Transient Urinary Retention Research Articles

MP70-12 SALVAGE FOCAL CRYOTHERAPY OFFERS SIMILAR SHORT-TERM ONCOLOGICAL CONTROL AND IMPROVED URINARY FUNCTION COMPARED TO SALVAGE WHOLE GLAND CRYOTHERAPY FOR RADIATION RESISTANT/RECURRENT PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II (MP70)1 Apr 2020MP70-12 SALVAGE FOCAL CRYOTHERAPY OFFERS SIMILAR SHORT-TERM ONCOLOGICAL CONTROL AND IMPROVED URINARY FUNCTION COMPARED TO SALVAGE WHOLE GLAND CRYOTHERAPY FOR RADIATION RESISTANT/RECURRENT PROSTATE CANCER Wei Phin Tan*, Ahmed Elshafei, Alireza Aminsharifi, and Thomas Polascik Wei Phin Tan*Wei Phin Tan* More articles by this author , Ahmed ElshafeiAhmed Elshafei More articles by this author , Alireza AminsharifiAlireza Aminsharifi More articles by this author , and Thomas PolascikThomas Polascik More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000950.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The treatment of radiation-persistent prostate cancer remains a challenge and should be tailored to the individual patient. We aim to compare short-term oncological and functional outcomes of salvage focal cryotherapy (SFC) to salvage total cryotherapy (STC) for radiation persistent/recurrent prostate cancer. METHODS: We queried the COLD registry for men who underwent SFC and STC of the prostate for radiation persistent/recurrent disease. Propensity score weighting was used to match age at time of treatment, pre-salvage therapy PSA, Gleason sum, and pre-salvage cryotherapy androgen deprivation therapy status. Primary outcome was progression-free survival (PFS). RESULTS: A total of 385 men with biopsy-proven persistent/recurrent prostate cancer after primary radiotherapy were included in the study. Median follow-up, age, PSA and Gleason sum pre-salvage cryotherapy was 24.4 months (1st/3rd quartile: 9.8/60.3), 70 years (1st/3rd quartile: 66/74), 4 ng/dl (1st/3rd quartile: 2.7/5.6) and 7 (1st/3rd quartile: 6/8), respectively. After propensity score weighting, patients who were treated with STC did not have a significant difference test in PFS compared to patients treated with SFC on weighted log-rank test (79.8% vs. 76.98%, p= 0.11). SFC was associated with a lower probability of post-treatment transient urinary retention (5.6% vs 22.4%. p<0.001). There were no significant differences in rectal fistula (1.4% vs 3.8, p=0.30), new onset urinary incontinence within 12 months (9.3% vs 15.1%, p=0.19) or new-onset erectile dysfunction within 12 months (52.6% vs 59.6, p=0.47) in the SFC vs STC group, respectively. CONCLUSIONS: STC has similar 2-year oncological outcome compared to SFC in the radiation- persistent/recurrent disease population, but patients who underwent SFC have a lower urinary retention rate compared to STC. Source of Funding: WPT is supported by the Ruth L. Kirschstein NRSA Institutional Research Training Grant (T32-CA093245). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1059-e1060 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wei Phin Tan* More articles by this author Ahmed Elshafei More articles by this author Alireza Aminsharifi More articles by this author Thomas Polascik More articles by this author Expand All Advertisement PDF downloadLoading ...

Split Cord Malformation: Presentation, Management, and Surgical Outcome

Split cord malformation (SCM) is a rare anomaly characterized by a split along the midline of the cord, which divides it into 2 symmetric or nonsymmetric entities. SCM surgical indications and outcomes are still debatable, the signs and symptoms are generally nonspecific and are commonly associated with other anomalies and deficits. We retrospectively searched the hospital database at King Abdulaziz Medical City, Riyadh, Saudi Arabia for patients with SCM between 1998 and 2018. Descriptive statistics were used to present categorical data as percentages and frequencies. A total of 25 patients were included in this series. The mean age of patients at the time of diagnosis was 4.4 years. A total of 18 patients (72%) underwent surgical correction. The mean difference between the age at diagnosis and the age at correction was 7 months. All patients underwent intraoperative neurophysiologic monitoring. Postoperative complications were minimal. Cerebrospinal fluid leakage was noted in 2 patients, transient urinary retention was noted in 1 patient, and transient unilateral leg paresis was noted in 1 patient. Most patients (n= 15, 83%), were discharged within 19 days after surgery, and 81% showed improvement postoperatively. Over the long-term follow-up, none of the patients developed new urologic or neurologic deficits. Most patients with SCM present during childhood. Postoperative complications after SCM corrective surgery are generally minimal, and the overall outcomes, mainly including partial or complete symptomatic improvement and/or symptom stability and hydronephrosis resolution, were favorable.

Salvage Focal Cryotherapy Offers Similar Short-term Oncologic Control and Improved Urinary Function Compared With Salvage Whole Gland Cryotherapy for Radiation-resistant or Recurrent Prostate Cancer

We compared the short-term oncologic and functional outcomes of salvage focal cryotherapy (SFC) with those of salvage total cryotherapy (STC) for radiotherapy (RT)-persistent/recurrent prostate cancer. We queried the Cryo On-Line Database registry for men who had undergone SFC and STC of the prostate for RT-persistent or recurrent disease. Propensity score weighting was used to match age at treatment, presalvage therapy prostate-specific antigen level, Gleason sum, and presalvage cryotherapy androgen deprivation therapy status. The primary outcome was progression-free survival. A total of 385 men with biopsy-proven persistent or recurrent prostate cancer after primary RT were included in the present study. The median follow-up, age, prostate-specific antigen, and Gleason sum before salvage cryotherapy was 24.4 months (first and third quartile, 9.8 and 60.3), 70 years (first and third quartile, 66 and 74 years), 4 ng/dL (first and third quartile, 2.7 and 5.6 ng/dL), and 7 (first and third quartile, 6 and 8), respectively. After propensity score weighting, the difference in progression-free survival was not statistically significant between the patients who had undergone STC and those who had undergone SFC (79.8% vs. 76.98%; P= .11 on weighted log-rank test). SFC was associated with a lower probability of post-treatment transient urinary retention (5.6% vs. 22.4%; P< .001). No significant differences were found in the incidence of rectal fistula (1.4% vs. 3.8; P= .30), new-onset urinary incontinence within 12 months (9.3% vs. 15.1%; P= .19), or new-onset erectile dysfunction within 12 months (52.6% vs. 59.6%; P= .47) between the SFC and STC groups, respectively. STC resulted in similar 2-year oncologic outcomes compared with SFC in the RT-persistent/recurrent disease population. However, the patients who had undergone SFC had a lower urinary retention rate compared with those who had undergone STC.

Microsurgical Treatment of Recurrent Conus Medullaris Arteriovenous Malformation: 2-Dimensional Operative Video.

Arteriovenous malformations (AVMs) involving the conus medullaris have a unique angioarchitecture due to their involvement of the arterial basket of the conus medullaris, which represents an arterial anastomotic network between the anterior spinal artery (ASA) and posterior spinal arteries (PSAs) at the level of the conus medullaris.1 These lesions consist of a combination of a true AVM nidus, which is usually extramedullary, and direct shunts between the ASA, PSAs, and the venous system. Patients may present with radiculopathy, myelopathy, or subarachnoid hemorrhage.2A 40-yr-old woman status post T11-L1 laminoplasty for resection of a ruptured conus AVM 6 yr prior presented with routine follow-up angiography suggestive of an arteriovenous fistula. She was counseled regarding treatment options including endovascular embolization and microsurgical ligation or resection, and she elected to proceed with surgical treatment. At the time of surgery, a recurrent AVM was noted. A 2-dimensional intraoperative video illustrates the microsurgical treatment of her recurrent conus AVM. The patient recovered well postoperatively. Spinal angiography demonstrated complete obliteration of the lesion. The patient experienced transient urinary retention that was self-limited but otherwise was without any new neurological deficit. Due to the retrospective nature of this report, informed consent was not required.Video used with permission from Barrow Neurological Institute, all rights reserved.

Clinical analysis of postoperative complications of lumbosacral selective posterior rhizotomy for the treatment of spastic cerebral palsy

Objective To study the complications of lumbosacral selective posterior rhizotomy (SPR) for the treatment of spastic cerebral palsy and to provide the prevention strategies. Methods We retrospectively reviewed the surgical outcome and postoperative complications of 508 patients with spastic cerebral palsy who underwent SPR surgery at Department of Neurosurgery of Beijing Fengtai Hospital, The First Hospital of Peaking University from March 2003 to November 2016 and were followed up for more than one year. The complications were divided into 2 main categories: perioperative complications (from post operation to discharge) and medium to long-term (follow-up of over 1 year) complications. Incidence, causes, treatment approaches of complications as well as outcomes were analyzed. Results A total of 508 patients were included in this cohort. The overall response rate (modified Ashworth spasm scale≤2 grade) was 93.7% (476/508). Perioperative transient complications included lower extremity weakness in 76 (15.0%) cases, abdominal pain in 39 (7.7%), lower extremity sensory deficit in 29 (5.7%), headache related to low intracranial pressure in 18 (3.5%), transient urinary retention in 9 (1.8%), slow incision healing in 5 (1.0%), cerebrospinal fluid leakage in 3 (0.6%), incision infection in 2 (0.4%), and aspiration pneumonia in 2 (0.4%). All patients were followed up for 17-36 months, with an average of 22.5±5.4 months. Medium to long-term complications during follow-up included chronic back pain in 51(10.0%) cases, instability or subluxation of spine in 38 (7.5%), lower extremities dyskinesia in 31 (6.1%), scoliosis in 29 (5.7%), and lower extremity sensory deficit in 25 (4.9%). Conclusions The operation of SPR seems to be highly effective for the treatment of spastic cerebral palsy. Perioperative complications are mostly transient and can be resolved within 2 weeks following proper treatment. Medium to long-term complications usually have no significant negative effect on the patient's quality of life. Key words: Cerebral palsy; Postoperative complications; Selective posterior rhizotomy

Selective posterior rhizotomy of lumbosacral region for relief of spasticity of lower limbs of cerebral palsy

Objective To study the effectiveness of selective posterior rhizotomy of lumbosacral region for relief of spasticity of lower limbs of cerebral palsy. Methods A total of 48 patients of spastic cerebral palsy who had undergone SPR at Department of Neurosurgery, The People's Hospital of Liaoning Province from January 2013 to January 2015 were followed-up with limb spasticity, gait and quality of life. The changes of muscle tone were evaluated by the modified Ashworth scale (mAS), the motor function was assessed by the gross motor function classification system (GMFCS), the quality of life was assessed by the activity of daily living(ADL) score, and the salivation condition was assessed by the teacher salivation grading method (TDS). Results All patients were followed up for 12-30 months with a mean duration of 18.2±6.5 months. Compared with the preoperative results, mAS scores of the left hips, knees and ankles of the 96 patients at 6 months, 12 months and the last follow-up were lower with statistically significant differences (all P 0.05). Among postoperative complications, the incidence of lower limb sensory disorder and muscle weakness was 7.3%(7/96)and 9.4%(9/96), respectively, both of which were improved during follow-up. Two (4.2%) cases of transient urinary retention and 1 (2.1%) case of dysmenorrhea occurred post operation. The postoperative recurrence rate of spasm was 2.1% (1/48). Conclusion Lumbosacral SPR is a safe and effective way to treat spasticity of lower limbs in cerebral palsy patients and improve their quality of life. Key words: Cerebral palsy; Spasticity; Selective posterior rhizotomy; Treatment outcome; Prognosis

Use of MRI-Guided Biopsy for Selection and Follow-up of Men Undergoing Hemi-gland Cryoablation of Prostate Cancer

To investigate safety, efficacy, and quality of life impact of hemi-gland cryotherapy for clinically-significant prostate cancer (CaP), when patient selection and follow-up includes MRI-guided biopsy. Twenty-nine men with unilateral CaP (all clinically significant with prostate volume <60 cc) were enrolled in a prospective observational trial of hemi-gland cryotherapy. Mean patient age was 68.7 years. Median prostate-specific antigen (PSA) was 6.6 ng/mL. MRI-guided biopsy (3T-MRI, Artemis US fusion) was used for diagnosis and repeated at 6-month follow-up in all men. Treatment was under general anesthesia using the BTG/Galil system. Validated questionnaires were used to determine effects of treatment on urinary and sexual function and quality of life. Cryotherapy was completed satisfactorily in all 29 cases in <60 minutes with no intraoperative complications. Significant decreases in PSA (median decrease 5.6 ng/mL) and PSA density (median decrease 0.14 ng/mL/cc) were observed (P < .01). At 6 months, 23 patients (79%) demonstrated no residual cancer on follow-up MRI-guided biopsy of the treated side. Three patients (10%) revealed micro-residual disease. Three patients (10%) had residual cancer and underwent further treatment. Ipsilateral MRI lesions were present before treatment in 26 patients and after treatment in only 2, reflecting the gross ablative effect; however, MRI showed disappearance of lesions in 4 patients with residual tumor on biopsy. The single complication was 1 case of transient urinary retention; 85% of men who were sexually active continued without change after treatment. Voiding function was unchanged. Hemi-gland cryoablation for clinically-significant CaP is well-tolerated, and when patients are selected and followed by MRI/US fusion biopsy, cancer control appears promising at 6 months.

Arterial and end-tidal Carbon Dioxide Tension Changes during Spinal Anaesthesia in Upper Abdominal Laparoscopic Surgeries: A Comparison with General Anaesthesia

&#x0D; Nowadays, laparoscopic surgeries are being performed under subarachnoid block (SAB) safely.&#x0D; Aims: This study was to compare the arterial and end-tidal carbon dioxide (CO2) tension changes during spinal and general anaesthesia (GA) in CO2 pneumoperitoneum for upper abdominal laparoscopic surgeries.&#x0D; Settings and Design: This was a prospective randomized comparative clinical study.&#x0D; Materials and Methods: Eighty patients posted for upper abdominal laparoscopic surgeries were randomly allocated to two groups either to receive standard GA or lumbar SAB.&#x0D; Results: The demographic profiles of both the groups were comparable. The PaCO2 was increased gradually and sustained at its peaks within 20±4.37 minutes in both the groups. The mean±SD revealed to be higher in Group B (41.5500±2.1315) than Group A (40.8460±2.1136), but the difference between the two was not statistically significant (P=0.6142). There was a gradual increase in ETCO2 over the initial 10±2.07 minutes and reached a plateau within 20±5.74 minutes in both the groups and declined faster after deflation of pneumoperitoneum in SAB group. The mean±SD was found to be higher in Group B (33.923±1.642) than Group A (33.408±1.772), but it was also not statistically significant (P=0.4492). The difference of the arterial blood pH between the groups was not statistically significant. Three (7.5%) patients developed transient urinary retention and 2 (5%) patients suffered from post-dural puncture headache in SAB group.&#x0D; Conclusions: Arterial and end-tidal CO2 tension changes during upper abdominal laparoscopic surgery under SAB remain within physiological limit and comparable to the CO2 tensions under GA. However, per-operative complications in SAB are greater, while it is lesser in postoperative period in comparison to GA. SAB may be adopted in ASA physical status I patients with proper preoperative counselling.&#x0D; J Bangladesh Coll Phys Surg 2019; 37(1): 13-18&#x0D; &#x0D;

PD64-02 REAL LIFE EXPERIENCE WITH THE REZUM SYSTEM FOR BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III1 Apr 2018PD64-02 REAL LIFE EXPERIENCE WITH THE REZUM SYSTEM FOR BENIGN PROSTATIC HYPERPLASIA Daniel Mollengarden, Kenneth Goldberg, Daniel Wong, and Claus Goerg Roehrborn Daniel MollengardenDaniel Mollengarden More articles by this author , Kenneth GoldbergKenneth Goldberg More articles by this author , Daniel WongDaniel Wong More articles by this author , and Claus Goerg RoehrbornClaus Goerg Roehrborn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2974AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Convective radiofrequency water vapor thermal therapy with the Rezum system is a relatively new treatment for benign prostatic hyperplasia (BPH). We present results from a single surgeon in an office setting, including efficacy by prostate volume and patient satisfaction data. METHODS A retrospective review was performed on 129 patients who underwent the Rezum procedure by a single surgeon. All patients were at least four months out from treatment. International prostate symptom scores (IPSS), maximum flow rates (Qmax), residual urine volumes, medication usage, and adverse events were monitored. A scripted patient questionnaire was administered over the phone to obtain quality of life and satisfaction data. RESULTS Mean IPSS improved from a baseline of 18.3 to 6.9 and Qmax from 10.5 to 16.8 mL/sec at 3-6 months out (figure 1a). Improvements were independent of starting IPSS, treatment of a median lobe, and prostate size which measured up to 86 cc (figure 1b). There was a 17% prostate volume reduction on TRUS and 14% based on PSA levels. The most common adverse events were urinary tract infections (17%) and transient urinary retention (14%) (table 1). Ninety percent of patients stopped all BPH medications. Questionnaires revealed 86% of patients would recommend the procedure to a friend, and 77% and 74% were either satisfied or very satisfied with the procedure and its results, respectively (figure 2). CONCLUSIONS Rezum radiofrequency thermal therapy offers a minimally invasive option for BPH management with moderate improvement in symptoms and flow rate. The results appear to be independent of prostate size or presence of a median lobe, and patients are largely satisfied. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1219-e1220 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Daniel Mollengarden More articles by this author Kenneth Goldberg More articles by this author Daniel Wong More articles by this author Claus Goerg Roehrborn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV): Outcomes and complications

Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) is a minimally invasive alternative to open surgery. We have previously reported retrospective outcomes from our study group, and herein provide an updated prospective analysis with a focus on success rate, surgical technique, and complications among surgeons who have overcome the initial learning curve. To assess the safety and efficacy of RALUR-EV in children, among experienced surgeons. We reviewed our prospective database of children undergoing RALUR-EV by pediatric urologists at eight academic centers from 2015 to 2017. Radiographic success was defined as absence of vesicoureteral reflux (VUR) on postoperative voiding cystourethrogram. Complications were graded using the Clavien scale. Univariate regression analysis was performed to assess for association among various patient and technical factors and radiographic failure. In total, 143 patients were treated with RALUR-EV for primary VUR (87 unilateral, 56 bilateral; 199 ureters). The majority of ureters (73.4%) had grade III or higher VUR preoperatively. Radiographic resolution was present in 93.8% of ureters, as shown in the summary table. Ureteral complications occurred in five ureters (2.5%) with mean follow-up of 7.4 months (SD 4.0). Transient urinary retention occurred in four patients following bilateral procedure (7.1%) and in no patients after unilateral. On univariate analysis, there were no patient or technical factors associated with increased odds of radiographic failure. We report a radiographic success rate of 93.8% overall, and 94.1% among children with grades III-V VUR. In contemporary series, alternate management options such as endoscopic injection and open UR have reported radiographic success rates of 90% and 93.5% respectively. We were unable to identify specific patient or technical factors that influenced outcomes, although immeasurable factors such as tissue handling and intraoperative decision-making could not be assessed. Ureteral complications requiring operative intervention were rare and occurred with the same incidence reported in a large open series. Limitations include lack of long-term follow-up and absence of radiographic follow-up on a subset of patients. Radiographic resolution of VUR following RALUR is on par with contemporary open series, and the incidence of ureteral complications is low. RALUR should be considered as one of several viable options for management of VUR in children.

Histotripsy Treatment of Benign Prostatic Enlargement Using the Vortx Rx System: Initial Human Safety and Efficacy Outcomes

To assess clinical safety (primary) and efficacy (secondary) of histotripsy for treatment of symptomatic benign prostatic enlargement in a first-in human study. Twenty-five male subjects with moderate to severe lower urinary tract symptoms, prostate size between 30 and 80 g, and no evidence of prostate cancer were enrolled at 2 sites in a prospective, single-arm study. Treatment consisted of acoustic energy delivery through the perineum with integrated real-time transrectal ultrasound monitoring using the Vortx Rx system. Follow-up evaluations were performed on postoperative day 1 and 1, 3, and 6 months. Twenty-five men underwent histotripsy treatment with no serious intraoperative adverse events. Postoperatively, 3 cases of transient urinary retention (<3 days), 1 case of urinary retention (8 days in duration, defined as serious), a minor anal abrasion, and microscopic hematuria were considered device-related adverse events. Debulking of targeted prostate tissue was not observed with transrectal ultrasound imaging or with endoscopic visualization, and clinically meaningful improvement in uroflow or postvoid residual urine (PVR) did not occur. However, International Prostate Symptom Score improvement at 1 month was 12.5 (52.4%) ± 6.6 points (n = 25), at 3 months was 11.9 (50.8%) ± 7.6 points (n = 24), and at 6 months was 10.4 (44.0%) ± 7.6 points (n = 24) (P <.001). Prostate histotripsy was safe and well tolerated in this pilot human trial with improvement in lower urinary tract symptoms.

Convective radiofrequency water vapor thermal therapy for benign prostatic hyperplasia: a single office experience.

Convective radiofrequency water vaporthermal therapy with the Rezūm system is a relatively new treatment for benign prostatic hyperplasia (BPH). We present results from a single surgeon in an office setting. A retrospective review of 129 patients from a single surgeon who underwent the Rezūm procedure was performed. All patients were at least 4 months out from treatment. International prostate symptom scores (IPSS), maximum flow rates (Qmax), residual urine volumes, medication usage, and adverse events were monitored. Data were analyzed at baseline, 15-45 days, 46-90 days, and 91-180 days after treatment. A scripted patient questionnaire was attempted over the phone to all patients. It was administered by a resident and medical student who do not work in the provider's office. Maximal effects were noted at the 91-180 day interval. IPSS improved from a baseline of 18.3 to 6.9 and Qmax from 10.5 to 16.8 mL/s. Improvements were independent of starting symptom score, median lobe treatment, and prostate size. There was a 17% prostate volume reduction based on TRUS and 14% based on PSA. The most common adverse events were urinary tract infections (17%) and transient urinary retention (14%). In total 90% of patients were able to come off their BPH medications and 86% of patients would recommend the procedure to a friend. Rezūm radiofrequency water vaporthermal therapy offers a minimally invasive option for BPH management with moderate improvement in symptoms and flow rate. The results appear to be independent of prostate size or presence of a median lobe, and have now been replicated in a single office setting.

Surgical management of female pelvic organ prolapse with and without urinary incontinence: A single center experience.

The study reports a single center experience with surgical management of female pelvic organ prolapse (POP) with and without urinary incontinence.Between January 2006 and July 2016, 93 consecutive patients with anterior and/or apical symptomatic POP underwent abdominal sacrocolpopexy (ASC) or laparoscopic sacrocolpopexy (LSC) or pubovaginal cystocele sling (PCS); 25 patients had concomitant stress urinary incontinence (SUI). Subjective outcome was assessed by the Pelvic Floor Impact Questionnaire (short form) (PFIQ-7) investigating bladder, bowel and vaginal functions, sexual activity, and daily life. Objective outcomes included the POP anatomic correction by Baden Walker HWS classification, urinary tract infection (UTI) rates, urge urinary incontinence (UUI), and SUI rates. Data were prospectively collected.Forty-three patients underwent PCS, 29 ASC, and 21 LSC. Mean follow-up was 54.88 ± 33.1, 28.89 ± 23.5, and 16.8 ± 11.3 months for PCS, ASC, and LSC, respectively. POP recurrence occurred in 10.5%, 7.5%, and 0% while de novo (ie, in untreated compartment/s) POP occurred in 15.8%, 7.4%, and 4.8% of patients who have undergone PCS, ASC, and LSC, respectively. Kaplan–Meier estimates of POP-free survival showed no difference among the 3 procedures. All procedures significantly reduced PFIQ-7 scores improving quality of life and the rates of recurrent UTIs and concomitant UUI. PCS cured all cases with concomitant SUI; de novo SUI occurred only in 7.4% and 4.8% of patients who have undergone ASC and LSC, respectively. Mean surgical time was significantly shorter for PCS compared to ASC and LSC (P = .0001), and for ASC compared to LSC (P = .004); there was no difference in postoperative pain and hospital stay. Compared to ASC/LSC, PCS involved a higher rate (27.9% vs 6%; P = .01) of minor complications, mainly transient urinary retention, and a lower rate (0% vs 8%; P = .06) of complications requiring surgery.In this single center experience, PCS was not only provided similar subjective and objective results than ASC and LSC but also able to correct concomitant SUI without causing de novo SUI and was safer than other 2 techniques, in female POP repair.

Early Experiences of Contact Laser Vaporization of the Prostate using the 980 nm High Power Diode Laser for Benign Prostatic Hyperplasia.

We report early experiences of contact laser vaporization of the prostate for symptomatic benign prostatic hyperplasia (BPH). A total of 80 patients recruited at four institutions in Japan from April 2013 through September 2014 underwent contact laser vaporization of the prostate using 980 nm high power diode laser with an end-firing fiber in the contact mode. Patients were followed prospectively at 1 day, 2, 4, 8, 12, and 24 weeks, postoperatively per protocol, and at 1 and 2 years post-protocol. Of 76 eligible patients, 64 (84.2%) achieved more than 50% decrease in International Prostate Symptom Score at 24 weeks (95% confidence interval: 74.0-91.6%), clearing the pre-fixed non-inferiority efficacy level to transurethral resection of the prostate (65%). Symptom scores, maximum flow rate, post-void residual urine, and prostate volume showed significant improvements at 12 and 24 weeks after the surgery. Perioperative complications included transient urinary retention (n = 20), retrograde ejaculation (5), bladder neck contracture (4), urethral stricture (3), stone in prostatic bed (3), bladder stone (2), bladder perforation (1), bladder deformity (1), and transient urgency incontinence (1). Urinary retention and bladder neck contracture occurred almost exclusively at one institution. Improved symptom scores, maximum flow rate, and post-void residual urine observed at 24 weeks remained virtually unchanged at 1 and 2 years. Early experience of contact laser vaporization in Japan showed efficacy comparable to transurethral resection of the prostate as a surgical procedure for BPH at 24 weeks. Long-term efficacy of the procedure remains uncertain.

Use of Low Dose Ziconotide as First-Line Intrathecal Monotherapy

Ziconotide use in intrathecal drug therapy (IDT) has been limited by dosing related side effects. We examine our experience with ziconotide as a first line IDT monotherapy in patients with chronic pain and present our low and slow dosing algorithm aimed at reducing these patient experienced side effects while adequately managing pain. We retrospectively reviewed demographics, dosing, and outcomes of 15 consecutive patients with complete three-month data sets implanted with intrathecal pain pumps more than three years utilizing ziconotide as a first-line monotherapy. Ziconotide response was assessed at visit 5 (69 ± 10 days) and responders were characterized by having 30% or greater improvement in numerical rating scale scores (n = 7), or activities of daily living (ADL) (n = 7). Eight of our patients had a response in at least one measure (53%). In our eight responders, NRS score decreased from 8.4 ± 0.7 at baseline (consult visit) to 2.4 ± 1.0 at 2.6 months and 4.0 ± 1.3 at most recent follow-up, mean of 12.9 months after implant. We noted that our responders tended to have neuropathic pain with an objective etiology. Initial dosing in 12 patients was 1.2 mcg/day (range for the other three patients was 0.6-1.4). Following initial dosing, visits were at 2-4 week intervals with mean titration doses between 1.1 and 2.8mcg/day. Slight dizziness in two patients and transient urinary retention in one patient occurred, all resolving with dose reduction. No patients had discontinued use at three-month follow-up. We present our experience with low and slow ziconotide IDT as a first-line monotherapy, which showed no side effects resulting in discontinuation of the medication at three-month follow-up. Using a conservative dosing strategy, we were able to effectively treat 53% of patients.

MP24-19 TRANSVESICAL VENTRAL BUCCAL MUCOSA GRAFT INLAY CYSTOPLASTY FOR RECONSTRUCTION OF REFRACTORY BLADDER NECK CONTRACTURES AFTER BENIGN PROSTATIC HYPERPLASIA SURGERY: SURGICAL TECHNIQUE AND PRELIMINARY RESULTS

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I1 Apr 2017MP24-19 TRANSVESICAL VENTRAL BUCCAL MUCOSA GRAFT INLAY CYSTOPLASTY FOR RECONSTRUCTION OF REFRACTORY BLADDER NECK CONTRACTURES AFTER BENIGN PROSTATIC HYPERPLASIA SURGERY: SURGICAL TECHNIQUE AND PRELIMINARY RESULTS Rodrigo Donalisio da Silva, Jeffrey M. Marks, Fernando J. Kim, and Brian J. Flynn Rodrigo Donalisio da SilvaRodrigo Donalisio da Silva More articles by this author , Jeffrey M. MarksJeffrey M. Marks More articles by this author , Fernando J. KimFernando J. Kim More articles by this author , and Brian J. FlynnBrian J. Flynn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3313AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The treatment of bladder neck contracture (BNC) after BPH surgery is challenging and may even require open reconstructive surgery in patients that whish to avoid chronic catheterization or suprapubic urinary diversion. The aim of this study is to introduce a novel surgical technique for the reconstruction of refractory BNC using buccal mucosal graft (BMG) inlay through a transvesical approach. METHODS We performed a retrospective analysis of patients that underwent open reconstructive surgery for refractory BNC after BPH surgery from 2010-2016 by a single surgeon (BJF). Steps of the procedure: transvesical ventral wedge resection of the fibrotic bladder neck contracture and spread fixation of appropriately sized BMG inlay. The patients were followed for post-operative complications and stricture recurrence with uroflowemtry, PVR, cystoscopy and outcome questionnaires. Outcome measures included length of follow-up, surgical technique, operative time, hospital stay, complications, and subsequent need for catheterization RESULTS A total of 13 patients presented refractory BNC of which 11 were suitable for reconstruction and 2 required urinary diversion. Eleven patients underwent reconstruction underwent transvesical ventral buccal mucosa graft inlay cystoplasty. Prior BPH surgery included transurethral resection of the prostate (64%), plasma vaporization of prostate (27%), and open prostatectomy (9.1%). Urinary retention (82%) was the most common presenting symptom and 73% of patients were using a catheter (Foley, suprapubic, self-catheterization) pre-operatively. An average of 2.3 endoscopic procedures were performed before BNC reconstruction. Overall, BNC diameter was 9.1 Fr. The average BMG size was 11.3 cm2, operative time was 298 minutes, and hospital stay was 3.3 days. Post-operatively, four patients had transient urinary retention and two had epididymorchytis. At a mean follow-up of 1.2 (0-5.1) years, only one patient had chronic retention and was considered a failure and remains dependent on self-catheterization. CONCLUSIONS BNC after BPH surgery is challenging surgical issue. Transvesical ventral BMG inlay cystoplasty is a feasible option that effectively treats refractory BNC. This graft augmentation technique using buccal mucosa graft provide good outcomes with low morbidity for patients that failed multiple endoscopic treatments © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e309 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Rodrigo Donalisio da Silva More articles by this author Jeffrey M. Marks More articles by this author Fernando J. Kim More articles by this author Brian J. Flynn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V5-11 ROBOTIC SIMPLE PROSTATECTOMY: THE RETROPUBIC APPROACH

You have accessJournal of UrologyBPH and Voiding Dysfunction1 Apr 2017V5-11 ROBOTIC SIMPLE PROSTATECTOMY: THE RETROPUBIC APPROACH Unwanaobong Nseyo, Yahir Santiago-Lastra, and Jill Buckley Unwanaobong NseyoUnwanaobong Nseyo More articles by this author , Yahir Santiago-LastraYahir Santiago-Lastra More articles by this author , and Jill BuckleyJill Buckley More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1416AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several surgical options for the management of BPH. We present the case of a patient with a large prostate gland on TRUS during prostate biopsy and transient urinary retention. GIven size of the gland and long distance to bladder neck as well as patient's status as Jehovah's witness, decision made to use retropubic approach to robotic simple prostatectomy. METHODS Video recorded of surgical procedure RESULTS Patient with minimal blood loss during the procedure, no additional need for transfusion. Patient discharged on post-op day 3 after uncomplicated hospital course. Small leak seen on post-op VCUG resulted in additional week of catheter use and resolution on repeat imaging. Patient with resolution of lower urinary tract symptoms. CONCLUSIONS Retropubic approach to robotic simple prostatectomy can be an option for surgical management of large glands and a safe and effective alternative to the transvesical approach. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e602 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Unwanaobong Nseyo More articles by this author Yahir Santiago-Lastra More articles by this author Jill Buckley More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Full-Endoscopic Assisted Lumbar Decompressive Surgery Performed in an Outpatient, Ambulatory Facility: Report of 5 Years of Complications and Risk Factors

Background: Minimally invasive surgery (MIS) technique is becoming the standard tissue sparing approach for decompression of lumbar central and lateral recess stenosis, intervertebral disc herniation, or any situation that would have required extensive open decompression laminectomy. Full-endoscopic or arthroscopic assisted surgery is arguably the “ultra-MIS” approach to lumbar spinal pathology. Age and body mass index (BMI) are significant risk factors to be considered in full-endoscopic assisted ultraMIS. With limited medical literature published on complication rates for MIS, reports on the ultra-MIS approach are even scarcer for free-standing, outpatient ambulatory settings. Objectives: The primary goal of this study is to compare outcomes for full-endoscopic assisted ultraMIS lumbar decompression surgical techniques, performed in a free-standing, outpatient ambulatory facility, with other spine surgery techniques. Study Design: This is a Western Institutional Review Board (WIRB)-approved retrospective review of prospectively collected patient demographic and outcomes data for full-endoscopic assisted interlaminar and transforaminal lumbar decompressive surgery. Setting: Free-standing, outpatient ambulatory surgery facility. Methods: A population of 178 patients, whose age ranged between 16 and 90 years old (mean 45.5 years), with a variety of clinical presentation of symptoms underwent lumbar decompressive surgery using an interlaminar or transforaminal full-endoscopic assisted approach between January 2011 and December 2015. Operative (OR) time, complication rates, estimated blood loss, preoperative and postoperative leg and back VAS, and patient satisfaction ratings at 6, 9, and 12 months post operation are reported. Results: Age is a significant predictor of OR time; older patients generally have longer surgeries. BMI does not have statistically significant effect on OR time; heavier patients have similar OR time as other cohorts. There were no reportable intra-operative complications in this series of 178 patients. There were 3 major (1.69%) and three 3 (1.69%) postoperative complications. The 3 major complications were all incidences of early postoperative reherniation that resulted in re-operation. The minor complications included 2 cases of sympathetically mediated pain syndrome and one case of postanesthetic transient urinary retention. About 95% of patients had less than 5 mL of blood loss. No patients lost more than 35 mL of blood during surgery. Visual analog scale (VAS) score dropped from 7 to 3, on a scale of 0 to 10 with 10 being the worst pain imaginable, within 2 months postoperative. On average, 70% to 80% of patients were satisfied or greatly satisfied with the surgery, and 85% to 92% of patients would recommend this type of surgery. Limitations: Retrospective study. Conclusions: Full-endoscopic assisted ultra-MIS technique is a viable option for lumbar decompressive surgery in a free-standing, outpatient ambulatory facility. The patient population in this study demonstrates its safety, efficacy, and effectiveness for treatment of various lumbar pathologies. It is particularly relevant that age and obesity are not contra-indications. Key words: Full-endoscopic, minimally invasive spine surgery, postoperative complications, lumbar discectomy, lumbar decompression, lumbar disc herniation, spinal stenosis, endoscopic discectomy, ultraMIS, arthroscopic

Multi-Institutional Review of Outcomes and Complications of Robot-Assisted Laparoscopic Extravesical Ureteral Reimplantation for Treatment of Primary Vesicoureteral Reflux in Children

Robot-assisted laparoscopic extravesical ureteral reimplantation has been proposed as a minimally invasive alternative to open ureteral reimplantation for correcting primary vesicoureteral reflux in children. However, in the current literature there are conflicting data regarding the safety and efficacy of this approach. Amid ongoing debate we analyzed outcomes and complications from this procedure in a large multi-institutional cohort. We reviewed the records of children who underwent robot-assisted laparoscopic extravesical ureteral reimplantation at 9 academic centers from 2005 to 2014. Radiographic failure was defined as persistent vesicoureteral reflux on postoperative voiding cystourethrogram or radionuclide cystogram. Complications were graded using the Clavien-Dindo scale. A total of 260 patients (363 ureters) underwent robot-assisted laparoscopic extravesical ureteral reimplantation for primary vesicoureteral reflux during the study period. The cohort included 90 patients with either duplex ureter (42), failed endoscopic treatment (40) or concomitant diverticulectomy (8). Of the 280 ureters with postoperative voiding cystourethrogram or radionuclide cystogram available radiographic resolution was seen in 246 (87.9%). There were 25 complications overall (9.6%), with 7 grade 3 complications (2.7%) and no grade 4 or 5 complications. Four patients (3.9%) had transient urinary retention following bilateral reimplantation. Robot-assisted laparoscopic extravesical ureteral reimplantation has a low complication rate consistent with published series of open ureteral reimplantation. Radiographic success rates are approaching those of the open procedure but continue to fall short of the gold standard approach. These findings necessitate critical thinking regarding potential technique improvements and further prospective investigation into the efficacy of this procedure.

Prolonged urinary retention can and does occur after any type of ureteral reimplantantion.

Transient urinary retention has been recognized as a complication of bilateral ureteroneocystostomy (UNC), when performed extravesically. The objective of this study was to review a collective surgeons' experiences of unilateral extra- and unilateral and/or bilateral intra-vesical ureteral reimplanation, where urinary retention greater than 6weeks, or what we have termed, "prolonged urinary retention" (PUR), occurred. We retrospectively reviewed charts to identify PUR after any open or robotic reimplant, other than bilateral extravesical, between 1998 and 2015 as reported by five surgeons. During the review period, ten cases were documented where PUR was encountered. Bilateral Cohen reimplants (5), unilateral extravesical open reimplant with ureteral tapering (3), unilateral Cohen reimplant (1) and unilateral extravesical robotic reimplant with tapering (1) were associated with PUR. Younger males predominated (70%). The mean age at operation of the patients was 3.1years. Eventually 7/10 patients were able to void normally, with periods ranging from 6weeks to 8years. The remaining three patients are still unable to void more than 5years after UNC. A majority of the samples (6/10) were suspected to have bowel and bladder dysfunction (BBD), but neurologically all were normal. PUR can occur as a potential complication following any type of UNC and is associated with the risk of significant morbidity, including permanent urinary retention. Patients and caregivers should be counseled accordingly.