Retrograde Leak Point Pressure Research Articles

Proper 6-branch suburethral autologous sling tensioning during robotic assisted radical prostatectomy with the intraopeartive use of retrograde perfusion sphincterometry: the technique.

The aim of this paper is to describe our surgical technique and results of proper 6-branch autologous sling tensioning during RALP employing intraoperatively the Retrograde Perfusion Sphincterometry (RPS). Between May 2016 and February 2020, 374 patients underwent RALP with the 6-branch suburethral autologous sling tensioned under intraoperative guidance of RPS. Surgical procedure: Retrograde Leak Point pressure (RLPP) was evaluated by means of RPS after pneumoperitoneum induction (RLPPp), after urethrovescical anastomosis (RLPPa) and during proper sling tensioning (RLPPs). The goal of the sling tensioning was to obtain at the end of the procedure similar pressures as after pneumoperitoneum induction (RLPPs ≅ RLPPp). Intraoperative variables, postoperative complications, and continence recovery outcomes were assessed. A descriptive statistical analysis was performed. Sling positioning and tensioning was feasible in all patients. Mean operative time was 215min. Proper sling tensioning allowed for the possibility to restore sphincteric efficacy to preoperative value (RLPPs vs. RLPPp (42.5 vs. 42.6) cmH2O). Urinary continence was achieved, respectively, in 58%, 67%, 74%, 88% and 92% of patients after 24h, 10days, 1month, 6months and 1year after catheter removal. In conclusion, RPS revealed a valid option for proper autologous 6-branch sling tensioning during RALP, offering the possibility to restore sphincteric apparatus efficiency to its preoperative status to improve EUC.

Is pre-operative urodynamic bladder function the true predictor of outcome of male sling for post prostatectomy incontinence?

PurposeTo investigate pre-operative urodynamic parameters in male sling patients to ascertain whether this might better predict surgical outcomes and facilitate patient selection.MethodsWe performed a retrospective, case notes and video-urodynamics, review of men who underwent AdVanceXP male sling in three London hospitals between 2012 and 2019. Urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was performed in one centre.ResultsSuccessful outcome was seen in 99/130 (76%) of men who required one pad or less per day. The dry rate was 51%. Pad usage was linked to worse surgical outcomes, mean 2.6 (range 1–6.5) for success vs 3.6 (range 1–10) although the ranges were wide (p = 0.002). 24 h pad weight also reached statistical significance (p = 0.05), with a mean of 181 g for success group versus 475 g for the non-successful group. The incidence of DO in the non-successful group was significantly higher than in successful group (55% versus 29%, p = 0.0009). Bladder capacity less than 250 ml was also associated with worse outcomes (p = 0.003). Reduced compliance was not correlated with outcomes (31% for success groups vs 45% for non-successful group, p = 0.15). Preoperative RLPP was performed in 60/130 patients but did not independently reach statistical significance (p = 0.25).ConclusionUrodynamic parameters related to bladder function—detrusor overactivity and reduced maximum cystometric capacity predict male sling outcomes and may help in patient selection for male sling (or sphincter) surgery; whereas urodynamic parameters of sphincter incompetency (RLPP) were not predictive. Further larger scale studies are required to confirm these findings.

PD37-12 URODYNAMIC PREDICTORS OF SURGICAL OUTCOMES FOLLOWING MALE SLING IMPLANTATION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy II (PD37)1 Apr 2020PD37-12 URODYNAMIC PREDICTORS OF SURGICAL OUTCOMES FOLLOWING MALE SLING IMPLANTATION Bogdan Toia*, Lap Yan Leung, Raveen Saigal, Eskinder Solomon, Sachin Malde, Claire Taylor, Arun Sahai, Rizwan Hamid, Tamsin Greenwell, Jai Seth, Davendra Sharma, and Jeremy Ockrim Bogdan Toia*Bogdan Toia* More articles by this author , Lap Yan LeungLap Yan Leung More articles by this author , Raveen SaigalRaveen Saigal More articles by this author , Eskinder SolomonEskinder Solomon More articles by this author , Sachin MaldeSachin Malde More articles by this author , Claire TaylorClaire Taylor More articles by this author , Arun SahaiArun Sahai More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , Jai SethJai Seth More articles by this author , Davendra SharmaDavendra Sharma More articles by this author , and Jeremy OckrimJeremy Ockrim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000908.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The surgical options for post prostatectomy incontinence are implantation of an artificial sphincter or male sling. Outcomes for artificial sphincters, and predictive values for good outcome have been documented. However, the criteria for patient selection and the likelihood of a good outcome for male slings are limited. Most authors have relied on pad number/weight as their primary parameter, despite poor correlation with success rates. It remains unclear whether pre-operative urodynamic parameters might better predict surgical outcomes and facilitate patient selection. METHODS: We performed a retrospective case notes and video-urodynamics review of men who underwent AdVanceXP male mid-urethral sling insertion in three London hospitals between 2012 and 2019. Collected data included demographics, postoperative continence and urodynamic parameters. Video-urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was only performed in one centre. Analysis was performed using chi-squared and independent t tests, with p<0.05 is considered significant. RESULTS: 114 men were identified. 89/114 (78%) patients were cured of their incontinence requiring 1 pad per day or less for reassurance (59/114 (52%) did not use any pads), whilst 25/114 (22%) patients remained significantly wet. Success by urodynamic parameters is shown in Figure 1. 43/114 (38%) had detrusor overactivity (DO) on preoperative urodynamics, with a mean pressure of 41cmH2O (range 15-78). The rate of DO demonstrated in the wet group was significantly higher than in dry group (60% vs 31%, p=0.009), but the peak DO pressure did not correlate with outcomes (p = 0.778). 31/114 (27%) had abnormal compliance, with higher incidence in the wet group (48% vs. 21%, p= 0.008). Having a bladder capacity less than 400ml was also associated with worse outcomes (p=0.001). Preoperative RLPP did not correlate with surgical outcomes (p=0.495), but was only was performed in 55 men (48%). CONCLUSIONS: Urodynamic parameters can be used to predict outcome for male sling. The predictors of significance are detrusor overactivity, reduced compliance and reduced bladder capacity (<400mls). Further study is required to accurately define urodynamic parameters that will differentiate outcomes and criteria for sling (and sphincter) selection. Source of Funding: No funding required © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e732-e733 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bogdan Toia* More articles by this author Lap Yan Leung More articles by this author Raveen Saigal More articles by this author Eskinder Solomon More articles by this author Sachin Malde More articles by this author Claire Taylor More articles by this author Arun Sahai More articles by this author Rizwan Hamid More articles by this author Tamsin Greenwell More articles by this author Jai Seth More articles by this author Davendra Sharma More articles by this author Jeremy Ockrim More articles by this author Expand All Advertisement PDF downloadLoading ...

Short-term evaluation of the adjustable bulbourethral male sling for post-prostatectomy urinary incontinence.

The Argus perineal sling is a minimally invasive surgical option to treat post-prostatectomy stress urinary incontinence (PPSUI). This study retrospectively evaluated the short-term clinical outcomes with the Argus sling for PPSUI management and determined the effects of potential preoperative parameters on intraoperative retrograde leak point pressure (RLPP). In this retrospective review of 16 men with various degrees of stress incontinence after prostatic surgery who underwent Argus sling, PPSUI was evaluated by pad usage, urodynamics, 24-hour pad weight, and validated questionnaires. Findings before and a minimum of 6 months after sling placement were compared. "Cure" was defined as no pad usage or the use of 1 pad for security; "improvement" was defined as a reduction in daily pad use by >50%. After a mean (±SD) follow-up of 9.75 ± 3.51 months, 62.5% of patients were cured, 18.75% were improved, and 18.75% were still incontinent. Preoperative 24-hour pad weight was positively correlated with RLPP (P = .0121, r = 0.6286). Mean RLPP was 37.93 ± 3.45 cmH2 O. During follow-up, 44% of men had transient perineal or scrotal pain managed conservatively. Sling explantation, reported in 3 of 16 patients, was associated with urethral erosion or previous radiation therapy. The Argus male sling can lead to satisfactory results in carefully selected patients. Increased stress urinary incontinence severity based on 24-hour pad weight required higher RLPP to achieve continence. Favorable satisfaction variables and quality of life scores are affected by appropriate intraoperative tensioning pressure.

V30 - Intraoperative evaluation of retrograde leak point pressure (RLPP) during robotic assisted radical prostatectomy (RALP) for proper autologous sling tensioning to improve early urinary continence (EUC): The technique

V30 - Intraoperative evaluation of retrograde leak point pressure (RLPP) during robotic assisted radical prostatectomy (RALP) for proper autologous sling tensioning to improve early urinary continence (EUC): The technique

Virtue Quadratic Male Sling for stress incontinence-surgical guide for placement and delayed revision.

The algorithm for surgical management of post prostatectomy incontinence classically includes male slings and artificial urinary sphincter (AUS) placement. The Virtue Quadratic Male Sling was designed to provide both urethral elevation and prepubic compression making it a viable option for a wider spectrum of incontinent men whose symptoms range from mild to severe. With a focus on two key steps of the surgery, (I) sling fixation (II) use of intraoperative retrograde leak point pressure (RLPP), this guide is intended to outline a safe and efficacious treatment for post-prostatectomy incontinence. Intriguingly, the sling can be revised in the event of refractory or worsening leakage, and does not preclude the placement of an AUS should it be needed. This paper describes a step by step approach to performing the procedure as well as expert tips to improve outcomes and avoid/manage complications that have been learned over the years.

Intraoperative Retrograde Perfusion Sphincterometry to Evaluate Efficacy of Autologous Vas Deferens 6-Branch Suburethral Sling to Properly Restore Sphincteric Apparatus During Robot-Assisted Radical Prostatectomy.

The aim of this study is to describe (urodynamically) the effect of the use of a 6-branch autologous suburethral sling, made with absorbable sutures and vas deferens, to support the bladder neck and urethra during robot-assisted laparoscopic prostatectomy (RALP) to improve early urinary continence (EUC) recovery. Retrograde leak point pressure (RLPP) was intraoperatively evaluated, by means of retrograde perfusion sphincterometry (RPS), in 77 patients (mean age ± standard deviation [SD]: 65.64 ± 7.23 years, mean body mass index ± SD: 26.69 ± 3.89) scheduled to undergo RALP at our institution. RLPP was evaluated before (RLPPb) and after pneumoperitoneum induction (RLPPp). RLPP was then evaluated after urethrovesical anastomosis (RLPPa) and after proper sling tensioning (RLPPs), with the aim to obtain the same pressure as after pneumoperitoneum induction. EUC recovery, defined as the use of no pad, was assessed 10 days, 30 days, and 6 months after catheter removal. RPS and proper autologous 6-branch sling positioning were feasible in all patients, without perioperative complications and negligible impact on overall operative time. Pneumoperitoneum induction increased, similarly, RLPP in all patients. An important decrease of sphincteric capability was evident after prostate removal and the following urethrovesical anastomosis, while proper sling tensioning allowed for restoration of sphincteric apparatus capability to its presurgical status (mean RLPPs 40.84 cmH2O vs RLPPp 40.39 cmH2O, p = 0.942). EUC recovery within 10 days after catheter removal was achieved in 59 (77%) patients and progressively improved over time. RPS, intraoperatively performed during RALP, allows for precise evaluation of the impact of the surgical procedure on sphincteric apparatus competence. Moreover, the use of the 6-branch suburethral sling, in association with RPS, allows for restoration of the proper supporting system to the urethral sphincter, similar to the preoperative condition, offering the basis for EUC recovery after radical prostate surgery.

Retrograde leak point pressure measurement improves outcomes of the Virtue male sling for postprostatectomy incontinence.

We aimed to compare the efficacy of two different sling tensioning approaches, and to report our experience, including safety and impact on quality of life (QoL) of the Virtue® male sling for the treatment of postprostatectomy incontinence (PPI). From our prospectively maintained database, we retrospectively identified all men treated with the Virtue male sling for PPI between March 2009 and February 2014 by two urologists in two institutions. Baseline demographic data and the sling tensioning method were abstracted from the database. Likewise, the Patient Global Impression of Improvement (PGI-I) scale, severity of incontinence, and clinical outcomes were also abstracted. 48 patients were treated with the Virtue quadratic male sling. Sling tensioning was done using cystoscopy in the first 18 patients (Group 1), while per-operative retrograde leak point pressure (RLPP) measurement was done in the last 30 patients (Group 2). The median (interquartile range [IQR]) followup from the day of surgery was 22 (15-41) months. At the last followup visit, 7 (39%) patients in Group 1 were cured or improved of their PPI, compared to 21 (70%) patients in Group 2 (p=0.03). The final median (IQR) RLPP in these patients was 41 (37-48) cm H2O. Transient pain was the most common adverse event, occurring in 23 (48%) of patients. Twenty-one (70%) patients in Group 2 were "much better" or "very much better" with their device, compared to 7 (39%) in Group 1 (p=0.0008). The Virtue male sling is a valuable treatment option for PPI. Per-operative RLPP measurement significantly improves cure and satisfaction rates.

The correlation between retrograde leak point pressure and 24-hour pad weight.

To assess the correlation between retrograde leak point pressure (RLPP) and 24-hr pad weight (24PW) in men with post-prostatectomy incontinence. We performed RLPP and 24PW measurements on 61 patients with a history of post-prostatectomy stress urinary incontinence (SUI). We examined the relationship of RLPP and 24PW. We also reviewed the urodynamic and clinical data of these patients to explain our findings. The mean age was 70 years (SD ± 7.4, range: 51-87). The mean RLPP was 36.8 cmH2 O (SD ± 15.3, range: 9-76), the mean 24PW was 499 g (±677 g, range: 16.5-3,177 g). There was a good and significant negative correlation between RLPP and 24PW (r = 0.56, P < 0.01). RLPP was able to differentiate between cases of mild/moderate (<400 g) and severe (≥400 g) incontinence. Patients with RLPP <30 cmH2 O had significantly higher 24PW (mean 825 g, median 768 g) when compared with patients with RLPP >30 cmH2 O (mean 257.8 g, median 100 g, P < 0.01). RLPP could be used as an objective and potentially more reliable substitute to pad weight to objectify and stratify SUI in post-prostatectomy patients. Neurourol. Urodynam. 36:1119-1123, 2017. © 2016 Wiley Periodicals, Inc.

PD01-02 THE CORRELATION BETWEEN RETROGRADE LEAK POINT PRESSURE AND 24-HOUR PAD WEIGHT FOR MEN WITH POST PROSTATECTOMY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2016PD01-02 THE CORRELATION BETWEEN RETROGRADE LEAK POINT PRESSURE AND 24-HOUR PAD WEIGHT FOR MEN WITH POST PROSTATECTOMY INCONTINENCE Eskinder Solomon, Sachin Malde, Mahreen Pakzad, Rizwan Hamid, Julian Shah, Tamsin Greenwell, and Jeremy Ockrim Eskinder SolomonEskinder Solomon More articles by this author , Sachin MaldeSachin Malde More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , Julian ShahJulian Shah More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , and Jeremy OckrimJeremy Ockrim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2022AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the correlation between retrograde leak point pressure (RLPP) and 24-hour pad weight (24PW) in men with post prostatectomy incontinence METHODS We performed RLPP and 24PW measurements on 61 patients with post-prostatectomy stress urinary incontinence (SUI). We examined the relationship of RLPP and 24PW. We also reviewed the urodynamic and clinical data of these patients to explain our findings. RESULTS The mean age was 69.5 years (SD + 7.4, range: 51-87). The mean RLPP was 36.8 cmH2O (SD +/- 15.3, range: 9-76), the mean 24h pad-weight was 499g (+ 677g, range: 16.5g-3177g). There was a strong and significant negative correlation between RLPP and 24h pad-weight (r=0.56, p<0.0001). RLPP was a strong predictor of cases of mild/moderate (<400g) and severe (>400g) incontinence (Figure 1). Patients with RLPP = 30 had significantly higher 24h pad weight (mean 825g, median 768g) when compared with patients with RLPP > 30 (mean 257.8g, median 100g), p < 0.0001. Figure 1: Boxplot showing that patients with severe incontinence had statistically significantly lower RLPP than patient with mild or moderate incontinence CONCLUSIONS There is a good correlation between RLPP and 24PW. RLPP can distinguish between mild/moderate and severe levels of incontinence. RLPP could be used as an objective and more reliable substitute to pad weight to objectify and stratify SUI in post-prostatectomy patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e45-e46 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Eskinder Solomon More articles by this author Sachin Malde More articles by this author Mahreen Pakzad More articles by this author Rizwan Hamid More articles by this author Julian Shah More articles by this author Tamsin Greenwell More articles by this author Jeremy Ockrim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

66 The correlation between retrograde leak point pressure and 24-hour pad weight for men with post prostatectomy incontinence

66 The correlation between retrograde leak point pressure and 24-hour pad weight for men with post prostatectomy incontinence

Does Use of a Second Cuff Improve Artificial Urinary Sphincter Effectiveness? Evaluation Using a Comparative Cadaver Model

The artificial urinary sphincter is the gold standard long-term solution for male stress incontinence. Some urologists believe that including a second urethral cuff at the time of placement can improve efficacy but strong evidence is lacking. We compared the functionality of a single vs a tandem cuff in a cadaver model. Artificial urinary sphincter reservoir pressure was confirmed at 61 to 70 cm H2O. The bulbar urethra was dissected through a perineal approach in each of 4 cadavers. Distal and proximal bulbar urethral circumference was measured. The membranous urethra was transected. Cuffs sized based on circumference measurements were placed distal and proximal, and connected to the reservoir and pump. Retrograde leak point pressure was measured sequentially across the distal, proximal and tandem cuffs. We used the Friedman test to compare retrograde leak point pressure among the 3 cuff positions, the paired t-test to compare distal and proximal urethral circumferences and the Spearman correlation to compare urethral circumference to retrograde leak point pressure. Mean retrograde leak point pressure across the distal, proximal and tandem cuffs was 73.5, 77.75 and 79.25 cm H2O, respectively (p=0.44). Mean urethral circumference of the distal and proximal bulbar urethra was 4.78 and 5.83 cm, respectively (p=0.019). There was a strong positive correlation between urethral circumference and retrograde leak point pressure (rs=0.5). The tandem cuff did not improve retrograde leak point pressure. Proximal bulbar urethral circumference was greater than distal circumference and increasing urethral circumference correlated with increasing retrograde leak point pressure. Therefore, the perceived benefit of tandem cuffs may reflect more proximal placement of one of the cuffs.

MP88-18 DOES USE OF A SECOND CUFF IMPROVE ARTIFICIAL SPHINCTER EFFECTIVENESS? EVALUATION USING A COMPARATIVE CADAVER MODEL

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-18 DOES USE OF A SECOND CUFF IMPROVE ARTIFICIAL SPHINCTER EFFECTIVENESS? EVALUATION USING A COMPARATIVE CADAVER MODEL Madeleine Manka and E. James Wright Madeleine MankaMadeleine Manka More articles by this author and E. James WrightE. James Wright More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1851AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The artificial urinary sphincter (AUS) has long been recognized as the most effective long-term solution for men with severe stress incontinence. It is widely believed that inserting a second (tandem) urethral cuff can improve device efficacy, but this supposition is backed by little empirical evidence. In this study, we directly compare the functionality of a single versus tandem cuff in a cadaver model. METHODS The AUS reservoir pressure was confirmed to be between 61-70 cm H2O via burette test. The bulbar urethra was dissected using a perineal approach in each cadaver (n=4). The resting urethral circumference of the distal and proximal bulbar urethra was measured. The membranous urethra was transected. Appropriately sized occlusive cuffs were placed in the distal and proximal positions and connected to the pressure reservoir and control pump. Retrograde leak point pressure (RLPP) was measured sequentially across the distally placed single cuff, the proximally placed single cuff, and two tandem cuffs by inserting a catheter in the occluded urethra and raising an attached bag of fluid until leakage was seen across the transected urethra. The height between the fluid and cuff was recorded (cm H2O). A Friedman test was used to compare RLPP between the three cuff configurations, a paired t test to compare distal and proximal urethral circumference, and a Pearson correlation to compare urethral circumference to RLPP. RESULTS Mean RLPP across the distal, proximal and tandem cuffs was 70.25, 77.75, and 76.75 cm H2O respectively (p=0.14). Mean urethral circumference of the distal and proximal bulbar urethra was 4.78 and 5.83 cm respectively (p =0.019). There was a strong positive correlation between urethral circumference and RLPP (r = 0.75). CONCLUSIONS The tandem cuff does not appear to improve leak point pressure. In addition, the proximal bulbar urethral circumference (below the crus) was found to be significantly greater than the distal urethral circumference. Increasing urethral circumference was strongly correlated with an increase in the pressure needed to overcome cuff occlusion (RLPP). Therefore, it would appear that the perceived benefit of a second urethral cuff reflects function of the more proximal cuff alone. In our model, a tandem cuff did not increase effectiveness of the AUS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1098-e1099 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Madeleine Manka More articles by this author E. James Wright More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Retrograde leak point pressure correlates with 24 h pad weight for assessing post prostatectomy incontinence

Retrograde leak point pressure correlates with 24 h pad weight for assessing post prostatectomy incontinence

V8-12 MEASURING THE RETROGRADE LEAK POINT PRESSURE IMPROVES OUTCOMES OF THE VIRTUE MALE SLING

You have accessJournal of UrologyMale Voiding/Infection/Infertility/Testis1 Apr 2014V8-12 MEASURING THE RETROGRADE LEAK POINT PRESSURE IMPROVES OUTCOMES OF THE VIRTUE MALE SLING Michael Sourial and Le-Mai Tu Michael SourialMichael Sourial More articles by this author and Le-Mai TuLe-Mai Tu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2159AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Male slings were introduced in the 1990s and have been shown to be safe and effective alternatives to the artificial urinary sphincter. We report our experience with the Virtue Male Sling. Objectives of the study are to evaluate the efficacy and complication rate of the Virtue Male Sling for the treatment of post-prostatectomy incontinence (PPI) with and without per-operative retrograde leak point pressure (RLPP) measurement, and to evaluate the subjective satisfaction rate from patients regarding quality of life after treatment. METHODS Retrospective evaluation of continence rate and complications in 42 men consecutively treated with the Virtue Male Sling for PPI between March 2009 and October 2013. Adequate sling tensioning was verified with cystoscopy in the first 18 patients, while per-operative measurement of RLPP was carried out in the last 24 patients. Follow-up schedule was at 2, 6, and 12 months, then yearly. Patient Global Impression of Improvement (PGI-I) scale was used to measure subjective satisfaction at the last follow-up visit. RESULTS Mean (range) follow-up was 15.3 (0.5 - 45) months. Mean (range) age was 67 (53 - 83) years. 12 (28%) patients had mild, 20 (48%) patients had moderate, and 10 (24%) patients had severe PPI. Of the first 18 patients who did not have RLPP measured during the surgery, 11 (61%), 3 (17%), and 4 (22%) patients had no improvement (<50% pad reduction), improvement (0-1 pad per day or > 50% pad reduction), and cure (0 pad per day) of their PPI respectively, compared to 6 (25%), 4 (17%), and 14 (58%) of the last 24 patients who did have RLPP measured. Final mean (range) per-operative RLPP measurement was 43.6 (35 - 58) cm H2O. 11 (61%) of the 18 patients who did not, compared to 5 (20%) of 24 patients who did have RLPP measured had subsequent surgical treatments for unimproved PPI. Transient pain occurred in 7 (39%) of the 18 who did not, compared to 15 (62%) of the 24 patients who did have RLPP measured. In the group with RLPP measurement, 1 patient had a wound dehiscence which was debrided and primarily closed, and 3 patients had urinary retention, all of which resolved within 1 week. 6 (33%) of the 18 patients who did not, compared to 16 (67%) of the 24 patients who did have RLPP measured were ‘satisfied’ or ‘very satisfied’ with their device. CONCLUSIONS The Virtue Male Sling is a safe and valuable treatment option for mild and moderate PPI. Per-operative RLPP measurement significantly improves cure and satisfaction rates. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e788 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Michael Sourial More articles by this author Le-Mai Tu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Chronic sacral nerve stimulation as a novel treatment for stress urinary incontinence-A rat model

We propose an animal model to evaluate the effect of chronic sacral nerve stimulation (SNS) on surgically induced intrinsic sphincter deficiency (ISD) secondary to transabdominal urethrolysis (U-Lys). Twenty-five 6-week old virgin female Sprague-Dawley rats were divided into four groups: control (CTRL), U-Lys only, SNS only, and both (U-Lys/SNS). Groups CTRL (N = 5) and U-Lys only (N = 5) were maintained in the animal research facility in standard fashion for 2 weeks. Groups SNS only (N = 5) and U-Lys/SNS (N = 10) underwent chronic SNS for 6 continuous hours daily for 2 weeks. Retrograde leak point pressure (RLPP) was measured at baseline and at 2 weeks following observation or treatment. Five consecutive RLPP measurements were averaged per measurement cycle. SAS 9.3 was used to evaluate means and standard deviation. Baseline mean RLPP was 65 mmHg. The U-Lys only group mean RLPP at initial urethrolysis (58 mmHg) decreased (31 mmHg, P < 0.0001) after 2 weeks of observation. In the SNS only group, mean RLPP significantly increased from baseline (73 mmHg) after 2 weeks of chronic SNS stimulation (80 mmHg, P < 0.01). In rats that underwent both U-Lys and SNS stimulation mean RLPP was initially low (46 mmHg) after U-Lys and then significantly increased after 2 weeks of SNS (65 mmHg, P < 0.0001). Chronic SNS mediates an improvement in urethral sphincteric function at stimulation parameters similar to those used in humans for treating voiding dysfunction. SNS increased urethral resistance in rats with and without surgically induced ISD.

Monitoring of Erectile and Urethral Sphincter Dysfunctions in a Rat Model Mimicking Radical Prostatectomy Damage

Animal models of urinary incontinence and erectile dysfunction following radical prostatectomy (RP) are lacking. To develop an animal model of combined post-RP urethral sphincter and erectile dysfunctions, and noninvasive methods to assess erectile function (EF) and urinary sphincter function (USF) during prolonged follow-up. In the main experiments, 60 male Sprague Dawley rats were randomized to a sham operation (N = 30) or electrocautery of both sides of the striated urethral sphincter (N = 30). EF and USF were evaluated preoperatively and on postoperative days 7, 15, 30, 60, and 90. Sphincter and penile tissue samples were evaluated histologically on days 7 (N = 10) and 30 (N = 10) to detect apoptosis (TUNEL assays) and fibrosis (Trichrome Masson staining). To assess EF, we measured systemic and penile blood flow using penile laser Doppler and penile rigidity using a durometer before and after apomorphine injection. USF was assessed based on the retrograde leak point pressure (LPPr). Apomorphine increased baseline Doppler flow by 180% (95% confidence interval, 156-202%) and penile hardness from 3.49 ± 0.5 to 7.16 ± 0.82 Shore A units but did not change systemic arterial flow. Mean LPPr was 76.8 ± 6.18 mm Hg at baseline and decreased by 50% after injury, with no response to apomorphine on day 7. EF and USF impairments persisted up to 90 days post injury. Histology showed penile apoptosis on day 7 and extensive urethral sphincter and penile fibrosis on day 30. Our data did not allow us to determine whether the impairment in erectile response to apomorphine preponderantly reflected arterial penile insufficiency or veno-occlusive dysfunction. Electrocautery of the striated urethral sphincter caused severe and lasting impairment of EF and USF that could be monitored repeatedly using minimally invasive methods. This new animal model may hold potential for developing new treatments designed to correct post-RP impairments.

Anatomical and Manometric Comparison of Perineal and Transscrotal Approaches to Artificial Urinary Sphincter Placement

We compared cuff sites and assessed anatomical and manometric differences between the transscrotal and perineal approaches to artificial urinary sphincter placement in fresh male cadavers. Artificial urinary sphincter implantation using perineal and transscrotal incisions was performed in 15 fresh male cadavers. The artificial urinary sphincter cuffs were placed as proximal as possible using each approach. After measuring urethral circumference at each cuff site, an appropriately sized cuff was placed at each location. The 61 to 70 cm H(2)O pressure reservoir and control pump were then connected to the cuffs. Retrograde leak point pressure was assessed sequentially across each cuff. The paired t test was used to compare urethral circumference and retrograde leak point pressure between the 2 approaches. Mean urethral circumference using the perineal and transscrotal approaches was 5.38 (range 3.2 to 7.5) and 3.81 cm (range 3 to 4.5), respectively (p <0.0001, 95% CI of difference 0.99-2.13). Mean retrograde leak point pressure using the perineal and transscrotal approaches was 90.1 and 64.9 cm H(2)O, respectively (p = 0.0002, 95% CI of difference 13.7-33.5). On visual inspection of cuff sites, the perineal approach was more proximal on the urethra than the transscrotal approach. While the transscrotal approach to artificial urinary sphincter placement has the advantage of technical ease, the anatomical and manometric findings of this cadaver study suggest that the perineal approach offers a more proximal cuff location, more robust urethral size and more effective urethral coaptation than the transscrotal approach.

519 CORRELATION OF RETROGRADE LEAK POINT PRESSURE WITH OBJECTIVE SEVERITY OF INCONTINENCE AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy I1 Apr 2012519 CORRELATION OF RETROGRADE LEAK POINT PRESSURE WITH OBJECTIVE SEVERITY OF INCONTINENCE AFTER RADICAL PROSTATECTOMY Ingrid Schauer, Erik Randall Huber, Michael Rutkowski, Peter Birner, and Wilhelm Alexander Hübner Ingrid SchauerIngrid Schauer Krems, Austria More articles by this author , Erik Randall HuberErik Randall Huber Korneuburg, Austria More articles by this author , Michael RutkowskiMichael Rutkowski Korneuburg, Austria More articles by this author , Peter BirnerPeter Birner Vienna, Austria More articles by this author , and Wilhelm Alexander HübnerWilhelm Alexander Hübner Korneuburg, Austria More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.591AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES As variable treatment options are required for different grades of post-prostatectomy stress urinary incontinence (SUI) an evaluation of patients before incontinence correction surgery is necessary. The objective of this study was to determine if the retrograde leak point pressure (RLPP) correlates with the severity of incontinence in patients after radical prostatectomy (RPE). METHODS 12 patients suffering from post-prostatectomy SUI, admitted for incontinence correction surgery, were evaluated by RLPP, 24h micturition protocol, pad count, 20-minute pad-test and 24h pad-weight. RLPP was measured by retrograde infusion of the urethra using a tip hole catheter, which was blocked in the navicular fossa. The relationship between the parameters was examined with Pearson correlation. RESULTS The patients' mean age was 68 years (SD +/− 6.5, range: 54-77), the mean RLPP was 34.3 cmH2O (SD +/− 10.4 cmH2O), the mean 20-minute pad-test was 23.8g (SD +/− 38.0g) and the mean 24h pad-weight was 275.3g (SD +/− 333.0g). No significant correlation could be found between 24h pad-weight and 20-minute pad-test or pad count (r=0.06, p=0.91 and r=0.31, p=0.51, respectively). There was a strong and significant negative correlation between RLPP and 24h pad-weight (r=-0.87, p=0.025). CONCLUSIONS Currently the 24h pad-weight constitutes the gold standard in evaluation of urinary incontinence. Nevertheless, it is time-consuming and depends on the compliance of the patient. Neither the 20-minute pad-test nor the pad count showed a significant correlation with 24h pad-weight; therefore seem to be of questionable value in evaluation of incontinence. In contrast the RLPP demonstrates a strong and significant negative correlation with 24h pad-weight, thus it could be used as a standardized and practicable parameter to objectify SUI in post-prostatectomy patients. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e213 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ingrid Schauer Krems, Austria More articles by this author Erik Randall Huber Korneuburg, Austria More articles by this author Michael Rutkowski Korneuburg, Austria More articles by this author Peter Birner Vienna, Austria More articles by this author Wilhelm Alexander Hübner Korneuburg, Austria More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

291 Male sling adjustment: Can the retrograde leak point pressure help to reduce postoperative urethral lesions?

291 Male sling adjustment: Can the retrograde leak point pressure help to reduce postoperative urethral lesions?