Postoperative Retention Research Articles

Modified ventriculoperitoneal shunt applied to temporary external ventricular drainage

External ventricular drainage (EVD) is a common procedure in neurosurgical practice. Presently, the three methods used most often include direct EVD (dEVD), long-tunneled external ventricular drains (LTEVDs), and EVD via the Ommaya reservoir (EVDvOR). But they possess drawbacks such as limited duration of retention, vulnerability to iatrogenic secondary infections, and challenges in regulating drainage flow. This study aimed to explore the use of a modified ventriculoperitoneal shunt (mVPS)—the abdominal end of the VPS device was placed externally—as a means of temporary EVD to address the aforementioned limitations. This retrospective cohort study, included 120 cases requiring EVD. dEVD was performed for 31 cases, EVDvOR for 54 cases (including 8 cases with previously performed dEVD), and mVPS for 35 cases (including 6 cases with previously performed EVDvOR). The one-time success rate (no need for further other EVD intervention) for dEVD, EVDvOR, and mVPS were 70.97%, 88.89%, and 91.42%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Puncture needle displacement or detachment was observed in nearly all cases of EVDvOR, while no such complications have been observed with mVPS. Apart from this complication, the incidence of postoperative complications was 35.48%, 14.81%, and 8.5%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Mean postoperative retention for EVD was 14.68 ± 9.50 days, 25.96 ± 15.14 days, and 82.43 ± 64.45 days, respectively (P < 0.001). In conclusion, mVPS significantly extends the duration of EVD, which is particularly beneficial for patients requiring long-term EVD.

Comparison of outcomes in patients with and without neurologic diseases undergoing holmium laser enucleation of the prostate.

We aimed to compare holmium laser enucleation of the prostate (HoLEP) outcomes in patients with and without neurologic diseases (ND). A prospectively maintained database of patients undergoing HoLEP from January 2021 to April 2022 was reviewed. The following ND s were included: diabetes-related neuropathy/neurogenic bladder, Parkinson's disease, dementia, cerebrovascular accident, multiple sclerosis, traumatic brain injury, transient ischemic attack, brain/spinal tumors, myasthenia gravis, spinal cord injury, and other. Statistical analysis was performed using t-tests, Chi-squared, and binomial tests (p<0.05). A total of 118 ND patients were identified with 135 different neurologic diseases. ND patients were more likely to have indwelling catheters (57% vs. 39%, p=0.012) and urinary tract infections (UTIs) preoperatively (32% vs. 19%, p=0.002). Postoperatively, ND patients were more likely to fail initial trial of void (20% vs. 8.1%, p<0.001) and experience an episode of acute urinary retention (16% vs. 8.5%, p=0.024). Within 90 days postoperative, the overall complication rate was higher in the ND group (26% vs. 13%, p=0.001). Within the ND group, 30/118 (25%) had ≥1 UTI within 90 days preoperative, which decreased to 10/118 (8.7%) 90 days postoperative (p<0.001). At last followup (mean 6.7 months [ND] vs. 5.4 months [non-ND], p=0.03), four patients (4.4%) in the ND group required persistent catheter/clean intermittent catheterization compared to none in the non-ND group (p=0.002). Patients with ND undergoing HoLEP are more likely to experience postoperative retention and higher complication rates compared to non-ND patients. While UTI rates are higher in this population, HoLEP significantly reduced three-month UTI and catheterization rates.

Reconstruction of Urethral Sphincter With Polyacrylamide Hydrogel.

Urethral bulking is an alternative to synthetic midurethral sling for the treatment of stress urinary incontinence (SUI) in women. Urethral bulking agents, which are injected in the submucosal tissues of the proximal urethra/bladder neck, have demonstrated less adverse effects with similar satisfaction rates but lower subjective and objective cure rates when compared with midurethral sling. Cystoscopic Reconstruction of External Sphincter Technique (CREST) is a novel technique, which reinforces the natural closure mechanism of the external urinary sphincter (EUS). The aim of the study was to provide safety and efficacy data for injecting polyacrylamide hydrogel (PAHG) in the components of the female EUS. This was a retrospective chart review of patients using CREST with PAHG as initial treatment for SUI by a single surgeon from January 2022 to October 2022. Exclusion criteria are as follows: younger than 18 years, prior SUI surgery, concomitant pelvic organ prolapse or reconstructive procedure, neurological conditions, or history of radiation. Subjective and objective cure rates were measured by patient-reported symptoms and cough stress test. Urinary retention, postoperative urinary infection, and de novo urinary urgency were assessed. One hundred and thirteen consecutive patients met inclusion criteria with median follow-up of 3 months. Eighty-five percent of participants reported subjective improvement, 69% reported subjective cure, and 69% demonstrated objective cure. Nine patients reported transient postoperative retention, 8 reported postoperative urinary tract infections, and 5 reported de novo urgency. There were no serious adverse events. CREST is a novel technique for injection of PAHG, into the EUS to treat SUI. Our data suggest that this technique could improve urethral injection outcomes with minimal complications.

The importance of routine genetic testing in pediatric epilepsy surgery.

Genetic variants in relevant genes coexisting with MRI lesions in children with drug-resistant epilepsy (DRE) can negatively influence epilepsy surgery outcomes. Still, presurgical evaluation does not include genetic diagnostics routinely. Here, we report our presurgical evaluation algorithm that includes routine genetic testing. We analyzed retrospectively the data of 68 children with DRE operated at a mean age of 7.8 years (IQR: 8.1 years) at our center. In 49 children, genetic test results were available. We identified 21 gene variants (ACMG III: n = 7, ACMG IV: n = 2, ACMG V: n = 12) in 19 patients (45.2%) in the genes TSC1, TSC2, MECP2, DEPDC5, HUWE1, GRIN1, ASH1I, TRIO, KIF5C, CDON, ANKD11, TGFBR2, ATN1, COL4A1, JAK2, KCNQ2, ATP1A2, and GLI3 by whole-exome sequencing as well as deletions and duplications by array CGH in six patients. While the results did not change the surgery indication, they supported counseling with respect to postoperative chance of seizure freedom and weaning of antiseizure medication (ASM). The presence of genetic findings leads to the postoperative retention of at least one ASM. In our cohort, the International League against Epilepsy (ILAE) seizure outcome did not differ between patients with and without abnormal genetic findings. However, in the 7/68 patients with an unsatisfactory ILAE seizure outcome IV or V 12 months postsurgery, 2 had an abnormal or suspicious genetic finding as a putative explanation for persisting seizures postsurgery, and 3 had received palliative surgery including one TSC patient. This study highlights the importance of genetic testing in children with DRE to address putative underlying germline variants as genetic epilepsy causes or predisposing factors that guide patient and/or parent counseling on a case-by-case with respect to their individual chance of postoperative seizure freedom and ASM weaning. PLAIN LANGUAGE SUMMARY: Genetic variants in children with drug-resistant epilepsy (DRE) can negatively influence epilepsy surgery outcomes. However, presurgical evaluation does not include genetic diagnostics routinely. This retrospective study analyzed the genetic testing results of the 68 pediatric patients who received epilepsy surgery in our center. We identified 21 gene variants by whole-exome sequencing as well as deletions and duplications by array CGH in 6 patients. These results highlight the importance of genetic testing in children with DRE to guide patient and/or parent counseling on a case-by-case with respect to their individual chance of postoperative seizure freedom and ASM weaning.

Hydrogen-Generating Silicon-Based Agent Improves Fat Graft Survival in Rats.

Regulating excessive inflammation and oxidative stress in fat grafting may improve retention rates. Hydrogen effectively combats oxidative stress and inflammation and reportedly inhibits ischemia-reperfusion injury in various organs. However, with conventional methods of hydrogen administration, incorporating hydrogen continuously into the body over a long period of time is difficult. The authors hypothesized that a silicon (Si)-based agent they recently developed would aid in fat grafting, as it can generate large amounts of hydrogen continuously in the body. Fat grafting was performed on the backs of rats fed either a normal or 1.0 wt% Si-based agent-containing diet. To investigate synergistic effects with adipose-derived stromal cells (ASCs), which improve retention rates of fat grafting, fat grafting with ASCs (1.0 × 10 5 /400 mg fat) was also performed in each rat. Postoperative retention rates of grafted fat over time, inflammatory indices, apoptosis, oxidative stress markers, histologic findings, and expression levels of inflammation-related cytokines and growth factors were compared among the 4 groups. Intake of Si-based agent and addition of ASCs significantly reduced inflammatory indices, oxidative stress, and apoptosis of grafted fat, and improved long-term retention rates, histologic measures, and grafted fat quality. Under the experimental conditions, intake of the Si-based agent and addition of ASCs yielded comparable improvements in fat graft retention. Combining the 2 enhanced these effects. Oral administration of a hydrogen-generating Si-based agent may improve grafted fat retention by regulating the inflammatory response and oxidative stress in grafted fat. This study demonstrates improved grafted fat retention rates using a Si-based agent. This Si-based agent has the potential to expand the range of therapeutic indications of hydrogen-based therapy to conditions for which hydrogen has yet to be found effective, such as fat grafting.

A Study on Breast Augmentation Using Fat Grafting With Stromal Vascular Fraction.

Stromal vascular fraction (SVF) and fat grafting are emerging alternatives to implants for breast augmentation. However, the lack of controlled clinical data has led to conflicting results regarding the effectiveness of surgical treatments. This study aimed to identify the key factors affecting the outcomes of fat grafting with SVF and to recognize novel methods to improve the retention rate. In total, 384 women underwent breast augmentation using fat grafting with SVF. The patients were preoperatively and postoperatively managed and recalled for follow-up at 3, 6, and 18 months. The average volume of the injection in the left breast was 162.35 mL (range, 50-260 mL). The postoperative retention rates were 78.65% in 384 patients at 3 months, 77.17% in 273 patients at 6 months, and 77.48% in 102 patients at 18 months. The retention rates were compared based on the number of SVF cells; patients with more than 60 million cells had a retention rate of 70.77%, and those with less than 60 million cells had a retention rate of 85.60% at 18 months. The retention rates at the 18-month follow-up were 65.62% and 85.09% in stiff and soft breasts, respectively. A higher number of cells in the SVF was associated with a greater retention volume, and the retention volume was greater in patients with soft breasts.Given the higher use of the right arm, after 18 months of the surgery, the retention rate of the right breast (60.35%) was lower than that of the left breast (77.48%) ( P < 0.05; t = -13.199). Limiting arm movement, increasing the number of cells in the SVF, and improving the skin tension might enhance the retention rate in patients undergoing breast augmentation.

MP13-09 COMPARISON OF OUTCOMES IN PATIENTS WITH AND WITHOUT NEUROLOGICAL DISEASES UNDERGOING HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP)

You have accessJournal of UrologyCME1 Apr 2023MP13-09 COMPARISON OF OUTCOMES IN PATIENTS WITH AND WITHOUT NEUROLOGICAL DISEASES UNDERGOING HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Jenny Guo, Mark Assmus, Nicholas Dean, Matthew Lee, Jessica Helon, Mitchell Huang, and Amy Krambeck Jenny GuoJenny Guo More articles by this author , Mark AssmusMark Assmus More articles by this author , Nicholas DeanNicholas Dean More articles by this author , Matthew LeeMatthew Lee More articles by this author , Jessica HelonJessica Helon More articles by this author , Mitchell HuangMitchell Huang More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with neurological diseases (ND) are often excluded in the BPH literature due to higher rates of complications and worse peri-operative outcomes. In this study, we sought to compare HoLEP outcomes in patients with and without ND to determine if HoLEP reduced urinary tract infection (UTI) rates in the ND population. METHODS: We collected a prospectively maintained database of patients undergoing HoLEP from January 2021 to April 2022 and identified 118 patients with and 474 without ND. The following diseases were included: diabetes-related neuropathy (DM), Parkinson’s disease (PD), dementia (D), cerebrovascular accident (CVA), multiple sclerosis (MS), traumatic brain injury/hemorrhage (TBI), transient ischemic attack (TIA), brain/spinal tumors (BT), myasthenia gravis (MG), spinal cord injury (SCI), multiple systems atrophy (MSA), cerebral palsy (CP), and other. Statistical analysis was performed using t-tests, Chi-squared, and binomial tests (p<0.05). RESULTS: A total of 118 patients were identified with 135 different neurological diseases: DM (30), PD (9), D (17), CVA (26), MS (2), TBI (8), TIA (16), BT (16), MG (4), other (7). ND patients were more likely to have indwelling catheters (61% vs 43%, p=0.01) and UTIs pre-operatively (32% vs 19%, p=0.002). Post-op, ND patients were more likely to fail initial trial of void (20% vs 8.1%, p<0.001) and experience acute urinary retention (16% vs 8.5%, p=0.024). Within 90 days post-op, complication rates were higher in the ND group (26% vs 13%, p=0.001). Within the ND group, 30/118 (25%) had ≥1 UTI within 90 days pre-op which decreased to 10/118 (8.7%) 90 days post-op (p<0.001). At time of last follow-up (mean: 4.2 mos (ND) vs 3.95 mos (non-ND), p=0.4), 5 patients (5.6%) in the ND group utilized CIC/foley post-HoLEP compared to 0 in the non-ND group (p<0.001)- 2 on CIC BID/1x per month but voiding otherwise and 3 requiring indwelling catheter (1 due to personal preference). IPSS scores and Michigan Incontinence Symptom Index (M-ISI) scores were similar amongst both groups. ND patients exhibited significant improvements in pre- vs post-op IPSS Scores (24.5 vs 7.8, p<0.001) and M-ISI bother scores (1.7 vs 1.1, p=0.04). CONCLUSIONS: Patients with neurological diseases undergoing HoLEP are more likely to experience post-op retention and higher complication rates compared to non-ND patients. While UTI rates are higher in this population, HoLEP significantly reduced 3-month UTI rates and catheterization rates. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e176 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jenny Guo More articles by this author Mark Assmus More articles by this author Nicholas Dean More articles by this author Matthew Lee More articles by this author Jessica Helon More articles by this author Mitchell Huang More articles by this author Amy Krambeck More articles by this author Expand All Advertisement PDF downloadLoading ...

MP13-11 SAFETY AND EFFICACY OF CONCURRENT BLADDER BOTOX INJECTION AT THE TIME OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE: A COMPARATIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP13-11 SAFETY AND EFFICACY OF CONCURRENT BLADDER BOTOX INJECTION AT THE TIME OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE: A COMPARATIVE STUDY Mitchell M. Huang, Nicholas Dean, Mark Assmus, Matthew S. Lee, Jenny Guo, Jessica Helon, and Amy E. Krambeck Mitchell M. HuangMitchell M. Huang More articles by this author , Nicholas DeanNicholas Dean More articles by this author , Mark AssmusMark Assmus More articles by this author , Matthew S. LeeMatthew S. Lee More articles by this author , Jenny GuoJenny Guo More articles by this author , Jessica HelonJessica Helon More articles by this author , and Amy E. KrambeckAmy E. Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men with bladder outlet obstruction from benign prostatic hyperplasia (BPH) can present with symptoms of urge incontinence (UI) secondary to overactive bladder (OAB). Intradetrusor Botox injection is a well-established treatment for OAB, but its use at the time of holmium laser enucleation of the prostate (HoLEP) has not been previously reported. We investigated the safety and efficacy of concurrent intradetrusor Botox for OAB at the time of HoLEP. METHODS: We prospectively identified men who had both BPH and UI secondary to OAB treated with concurrent injection of 200U intradetrusor Botox at the time of HoLEP. We propensity-scored matched to a cohort of HoLEP-only patients based on age, self-reported UI, pre-operative Michigan Incontinence Symptom Index (M-ISI) score, and prostate size. Complications and patient-reported outcomes were compared using Wilcoxon, paired T-, and Fisher’s exact tests as appropriate. RESULTS: We identified 82 men with baseline UI – 41 treated with HoLEP+Botox (“Botox” group) and 41 with HoLEP only (“control” group). The groups were matched by age (mean 73.3 vs 72.2 years, p=0.7), prostate size (mean 106.7 vs 119.9 g, p=0.2), and pre-op M-ISI score (mean 13.1 vs 11.0, p=0.4). Both groups had similar pre-procedure International Prostate Symptom Scores (IPSS) (mean 21.4 Botox vs 21.5, p=0.8). The control group had more men in retention at baseline (46% vs 10%, p<0.001). In the Botox group, there was a mean 6.2-point reduction in M-ISI (p<0.001) and 11.7-point reduction in IPSS (p<0.001) post-operatively. In the control group, there was mean 14.8-point reduction IPSS (p<0.001), but no significant change in M-ISI (p=0.2). In both cohorts, all men had a successful initial trial of void (p=1) and no men had post-operative urinary tract infection (p=1). Transient post-op retention was observed in 3 Botox patients (all managed with temporary catheter for 1-2 days) compared to 0 control patients, but this difference was not significant (p=0.2). CONCLUSIONS: Concurrent bladder Botox injection at the time of HoLEP is safe and associated with reduced patient-reported severity of urinary incontinence and improved IPSS. These findings support further investigation of simultaneous Botox injection and HoLEP in men with concomitant BPH and OAB. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e177 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitchell M. Huang More articles by this author Nicholas Dean More articles by this author Mark Assmus More articles by this author Matthew S. Lee More articles by this author Jenny Guo More articles by this author Jessica Helon More articles by this author Amy E. Krambeck More articles by this author Expand All Advertisement PDF downloadLoading ...

Tension-Free Vaginal Tape and Polyacrylamide Hydrogel Injection for Primary Stress Urinary Incontinence: 3-Year Followup from a Randomized Clinical Trial.

We sought to determine whether polyacrylamide hydrogel (PAHG) is noninferior to tension-free vaginal tape (TVT) in the treatment of women with primary stress urinary incontinence (SUI). In this noninferiority trial, 223 women eligible for operative SUI treatment were randomized for TVT (110) or PAHG (113). Primary outcome was patient satisfaction and the noninferiority margin for the difference was 20%. Secondary outcomes were effectiveness and complications. At 3 years, 188 (84.3%) women attended the followup. The satisfaction score (visual analogue scale 0-100) median was 98.5 (IQR 90-100) in the TVT group and 90.0 (IQR 70-100) in the PAHG group, whereas a score ≥80 was reached in 87 (94.6%) and 65 (67.7%), respectively (difference 26.9%, 95% CI 16.7% to 36.8%). Thus, PAHG did not meet the noninferiority criteria set in our study. The cough stress test was negative in 88 (95.7%) of TVT patients vs 75 (78.1%) of PAHG patients (difference 17.5%, 95% CI 8.6% to 26.9%). Any peri- or postoperative complication before crossover between the groups was detected in 40 (43.5%) women in the TVT group and 23 (24.0%) women in the PAHG group (difference 19.5%, 95% CI 6.8% to 31.4%). In midterm followup, PAHG did not reach in patient satisfaction the noninferiority set in our study. Furthermore, mid urethral TVT slings show better subjective and objective cure rates than PAHG. However, complications were more often associated with TVT. Since the majority of PAHG treated women were also cured or improved, primary SUI women can be offered PAHG as a safe and durable alternative treatment.

Effect of Comprehensive Care Based on Appropriate Chinese Medicine Techniques on Urinary Retention and Bladder Function Recovery after Total Hysterectomy in Patients with Cervical Cancer.

Objective To investigate the effect of comprehensive care based on appropriate Chinese medicine techniques on urinary retention and bladder function recovery after total hysterectomy in patients with cervical cancer. Methods A total of 148 cases admitted after radical hysterectomy for cervical cancer from January 2019 to early September 2019 were used as the observation sample and were divided into control and experimental groups based on a randomized double-blind method. There were 74 cases each. The control group was given comprehensive care, and the experimental group was given comprehensive care based on appropriate Chinese medicine techniques. The intervention period was 2 weeks after surgery. The recovery rate of bladder function and the occurrence of urinary retention were compared between the two groups, and the duration of postoperative retention of urinary catheter, the amount of residual urine, and the feeling of urination were counted. Results The experimental group had better urinary catheter retention time, time to first spontaneous voiding, time to get out of bed, and time to anal discharge than the control group; the experimental group had a higher rate of good bladder function recovery than the control group and better bladder recovery time, residual urine volume, and incidence of urinary retention than the control group; the patients in the experimental group had better UDI-6 scores. Conclusion The implementation of comprehensive care based on appropriate Chinese medicine techniques can relieve patients' difficulty in urination and improve their quality of life.

AdVance and AdVance XP Male Sling Comparison, an Institutional Experience

ABSTRACT Introduction The AdVance male sling has been used for many years for the treatment of male stress urinary incontinence with multiple previous studies evaluating its efficacy. More recently, a new generation AdVance XP was designed with modifications in its design and surgical tools in hopes to improve patient outcomes. Objective The aim of our study was to provide our institution's outcomes comparing objective and patient-reported outcomes of the AdVance male sling to the AdVance XP. Methods All patients who have had placement of an AdVanceXP male urethral sling were retrospectively reviewed. Inclusion criteria included the necessity of one year post-operative follow up. We then identified a comparative cohort who had the most recent placement of the AdVance sling. We compared patient demographics, baseline characteristics, functional outcomes, voiding studies and complications. Results A total of 11 patients who received the AdVanceXP were compared to 11 patients who received the AdVance male sling. There were no statistically significant differences in baseline demographics between the two groups (Table1). When comparing the AdVance XP to Advance, there was no difference in change in average flow rate (-1.26mL/s vs -5mL/s, p=0.476) or peak flow (-5.11mL/s vs -5.73mL/s, p=.936). Patient's pre-surgical pad usage was greater in the AdVanceXP than the AdVance sling groups (2.64 vs 1.60, p=0.019). The mean decrease in pad usage was 1.95 pads in those with the AdVanceXP compared to 1.36 pads with the AdVance (p=.227). There were no statistically significant differences in operative times between the AdVanceXP and the AdVance male sling (64.5min vs 68.8min, p=.249). Both groups had one patient who had issues with post-operative pain and neither group had any patients with post-operative retention, infection or need for reoperation within one year. Conclusions Patient's who had placement of the AdVanceXP were found to have a greater reduction in pad usage when compared to the AdVance sling, though not reaching statistical significance. Disclosure No

Bipolar versus Monopolar Transurethral Resection of Prostate in Treatment of Benign Prostatic Enlargement

Introduction: Bipolar transurethral resection (B-TURP) is an effective modality for surgery of Benign Prostatic Obstruction, and has been widely studied for its efficacy and safety against the well-established method; Monopolar Transurethral resection (M-TURP). Objectives: The study aimed to assess the feasibility of B-TURP over M-TURP in terms of hospital stay, resection time, resected tissue volume, changes in hemoglobin and sodium, blood transfusion required, complications like TUR syndrome, clot retention and hemorrhagic episodes. Methodology: An analytical study was done in cases who underwent TURP from August 2018 to August 2020. Parameters like hospital stay, resection time, resected tissue volume, changes in hemoglobin and sodium, blood transfusion required, complications like TUR syndrome, clot retention and hemorrhagic episodes were compared in between B-TURP and M-TURP. Statistical analysis was done using SPSS 22.0 software. Results: Seventy-three patients were compared in this study; 33 had undergone B-TURP and 40 patients had undergone M-TURP. Total hospital stay was slightly lesser in B-TURP. The post-operative Hb in M-TURP was significantly lesser than B-TURP (11.10±1.321 vs 12.24±1.225, P&lt;0.001). Although the drop in hemoglobin was statistically significant in both the groups, the hemoglobin drop was slightly lesser in B-TURP. The mean difference in pre and post-operative hemoglobin was 1.148 in M-TURP and 0.181 in B-TURP. TUR syndrome was significantly higher in M-TURP (6,8.2% vs 0, 0%; P=0.029). There was no significant difference in between resection time, post-operative sodium, post-operative hemorrhagic episodes, clot retention and blood transfusions. Conclusion: Bipolar TURP is safe and effective for transurethral resection of prostate with relative shorter hospital stay, lesser bleeding and TUR syndrome in comparison to Monopolar TURP.

Urinary retention is rare after colpocleisis and concomitant midurethral sling: a 10-year experience

The optimal method of managing stress urinary incontinence (SUI) in women undergoing colpocleisis remains unclear, especially in a setting of urinary retention. We aim to compare postoperative retention after colpocleisis with or without concomitant midurethral sling (MUS). A retrospective chart review of all women who underwent colpocleisis with or without MUS from October 2007 to October 2017 was performed. Women with preoperative and 2-week postoperative post-void residual volume (PVR) measurements were included. Urinary retention was defined as PVR of ≥100ml. Analysis included t tests/Wilcoxon rank, Chi-squared/Fisher's exact, and multivariate linear regression models. A total of 231 women with a mean age of 77.7years (± 6.0years SD) met the inclusion criteria. One hundred and thirty-eight women underwent colpocleisis alone, whereas 93 women had colpocleisis with MUS. Preoperative retention rates were high (44.9% vs 34.4%, for colpocleisis alone versus with MUS, p = 0.114). Postoperative retention rates were lower and similar between the groups (10.1% vs 11.8%, for colpocleisis alone vs with MUS, p = 0.69). Linear regression models showed the adjusted odds ratio for postoperative urinary retention in patients with concomitant MUS was 1.68 (95% confidence interval: 0.64-4.41) compared with patients with colpocleisis alone and this did not reach statistical significance (p = 0.292). Fortunately, after colpocleisis, women had high rates of resolution of retention, regardless of MUS (80.3% vs 90.6% for colpocleisis alone vs with MUS; p = 0.20). Few women required reoperation for retention (3.1%). Placement of an MUS at the time of colpocleisis is a safe and effective therapy. This appears to be unaffected by preoperative urinary retention status.

Transvaginal subfascial synthetic mesh sling in female stress urinary incontinence: A Novel technique

The object of this paper is to assess the treatment outcome and overall efficacy of a novel technique of transvaginal subfascial synthetic mesh for female stress urinary incontinence. The study included 53 patients of female stress urinary incontinence managed at our institution between March 2005 and December 2015. Preoperative evaluation included a detailed history, base-line investigations and cystoscopic examination including stress test, uroflometry with residual urine was done in all cases. Lower urinary tract imaging and urodynamic evaluation was done in selected cases . patients with concomitant pelvic organ prolapse and severe BMI were excluded from the study. All patients underwent a transvaginal subfascial sling procedure under regional anesthesia. Urethral catheter was removed the day after procedure. Post procedure results were assessed in terms of improvement in stress urinary incontinence, procedure related complications, and overall satisfaction of the patient. Mean age of the patients was 43.5 years (25-63 years). All patients were multiparous. Complete resolution of symptoms in 49 patients (92.4%) while in 4 patients (7.5%) had some degree of SUI. Urinary retention in 3 (5.6%), increased frequency in 5 (9.4%) patients and urge incontinence in 2 (3.7%) One (1.8%) had mesh erosion at 3 months after the procedure. None of the patient had any sexual dysfunction on follow up. Overall success rate of the procedure was around 93%.However patients with preoperatively urge incontinence needs anticholinergics in post operative period for 1-2 months. Operative time was 30-45 minutes. Three patients (5.6%) who experience transient postoperative retention had no symptoms of SUI on follow up. Transvaginal subfascial sling is a modification of the original mid urethral sling procedure with an advantage of being less invasive, simpler to learn and achieve similar results compared to other sling procedures.

Anticipating Urinary Retention Following Total Hip and Total Knee Replacements.

Introduction:Urinary retention is a widely recognised postoperative complication. Although anecdotally lower limb arthroplasty is linked with high rates of urinary retention, there are no current accepted standards for determining which patients are at higher risk and should therefore be offered intra operative catheterisation.Materials and Methods:One hundred patients, 55 females and 45 males, who underwent uncomplicated total hip or total knee replacements at Furness General Hospital were recruited between January and April 2017.Results:Post-operative urinary retention was seen frequently, with 38 patients (38%) requiring post-operative catheterisation. Twenty-one males (46%) developed postoperative retention compared to 17 (30%) of females, representing a statistically significant increase in risk seen in male patients. (p 0.009). Post-operative urinary retention requiring catheterisation was associated with increasing age, with those over 75 years having a significantly higher risk than those less than 75 years irrespective of gender (p 0.04). There was no significant difference in urinary retention rates between patients who had general (n=21) or spinal anaesthetic (n=79) with 33% of GA patients and 39% of spinal anaesthetic patients requiring catheterisation (p 0.17).Conclusion:There are increased rates of urinary retention seen in lower limb arthroplasty patients than those described in the general surgical population, with male patients and all those over 75 years of age having a significantly higher risk. Clinically, it may therefore be sensible to consider offering routine intra operative catheterisation to this cohort of patients.

Stress Urinary Incontinence Surgery Outcomes: A 6-Year Review

Study Objective A variety of surgical procedures exist to correct stress urinary incontinence (SUI). Mid-urethral slings are currently considered the gold standard. Recent FDA warnings regarding mesh use in pelvic organ prolapse surgeries may have caused negative perceptions towards mesh-based procedures. The objective of this study is to review the outcomes and complications associated with the different surgical procedures performed for SUI. Design A retrospective chart review of patients undergoing SUI surgery from 2013–2018 was performed and included: Mid-urethral sling (MUS), laparoscopic polypropylene mesh sling (Lap mesh sling), laparoscopic Burch (Burch) and autologous fascial sling (AFS). Setting Tertiary care academic center. Patients or Participants Patients were identified from our center's operating room database and verified with office charts from the involved 6 surgeons. Interventions N/A Measurements and Main Results Patient demographics, pre/intra/post-operative measures and surgical outcomes (up to 2 years post-surgery) were reviewed. Of 649 charts, 32% (209/649) had MUS, 31% (200/649) had lap mesh sling, 25% (161/649) had Burch and 12% (79/649) had AFS. 408/649 (62.9%) had concomitant procedures with the most common being posterior vaginal repair (274/408). Intra/post-surgical complication rates were: DVT/PE (0/649), transfusion (0/649), re-operation for hemorrhage (2/649), bladder injury (9/649), bowel injury (4/649), readmission (32/649). Post-op urinary retention rates (and mean duration of catheter use) were: MUS 22.5% (8.4 days), Lap mesh sling 52.0% (11.2 days), Burch 61.5% (5.7 days) and AFS 93.7% (15.9 days). Overall, 232/649 (35.7%) and 124/649 (19%) had information available for the 1- and 2-year follow-up visits. At 1-year post-operatively, SUI was cured in 89% (79/89) of MUS, 82% (63/77) of Lap mesh sling, 92.0% (23/25) of Burch and 58.5% (24/41) of AFS. Conclusion The 2 most common surgical procedures for SUI at our center involve the use of permanent mesh: MUS and laparoscopic mesh sling. Overall, there are low complication rates and good 1-year cure rates for all surgeries except AFS.

The role of perioperative medications in urinary retention following midurethral sling

Postoperative urinary retention (PUR) is a known complication of midurethral sling (MUS) placement. The use of certain perioperative medications may influence the risk of this complication. This study aimed to investigate the association of perioperative medications with urinary retention after MUS. This was a retrospective study of women undergoing MUS placement for stress urinary incontinence by a fellowship-trained urologic surgeon between 2015 and 2018, under approval by the Institutional Review Board. Both retropubic and transobturator approaches were included. All patients underwent an active void trial following surgery. Intraoperative medications given by the anesthesia team were retrospectively noted. The Fisher's exact test was used to compare the association of PUR with categorical variables. A total of 82 patients were included, 17 (21%) of whom failed postoperative void trial due to urinary retention. Of 25 patients receiving perioperative scopolamine, 40% failed the postoperative void trial, compared to 12% of patients not receiving scopolamine (p = .048). Groups were then stratified based on scopolamine use due to the observed independent association with PUR. Subgroup analysis revealed a stronger association of postoperative retention with scopolamine in patients undergoing concomitant prolapse surgery. Notably, retention rate and scopolamine use were similar whether patients underwent sling placement alone or in combination with prolapse surgery. Rate of retention was also higher for retropubic versus transobturator slings (36% vs. 9%; p = .005). Perioperative scopolamine may be associated with an increased risk of postoperative urinary retention following MUS, especially in the setting of a concomitant prolapse surgery.

Transvaginal Paravaginal Native Tissue Anterior Repair Technique: Initial Outcomes

ObjectiveTo present the surgical technique and initial outcomes for a novel lattice-work technique, developed to increase the durability of the native tissue repair. Methods/ MaterialsAll patients undergoing transvaginal anterior prolapse repair with a single surgeon with at least 30 days of follow-up were prospectively enrolled starting in 2017. All patients received the same repair (Fig. 1). 2.0 polydioxanone (PDS) sutures are placed at the level of the obturator fascia/arcus tendineus distally and proximally on each side. The midline anterior colporrhaphy is performed with 4 2.0 PDS sutures which are then intertwined with the obturator sutures and tied to form a lattice of sutures to reinforce the cystocele repair and elevate the central defect repair laterally. Clinic notes, objective physical exam, and standardized subjective patient questionnaires (Pelvic Floor Disorders Inventory) were evaluated for patient outcomes. Recurrence was defined anatomically (Pelvic organ prolapse-Q Ba ≥-1) and subjectively (bothersome vaginal bulge). ResultsThere were 109 patients enrolled with a mean follow-up time was 12 months. Over the follow-up period, there were 12 anatomic recurrences (11%). This was not associated with concomitant apical or posterior repair. Mean time to recurrence was 13.9 months. There were no intraoperative complications. Transient urinary retention was the most notable complication (19%, managed conservatively). Rate of de novo stress urinary incontinence was low at 4%. ConclusionThis novel lattice-work technique is simple to perform and has excellent short term anatomic outcomes. Transient postoperative retention was observed; however, all cases self-resolved. Further follow-up is ongoing to characterize the long-term durability of this repair.

V13-07 STANDARDIZED TENSIONING TECHNIQUE FOR AUTOLOGOUS PUBOVAGINAL SLINGS

You have accessJournal of UrologyFemale Pelvic Surgery (V13)1 Apr 2020V13-07 STANDARDIZED TENSIONING TECHNIQUE FOR AUTOLOGOUS PUBOVAGINAL SLINGS Alan Quach*, Michael Maccini, David Koslov, Kirk Redger, and Brian Flynn Alan Quach*Alan Quach* More articles by this author , Michael MacciniMichael Maccini More articles by this author , David KoslovDavid Koslov More articles by this author , Kirk RedgerKirk Redger More articles by this author , and Brian FlynnBrian Flynn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000970.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent FDA public health notifications have created increased utilization of autologous pubovaginal slings (PVS). Unlike midurethral slings, there is no standardization in tensioning methods of autologous fascial slings, leading to increased rates of postoperative urinary retention (10%). Consequently we have made efforts to standardize our technique to lesson the risk of retention in this population. METHODS: Since 2013, we have adopted a standardized tensioning technique. Briefly, a rubber shod is placed on the suspension sutures at the level of the fascia bilaterally. A second rubber shod is placed at a defined distance above the fascia and the suspension sutures are tied. This predetermined distance is as follows: 0 cm spacing for occlusive slings, 1 cm spacing for patients with severe ISD, and 2 cm spacing for the remaining population. In this video we will demonstrate autologous rectus fascial harvest and our standardized rubber shod tensioning technique in a 53 year old female with recurrent stress urinary incontinence following removal of exposed transvaginal mesh. RESULTS: In 168 patients, our overall SUI cure rate (<1 pad per day) was 78%. The standardized tensioning group had a decreased risk of both postoperative retention and sling lysis (OR = 0.41 and 0.22, respectively). Increasing surgeon experience did not demonstrate an independent association with postoperative retention. CONCLUSIONS: Our standardized tensioning technique for autologous PVS reduces the risk of postoperative retention and sling lysis while maintaining excellent continence outcomes. This technique offers reproducible tensioning which could reduce the learning curve for autologous PVS procedures. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1212-e1212 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alan Quach* More articles by this author Michael Maccini More articles by this author David Koslov More articles by this author Kirk Redger More articles by this author Brian Flynn More articles by this author Expand All Advertisement PDF downloadLoading ...

Holmium laser enucleation of the prostate in Jehovah's Witness patients.

To evaluate if HoLEP is a viable option for male patients with medication-refractory urinary symptoms due to an enlarged prostate who are surgical candidates, but do not accept blood product transfusion. Between August 2008 and March 2019, nine Jehovah's Witness patients were undergoing HoLEP for relief of lower urinary tract symptoms and urinary retention. We described change in hemoglobin, change in PSA, enucleated prostate weight, enucleation and morcellation times, length of stay, and postoperative retention rate. The average age was 71.4years (range 53-87). Urinary retention requiring catheterization was present in seven patients (78%). Two patients had a known diagnosis of prostate cancer preoperatively. The mean preoperative PSA on average was 21.6ng/dL. Patients had a wide range of gland sizes, with a mean enucleated weight of 141g (range 18-344g). Mean reduction in hemoglobin was 16.9% following HoLEP. All patients managed to void postoperatively. All but one patient went home on postoperative day 1, and this patient went home on postoperative day 2. No patients required blood product transfusion or return to the operating room for clot irrigation postoperatively. HoLEP is a reasonable option for Jehovah's Witness and other patients with contraindications to blood product transfusion requiring surgical management of urinary symptoms due to enlarged prostate.