Predictive Factors For Success Research Articles

Long-term Outcomes of Endoscopic Anti-reflux Surgery in Pediatric Patients with Vesicoureteral Reflux: Urinary Tract Infection, Renal Scarring, and Predictive Factors for Success.

BackgroundTo report the long-term outcomes of endoscopic surgery (ES) in pediatric patients with vesicoureteral reflux in terms of success rate, urinary tract infection, and renal function.MethodsWe retrospectively reviewed the records of 73 pediatric patients (110 ureters) who underwent ES for vesicoureteral reflux. Ultrasonography was performed 1, 3, and 12 months postoperatively. Voiding cystourethrography was performed 3 months postoperatively and repeated after 1 year if vesicoureteral reflux persisted. Success was defined as the absence of reflux at the first voiding cystourethrography. Renal scans were performed at least 12 months postoperatively. Renal function deterioration was defined as a new scar or a greater than 5% decrease in function.ResultsThe median follow-up duration was 24 (12–118) months. The overall success was 65.6%, while it was 78.9%, 87.0%, 62.5%, 37.5%, 66.7% for grades I, II, III, IV, and V, respectively. In multivariate analyses, significant predictive factors for success were vesicoureteral reflux grade (odds ratio [OR], 0.28; P < 0.001) and mound detection at the first postoperative ultrasonography (OR, 13.53; P < 0.001). Renal function deterioration was found in 8 (15.3%) ureters and was less common in those with successful surgeries than in those with failures (9.5% vs. 40.0%; P = 0.035). No significant predictive factor for renal function deterioration or urinary tract infection was found.ConclusionSuccessful short-term outcomes of ES are expected in low-grade vesicoureteral reflux, especially when a mound is detected by postoperative ultrasonography. However, unpredictable long-term renal deterioration warrants continued follow-up.

Mucosal advancement flap for fistula-in-ano: A single-institution experience

Background and Objective: Mucosal advancement flap (MAF) is a well-described definitive treatment for complex fistula-in-ano, with high healing rates ranging from 37 to 87% for cryptoglandular fistula, but with mild incontinence rates of up to 35%. There is a paucity of Australian data to support the efficacy and complication rates of MAF, nor predictive factors for success. Patients and Methods: This was a retrospective study, with ethical approval granted by St. Vincent's Hospital Melbourne (SVHM) Quality and Risk Unit. Patients who underwent MAF at SVHM and St Vincent's Private Hospital Fitzroy from 2011 to 2015 were included in the study; all data were collected from patient medical records. Results: A total of 65 patients were treated with MAF during the study period. Fistula etiology was cryptoglandular in 82%, anovaginal in 11%, and perianal Crohn's disease in 7% of patients. Overall success rates for MAF were 66% for cryptoglandular fistula, 14% for anovaginal fistula, and 40% for Crohn's fistula. Excluding anovaginal fistulae, the success rate of MAF was 74% for males and 57% for females. MAF performed for an anterior internal opening was associated with a success rate of 65% versus 56% for a posterior internal opening. Postoperative fecal incontinence rate was 6%. Five of the patients with failed MAF underwent a second sphincter-preserving procedure; none of these were successful. Conclusion: This study supports the use of MAF for the treatment of complex fistula-in-ano, with a success rate compatible with existing literature and a low incontinence rate.

Clinical Analysis on the Effectiveness of Transvaginal Cervical Cerclage in Singleton Pregnancies and Its Predictive Factors

Objective: To evaluate the effectiveness of transvaginal cervical cerclage in singleton pregnancies with cervical incompetence, determine the predictive factors of success and failure, and then compare elective and emergency cerclage. Study Design: This was a retrospective study of 62 patients who underwent cervical cerclage in The First Hospital of Jilin University, China, between May 2015 and January 2018. Successful group was defined as those who delivered live babies and failure group who experienced abortion or stillbirth. Results: Out of 104 patients, 62 met inclusion criteria. In 62 cases, 47 (75.8%) succeeded and 15 (24.2%) failed. In successful group, 21 (44.7%) women delivered pretermly and 26 (55.3%) termly. No severe complications occurred except cervical laceration (2, 3.23%), premature rupture of membranes (13, 20.97%). In 62 cases, 40 (64.5%) have ≤2 previous second-trimester losses and 22 (35.5%) have >2 previous second-trimester losses. No significant differences were found in neonatal outcomes. Analysis revealed that higher postoperative C-reactive protein and presence of premature rupture of membranes were the strongest predictors of cerclage failure. Among 62 cases, 48 (77.4%) were allocated in elective and 14 (22.6%) in emergency cerclage. Pregnancy prolongation was significantly more (P = 0.014) in elective group with no significant differences in premature rupture of membranes, neonatal outcomes (all P > 0.05) except Apgar score at 5 min (P = 0.042). Conclusion: Achieving 75.8% live births proves that transvaginal cervical cerclage is an effective and safe technique in prolonging the gestational age, improving the obstetric outcomes in singleton pregnancies with cervical incompetence under various cerclage indications. Postoperative C-reactive protein and premature rupture of membranes are the predictive factors related to success or failure. Elective cerclage is more effective in prolonging the pregnancy compared to emergency cerclage, no significant differences are seen regarding neonatal outcomes and complications.

Long-Term Functional Outcomes of S3 Sacral Neuromodulation for the Treatment of Idiopathic Overactive Bladder

To assess the long-term functional outcomes of sacral neuromodulation (SNM) in the treatment of refractory idiopathic overactive bladder (IOAB) and to determine predictive factors for success. To obtain long-term data, all consecutive patients suffering from IOAB and treated by SNM at a single tertiary care center between December 1996 and December 2004 were included. Data regarding patient demographics, past medical, and surgical history, bladder diary, complications as well as device revision and removal rates were collected. Success was defined as an improvement ≥ 50% of any clinical parameter. Overall, 34 patients, with a median age of 57.8 years (IQR 44.8-65.7) were included. Immediately after definitive implantation, 2 (6%) patients were lost to follow-up. After a median follow-up of 9.7 years (IQR 4.7-12.0), SNM was considered successful in 20 (63%) patients. Mean amount of protections used per 24 hours significantly decreased (4.1 preoperatively vs. 1.8 at the last follow-up visit, p = 0.02). Devices were removed in 2 (6%) patients due to pain and lack of efficacy. Twenty-two revision surgeries were performed in 15 (47%) patients. First revision surgery occurred after a mean of 6.2 years (± 3.1). Revision surgeries were mainly performed for end of battery life/device dysfunction (n = 18, 82%). No significant predictor for success was identified. With a median follow-up time of 9.7 years, this retrospective SNM study reports a 63% efficacy rate (≥ 50% improvement) for the treatment of refractory IOAB. Moreover, it is a well-tolerated and minimally invasive therapy.

Induction of labour: clinical predictive factors for success and failure

Induction of labour (IOL) is a widely-used practice in obstetrics. Our aim was to evaluate predictors of vaginal delivery in postdate pregnancies induced with prostaglandins. We conducted a retrospective cross-sectional study with analytic component. A total of 145 women, admitted for IOL after the 41st week of gestation, were induced with a vaginal pessary releasing prostaglandins. Type of delivery, whether vaginal or caesarean, was the outcome. Several maternal and foetal variables were investigated. The Kaplan–Maier curves, monovariate and a multivariate logistic regression were carried out. In our population, 80.7% of women had vaginal delivery after the induction. Multiparity and a high Bishop score at the beginning of the IOL were protective factors for a vaginal delivery (respectively OR 0.16, p = .028 and OR 0.62, p = .034) while age >35 years, and the foetal birth weight >3500 g at the birth, resulted in being risk factors for caesarean section (respectively OR 4.20, p = .006 and OR 3.63, p = .013).IMPACT STATEMENTWhat is already known on this subject: Induction of labour (IOL) is a widely used practice in obstetrics. Scientific literature shows several predictors of successful induction, although there is no unanimity except for ‘multiparity’ and ‘favourable Bishop score’ which are associated with positive outcome of the induction. The main difficulty in finding other predictive factors is the heterogeneity of this field (different local protocols in each hospital, type of induction, populations and outcomes chosen in each study). In addition to that, populations are not always comparable due to the different gestation. For this reason, we decided to select a specific population of women, such as low risk postterm pregnancies induced with prostaglandins, in order to detect possible predictive factors for the success of the IOL for women with uncomplicated pregnancies.What the results of this study add: Our study agrees with existing literature that ‘multiparity’ and ‘Bishop score’ are linked with the success of IOL and adds that ‘maternal age’ and ‘foetal birth weight’ are significant risk factors for the population of uncomplicated post term pregnancies induced with prostaglandins.What the implications are of these findings for clinical practice and/or further research: Our results agreed with the existing literature regarding parity and Bishop score but not for maternal age and birth weight. This adds new precious data to the literature which could be used for systematic reviews and for implementing IOL guidelines and protocols, nationally and internationally. Our findings could be also used for guiding future research in this field. It will be interesting to investigate the existence of not just specific factors but also any combination of variables which could predict the success of the procedure. At the moment these information cannot be used in terms of decision making for healthcare professionals as no variable is 100% predictive but once further research will be added, we may be able to know when is best time to start the IOL, how to facilitate the success of the procedure and how to best support the woman throughout the whole experience.

Utility and Safety of Repeated Ultrasound-Guided Core Needle Biopsy of Focal Liver Masses.

To evaluate the accuracy and safety of repeated ultrasound-guided core needle biopsy (CNB) for hepatic focal lesions and to assess the predictive factors for success of repeated CNB. For 5 years, 3085 CNBs were performed for focal hepatic lesions using an automated biopsy gun with an 18-gauge needle. Seventy-eight patients underwent repeated CNB because of pathologically inconclusive or unexpected results. Twelve patients were excluded because of unavailable additional tissue or follow-up imaging by radiofrequency ablation (n = 5), repeated CNB greater than than 3 months after the first CNB (n = 5), and insufficient follow-up time (n = 2). Sixty-six patients were finally enrolled after the exclusion criteria were applied. We retrospectively evaluated tumor necrosis, tumor size, number of passes, lesion site, depth, tumor conspicuity, and complications. Continuous data and the total scores of the grading system were analyzed by the Student t test, and categorical data and each category were analyzed by the Fisher exact test. The repeated CNB rate was 2.5% (78 of 3085). The diagnostic accuracy of the repeated biopsies was 83.3% (55 of 66). Comparing the diagnostic group with the nondiagnostic group, no variable (ie, size, depth, necrosis, lesion site [segment], and number of passes) had a statistically significant difference. Tumor conspicuity was a significant factor for predicting successful repeated biopsy (P < .001). The cumulative complication rate was 10.6% (7 of 66), with only minor complications. Repeated CNB is an accurate and safe procedure for obtaining a histologic diagnosis of hepatic focal lesions if the initial biopsy fails. High tumor conspicuity showed a significant correlation with successful repeated CNB.

Predictive factors of success in neurofeedback training for children with ADHD

ABSTRACTIntroduction: Neurofeedback (NF) training aims the enhancement of self-regulation over brain activities. While it is largely recognized as an effective treatment for attention deficit hyperactivity disorder (ADHD), the existence of non-learners has also been reported. The present study explored pre-training assessment indices that could predict learners prior to NF training. Methods: Twenty-two children with ADHD participated in slow cortical potential (SCP) NF training and completed pre- and post-training assessments. Participants were classified into learners or non-learners based on their progress in the SCP regulation, and pre-training indices that differentiate the two groups were examined by decision tree analysis. Results and Discussion: The learner rate in NF training was 45.5%. Learners were predicted by pre-training cognitive and neurophysiological measures regarding Stroop tasks, which suggested relatively intact executive function as their characteristics. Given that NF training is not universally effective for children with ADHD, further studies are necessary to establish application criteria.

G-POEM with antro-pyloromyotomy for the treatment of refractory gastroparesis: mid-term follow-up and factors predicting outcome.

Gastric peroral endoscopic pyloromyotomy (G-POEM) was introduced for treating refractory gastroparesis. To present a series of patients focussed on clinical mid-term efficacy and predictive outcomes factors. This was a single centre study of 29 patients operated on between January 2014 and April 2016, with disturbed gastric emptying scintigraphy (GES) and/or elevated Gastroparesis Cardinal Symptoms Index (GCSI). The procedures were performed as previously described. The primary endpoint was the efficacy at 3 and 6 months, based on GCSI and symptoms. The secondary endpoints were GES evolution, procedure reproducibility and safety, and identification of predictive factors for success. There were 10 men, 19 women (mean age 52.8±18). The technical success rate was 100% (average 47 minutes). There were two complications managed conservatively: one bleeding and one abscess. The median follow-up was 10±6.4 months. The clinical success rate was 79% at 3 months, 69% at 6 months, with a significant decrease in the mean GCSI compared to pre-operatively (3.3±0.9 vs 1±1.2 and 1.1±0.9 respectively). The GES (n=23) normalised in 70% of cases, with a significant improvement of the mean half emptying time and retention at 2 hours, and a discordance in 21% of the cases. In univariate analysis, diabetes and female gender were significantly associated with risk of failure, but not confirmed in multivariate analysis. The mid-term efficacy of G-POEM reaches 70% at 6 months. The procedure remains reproducible and safe. Diabetes and female gender were predictive of failure.

PD60-04 PREDICTIVE FACTORS OF SUCCESS IN ADULT PATIENTS TREATED FOR URETHRAL STRICTURE AFTER PRIMARY HYPOSPADIAS REPAIR FAILURE: A MULTIVARIABLE ANALYSIS OF A SINGLE-SURGEON SERIES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) IV1 Apr 2017PD60-04 PREDICTIVE FACTORS OF SUCCESS IN ADULT PATIENTS TREATED FOR URETHRAL STRICTURE AFTER PRIMARY HYPOSPADIAS REPAIR FAILURE: A MULTIVARIABLE ANALYSIS OF A SINGLE-SURGEON SERIES Guido Barbagli, Nicola Fossati, Alessandro Larcher, Francesco Montorsi, Salvatore Sansalone, Denis Butnaru, and Massimo Lazzeri Guido BarbagliGuido Barbagli More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Salvatore SansaloneSalvatore Sansalone More articles by this author , Denis ButnaruDenis Butnaru More articles by this author , and Massimo LazzeriMassimo Lazzeri More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2750AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The repair of urethral strictures after hypospadias repair still represent a challenging problem. Although the number of surgeries for the correction of primary hypospadias may represent a risk factor for surgical failure, no evidence for this currently exists in the current literature. Therefore, we investigated the predictive factors of success in adult patients treated for urethral stricture after primary hypospadias repair failure. METHODS The study was an observational, retrospective, descriptive study of adults with urethral strictures following hypospadias surgery. We included only patients with complete clinical data regarding the type of primary hypospadias, the number of operations needed for repair and the surgeon who performed the repair. The primary outcome of the study was treatment failure, defined as the need for any post-operative instrumentation. Secondary outcomes consisted of the relationships between the site of hypospadias, the site of the stricture and patient demotivation, defined as patient refusal of further treatments. Statistical analyses were performed using Stata (StataCorp LP, College Station, TX, USA) version 12.0. Tests were two-sided with a significance level set at p<0.05. RESULTS Overall, 408 patients were included in the study. The most frequent type of primary hypospadias was penile (56%), whereas the most frequent site of secondary stricture was penile (49%). A concordance between the site of primary hypospadias and the site of the secondary stricture was observed. A Kaplan Meier analysis revealed that two-stage techniques were significantly associated with lower treatment failure-free survival compared to one-stage techniques (p=0.001). At multivariable analysis, the number of previous operations needed for initial hypospadias repair was not associated with the risk of treatment failure (hazard ratio 0.95; 95% Confidence Interval: 0.88 - 1.03; p=0.2). Conversely, length of stenosis, with a cut-off of 3 cm (HR 1.42; CI 1.09 - 1.74; p=0.003), and presence of lichen sclerosus (HR 1.92; CI 1.01 - 3.65; p=0.047) were associated with an increased risk of treatment failure. Age (HR 1.03; CI 1.01 - 1.05; p=0.003), diabetes (HR 6.68; CI 1.38 - 32.3; p=0.018), penile hypospadias (HR HR 0.40; CI 0.24 - 0.68; p<0.001) and presence of lichen sclerosus (HR 2.51; CI 1.24 - 5.09; p=0.011) were associated with increased risk of patient demotivation for further surgeries. CONCLUSIONS Stricture length, but not the number of previous operations needed for primary hypospadias repair, was associated with the risk of failure. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1184 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Guido Barbagli More articles by this author Nicola Fossati More articles by this author Alessandro Larcher More articles by this author Francesco Montorsi More articles by this author Salvatore Sansalone More articles by this author Denis Butnaru More articles by this author Massimo Lazzeri More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Bilateral Posterior Tibial Nerve Stimulation in the Treatment of Rectal Evacuation Disorder: A Preliminary Report.

Posterior tibial nerve stimulation influences both motor and sensory pathways, as well as the central nervous system. Stimulation of posterior tibial nerve roots (L4 to S3) could improve stool evacuation through S3 and/or S2 stimulation. This study aimed to assess the efficiency of bilateral posterior tibial nerve stimulation in the treatment of rectal evacuation disorder without anatomic obstruction. This was a prospective case series studying the treatment of patients with obstructed defecation by posterior tibial nerve stimulation. The study was conducted at a tertiary referral academic medical center. Patients with rectal evacuation disorder without anatomic obstruction who were failing maximal conservative treatments were included. Thirty minutes of bilateral transcutaneous posterior tibial nerve stimulation was applied 3 times weekly for each patient for 6 consecutive weeks. The primary end point was the change in the modified obstructed defecation score. Secondary end points were changes in rectal sensitivity volumes (urge to defecate volume and maximal tolerable volume) and quality of life using the Patient Assessment of Constipation-Quality of Life questionnaire. Thirty-six patients (25 women) completed the trial. The mean age of patients was 57.2 years (SD = 14.4 y). No adverse events were reported. Symptomatic successful outcome was reported in 17 patients (47%) and modified obstructed defecation score decreased over 6 weeks (mean decrease = 10 points (95% CI, 8.7-11.3 points); p < 0.0001). Patients with successful outcome (responders) had relatively lower preoperative modified obstructed defecation score compared with patients with unsuccessful outcome (nonresponders). In the successful group, there were significant improvement after 6 weeks in both Patient Assessment of Constipation-Quality of Life score (mean improvement = 43.0 points (95% CI, 35.2-50.7 points); p < 0.0001) and rectal sensitivity (significant reductions in urge to defecate volume (from 258.1 ± 21.2 to 239.6 ± 15.3; p < 0.0001) and maximal tolerable volume (from 304.5 ± 24.8 to 286.8 ± 19.7; p < 0.0001)). No significant change in Patient Assessment of Constipation-Quality of Life or rectal sensitivity was observed in the nonresponders. The study was designed just to proof the concept, but small sample size is a limitation. Another limitation is the short duration of study of only 6 weeks. Current data showed that bilateral transcutaneous posterior tibial nerve stimulation can improve symptoms in a considerable percentage of patients with obstructed defecation without anatomic obstruction. The procedure is more effective in patients with a less-modified obstructed defecation score. Additional studies are needed to discover the predictive factors for success.

Predicting factors for success of vaginal delivery in preterm induction with prostaglandin E2.

ObjectiveTo evaluate the efficacy and safety of prostaglandin (PG) E2 for preterm labor induction and to investigate the predictive factors for the success of vaginal delivery.MethodsA retrospective cohort study was performed in women (n=155) at 24+0 to 36+6 weeks of gestation who underwent induction of labor using a PGE2 vaginal pessary (10 mg, Propess) from January 2009 to December 2015. Success rates of vaginal delivery according to gestational age at induction and incidence of intrapartum complications such as tachysystole and nonreassuring fetal heart rate were investigated. Multivariable logistic regression analysis was performed to evaluate the predictive factors for success of labor induction.ResultsThe vaginal delivery rate was 57% (n=89) and the rate of cesarean delivery after induction was 43% (n=66). According to gestational age, labor induction was successful in 16.7%, 50.0%, and 62.8% of patients at 24 to 31, 32 to 33, and 34 to 36 weeks, showing a stepwise increase (P=0.006). There were 18 cases (11%) of fetal distress, 9 cases (5.8%) of tachysystole, and 6 cases (3.8%) of massive postpartum bleeding (>1,000 mL). After adjusting for confounding factors, multiparity (odds ratio [OR], 8.47; 95% confidence interval [CI], 3.10 to 23.14), younger maternal age (OR, 0.84; 95% CI, 0.75 to 0.94), advanced gestational age at induction (OR, 1.06; 95% CI, 1.02 to 1.09), rupture of membranes (OR, 11.83; 95% CI, 3.55 to 39.40), and the Bishop score change after removal of PGE2 (OR, 2.19; 95% CI, 1.0 to 4.8) were significant predictors of successful preterm vaginal delivery.ConclusionAn understanding of the principal predictive factors of successful preterm labor induction, as well as the safety of PGE2, will provide useful information when clinicians consult with preterm pregnant women requiring premature delivery.

Botulinum toxin injection in the patients with Duane syndrome type 1

PurposeTo evaluate the efficacy of botulinum toxin injection in the patients with type 1 Duane syndrome and identify the predictive factors for success. MethodsSixteen patients with esotropic type 1 Duane syndrome without history of ocular surgery were selected for this interventional case series. The botulinum toxin was injected in the medial rectus of all patients. Visual acuity, dry refraction, cyclo-refraction, ocular motility, and amount of deviation were measured. Complete success, partial success, and failure were defined as residual deviation/face turn less than 8 prism diopters (PD)/5°, 8-20 PD/5-15°, and equal or greater than 20 PD/15°, respectively. ResultsSixteen cases (6 males) were included in our study. The mean esotropia was 26.27 ± 8.35 (12-40 PD) which was reduced significantly to 13.5 ± 12.39 PD during 6 months follow-up (p < 0.001). Face turn was improved significantly from a preoperative mean of 18.27° to: 0.094° at 1 week, 0.11° at 1 month, 3.31° at 3 months, and 7° at 6 months (p < 0.001). Complete success was seen in 6 patients (37.5%), partial success in 4 patients (25%), and failure in 6 patients (37.5%). There was a significant relation between the amount of forced duction testing (FDT) and the success rate (p: 0.019). No complication was seen during injections. ConclusionsBotulinum toxin could be an alternative treatment in Duane syndrome with appropriate case selection. FDT could be a predictive factor for response to botulinum toxin.

Weight reduction and improvement in diabetes by the duodenal-jejunal bypass liner: a 198 patient cohort study.

The duodenal-jejunal bypass liner (DJBL) is an endoscopic treatment for patients with type 2 diabetes mellitus (T2DM) and (morbid) obesity. The aim of the current study was to determine its efficacy and safety profile. Inclusion criteria for treatment with a DJBL were: age 18-70years, BMI 28-45kg/m2, and T2DM with a HbA1c>48mmol/mol. Primary outcomes were changes in HbA1c and body weight. Secondary outcomes included changes in blood pressure, lipids, and anti-diabetic medication. Predictive factors for success of treatment with the DJBL were determined. Between 2011 and 2014, 185 out of 198 patients successfully underwent a DJBL implantation procedure, with an intended implantation time of 12months. In these 185 patients, body weight decreased by 12.8±8.0kg (total body weight loss of 11.9±6.9%, p<0.001), HbA1c decreased from 67 to 61mmol/mol (p<0.001) despite a reduction in anti-diabetic medication, and blood pressure and serum lipid levels all decreased. In total, 57 (31%) DJBLs were explanted early after a median duration of 33weeks. Adverse events occurred in 17% of patients. C-peptide ≥1.0nmol/L and body weight ≥107kg at screening were independent predictive factors for success. Treatment with the DJBL in T2DM patients with (morbid) obesity results in improvement in glucose control, a reduction in anti-diabetic medication, and significant weight loss. The largest changes are observed within the first 3-6months. Initial C-peptide levels and body weight may help to select patients with the greatest chance of success.

Results of long-term retrograde rectal cleansing in patients with constipation or fecal incontinence.

The aim of the present study was to determine the success rate, quality of life and predictive factors of success associated with long-term rectal cleansing (RC) for defecatory disorders. All patients who started RC between January 2010 and August 2014 in our referral hospital were sent questionnaires concerning actual RC, Short Form 36 Health Survey (SF-36), Fecal Incontinence Quality of Life (FI-QoL) and the Beck Depression Inventory (BDI). In addition, they were contacted in May and December 2015 for further follow-up information. Eighty-six patients were offered RC, and 60 patients (45 women, 15 men) started RC. Thirty-three (55%) patients stopped RC after a median time of 6months. Twenty-seven (45%) continued for a median time of 12months. Forty-three (72%) patients responded to the questionnaires. SF-36 showed that patients still using RC had more energy and were less fatigued than patients who discontinued therapy. No significant difference was found between patients who stopped and continued RC concerning age, gender, defecation disturbance, underlying disorders, anorectal function, colon-transit time, FI-QoL or BDI-score. Twenty-three patients (38%) were still performing RC after 21months, 22 patients (37%) after 28months and 1 patient was lost to follow-up. RC is a moderately effective long-term alternative in patients who do not respond to medical therapy and biofeedback exercises. There is a high dropout rate in the firstmonths, but a moderate rate of continuation in the period hereafter. No predictive factors for continuation were found in medical history or function tests. Those who continued RC performed better on the SF-36 subscale energy/fatigue.

Fluoroscopic removal of retrievable self-expandable metal stents in patients with malignant oesophageal strictures: Experience with a non-endoscopic removal system

To evaluate clinical outcomes of fluoroscopic removal of retrievable self-expandable metal stents (SEMSs) for malignant oesophageal strictures, to compare clinical outcomes of three different removal techniques, and to identify predictive factors of successful removal by the standard technique (primary technical success). A total of 137 stents were removed from 128 patients with malignant oesophageal strictures. Primary overall technical success and removal-related complications were evaluated. Logistic regression models were constructed to identify predictive factors of primary technical success. Primary technical success rate was 78.8 % (108/137). Complications occurred in six (4.4 %) cases. Stent location in the upper oesophagus (P=0.004), stricture length over 8 cm (P=0.030), and proximal granulation tissue (P<0.001) were negative predictive factors of primary technical success. If granulation tissue was present at the proximal end, eversion technique was more frequently required (P=0.002). Fluoroscopic removal of retrievable SEMSs for malignant oesophageal strictures using three different removal techniques appeared to be safe and easy. The standard technique is safe and effective in the majority of patients. The presence of proximal granulation tissue, stent location in the upper oesophagus, and stricture length over 8 cm were negative predictive factors for primary technical success by standard extraction and may require a modified removal technique. • Fluoroscopic retrievable SEMS removal is safe and effective. • Standard removal technique by traction is effective in the majority of patients. • Three negative predictive factors of primary technical success were identified. • Caution should be exercised during the removal in those situations. • Eversion technique is effective in cases of proximal granulation tissue.

Anneaux intra-cornéens Ferrara implantés au laser femtoseconde dans le traitement du kératocône : résultats fonctionnels à 1 an

Intrastromal corneal rings (ICR) have been used for several years for the correction of irregular astigmatism in patients with keratoconus. To evaluate the effectiveness of femtosecond-assisted ICR implantation for treatment of keratoconus and to define predictive factors of success. We undertook a retrospective study of patients with keratoconus who underwent femtosecond-assisted Ferrara ICR implantation between December 2012 and May 2014 at the University Hospital of Besançon. To determinate predictive factors of success, we divided patients into 2 groups based on the gain of at least two lines of best corrected visual acuity (BCVA) at 1 year after surgery ("good responders") or the gain of only one line of BCVA, no change, or the loss of lines of BCVA ("poor responders"). For each group, we analyzed preoperative refractive and keratometric values. Moreover, to verify if preoperative visual acuity could be a predictive factor of success, four groups were created based on initial visual acuity, and postoperative BCVA was compared. We retrospectively studied 32 eyes of 29 patients with keratoconus who underwent femtosecond-assisted Ferrara ICR implantation between December 2012 and May 2014 at the University Hospital of Besançon. From one month to 1 year postoperatively, we observed a significant improvement in BCVA and a significant decrease in cylinder and keratometry values (P<0.05). In total, 90.6% of patients had an increase in visual acuity (VA) of at least one line within 1 year while 9.4% had a decrease or stability of their VA. The average cylinder value decreased from -4.81±2.45 diopters (D) preoperatively to -2.39±1.94 D (P<0.001) at 1 year postoperatively, and the average of the maximum keratometry from 51.14±3.89 D to 48.52±4.00 D (P<0.05). Four predictive factors of success were statistically significant: type of ectasia (type 1 or 2), stage of keratoconus (Krumeich 1 or 2), implantation of only 1 ICR and a preoperative VA less than 0.4 (decimal scale). Eighty-six percent of patients with an initial VA<0.4 (decimal scale) gained 2 lines of BCVA within 1 year and 80% 3 lines versus 52% and 41%, respectively for patients with initial VA≥0.4 (decimal scale). Femtosecond-assisted Ferrara ICR implantation for treatment of keratoconus is a reliable and reversible technique. Implantation results in greater efficiency for patients with moderately advanced asymmetric keratoconus with an initial VA<0.4 (decimal scale).

MP17-03 THE MAXIMUM DETRUSOR PRESSURE AS A PREDICTIVE FACTOR AFTER INCONTINENTATION PROCEDURES FOR SURGICAL MANAGEMENT OF DETRUSOR-SPHINCTER DYSSYNERGIA

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction1 Apr 2016MP17-03 THE MAXIMUM DETRUSOR PRESSURE AS A PREDICTIVE FACTOR AFTER INCONTINENTATION PROCEDURES FOR SURGICAL MANAGEMENT OF DETRUSOR-SPHINCTER DYSSYNERGIA Alexandre Hourié, François-Xavier Nouhaud, Maximilien Baron, John-David Rebibo, Jean-Nicolas Cornu, and Philippe Grise Alexandre HouriéAlexandre Hourié More articles by this author , François-Xavier NouhaudFrançois-Xavier Nouhaud More articles by this author , Maximilien BaronMaximilien Baron More articles by this author , John-David RebiboJohn-David Rebibo More articles by this author , Jean-Nicolas CornuJean-Nicolas Cornu More articles by this author , and Philippe GrisePhilippe Grise More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2671AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detrusor-sphincter dyssynergia (DSD) is the most common cause of functional bladder outlet obstruction in patients with neurogenic bladder. In patients who cannot use clean intermittent self-catheterization (CISC), incontinentation either by placement of sphincteric stent prosthesis or sphincterotomy has been described as an effective treatment. However, no clear predictive factor of success or failure has been clearly identified. Our goal was to evaluate the impact of the pre-operative maximum detrusor pressure (MDP) on efficacy outcomes after incontinentation procedures for DSD in male patients with neurogenic bladder. METHODS A retrospective study was performed in 41 male patients treated between 2006 and 2013 in a tertiary reference center. All patients had a neurogenic bladder with voiding dysfunction, and DSD confirmed by urodynamic studies (including filling cystometry, MDP measurement, and uroflowmetry). All patients were unable or secondary failed to practice CISC. Patients underwent sphincterotomy or placement of a sphincteric stent prosthesis, and were then followed every 6 months. Success was defined as a post-void residual volume < 150 ml. Influence of MDP on treatment efficacy was evaluated through a Mann-Whitney U-Test. All statistical analyses were done with XLStat for Windows. RESULTS Mean patient age was 39 years. Underlying neurological diseases causing DSD were spinal cord injury, multiple sclerosis, or congenital syndromes. Twenty- six patients had a sphincteric stent placement (Memocath™, Bard, Covington, USA) and 15 had endoscopic sphincterotomy. Treatment was successful in 31 patients (76%). Patients with successful outcomes had a significantly higher mean preoperative MDP (59.6 vs. 29.7 cmH2O; p=0.002). Patients with MDP over the threshold of 40 cmH2O had a 90 % success rate. These differences were maintained at 6 months, MDP being higher in the success group than in the failure group (59.5 vs. 39.8 cm H20 respectively, p=0.008). The technique used (stent placement or sphincterotomy) had no impact on immediate or 6-month success rates. CONCLUSIONS Our results suggested that MDP is associated with treatment success rate after surgical management of DSD of neurogenic origin by sphincteric stent placement or sphincterotomy. A threshold of 40cm H20 is associated with high positive predictive value. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e185 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Alexandre Hourié More articles by this author François-Xavier Nouhaud More articles by this author Maximilien Baron More articles by this author John-David Rebibo More articles by this author Jean-Nicolas Cornu More articles by this author Philippe Grise More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

HOLMIUM LASER: YAG LITHOTRIPSY IN URETERAL CALCULI MANAGEMENT

Objective: To know predictive factors for success of holmium laser: YAG lithotripsy in ureteral calculi management. Materials &amp; Methods: This prospective cohort study was conducted in January 2013 to May 2015 at Kardinah Tegal Hospital Central Java. Patients diagnosed with proximal and distal stones were included. Pediatric, obesity, pregnancy, ureteral anomaly, and ureteroscopy (URS) cannot reach ureteral level of stone were excluded. We used semirigid URS (Wolf) 6/7.5F, monitor video, and holmium laser: YAG litotriptor (Versa Pulse, Lumenis, Germany), with wavelength 2100 nm, output 1-60 watt, fiber length 365 μm, laser power 2.5-10 watt with energy 0.5-1 Joule/5-15 Hz. Results: Of 50 ureteral stone patients, consisted proximal 13 (26%) and distal 37 (74%) were included in this study. Mean age 42.94 ± 11.31 years, with 28 male (56%) and 22 female (44%). Mean stone burden was 88.10 ± 57.41 mm2. There were 6 (12%) patients with multiple stones. This procedure consumed energy 1079.02 ± 1624.00 joule and duration of operation was 19.02 ± 21.17 minutes. We inserted DJ stent after the procedure in 41 patients (82%). There were 2 failure (4%), which were stone migration to kidney and conversion to open surgery. There were significant differences of stone burden (p 0.013), duration of operation (p 0.038), and stone number (p 0.000) with stone free rate, but not in age, sex, stone location and energy. Stone free rate of this procedure was 90%. Conclusion: Stone burden, duration of operation, and stone number were predictive factors for success of holmium laser: YAG lithotripsy in ureteral calculi management.

Efficacy of the endoscopic management of postoperative fistulas of leakages after esophageal surgery for cancer: a retrospective series

Anastomotic leakages are severe and often lethal adverse events of surgery for esophageal cancer. The endoscopic treatment is growing up in such indications. The aim was to evaluate the efficacy and describe the strategy of the endoscopic management of anastomotic leakages/fistulas after esophageal oncologic surgery. Single-center retrospective study on 126 patients operated for esophageal carcinomas between 2010 and 2014. Thirty-five patients with postoperative fistulas/leakages (27%) were endoscopically managed and included. The primary endpoint was the efficacy of the endoscopic treatment. The secondary endpoints were: delays between surgery, diagnosis, endoscopy and recovery; number of procedures; material used; and adverse events rate. Uni- and multivariate analyses were carried out to determine predictive factors of success. There were mostly men, with a median age of 61.7years±8.9 [43-85]. 48.6% underwent Lewis-Santy surgery and 45.7% Akiyama's. 71.4% patients received neo-adjuvant chemo-radiation therapy. The primary and secondary efficacy was 48.6 and 68.6%, respectively. The delay between surgery and endoscopy was 8.5days [6.00-18.25]. Eighty-eight percentages of the patients were treated using double-type metallic stents, with removability and migration rates of 100 and 18%, respectively. In the other cases, we used over-the-scope clips, naso-cystic drain or combined approach. The mean number of endoscopy was 2.6±1.57 [1-10]. The mortality rate was 17%, none being related to procedures. No predictive factor of efficacy could be identified. The endoscopic management of leakages or fistulas after esophageal surgery reached an efficacy rate of 68.8%, mostly using stents, without significant adverse events. The mortality rate could be decreased from 40-100 to 17%.

Amateur cyclists can complete the full Tour de France in the same amount of days as professional cyclists

Introduction : Participating in the Tour de France (TdF), 3.497 kilometres in 21 days, is a challenge for professional as well as for amateur cyclists. The exceptional high demands both physically and mentally enhance the risk of falling sick or getting injured. The aim of this study was to investigate what factors can potentially predict whether an amateur cyclist can complete all kilometres of the official TdF (version 2012). Methods: Prospective single – centre cohort study from June 29th, 2012 till August 19th, 2012. 24 amateur cyclists (3 women) from 29 – 60 years old participating in the TdF 2012, starting and finishing one day before the professional cyclists, were included in this study. All participants completed a questionnaire on general training information. In the six months before the start of the TdF participants performed an cardiopulmonary exercise test (CPET). The participants were asked to register their level of perceived stress and exhaustion on a Borg scale every day. On day 1, 6, 13, 19 and 23 they were asked to fill out a Profile of Mood States (POMS) questionnaire. Apart from this they were asked to fill in a diary on food and fluid intake in three consecutive days. Data on injuries and sickness were registered by the participating training sports physician (TB). Participants were allowed to skip one or more days for any reason. In that case they were considered as ‘did not complete the full TdF’. Data analysis was performed using logistic regression analysis. Results : 23 amateur cyclists (average age of 48 years) were included in this study. One cyclist was excluded due to lack of motivation to complete the full TdF. These cyclists trained on an average 5.931 kilometres in six months before the start of the TdF. CPET before the TdF revealed an average VO2max of 39 mL/min/kg and an average maximal workload of 4,3 W/kg. 78% (n = 18) of the participants completed the full TdF. They completed 3.564 kilometres and 45.676 climbing meters in 141 hours with an average speed of 25,6 km/h. All participants who had completed the full TdF had a maximal workload of > 4,0 W/kg during CPET before TdF (p = 0.003). Other factors such as: age over 50 years old (p = 0.059) and > 6.000 training kilometres (p = 0.098) appeared not to be of predictive value. Five participants could not complete TdF due to patella-femoral pain syndrome (1), lower respiratory tract infections (3) and clavicular fracture (1). After finishing TdF 22% of participants could not work for a few days due to illness. Discussion : Lower respiratory tract infection was the most frequent reason to skip one or more days of the TdF. Due to extreme physical and living conditions it was easy for a virus to spread among the participants. Two rest days during the TdF was not enough for these cyclists to recover and regain enough strength to fully complete the TdF. The only significant difference between participants that completed the TdF versus participants who did not was their maximal workload during CPET. Other factors: age and kilometres of training before TdF were not of predictive value. However, it is known that maximal workload declines 6-10% after the age of 25 years in healthy men.1 Conclusion it is possible for amateur cyclists to fully ride the TdF in the same amount of days as professional cyclists. But bear in mind that due to the small study population it is difficult to extrapolate the predictive factor of success to another group of amateur cyclists facing a similar challenge.