Transient Urinary Incontinence Research Articles

A novel technique for thulium laser enucleation of the prostate: anterior releasing with ThuLEP (ARTh technique)

Thulium laser enucleation of the prostate (ThuLEP) is a highly effective approach to the treatment of benign prostatic hyperplasia. We present here a description of the “ARTh Technique” and the benefits it offers in terms of improved visualization, short operation times, and easy recognition of the dissection plane, describing specifically the anterior release (AR) technique using ThuLEP(Th). Included in this retrospective study were 32 consecutive patients operated on between January 2022-November 2022. Parameters were measured before and after the procedure: the International Prostate Symptom Score(IPSS), maximum flow rate(Qmax), post-void residual urine(PVR) prostate-specific antigen(PSA), prostate volume, operation-time, morcellation-time, catheterization-time and presence of transient urinary incontinence, and compared. The median age of patients undergoing enucleation of the prostate using the ARTh technique was 64 years (range: 44–83). The median prostate volume of the patients was 83.5 ml(50–128 ml), preoperative-IPSS was 24.8(15–33), postoperative-IPSS was 7(5–11), preoperative-Qmax was 8.1 ml/Sects. (5–11.5 ml/sec), postoperative-Qmax was 26.9 ml/Sect. (20.8–34 ml/sec), preoperative-PVR was 145 ml(75–258 ml), postoperative-PVR was 36.2 ml(0–66 ml), total operation time was 51.4 min(28–82 min), enucleation time was 36.9 min(19–51 min) and morcellation time was 15.3 min(8–27 min). The ARTh technique is a safe procedure that allows the surgeon to easily recognize and adhere to the defined dissection plane, thus decreasing operation times, significantly reducing the rate of postoperative transient urinary incontinence (TUI).

Enhancing continence post holmium laser enucleation of the prostate: assessment of novel technique through randomized clinical trial.

Transient urinary incontinence (UI) is distressing event following holmium laser enucleation of the prostate (HoLEP). Novel technique namely, veil sparing HoLEP (VS-HoLEP), was proposed to improve early continence outcome. In this trial (NCT03494049), VS-HoLEP was compared to standard HoLEP (St-HoLEP). VS-HoLEP entails early apical separation with sparing of ventral apical mucosal veil proximal to the verumontanum. Eligible symptomatic BPH patients were randomly allocated to St-HoLEP (91) and VS-HoLEP (89). The primary outcome was UI as depicted by one-hour pad test at one month postoperatively. Other outcome measures include all perioperative parameters, complications, and urinary outcome measures at different follow-up points. Median preoperative prostate size was 138 (50:282) and 128 (50:228) mL in St-HoLEP and VS-HoLEP groups respectively. At one month the number of patients with positive one-hour pad test was 21 (23.1%) and 10 (11.4%) in St-HoLEP and VS-HoLEP groups respectively (P 0.047). The difference was significantly in favor of VS-HoLEP considering the number of patients reporting UI, the number of patients with positive one-hour pad test as well as the grade of UI reported at one and 4 months. The difference was not statistically significant at 12 months. The median time to patients' reported continence was 8 (1-52) and 1.5 (1-52) weeks in St-HoLEP and VS-HoLEP groups respectively (P≤0.005). The technique independently predicted positive one-hour pad test at one and four months respectively. At twelve months presence of DM (diabetes mellitus) and more percent PSA reduction independently predicted positive one-hour pad test. Veil sparing HoLEP enhances significantly early postoperative urine continence both subjectively and objectively. Optimization of the surgical technique could cut short the number of leaking patients and reduce the degree as well as the duration of transient postoperative urine leak.

Endoscopic callosotomy as a minimally invasive approach to treat paediatric refractory epilepsy: case series.

Endoscopic callosotomy has emerged as a promising and minimally invasive technique for the treatment of refractory epilepsy. This paper aims to review the clinical outcomes and advancements associated with endoscopic callosotomy as a therapeutic option. This study includes 14 Paediatric patients diagnosed and managed at Al-azhar university hospitals. Those 14 patients were studied over 2 years. All patients underwent a corpus callosotomy using the bimanual endoscopic technique. Endoscopic anterior corpus callosotomy was done in 13 patients while one case underwent endoscopic complete callosotomy. The most frequent complication was transient disconnection syndrome followed by transient Urinary incontinence and one case had minor CSF leak. As regard seizure freedom outcome (Engel's Outcome Scale): 4 cases (28.6%) became seizure free (Engle class I), 5 cases (35.7%) with Engle class II, 1 case (7.1%) with Engle class III and 4 cases (28.6%) classify as Engle class IV. As a minimally invasive technique with a favorable impact on cognitive function, less complications and a significant reduction in seizure frequency and severity in the majority of paediatric patients, endoscopic corpus callosotomy offeres substantial benefits in managing refractory epilepsy in paediatric.

Holmium Laser Enucleation of the Prostate for Advanced Prostate Cancer-Related Bladder Outlet Obstruction: Assessing Effectiveness and Unraveling Factors Impacting Postoperative Urinary Incontinence.

This study investigated the factors associated with transient urinary incontinence (TUI) after holmium laser enucleation of the prostate (HoLEP) as a palliative treatment in patients with severe bladder outlet obstruction (BOO) and advanced prostate cancer (PCA). Data of 28 patients with advanced PCA (≥cT3) who underwent palliative HoLEP between October 2018 and March 2021 were included in this retrospective study. After collection of the pre-, intra-, and postoperative (1, 3, and 12 months) data of patients from their medical records, variables of patients with and without TUI at 1 and 3-12 months postoperatively were statistically compared. Multivariate analysis was performed to investigate the factors associated with postoperative TUI. Compared to baseline, the mean total international prostate symptom score, quality of life score, maximum flow rate (Qmax), and postvoid residual (PVR) were significantly improved 1 month postoperatively, and this was maintained until 12 months postoperatively (p<0.001). Of the 28 patients, 14 (50.00%) and 6 (21.43%) presented with TUI at 1 and 3-12 months postoperatively, respectively. Patients with TUI at 1 month follow-up showed a significantly lower preoperative Qmax (p=0.027), larger preoperative PVR (p=0.004), and higher likelihood of bladder neck tumor invasion (p=0.046). Conversely, patients with TUI at 3-12 months postoperatively were significantly older (p=0.033) and had a longer enucleation time (p=0.033). Multivariate analysis demonstrated that the factors affecting TUI were preoperative Qmax (odds ratio [OR]=0.61; 95% confidence interval [CI]=0.39-0.93; p=0.016) and bladder invasion of the tumor (OR=26.72; 95% CI=1.83-390.42; p=0.022) after 1 month; however, none of the variables correlated significantly with TUI at 3-12 months. Palliative HoLEP is an effective management option in patients with advanced PCA-related BOO. Lower preoperative Qmax and bladder neck tumor invasion are the factors affecting TUI at 1 month postoperatively.

Outcome of transurethral resection of the prostate (TURP) using 5% dextrose water as irrigant.

TURP remains the gold standard for simple prostatectomy presently. Different fluids have been used for irrigation while performing monopolar TURP. The choice of irrigation fluid depends on a lot of factors. We sought to find out if the outcome of monopolar TURP using 5% dextrose water in our setting compares with findings in other studies using different fluids as irrigation fluid in monopolar TURP. This was a prospective study of 220 patients who had monopolar TURP using 5% dextrose water as irrigation fluid from 2015 to 2020. The study was completed by 220 patients. The mean age was 66.25 yrs. The mean weight of prostate was 53.2 g, and mean resected weight was 30.10 g using a mean irrigation volume of 45.35 liters, 5% dextrose water over a mean resection time of 66.08 mins. The mean changes in International Prostate Symptom Score/quality of life score (IPSS/QOLS) were statistically significant. Early complications recorded were postoperative hematuria with clot retention (1.4%), urinary tract infection (UTI) (13.2%), and secondary hemorrhage (10%). TURP syndrome was not recorded. Late complications seen within 2 years follow-up were transient urinary incontinence (6.4%), urethral stricture (4.1%), and bladder neck contracture (2.3%). There was no repeat TURP for residual adenoma within this period. TURP using 5% dextrose water has comparable outcomes to other irrigation fluids for monopolar TURP. It is a good alternative to any other irrigation fluid.

Long-term outcomes of bipolar transurethral enucleation and resection of the prostate on patients with benign prostatic obstruction: a 10-year follow-up.

We aimed to explore the long-term outcomes of bipolar transurethral enucleation and resection of the prostate (B-TUERP) in patients with benign prostatic hyperplasia (BPH). A total of 1195 patients with BPH who underwent B-TUERP from July 2006 to June 2010 were enrolled in this retrospective study. Preoperative data, particularly urodynamic study (UDS) parameters, were collected by questionnaire and examination. Postoperative follow-up was performed at 3, 6, 12, 36, 60 and 120 months, respectively. Demographic, perioperative and functional data were analysed. International Prostate Symptom Score, quality of life and overactive bladder syndrome score (OABSS) were used to assess the functional scores. Predictors of postoperative urgency incontinence were identified by univariate analysis. Long-term outcomes of functional score were significantly better than the preoperative values. All UDS variables, including maximum urinary flow rate, postvoid residual urine volume, compliance, maximum cystometric capacity (MCC), bladder outlet obstruction index, prostatic urethral pressure and detrusor pressure at maximum urinary flow rate, were all significantly improved. No one required reoperation due to recurrent BPH. The postoperative rate of transient urinary incontinence was 31.7%, while the long-term incontinence rate was 0%. Retrograde ejaculation occurred in 44.3% patients who remained sexually active after operation. Patients who had transient urge incontinence were older with preoperative higher OABSS, prostate-specific antigen (PSA) and detrusor overactivity rate and lower MCC. B-TUERP is a safe, successful and highly effective treatment for BPH at 10-year follow-up. Increased age, OABSS, PSA level and detrusor overactivity rate are potential predictors for urge incontinence after B-TUERP.

Enucleation vs. vaporization of benign prostatic hyperplasia: a head-to-head comparison of the various outcomes and complications. A systematic review and meta-analysis.

Vaporization of the prostate (VP) and endoscopic enucleation of the prostate (EEP) are reliable and frequently used methods for BPO relief. Both surgeries utilize lasers and EAU recommends them in similar patient cohorts. Our objective was to compare intra- and perioperative results of patients who had undergone VP and EEP. A systematic literature search was performed in three databases (MEDLINE, Web of Science and Scopus). The detailed search strategy is available at Prospero, CRD42020204739. Primary outcomes were functional results (IPSS, QoL, PVR, Q<inf>max</inf>), and secondary outcomes were intraoperative results, postoperative PSA and prostate volume, complications, and recurrence rate. VP required less operative time compared to EEP, mean difference -5.51 (95% CI -7.52; -3.50). IPSS and Q<inf>max</inf> for VP were worse after 12-month follow-up, mean difference 0.89 (95% CI 0.52; 1.27) and -3.7 (95% CI -4.56; -2.85), respectively, while QoL did not differ significantly. Postoperative PSA level was higher in the VP group, mean difference 2.28 (95% CI 2.00; 2.55). VP was associated with reduced Clavien-Dindo grade I (OR=4.16; 95% CI 2.96; 5.84) and grade II (OR=3.79; 95% CI 2.25; 6.39) complication rate, especially in terms of the percentage of blood transfusion and transient urinary incontinence. The rate of complications grade IIIa and higher was similar (3-6%). Reoperation rate was only estimated in one study and was significantly higher in the PVP group at 60 months of follow-up, 2.7% vs. 0%, P<0.05. EEP and VP share the efficacy and safety in BPH management. Our meta-analysis shows comparable complication rate in Clavien-Dindo III, VP superiority in operation time, and EEP superiority in long-term functional outcomes and PSA reduction.

MP09-08 COMPARISON OF VAPORIZATION AND ENUCLEATION TECHNIQUES BASED ON THE FUNCTIONAL OUTCOMES AND COMPLICATIONS OF PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA: SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP09)1 Sep 2021MP09-08 COMPARISON OF VAPORIZATION AND ENUCLEATION TECHNIQUES BASED ON THE FUNCTIONAL OUTCOMES AND COMPLICATIONS OF PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA: SYSTEMATIC REVIEW AND META-ANALYSIS Anastasia Shpikina, Andrey Morozov, Mark Taratkin, Alexey Novikov, and Dmitry Enikeev Anastasia ShpikinaAnastasia Shpikina More articles by this author , Andrey MorozovAndrey Morozov More articles by this author , Mark TaratkinMark Taratkin More articles by this author , Alexey NovikovAlexey Novikov More articles by this author , and Dmitry EnikeevDmitry Enikeev More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001982.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nowadays the most commonly used methods of BPH surgical treatment are vaporization (PVP) and enucleation of the prostate (EEP). We aimed to compare intra- and perioperative results of the patients who underwent PVP and EEP. METHODS: A systematic literature search was performed in 3 databases (MEDLINE, Web of Science and Scopus) on a search query: (EEP OR «prostate enucleation» OR «BPH enucleation») AND (PVP OR prostate AND vaporization) according to PRISMA guidelines. The detailed search strategy is available at Prospero, CRD42020204739. The scope of the review according to PICO process is as follows: P - patients with BPH. I - any types of EEP or PVP C - preoperative data, operation characteristics, outcomes of different types of EEP and PVP O - functional outcomes, effectiveness of the procedures, safety. Primary outcomes were functional results (IPSS, QoL, PVR, Qmax). Secondary outcomes were intraoperative results, postoperative PSA and prostate volume, complications, and recurrence rate. RESULTS: The search identified 436 articles, and the final sample contained 15 articles covering a period 2011-2020 years. Functional outcomes (IPSS, QoL и Qmax) were comparable at 12 months follow-up (figure 1). Elkoushy et al. showed benefit of EEP over PVP at 36 months follow-up, IPSS 7.2±8.4 vs 3.1±4.6, p=0.01, and Qmax 24.3±16.2 ml/s vs 28.1±10.2 ml/s, p=0.001. While EEP and PVP duration did not differ significantly in BPH <80 cm3, higher BPH volume was associated with longer operative time. Complication rate (Clavien-Dindo I and II) was higher in the EEP group (13–42%) comparing to PVP (10.3–21.7%), especially the percentage of blood transfusion and transient urinary incontinence. But the rate of complications grade IIIa and higher was similar (3–6%). Reoperation rate was significantly higher in the PVP group at 60 mo. follow-up, 2.7% vs 0%, p <0.05. Postoperative prostate volume and PSA level were also higher in the PVP group. CONCLUSIONS: Short-term outcomes of the patients were comparable in both enucleation and vaporization groups. Long-term results including the percentage of relapse were better in patients who underwent enucleation of the prostate. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e162-e162 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anastasia Shpikina More articles by this author Andrey Morozov More articles by this author Mark Taratkin More articles by this author Alexey Novikov More articles by this author Dmitry Enikeev More articles by this author Expand All Advertisement Loading ...

Diagnosis and Management of Female Paraurethral Cysts: A Tertiary Hospital Experience

Objective: To report a case series of female paraurethral cysts (FPCs) at a tertiary hospital. Materials and Methods: Sixteen proximal- and distal-FPC cases treated between 2010 and 2019 were retrospectively evaluated. Demographics, clinical presentations, diagnostic methods, treatments, and outcomes were analyzed. Results: The mean age and BMI of the 11 proximal-FPC patients were significantly higher than those of the five distal-FPC patients [55.6 versus 39.8 years (p=0.008); 27.6 versus 21.5 kg/m² (p=0.036)], respectively. Comorbidity and parity statuses did not differ. The most common presenting symptoms were palpable mass (31.3%) and lower urinary tract symptoms (LUTS) (31.3%). There were palpable masses in four distal-FPC cases (80%), significantly more than in proximal-FPC at one case (9.1%) (p=0.013). Normal urinalyses were found in all five distal-FPC cases, significantly higher than in proximal-FPC at two cases (18.2%) (p=0.005). Diagnosis was confirmed solely by pelvic examination in three distal-FPC cases (60%) with palpable masses at the distal urethra, but in only one proximal-FPC case (9.1%) (p=0.063), otherwise, translabial ultrasound, CT, MRI, or VCUG was used. Patients were managed by transvaginal excision and urethral injury occurred in six (42.9%). While the groups’ operative times, blood losses, and catheter indwelling times were similar, proximal-FPC hospital stays were longer at three versus two days (p=0.019). Disease recurrence, transient stress urinary incontinence (SUI), and urethral stricture occurred in one, two and one of proximal-FPC cases, respectively. One distal FPC developed overactive bladder. The symptom-free success rate was 64.3%. Two proximal-FPC patients had adenocarcinoma. Conclusion: The FPC patients had various presentations. Diagnosis of FPC could be made clinically by pelvic examination. Further investigative imaging might be performed in the equivocal cases to confirm the diagnosis. Transvaginal removal was the mainstay treatment. Keywords: Case series; Management; Paraurethral cyst; Skene’s gland cyst; Urethral diverticulum

Comparison of different en bloc holmium laser enucleation of the prostate techniques to reduce the rate of postoperative transient urinary incontinence.

ObjectiveTo investigate postoperative risk factors for transient urinary incontinence (TUI) after different en bloc holmium laser enucleation of the prostate (HoLEP) techniques.MethodsWe retrospectively analyzed 169 consecutive patients who underwent HoLEP using the original en bloc technique (n = 41), en bloc with early mucosal strip detachment technique (n = 72), and three horseshoe-shaped incisions technique (n = 56) to treat bladder outlet obstruction from January 2017 to October 2019. Preoperative variables and surgical quality indexes were compared between the groups. TUI was defined as any hygienic or social problem caused by involuntary loss of urine at 2 weeks postoperatively. The postvoid residual urine volume, maximum urinary flow rate, and International Prostate Symptom Score (IPSS) were assessed.ResultsAmong all three techniques, the three horseshoe-shaped incisions technique was significantly associated with the lowest incidence of TUI and the lowest IPSS. Although not statistically significant, the three horseshoe-shaped incisions group also showed a trend toward a faster enucleation time. No life-threatening intraoperative complications occurred in any group.ConclusionUse of three horseshoe-shaped incisions in en bloc HoLEP prevented urethral sphincter damage with a low rate of postoperative TUI. Further long-term, multicenter comparative assessment is required.Research Registry number: 6848

Long-term effect of repeated deslorelin acetate treatment in bitches for reproduction control

Long-acting gonadotropin-releasing hormone (GnRH) analogs, which are approved for male dogs and ferrets, have been used off-label to suppress estrus in bitches predisposed to the side effects of spaying. Health data from the past 12 years were evaluated from bitches without progestogen pretreatment that received deslorelin acetate (DA) to suppress estrus for the first time before the age of 4.5 years. The study population included 32 client-owned bitches repeatedly treated with either 4.7 mg or 9.4 mg DA implants for a period of 5.3 ± 3.4 years (range 0.5–11.3 years). Follow-up information concerning immediate side effects of DA occurring within five months after the first DA treatment (n = 23) as well as long-term side effects of sustained gonadal suppression occurring after five months up to three years (n = 2), three years up to five years (n = 2) or more than five years (n = 8) were assessed through a questionnaire. Treatment was considered successful if no major side effects requiring medical treatment occurred, which applied to 26 out of 32 (81 %) bitches. In the six remaining bitches, the following major side effects led to treatment discontinuation: persistent urinary incontinence (n = 1), reoccurring induced heat (n = 1), uterine disease (n = 3) and/or ovarian tumor (n = 3). The bitches recovered completely after surgical spaying and/or DA implant removal. Minor side effects that did not require therapy or affect animal welfare included body weight changes (n = 18), subtle behavioral changes (n = 13), induced heat (n = 12), coat changes (n = 11), pseudocyesis (n = 6), transient urinary incontinence (n = 4), and/or temporary thickening of the uterine wall with little anechogenic content (n = 2). To examine a possible causal relationship between adverse side effects and DA treatment, further studies should compare the frequency of pathologies between groups of GnRH-treated, intact and spayed bitches of similar breeds and ages. Nevertheless, DA application before the age of 4.5 years may be a means of postponing surgical spaying for several years in breeds at high risk for developing urinary incontinence. Before DA is used in bitches, owners should be fully informed regarding possible side effects.

Internal hemipelvectomy for primary pelvic tumors, first experience in Peru: a case series

Internal hemipelvectomy (IH) is a newer surgical choice for pelvic tumors. It involves resection of the tumor, reconstruction of the pelvis without sacrificing the neurovascular structures, and preservation of the lower limb. We aimed to describe first experience with IH in primary pelvic tumors in Peru. Four patients aged 17 to 49 years old at the time of diagnosis were included. 75% were chondrosarcomas, and 25% were chondroblastomas. The IH types were 50% type II, 25% type I-A, and 25% type III. The neoplasm sizes differed from 5cm to more than 20 cm. Postoperative complications were right hip arthrosis, transient urinary incontinence, and abdominal eventration. Fifty percent had local recurrence, with a recurrence mean time of 24 months. As a first attempt at this technique in Peru, IH had promising results with a 100% overall survival at 30 months. However, more studies are required to analyze the factors associated with a high rate of recurrence (50%).

Transient bladder incontinence following ultrasound guided caudal epidural block

Caudal anesthesia is commonly used a regional anesthesia technique for sub-umbilical surgeries in pediatrics and for chronic pain management in adults. Ultrasound guided caudal epidural block improves the success rate with minimizes complications. We report a patient who underwent lateral sphincterotomy under ultrasound guided caudal epidural anesthesia and developed transient urinary incontinence with prolonged perineal sensory loss postoperatively.&#x0D; Key words: Anesthesia, Caudal epidural, Ultrasound.&#x0D; Citation: Preethipriyadharshini R, Vadhanan CP, Bokka N. Transient bladder incontinence following ultrasound guided caudal epidural block. Anaesth. pain intensive care 2021;25(1):102–104;&#x0D; DOI: 10.35975/apic.v25i1.1437&#x0D; Received: 17 October 2020; Reviewed: 4 November 2020; Accepted: 5 December 2020

Outcome Of Prostatic Abscess By Transurethral Resection In Diabetic Patients

Purpose: Prostatic abscess is an uncommon urologic disease but has a high mortality rate if not treated properly. Furthermore, diagnosis and proper treatment of prostatic abscess remain as a challenge for physicians. Transurethral resection of prostate in prostatic abscess is found very effective considering its rapid recovery. We compared data on transurethral resection of prostate (TURP), and transurethral incision of the abscess cavity (TUI) in 117 cases over a six and half year period.The details of surgical resection and all the followup visits were recorded and analyzed. Results: With a mean age of 61.53 ± 8.58 years, all diabetic patients had multifocal abscess cavities. Seventy six men underwent classical TURP similar to the technique used for benign prostatic enlargement(group 1), other 41 men underwent modified transurethral incision of the abscess cavity (TUI) (group 2). The abscess cavities resolved completely, and no patient required a second intervention. One patient in group 1 and 6 in group2 had postoperative fever requiring parenteral antibiotics (P = 0.716), 23 patients in group 1 had transient urinary incontinence,whereas none of the patients in group 2 had this complication (P = 0.055). 24 and 2 men in group 1 and 2 reported retrograde ejaculation respectively (P = 0.740). For the alleviation of symptoms and to get the urine culture negative post-operative antibiotic treatment was needed to be continued in group 1 for 7 days and in group 2 for more than 14 days. Conclusion: The modified resection technique of abscess cavity and formal TURPin the management of prostatic abscess give comparable outcome, but in diabetic patients as the abscess is multifocal transurethral resection ensures better drainage and faster postoperative recovery. Bangladesh Journal of Urology, Vol. 20, No. 1, January 2017 p.8-12

SC131 - Recovery from transient urinary incontinence post-HoLEP – findings from a prospective trial (EXPHO)

SC131 - Recovery from transient urinary incontinence post-HoLEP – findings from a prospective trial (EXPHO)

Is the membranous urethral length related to postoperative urinary incontinence after holmium laser enucleation of the prostate?

To investigate the findings of preoperative magnetic resonance imaging associated with the occurrence of transient urinary incontinence after holmium laser enucleation of the prostate. At a single institution, 360 patients underwent holmium laser enucleation of the prostate between January 2014 and December 2018. Of those, we retrospectively evaluated 237 who underwent preoperative magnetic resonance imaging and for whom postoperative evaluations were available for >3months after holmium laser enucleation of the prostate. We carried out preoperative magnetic resonance imaging, and measured the periurethral sphincter complex, levator ani thickness, membranous urethral length and minimal residual membranous urethral length. Logistic regression analysis was carried out to assess the variables associated with incontinence. Transient urinary incontinence occurred after holmium laser enucleation of the prostate in 68 patients (28.7%); 46 (67.6%) of whom recovered within 3 months. Multivariate analysis showed that the membranous urethral length was independently associated with postoperative urinary incontinence at 1 and 3months after surgery. The operative time was also independently associated with postoperative transient urinary incontinence at 1month after surgery. Preoperative membranous urethral length and operative time are independent predictors of transient urinary incontinence after holmium laser enucleation of the prostate. These findings should be considered by surgeons before surgery.

827 - Recovery from transient urinary incontinence post-HoLEP – findings from a prospective trial (ExpHo)

827 - Recovery from transient urinary incontinence post-HoLEP – findings from a prospective trial (ExpHo)

PD56-04 COMPARATIVE EFFICACY OF NOVEL SURGICAL TREATMENTS FOR BENIGN PROSTATIC HYPERPLASIA: SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (PD56)1 Apr 2020PD56-04 COMPARATIVE EFFICACY OF NOVEL SURGICAL TREATMENTS FOR BENIGN PROSTATIC HYPERPLASIA: SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS Chung-You Tsai* and Shi-Wei Huang Chung-You Tsai*Chung-You Tsai* More articles by this author and Shi-Wei HuangShi-Wei Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000966.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia. METHODS: Design Systematic review and network meta-analysis of randomised controlled trials. Data sources: A comprehensive search of PubMed, Embase, and Cochrane databases from inception to 31 March 2019. Study selection: Randomised controlled trials comparing vapourisation, resection, and enucleation of the prostate using monopolar, bipolar, or various laser systems (holmium, thulium, potassium titanyl phosphate, or diode) as surgical treatments for benign prostatic hyperplasia. The primary outcomes were the maximal flow rate (Qmax) and international prostate symptoms score (IPSS) at 12 months after surgical treatment. Secondary outcomes were Qmax and IPSS values at 6, 24, and 36 months after surgical treatment; perioperative parameters; and surgical complications. Data extraction and synthesis: Two independent reviewers extracted the study data and performed quality assessments using the Cochrane Risk of Bias Tool. The effect sizes were summarised using weighted mean differences for continuous outcomes and risk ratios for binary outcomes. Frequentist approach to the network meta-analysis was used to estimate comparative effects and safety. Ranking probabilities of each treatment were also calculated. RESULTS: 109 trials with a total of 13 676 participants were identified. Nine new surgical treatments were evaluated. Enucleation achieved better Qmax and IPSS values than resection and vapourisation methods at six and 12 months after surgical treatment, and the difference maintained up to 24 and 36 months after surgical treatment. For Qmax at 12 months after surgical treatment, the best three methods compared with monopolar transurethral resection of the prostate (TURP) were bipolar enucleation (mean difference 2.42 mL/s (95% confidence interval 1.11 to 3.73)), diode laser enucleation (1.86 (-0.17 to 2.53)), and holmium laser enucleation (1.07 (0.07 to 2.08)). The worst performing method was diode laser vapourisation (-1.90 (-5.07 to 1.27)). Eight new methods were better at controlling bleeding than monopolar TURP, resulting in a shorter catheterisation duration, reduced postoperative haemoglobin declination, fewer clot retention events, and lower blood transfusion rate. However, short term transient urinary incontinence might still be a concern for enucleation methods, compared with resection methods (odds ratio 1.92, 1.39 to 2.65). No substantial inconsistency between direct and indirect evidence was detected in primary or secondary outcomes. CONCLUSIONS: Eight novel endoscopic surgical methods for benign prostatic hyperplasia appeared to be superior in safety compared with monopolar TURP. Among these new treatments, enucleation methods showed better Qmax and IPSS values than vapourisation and resection methods. Source of Funding: Nil © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1189-e1189 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chung-You Tsai* More articles by this author Shi-Wei Huang More articles by this author Expand All Advertisement PDF downloadLoading ...

Clinical Profile, Surgical Approach and Outcome of Complicated Genital Fistulae in Urban Population of a Developing Nation.

To study aetiology and management of complicated genital fistulae and to evaluate the outcome of the treatment. This observational study enrolled patients with complicated genital fistulae from September 2008 to August 2018 at Sant Parmanand Hospital, Delhi. Patients underwent a reparative surgery or ureteric stenting after a detailed preoperative workup. Patients were followed up for the assessment of outcomes. A total of 16 patients were recruited: Ten (62.5%) patients had fistulae secondary to gynaecological surgeries (seven laparoscopic and three abdominal hysterectomies) and six (37.5%) patients had obstetric fistulae. At a mean follow-up of 5.8years among obstetric fistulae and 7.3years among post-operative fistulae, 100% success rate was maintained with the first attempt of reparative surgery or ureteric stenting. There were no major complications. Two patients had recurrent urinary tract infections, and one patient had transient urinary incontinence for 4weeks. The study demonstrates that complicated genital fistulae occur more commonly secondary to gynaecological surgeries as compared to obstetric complications in a contemporary cohort from a metropolitan city. A 100% success rate of reparative surgery could be achieved with a transperitoneal approach. Good outcome in ureteric fistulae can be achieved with conservative approach, after proper case selection.

Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis

ObjectiveTo assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia.DesignSystematic review and network meta-analysis of randomised controlled trials.Data sourcesA comprehensive search of PubMed, Embase, and...