common location of the cyst was in the thoracic region (n = 33). Syrinx was present in 26.2% of SIACs (n = 11). Resection was associated with significantly better postoperative pain compared to other surgical techniques (p = 0.01), significantly poorer postoperative urinary function (p = 0.029), and lower rates of sensory recovery in patients who presented preoperatively with sensory deficit (p = 0.041). No significant difference was seen in symptomatic outcomes between patients with primary and secondary SIACs. Resection and drainage are both effective methods of managing SIACs. In this observational study, resection was associated with significantly reduced pain postoperatively when compared with drainage, however also with significantly less improvement in postoperative urinary function. Therefore, resection should be the gold standard management option for SIACs, with drainage as an option where resection is unsafe, and drainage should also be considered in patients presenting with urinary dysfunction.