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Valipour R, Narouie B, Dadpour M, Torabinavid P, Momeni H, Radpour N, Ahmadzade M, Rouientan H, Danesh H, Emami MA. Impacts of Bariatric Surgery on Improvement of Incontinence Among Obese Asian Women: A Prospective Study and Literature Review. Obes Surg 2024; 34:1425-1431. [PMID: 38517646 DOI: 10.1007/s11695-024-07172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Limited studies investigate bariatric surgery's role in improving UI status among Asians, specifically Middle Eastern Asian women. The aim of this study is to investigate the effect of bariatric surgery on the three most prevalent urine incontinence (UI).We also reviewed the current literature exploring the studies performed in Asian countries. MATERIALS AND METHODS A total of 77 women out of 200 who had UI and indications for bariatric surgery completed demographic information and the questionnaire (QUID) prior to surgery and 6 months after the surgery. For statistical analysis, the Mann-Whitney U test, Wilcoxon test, and Friedman test were utilized. We also performed a literature review with the aim of investigating studies performed in Asian countries. RESULTS Among the initial analysis of 200 participants, 50.5% reported UI symptoms before surgery. The average weight loss was 29 kg, with a standard deviation of 7 kg. The mean BMI dropped 11.2 kg/m2, and the standard deviation was 2.5 after weight loss. Post-surgery, significant reductions in UI scores were observed across all severity levels, with a notable 44% achieving complete symptom resolution, indicating a substantial decrease in urinary incontinence. Stress, urine incontinence, and mixed urine incontinence symptoms had improved in 75%, 71%, and 30% of women, respectively. Notably, age and gynecological history were identified as critical factors influencing the extent of UI improvement. CONCLUSION This study reveals significant improvements in urinary incontinence scores, with age and gynecological history playing pivotal roles in UI improvement.
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Affiliation(s)
- Reza Valipour
- Department of Urology, Tehran Medical Sciences Branch, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Mehdi Dadpour
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parham Torabinavid
- Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran
| | - Hamidreza Momeni
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negar Radpour
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadese Ahmadzade
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Rouientan
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hoseinali Danesh
- Department of Surgery, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Aref Emami
- Department of Surgery, Zahedan University of Medical Sciences, Zahedan, Iran
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Pires RDS, Pereira CWA, Favorito LA. Is the learning curve of the urology resident for conventional radical prostatectomy similar to that of staff initiating robot-assisted radical prostatectomy? Int Braz J Urol 2024; 50:335-345. [PMID: 38446904 DOI: 10.1590/s1677-5538.ibju.2024.9909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION The superiority of the functional results of robot-assisted radical prostatectomyis still controversial. Despite this, it is known that minimally invasive surgery obtains better results when analyzing blood loss, blood transfusion and length of stay, for example. Several studies have analyzed the impact of the resident physician's involvement on the results of urological surgeries. The simple learning curve for robot-assisted radical prostate surgery is estimated to be around 10 to 12 cases. Learning curve data for robotic surgeons is heterogeneous, making it difficult to analyze. Rare studies compare the results of a radical prostatectomy of an inexperienced surgeon starting his training in open surgery, with the results of the same surgeon, a few years later, starting training in robotic surgery. OBJECTIVE to analyze the results of open radical prostatectomy surgeries (ORP) performed by urology residents, comparing them to the results of robot-assisted radical prostatectomy (RARP), performed by these same surgeons, after completing their training in urology. MATERIALS AND METHODS a retrospective analysis of the cases of only 3 surgeons was performed. 50 patients underwent ORP (group A). The surgeons who operated on the ORP patients were in the 3rd and final year of the urology residency program and beginners in ORP surgery, but with at least 4 years of experience in open surgery. The same surgeons, already trained urologists, began their training in robotic surgery and performed 56 RARP surgeries (group B). For the comparative analysis, data were collected on age, number of lymph nodes removed, surgery time, hospitalization time, drain volume, drain permanence time, indwelling bladdercateter (IBC) permanence time, positive surgical margin, biochemical recurrence, risk classification (ISUP), intra and postoperative complications, urinary incontinence (UI) and erectile dysfunction (ED). The console used was the Da Vinci Si, from Intuitive®. For statistical analysis, the Shapiro-Wilk test verified that the data did not follow normality, the Levene test guaranteed homogeneity, and the Mann-Whitney test performed the comparative analysis of the quantitative data. For the analysis of qualitative data, the Chi-square test was used for nominal variables and the Mann-Whitney U test for ordinal variables. Additionally, the Friedman test analyzed whether there was an improvement in the perception of UI or ED over the months, for each group individually (without comparing them), and the post-hoc Durbin-Conover test, for the results with statistically significant difference. We used a p-value < 0.05, and the Jamovi® program (Version 2.0). RESULTS there was no statistically significant difference between the groups for age, number of lymph nodes removed, positive surgical margin, biochemical recurrence, risk classification and urinary incontinence. Additionally, we observed that the surgical time was longer in group B. On the other hand, the length of stay, drain volume, drain time, IBC time, complication rate and levels of erectile dysfunction in the third and sixth months were higher in group A, when compared to group B. We also observed that there was no evolutionary improvement in ED over the months in both groups, and that there was a perception of improvement in UI from the 1st to the 3rd month in group A, and from the 1st to the 6th month, and from the 3rd to the 12th month, in group B. CONCLUSION the learning curve of RARP is equivalent to the curve of ORP. In general, the results for the robotic group were better, however, the functional results were similar between the groups, with a slight tendency of advantage for the robotic arm.
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Affiliation(s)
| | | | - Luciano Alves Favorito
- Unidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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Chow PM, Agrawal-Patel S, Wood H, Angermeier K. Prior male sling does not affect outcomes of artificial urinary sphincter. BJU Int 2024; 133:564-569. [PMID: 38243854 DOI: 10.1111/bju.16282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To investigate the outcomes of artificial urinary sphincter (AUS) placement in patients with post-prostatectomy urinary incontinence (PPUI) with or without a prior male sling. PATIENTS AND METHODS We performed a retrospective chart review of patients who underwent AUS for PPUI from 2007 to 2022. The primary endpoint was to determine the proportion of patients who achieved social continence, defined as self-reported use of 0-1 pad/day. The secondary endpoints were device failure rates and device failure-free survival. RESULTS The analysis included 210 patients, with 30 (14.3%) having had prior slings and 180 (85.7%) without prior slings. After AUS insertion, 80.0% of patients with prior slings and 76.7% of those without prior slings achieved continence (0-1 pad/day). There were six (20.0%) and 53 (29.4%) device failures in patients with and without prior slings, respectively. The median device failure-free survival was not reached in patients with prior slings and was 8.9 years in patients without prior slings (P = 0.048). Limitations include retrospective nature and small sample size. CONCLUSIONS The efficacy and safety of AUS in patients with prior slings are similar to those without. Prior sling is associated with a longer device failure-free survival. AUS remains a viable option in patients who have persistent PPI after prior slings.
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Affiliation(s)
- Po-Ming Chow
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shree Agrawal-Patel
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hadley Wood
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kenneth Angermeier
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Qin N, Romine JF, Visser J. Placement of an artificial urethral sphincter for treatment of passive urinary incontinence after inadvertent prostatectomy and balloon dilation treatment for stricture formation in a 5-month-old dog. J Am Vet Med Assoc 2024; 262:1-5. [PMID: 38295515 DOI: 10.2460/javma.23.11.0634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Describe the management of incontinence with several therapies, culminating with the apparently successful treatment utilizing artificial sphincter placement following an inadvertent prostatectomy. ANIMAL 5-month-old 7.5-kg male neutered Miniature Schnauzer. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES The patient was referred for dysuria and persistent stranguria following an iatrogenic total prostatectomy and urethrectomy. An extra pelvic urethral anastomosis was performed, followed by hospitalization for 2 weeks with a urinary catheter. The patient was further investigated for persistent stranguria, and a contrast urethrogram revealed a urethral stricture at the anastomosis site, which was treated with fluoroscopic balloon dilation. The stranguria resolved, but an acute nocturnal grade 3 passive urinary incontinence occurred, which was nonresponsive to medical management of phenylpropanolamine hydrochloride and estriol. An artificial urethral sphincter was placed, leading to continence after 5 top-ups to a total volume of 0.9 mL. The patient remained continent for 5.5 weeks before abrupt incontinence recurred, which was resolved by another 0.1-mL top-up. No further signs of incontinence occurred in the 11 months following. TREATMENT AND OUTCOME The placement of an artificial urethral sphincter successfully managed urinary incontinence in this patient. Continence was achieved with no significant complications other than a transient loss of continence. Long-term follow-up 14 months after sphincter placement revealed that the patient had remained continent since the final sphincter top-up. The owner reported a significant improvement in the patient's quality of life following successful incontinence management. CLINICAL RELEVANCE This case highlighted the benefits of placing an artificial urethral sphincter in managing urinary incontinence after select cases of prostatectomy in dogs that are unresponsive to medical management.
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Affiliation(s)
- Nancy Qin
- 1Department of Surgery, Animal Referral Centre, Auckland, New Zealand
| | - Jessica F Romine
- 2Department of Medicine, Animal Referral Centre, Auckland, New Zealand
| | - Judith Visser
- 1Department of Surgery, Animal Referral Centre, Auckland, New Zealand
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Kim CK. Proposed MRI-based membranous urethral length measurement standardization: a step to pave the way for clinical implementation? Eur Radiol 2024; 34:2619-2620. [PMID: 37740087 DOI: 10.1007/s00330-023-10246-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
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Barachisio Lisboa RB, Faber MDA, Pereira GMV, de Castro EB, Camargo ACM, Juliato CRT, Brito LGO. Transobturator Versus Minisling for Urinary Incontinence: A Randomized Controlled Trial. Urogynecology (Phila) 2024; 30:443-451. [PMID: 37737831 DOI: 10.1097/spv.0000000000001415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
IMPORTANCE The comparison between single-incision slings (SISs) and midurethral slings has been documented in the literature, but results vary according to the SIS device. OBJECTIVES The purpose of this study is to assess whether SIS (Solyx) is noninferior to transobturator (TOT) (Obtryx) sling for treating women with confirmed stress-predominant urinary incontinence. STUDY DESIGN A prospective, parallel, nonblinded, multicenter, noninferiority, randomized controlled study with 114 patients were randomized and followed 6 and 12 months after surgery. Interventions were midurethral TOT sling (Obtryx-halo; n = 58) or SIS (Solyx; n = 56). The primary outcome was improvement in the Patient Global Impression of Improvement (PGI-I). Secondary outcomes were the Kings Health Questionnaire (KHQ) instruments after treatment, subjective improvement, and surgical outcomes. RESULTS Both groups were homogeneous ( P = NS) regarding sociodemographic and clinical variables. There was improvement in the PGI-I after 6 ( P = 0.001) and 12 months ( P = 0.001) of treatment for women who underwent TOT sling. After 6 months, KHQ scores improved in the TOT group for the following domains: role limitations ( P = 0.026) and physical limitations ( P = 0.006). After 12 months, the TOT group presented better KHQ scores that were statistically significant from the SIS group in incontinence impact ( P = 0.012), physical limitations ( P = 0.001), and severity measures ( P = 0.017). Moreover, the TOT group presented higher subjective improvement after 6 months ( P = 0.006) than the SIS group. Mesh erosion was higher in the SIS group ( P = 0.006). Reoperations were not statistically different between groups. CONCLUSION There were higher scores in the PGI-I score and higher subjective improvement for the TOT sling after 6 and 12 months of treatment when compared with the SIS group.
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Affiliation(s)
| | - Marcelo de Arruda Faber
- From the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (SP), Brazil
| | | | - Edilson Benedito de Castro
- From the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (SP), Brazil
| | | | - Cássia Raquel Teatin Juliato
- From the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (SP), Brazil
| | - Luiz Gustavo Oliveira Brito
- From the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (SP), Brazil
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Bernard S, Evans H, Hoy NY, Suderman K, Cameron B, Sexsmith J, Kinnaird A, Rourke K, Dean L, Pituskin E, Usmani N, Tandon P, McNeely ML. Control4Life: A randomized controlled trial protocol examining the feasibility and efficacy of a combined pelvic health rehabilitation and exercise fitness program for individuals undergoing prostatectomy. Contemp Clin Trials 2024; 139:107482. [PMID: 38431130 DOI: 10.1016/j.cct.2024.107482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Urinary incontinence (UI), erectile dysfunction and cardiometabolic conditions are common after prostatectomy for prostate cancer (PCa). Although physical activity could improve overall survival and quality of survivorship, fear of UI can restrict participation in exercise. Individuals with PCa could benefit from therapeutic exercise programming to support continence recovery and cardiometabolic health. AIM The main objective of this study is to determine the feasibility and the effects of a combined pelvic health rehabilitation and exercise fitness program on UI after prostatectomy. The combined exercise program will be delivered both in-person and virtually. METHODS This study follows a modified Zelen, two-arm parallel randomized controlled trial design. A total of 106 individuals with PCa will be recruited before prostatectomy surgery. Participants will be randomized between two groups: one receiving usual care and one receiving a combined exercise fitness and intensive pelvic floor muscle training program. Exercise programming will begin 6-8 weeks after prostatectomy and will last 12 weeks. Outcomes include: the 24-h pad test (primary outcome for UI); physical fitness, metabolic indicators, and patient-reported outcomes on erectile function, self-efficacy, severity of cancer symptoms and quality of life. Important timepoints for assessments include before surgery (T0), after surgery (T1), after intervention (T3) and at one-year after surgery (T4). CONCLUSION This study will inform the feasibility of offering comprehensive exercise programming that has the potential to positively impact urinary continence, erectile function and cardiometabolic health of individuals undergoing prostatectomy for prostate cancer. CLINICALTRIALS REGISTRATION NUMBER NCT06072911.
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Affiliation(s)
- Stéphanie Bernard
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Québec, Canada
| | - Howard Evans
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Nathan Y Hoy
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kirsten Suderman
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce Cameron
- Patient-partner, Cancer Rehabilitation Clinic, Edmonton, Alberta, Canada
| | - John Sexsmith
- Patient-partner, Cancer Rehabilitation Clinic, Edmonton, Alberta, Canada
| | - Adam Kinnaird
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Keith Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Lucas Dean
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Edith Pituskin
- Cancer Care Alberta, Alberta Health Services, Edmonton, Alberta, Canada; Faculty of Nursing, University of Alberta, Edmonton; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Nawaid Usmani
- Cross Cancer Institute, Division of Radiation Oncology, Edmonton, Alberta, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Puneeta Tandon
- Department of Medicine, Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| | - Margaret L McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada; Cancer Care Alberta, Alberta Health Services, Edmonton, Alberta, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
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Sterling J, Simhan J, Flynn BJ, Rusilko P, França WA, Ramirez EA, Angulo JC, Martins FE, Patel HV, Higgins M, Swerdloff D, Nikolavsky D. Multi-Institutional Outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Patients With Postprostatectomy, Postradiation Anastomotic Stenosis. J Urol 2024; 211:596-604. [PMID: 38275201 DOI: 10.1097/ju.0000000000003848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE The treatment of urethral stenosis after a combination of prostatectomy and radiation therapy for prostate cancer is understudied. We evaluate the clinical and patient-related outcomes after dorsal onlay buccal mucosal graft urethroplasty (D-BMGU) in men who underwent prostatectomy and radiation therapy. MATERIALS AND METHODS A multi-institutional, retrospective review of men with vesicourethral anastomotic stenosis or bulbomembranous urethral stricture disease after radical prostatectomy and radiation therapy from 8 institutions between 2013 to 2021 was performed. The primary outcomes were stenosis recurrence and development of de novo stress urinary incontinence. Secondary outcomes were surgical complications, changes in voiding, and patient-reported satisfaction. RESULTS Forty-five men were treated with D-BMGU for stenosis following prostatectomy and radiation. There was a total of 7 recurrences. Median follow-up in patients without recurrence was 21 months (IQR 12-24). There were no incidents of de novo incontinence, 28 patients were incontinent pre- and postoperatively, and of the 6 patients managed with suprapubic catheter preoperatively, 4 were continent after repair. Following repair, men had significant improvement in postvoid residual, uroflow, International Prostate Symptom Score, and International Prostate Symptom Score quality-of-life domain. Overall satisfaction was +2 or better in 86.6% of men on the Global Response Assessment. CONCLUSIONS D-BMGU is a safe, feasible, and effective technique in patients with urethral stenosis after a combination of prostatectomy and radiation therapy. Although our findings suggest this technique may result in lower rates of de novo urinary incontinence compared to conventional urethral transection and excision techniques, head-to-head comparisons are needed.
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Affiliation(s)
- Joshua Sterling
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
- Department of Urology, SUNY Upstate Medical University, Syracuse, New York
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Brian J Flynn
- Division of Urology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul Rusilko
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Wagner A França
- Department of Urology, Hospital do Servidor Público Estadual de São Paulo, Sao Paulo, Brazil
| | | | - Javier C Angulo
- Department of Medical Clinic, Universidad Europea de Madrid, Madrid, Spain
| | - Francisco E Martins
- Department of Urology, University of Lisbon, Hospital of Santa Maria, Lisbon, Portugal
| | - Hiren V Patel
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Margaret Higgins
- Division of Urology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Swerdloff
- Department of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Dmitriy Nikolavsky
- Department of Urology, SUNY Upstate Medical University, Syracuse, New York
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Gauhar V, Castellani D, Herrmann TRW, Gökce MI, Fong KY, Gadzhiev N, Malkhasyan V, Pirola GM, Naselli A, Mahajan A, Maheshwari PN, Biligere S, Tursunkulov AN, Nasirov F, Petov V, Dellabella M, Lim EJ, Socarrás MR, Zawadzki M, Cormio L, Busetto GM, Teoh JYC, Somani BK, Enikeev D, Sofer M, Gómez Sancha F. Incidence of complications and urinary incontinence following endoscopic enucleation of the prostate in men with a prostate volume of 80 ml and above: results from a multicenter, real-world experience of 2512 patients. World J Urol 2024; 42:180. [PMID: 38507108 PMCID: PMC10954849 DOI: 10.1007/s00345-024-04886-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/12/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE To evaluate complications and urinary incontinence (UI) after endoscopic enucleation of the prostate (EEP) stratified by prostate volume (PV). METHODS We retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with different energy sources in 14 centers (January 2019-January 2023). INCLUSION CRITERIA prostate volume ≥ 80 ml. EXCLUSION CRITERIA prostate cancer, previous prostate/urethral surgery, pelvic radiotherapy. PRIMARY OUTCOME complication rate. SECONDARY OUTCOMES incidence of and factors affecting postoperative UI. Patients were divided into 3 groups. Group 1: PV = 80-100 ml; Group 2 PV = 101-200 ml; Group 3 PV > 200 ml. Multivariable logistic regression analysis was performed to evaluate independent predictors of overall incontinence. RESULTS There were 486 patients in Group 1, 1830 in Group 2, and 196 in Group 3. The most commonly used energy was high-power Holmium laser followed by Thulium fiber laser in all groups. Enucleation, morcellation, and total surgical time were significantly longer in Group 2. There was no significant difference in overall 30-day complications and readmission rates. Incontinence incidence was similar (12.1% in Group 1 vs. 13.2% in Group 2 vs. 11.7% in Group 3, p = 0.72). The rate of stress and mixed incontinence was higher in Group 1. Multivariable regression analysis showed that age (OR 1.019 95% CI 1.003-1.035) was the only factor significantly associated with higher odds of incontinence. CONCLUSIONS PV has no influence on complication and UI rates following EEP. Age is risk factor of postoperative UI.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, IRCCS INRCA, Ancona, Italy.
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy.
| | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Mehmet Ilker Gökce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
| | - Vigen Malkhasyan
- Urology Unit, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Giacomo Maria Pirola
- Urology Unit, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy
| | - Angelo Naselli
- Urology Unit, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy
| | - Abhay Mahajan
- Sai Urology Hospital and Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India
| | | | - Sarvajit Biligere
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | | | - Furkat Nasirov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Vladislav Petov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | | | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | | | | | - Luigi Cormio
- Andrology and Urology Unit, Bonomo Teaching Hospital, Andria, Italy
- Department of Urology, Ospedali Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Gian Maria Busetto
- Department of Urology, Ospedali Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Urology Department of Urology, Rabin Medical Center, Petah Tikva, Israel
| | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Tadesse S, Mekete D, Negese S, Belachew DZ, Namara GT. Urinary incontinence following successful closure of obstetric vesicovaginal fistula repair in Southern Ethiopia. BMC Womens Health 2024; 24:164. [PMID: 38454367 PMCID: PMC10919033 DOI: 10.1186/s12905-024-02979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/17/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Urinary incontinence (UI) after successful closure of obstetric vesicovaginal fistula (VVF) repair is a widely recognized public health problem. However, there is insufficient research evaluating the factors associated with UI after successful obstetric VVF repair in Ethiopia. OBJECTIVES The main aim of this study was to assess the magnitude and associated factors of UI following the successful closure of obstetric VVF repair at the Yirgalem Hamlin Fistula Center in the Sidama region of southern Ethiopia. METHODS A retrospective cross-sectional analytical study was performed on patients who underwent obstetric VVF repair at the Yirgalem Hamlin Fistula Center between 2016 and 2020. The data were collected from September to October 2021. EPI Data Version 3.1 and SPSS Version 25.0 were used for data entry and analysis. A multivariable binary logistic regression model was used for all variables significant in the bivariate binary logistic analysis to determine the association between the independent variables and outcome variables. The data are presented in tables and figures. Variables with a p-value < 0.05 were considered to be statistically associated with the study outcome. RESULTS In total, 499 study subjects were included. The magnitude of UI after successful closure of obstetric VVF repair was 23.25%. A Goh type 4 fistula (AOR = 4.289; 95% CI 1.431, 12.852), a fistula size > 3 cm (AOR = 8.855; 95% CI 4.786, 16.382), a partially damaged urethra (AOR = 2.810; 95% CI 1.441, 5.479), and a completely destroyed urethra (AOR = 5.829; 95% CI 2.094, 16.228) were found to be significantly associated factors with the outcome variable. CONCLUSIONS Nearly one in four patients who had successful closure of obstetric VVF repair at the Yirgalem Hamlin fistula center had UI, which is above the WHO recommendations. The presence of a Goh type 4 fistula, large fistula size, and damaged urethral status significantly affect the presence of UI. Therefore, interventions are necessary to prevent and manage UI among patients who underwent obstetric VVF repair and had a closed fistula.
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Affiliation(s)
- Shimelis Tadesse
- Department of Midwifery, College of Health Science, Mattu University, P. O. Box 318, Mattu, Ethiopia.
| | - Desta Mekete
- Department of Midwifery, College of Health Science, Mattu University, P. O. Box 318, Mattu, Ethiopia
| | - Shambel Negese
- Department of Midwifery, College of Health Science, Mattu University, P. O. Box 318, Mattu, Ethiopia
| | - Dereje Zeleke Belachew
- Department of Midwifery, College of Medicine and Health Science, Mizan Tepi University, Mizan Tefere, Ethiopia
| | - Galana Takele Namara
- Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
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Ripa F, Enikeev D, Talyshinskii A, Juliebø-Jones P, Tzelves L, Kallidonis P, Somani B. Should endoscopic laser excision be offered as the first-line management for patients with eroded mesh? Outcomes of a systematic review of literature. Curr Opin Urol 2024; 34:135-144. [PMID: 37933676 DOI: 10.1097/mou.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE OF REVIEW Mesh erosions following previous synthetic sling/mesh surgery for stress urinary incontinence (SUI) have become increasingly common. This systematic review provides evidence for the role of laser excision as a first-line management in patients with eroded mesh. RECENT FINDINGS Fourteen articles (173 patients) were included for the final review. Among these, 138 patients (79.8%) were submitted to trans-urethral laser excision of eroded urethral/bladder mesh over a median time to presentation of 36.6 months. Over a median follow-up of 23.6 months, 88 (63.7%) reported a complete resolution, 32 (23.2%) reported persistence or recurrence of SUI and 17 (12.3%) presented with recurrent mesh erosion. The success rate after a single endoscopic procedure was 66.5, vs. 93.5% after additional endoscopic procedures, with only 9 (6.6%) requiring open surgical excision. Overall, there were seven (5.1%) postoperative complications including two urethrovaginal fistulas, two UTIs and haematuria each, and one case of urethral diverticulum. SUMMARY Laser excision of eroded mid-urethral slings into either the bladder or urethra is a challenging complication of minimally invasive incontinence surgery. Laser excision was able to achieve a good success rate with single or staged endoscopic procedure with a low risk of complication. It represents a valid first treatment option, although patients should be managed in mesh referral centres in collaboration with uro-gynaecology teams.
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Affiliation(s)
- Francesco Ripa
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Urology Department, Rabin Medical Center, Petah Tikva, Israel
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Ali Talyshinskii
- Department of Urology, Astana Medical University, Astana, Kazakhstan
| | - Patrick Juliebø-Jones
- Department of Urology Haukeland and Department of Clinical Medicine, University Hospital, Bergen, Norway
| | - Lazaros Tzelves
- Department of Urology, University College of London Hospital, London, UK
| | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Nguyen K, McCormack L, Deans R, Nesbitt-Hawes E, Knapman B, Li F, Lim C, Abbott JA. A Prospective Study of Bladder Function Following Endometriosis Surgery With Up to Eight years Follow-up. J Minim Invasive Gynecol 2024; 31:205-212.e4. [PMID: 38042477 DOI: 10.1016/j.jmig.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
STUDY OBJECTIVE To assess long-term urinary function for women having laparoscopic surgery for endometriosis. DESIGN Institutional Review Board-approved nested cohort study within a larger randomized controlled trial assessing urinary function following any benign laparoscopy for gynecological presentations. SETTING Two tertiary-level university-affiliated hospitals. PATIENTS Women with histologically confirmed endometriosis within the randomized controlled trial between April 2012 and November 2019, where baseline urinary function was determined. INTERVENTIONS Women with histologically confirmed endometriosis were contacted between February and October 2020, and urinary function was re-assessed. MEASUREMENTS AND MAIN RESULTS Urinary function was assessed using validated questionnaires across the domains of filling, voiding, incontinence, and quality of life determined distant from surgery. Higher scores correlated with a greater severity of symptoms. From 518/711 (72.9%) women with histologically confirmed endometriosis, 289/518 (55.8%) consented to the nested study. At a mean of 50 months (range 12-103 months) post-operatively, 35 participants (12.1%) had sought treatment for bladder symptoms, and 81 participants (28.0%) reported at least one urinary tract infection since their index surgery. There was a significant worsening of symptoms for filling, voiding, incontinence, and quality of life pre-operative to post-operatively (2.27 vs 3.32, 0.93 vs 2.02, 1.06 vs 2.32, 0.83 vs 2.13 respectively, p <.001). There was no statistically significant difference in urinary questionnaire scores in participants with and without uterovesical endometriosis. There was no statistically significant difference in any parameter when comparing any revised American Society of Reproductive Medicine (rASM) stage of endometriosis. Participants who had post-operative urinary retention reported a higher mean voiding score than those who did not (3.24 vs 1.94, p = .017), while participants with post-operative urinary tract infection reported a higher mean frequency score than those who did not (5.17 vs 3.24, p = .016). CONCLUSION This study suggests a decline in urinary function over time following laparoscopic surgery for endometriosis that is not dependent on the severity or location of the disease.
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Affiliation(s)
- Kimberly Nguyen
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)..
| | - Lalla McCormack
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Rebecca Deans
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Erin Nesbitt-Hawes
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Blake Knapman
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Fiona Li
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Claire Lim
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Jason A Abbott
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
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Wang Q, Lin H, Wu N, Li Y, Zhao R, Xu Y, Lin C. Outcomes of a novel modified total colpocleisis for advanced pelvic organ prolapse in elderly women and its efficacy on lower urinary tract symptoms. Int J Gynaecol Obstet 2024; 164:1132-1140. [PMID: 37776064 DOI: 10.1002/ijgo.15161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of modified total colpocleisis for advanced pelvic organ prolapse (POP) in elderly women and to assess the improvement in lower urinary tract symptoms (LUTS) of the patients. METHODS An observational cohort study was conducted, including 105 POP patients who underwent modified total colpocleisis between April 2020 and December 2022. The study analyzed the patients' demographic characteristics, perioperative outcomes, and follow-up outcomes, including complications, remission of LUTS, satisfaction rates, and regret rates. Confirming the safety, durability, and patient satisfaction of modified total colpocleisis. RESULTS Most patients (95/105, 90.5%) had more than one comorbidity. Eighty-six (81.9%) had a concomitant hysterectomy, the average operative time was 112.78 ± 34.92 min, with a median estimated bleeding of 50 mL (10-300 mL). Perioperative changes in hemoglobin and hematocrit were 11.64 ± 10.03 g/L and 3.87% ± 3.05%, respectively. Urinary retention was the most common complication (10/105, 9.5%). With a median follow up of 16 months (3-35 months), 101 patients (96.2%) reported satisfaction with the results of the procedure, with none reporting regret. Both subjective and anatomical recurrence rates were quite low (2.9% and 5.7%, respectively). Twenty-three (21.9%) had de novo urinary incontinence, and the remaining LUTS such as frequent, urgent, hesitation, and difficulty emptying were significantly improved (P < 0.05). CONCLUSION Modified total colpocleisis is an effective treatment option for elderly women with severe POP. This procedure can significantly improve several LUTS, and most de novo incontinence is mild and has a limited impact on patients' quality of life.
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Affiliation(s)
- Qi Wang
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Hongbiao Lin
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Nengxiu Wu
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Ying Li
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Rong Zhao
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Ying Xu
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Chaoqin Lin
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
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Lo TS, Harun F, Chua S, Shen YH, Tan YL, Hsieh WC. Polypropylene anterior-apical single-incision UPHOLD-LITE mesh surgery in women with severe pelvic organ prolapse: Outcome at 53 months follow up. J Formos Med Assoc 2024; 123:331-339. [PMID: 37996329 DOI: 10.1016/j.jfma.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 10/07/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND AND PURPOSE We present this current study to complement with mesh inlays plausible benefits (UPHOLD-LITE System) on available long-term study amidst FDA's concern on mesh complications. This study aims to assess the medium-term outcomes of UPHOLD-LITE system for treatment of advanced pelvic organ prolapse (POP) and its complications, and lower urinary tract symptoms. METHODS This is a retrospective case series of 53 months follow-up of 123 consecutive patients who underwent UPHOLD-LITE system. Objective outcome measures the anatomical correction of prolapse with POP-Q ≤ Stage 1. Subjective outcome was patient's feedback to questions 2 and 3 of POPDI-6. Secondary outcome measures the quality of life, presence of lower urinary tract symptoms and complications. Quality of life is assessed by validated questionnaires on Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire 7 (IIQ-7), Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12 (PISQ-12) at 1 and 3 years post-operatively. RESULTS Objective outcome at 1 and 3 years was at 96.7 % and 95.4 % respectively. The subjective cure was 95.1 % and 91.6 %. Five-year cumulative cure rate maintained at 87.2 %. Secondary outcomes observed improvement on UDI-6, IIQ-7, POPDI-6 and PISQ-12 postoperatively. Bladder outlet obstruction improved while de novo urodynamic stress incontinence (USI) increased slightly post surgically. Mesh erosion rate was 0.8 %. CONCLUSION The UPHOLD-LITE system demonstrated good medium term anatomical correction of apical and anterior prolapse, with good subjective cure and improved quality of life. Whilst complication rate was low, slight increase in de novo USI was observed.
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Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Medical Center, Taipei, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC.
| | - Fazlin Harun
- Department of Obstetrics and Gynecology, Women and Children Hospital (Hospital Tunku Azizah), Kuala Lumpur, Malaysia
| | - Sandy Chua
- Department of Obstetrics and Gynecology, Cebu Institute of Medicine-Cebu Velez General Hospital, Cebu City, Philippines
| | - Yu-Hua Shen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC
| | - Yiap Loong Tan
- Department of Obstetrics and Gynecology, Kuching Specialist Hospital, KPJ Healthcare Group, Sarawak, Malaysia
| | - Wu-Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC
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15
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Meng LF, Jing JB, Wang M, Liu XD, Hou HM, Zhou YH, Zhang Y, Wang J, Wang J, Wang L, Lyu YY, Wu JY, Zhang YG, Wang XM, Wang JW. [Application of modified urethral separation method in artificial urethral sphincter implantation and its influence on intraoperative urethral pressure profilometry]. Zhonghua Yi Xue Za Zhi 2024; 104:427-432. [PMID: 38326054 DOI: 10.3760/cma.j.cn112137-20230926-00559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Objective: To explore the application of modified urethral separation method in artificial urethral sphincter (AUS) implantation in patients with stress urinary incontinence (SUI), and its influence on the results of urethral pressure profilometry. Methods: A prospective collection of clinical data was conducted on 25 patients with stress urinary incontinence who underwent modified urethral separation method in AUS implantation and underwent urethral pressure profilometry in Beijing Hospital, Beijing Jishuitan Hospital Affiliated to Capital Medical University and the Second Hospital Affiliated to Tianjin Medical University from March 2019 to June 2023. The improved urethral separation method was to borrow part of the white membrane tissue of the cavernous body while freeing the dorsal side of the cavernous body of the urethra. The circumference of the urethra, sleeve size, and urethral pressure were recorded, the patient's autonomous urinary control before and after surgery and the changes of the international consultation on incontinence questionnaire-short form (ICI-Q-SF) score, incontinence quality of life questionnaire (I-QoL) score, urinary frequency score, nocturia score were compared. Follow-up was conducted in the clinic or by telephone at 1, 3, 6, and 12 months after activation of the device, and once a year thereafter. Local skin status and urine control were assessed, residual urine volume was measured by ultrasound and subjective score scale was completed. Results: All patients were male, aged 27-85 (65.8±15.7) years old. The circumference of the cuff used in this study was 4.0 cm in 4 patients (16.0%), 4.5 cm in 16 patients (64.0%), 5.0 cm in 4 patients (16.0%), and 5.5 cm in 1 patient (4.0%). Among them, the urethral circumference matched the cuff size in 14 cases (56.0%), the urethral circumference was smaller than the cuff size in 4 cases (16.0%), and the urethral circumference was larger than the cuff size in 7 cases (28.0%). Preoperative urodynamic examination showed that the maximum urethral pressure (MUP) was (78.0±25.9) cmH2O, (1 cmH2O=0.098 kPa) and the maximum urethral closure pressure (MUCP) was (53.4±26.6) cmH2O. The MUP of AUS device in the inactivated state was (88.0±26.5) cmH2O, which was not significantly higher than that before operation (P>0.05). The MUCP was (68.2±24.5) cmH2O, which was significantly higher than that before operation (P<0.05). The MUP and MUCP of the AUS device in the activated state were (146.6±25.2) cmH2O and (123.0±28.3) cmH2O, which were significantly higher than those before surgery and in the inactivated state (both P<0.001). All patients in the group reached the social urinary control standards at the first month of device activation. During a follow-up period of 2-50 months, 22 patients (88.0%) used the initial AUS device and all met social urinary control standards. The AUS device was replaced in 1 case. One patient died of cerebrovascular accident. One patient removed the device due to complications. The number of pads [M (Q1, Q3)] used in 25 patients before and after operation was 4.5 (3.0, 6.5) and 1 (0, 1) respectively, with statistically significant differences (P<0.001). ICI-Q-SF score, I-QoL score, urinary frequency score and nocturia score of 25 patients were significantly improved after surgery (all P<0.05). The incidence of postoperative complications was 20.0% (5/25), including 2 cases of painless hematuria, 1 case of infection, 1 case of urethral erosion, and 1 case of dysuria. Except for one patient who experienced urethral erosion and had his sleeve removed, the remaining four patients regained social urination control with active support treatment, and no symptoms recurred until the last follow-up. Conclusion: The modified urethral separation method has no significant effect on urethral pressure in patients with SUI, and can increase the volume of peri-urethral tissue in the cuff, thereby reducing the risk of intraoperative urethral injury and the incidence of postoperative urethral erosion.
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Affiliation(s)
- L F Meng
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J B Jing
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - M Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - X D Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - H M Hou
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Y H Zhou
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Y Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - L Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Y Y Lyu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J Y Wu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Y G Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - X M Wang
- Department of Urology, South China Hospital Affiliated to Shenzhen University, Shenzhen 518111, China
| | - J W Wang
- Department of Urology, Beijing Jishuitan Hospital Affiliated to Capital Medical University, Beijing 100096, China
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Kominsky HD, Awad MA, Farhi J, Gahan JC, Cadeddu JA. Retzius-sparing vs. posterior urethral suspension: similar early-phase post-robotic radical prostatectomy continence outcomes. J Robot Surg 2024; 18:64. [PMID: 38315436 DOI: 10.1007/s11701-023-01754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/07/2023] [Indexed: 02/07/2024]
Abstract
Stress urinary incontinence (SUI) is a risk of robotic-assisted radical prostatectomy (RP) which can be a frustrating problem for both surgeons and patients. We aim to compare short-term continence outcomes between patients undergoing Retzius Sparing RP (RS-RP) and those undergoing standard RP with the inclusion of a PUS suture technique and suprapubic tube (PUS-RP). A retrospective review of 105 consecutive patients who underwent RP was performed, comparing patients who underwent RS-RP and PUS-RP. Our main outcome was pad usage as a surrogate for SUI. Patients were evaluated 4 weeks following RP and again at approximately 3 months. Continence was defined as no pad usage or up to one safety pad per day. Risk factors associated with not being continent were identified using univariate and multivariate analyses. In our cohort, 52 patients underwent RS-RP and 53 patients underwent PUS-RP. The two groups had similar patient demographics. Although not statistically significant, there was a higher rate of a positive surgical margin in the RS-RP compared to PUS-RP (25% vs 15%, p = 0.204). At one month follow-up for PUS-RP and RS-RP, there was no significant difference in the frequency of continent men (69.2% vs. 76.9%, p = 0.302). At 3-month follow-up for the two groups of patients, again, there was no significant difference in the frequency of continence for PUS-RP and RS-RP (86.2% vs 88%, p = 0.824). Patients who underwent RS-RP had similar rates of continence to those patients undergoing PUS-RP in the short-term post-operative period.
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Affiliation(s)
- Hal D Kominsky
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA
| | - Mohannad A Awad
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA
- Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Jacques Farhi
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA
| | - Jeffrey C Gahan
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA.
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Kubin N, Shakhaliev R, Labetov I, Kovalev G, Shulgin A, Nuriev A, Shkarupa D. Tunable tension tape versus transobturator tape in treatment of stress urinary incontinence in women: Randomized controlled trial. Neurourol Urodyn 2024; 43:311-319. [PMID: 38048085 DOI: 10.1002/nau.25351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/12/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION The synthetic mid-urethral slings are currently considered to be the most widely used technique for the surgical treatment of stress urinary incontinence (SUI). The most challenging aspect of the existing approaches is to achieve the optimal tension of the sling which treatment results are directly dependent on. To solve this problem, sling systems enabling an adjustment of the tension in the early postoperative period were created. A comparative study of the effectiveness and safety of such a system and a nonadjustable sling seems to be a relevant task. MATERIALS AND METHODS A double-blind, randomized, multicenter trial enrolled 320 patients with a mean age of 55.2 ± 11.2 years and confirmed SUI. Patients were randomized into two groups: the first group underwent a standard synthetic suburethral sling (transobturator tape [TOT]) procedure and the second group underwent a tunable tension tape sling (TTT) procedure. All patients underwent stress test, uroflowmetry and ultrasound scan to determine the postvoid residual volume. Urinary Distress Inventory Short Form 6, International Consultation on Incontinence Questionnaire-Short Form, Pelvic Organ Prolapse Incontinence Sexual Questionnaire 12 questionnaires were used to assess subjective efficacy. RESULTS Enhancement of prosthesis tension in the second group was required in 44 (28%) patients. Due to the possibility of tightening of the sling in the early postoperative period, the operation was effective in 143 (89%) patients in the adjustable sling group and in 109 (68%) patients in Group 1, p < 0.001. Loosening of the sling tension was performed in 25 (16%) patients in Group 2. The signs of obstructive voiding symptoms at the follow-up time of 36 months remained in Group 1 in 13 (8%) patients. Subjective satisfaction with treatment on the PGI-I scale was higher in Group 2: 100 (62%) versus 132 (82%), p < 0.001. CONCLUSION A synthetic mid-urethral TTT is superior to a standard nonadjustable sling in long-term effectiveness and safety.
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Affiliation(s)
- Nikita Kubin
- Urology Department, Saint-Petersburg State University Hospital, St. Petersburg, Russia
| | - Rustam Shakhaliev
- Urology Department, Saint-Petersburg State University Hospital, St. Petersburg, Russia
| | - Ivan Labetov
- Urology Department, Saint-Petersburg State University Hospital, St. Petersburg, Russia
| | - Gleb Kovalev
- Urology Department, Saint-Petersburg State University Hospital, St. Petersburg, Russia
| | - Andrei Shulgin
- Urology Department, Saint-Petersburg State University Hospital, St. Petersburg, Russia
| | - Alexey Nuriev
- Urology Department, Regional Clinical Hospital 3, Chelyabinsk, Russia
| | - Dmitry Shkarupa
- Urology Department, Saint-Petersburg State University Hospital, St. Petersburg, Russia
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18
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Hussain SNF, Phillips LAF, Godse A, Lall A, Gopal M. Ureteric Clipping for the Treatment of Urinary Incontinence in Girls With Ectopic Ureters: Predicting Who Is Going to Dilate and Does It Matter? Urology 2024; 184:199-205. [PMID: 37952605 DOI: 10.1016/j.urology.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To assess the effectiveness and midterm follow-up of laparoscopic upper pole ectopic ureteral clipping to treat urinary incontinence in girls with duplex kidneys and non/poorly functioning upper pole moieties. To see if preoperative characteristics increased the likelihood of significant postoperative dilatation and whether this dilation has clinical significance. METHODS A database review identified children who had undergone ureteric clipping at our institution. Patient details assessed included: age at presentation, age at procedure, significant past medical history, preoperative investigations, operative time, length of stay, postoperative symptoms, postoperative renal tract ultrasound findings and the need for subsequent intervention. RESULTS Six girls underwent clipping between March 2018 and May 2021. The mean age at presentation and surgery were 77months (39-186) and 86months (44-193), respectively. The mean operative time was 94 minutes (range 66-128 minutes). The median length of stay was 1 day (range 0-3days). All the girls were dry immediately after the procedure. During a mean follow-up of 51months (29-66) all children have remained symptom-free and required no further intervention. Two children have developed significant (>30 mm) but stable ureteric dilatation after clipping but have remained asymptomatic and therefore are continuing on conservative follow-up. Both these children had dilated ureters (>10 mm) preoperatively. CONCLUSION Ureteric clipping is quick, safe, and effective option in dealing with incontinence due to ectopic upper pole ureters in girls. Children with preoperative ureteric dilation seem to be at increased risk of postoperative dilation. However, as they remain asymptomatic, the clinical significance of this dilatation is unclear.
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Affiliation(s)
| | | | - Alok Godse
- Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Anupam Lall
- Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Milan Gopal
- Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
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19
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Blum KA, Mehr JP, Green TP, Macharia K, Kim D, Westney OL, Wang R. Complication rates in concurrent inflatable penile prosthesis and incontinence surgery: Comparing the penoscrotal versus perineal incision approach. Int J Impot Res 2024; 36:89-93. [PMID: 36357570 DOI: 10.1038/s41443-022-00628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022]
Abstract
The main objective of this study was to assess the IPP complication rates of patients undergoing placement via perineal incision versus more traditional penoscrotal approach in synchronous dual implantation. We identified 38 patients who underwent dual implantations of an IPP and AUS or urethral sling from 2011 to 2021 at a single tertiary center, 24 via perineal and 14 via penoscrotal incision. All IPP implants were done by a single surgeon. IPP postoperative complications were captured using the Clavien-Dindo classification at three separate time points, < 30 days, 30 days - 6 months, and > 6 months. The perineal group had two complications, IPP explantation due to rectourethral fistula (Grade III, > 6 months), and IPP explantation due to chronic genital pain (Grade III, > 6 months). The penoscrotal group had three complications, post-operative urinary retention requiring catheterization (Grade I, < 30 days), incision site infection (Grade I, < 30 days), and IPP explantation due to infection (Grade III, 30 days to < 6 months). There was no statistically significant difference in rate of patients with IPP complications between the two groups (p = 0.546) or in rate of IPP device malfunction (p = 0.264). These preliminary findings suggest that the single perineal incision is a viable surgical approach in synchronous dual implantation.
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Affiliation(s)
- Kyle A Blum
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Justin P Mehr
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Travis P Green
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Kirema Macharia
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Daniel Kim
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA
| | | | - Run Wang
- Department of Surgery, Division of Urology, University of Texas McGovern Medical School, Houston, TX, USA.
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA.
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20
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Ozawa Y, Aoki K, Koike S, Gozu S, Yokoyama T, Yamada M, Odagaki Y, Hisatome Y, Sakamoto H, Yoshioka K. Inguinal hernia leads to worse immediate urinary continence after robot-assisted radical prostatectomy. J Robot Surg 2024; 18:25. [PMID: 38217741 DOI: 10.1007/s11701-023-01780-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/10/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Patients with inguinal hernia (IH) may have voiding dysfunction and weak urethra-stabilizing periurethral fascial tissues, contributing to urinary incontinence. This study aimed to review the association between IH and urinary continence after robotic-assisted radical prostatectomy (RARP). METHODS This single-institution retrospective study included 251 consecutive cases of RARP between April 2019 and June 2022. Patients with concurrent IH or a history of adult IH repair were examined. The urine loss rate (ULR), defined as 24-h urine loss volume divided by the total urine volume immediately after urinary catheter removal (i.e., 6 or 7 postoperative days), was compared between the groups with (n = 33) and without IH (n = 214). Possible contributing factors for ULR were assessed, including age, body mass index (BMI), after benign prostatic hyperplasia surgery, prostate weight, and nerve-sparing. ULR was compared intergroup after propensity score matching countering selection biases. RESULTS Patients with IH were older (71.3 versus. 66.8 years, p < 0.01), had lower BMI (22.8 versus. 24.3, p < 0.01), and had higher ULR (14.5% versus. 5.1%, p < 0.01). In a multiple linear regression analysis (adjusted R2 = 0.084), IH (p < 0.01) was an independent contributing factor for ULR besides advancing age (p < 0.03). After propensity score matching adjusted for patient's age and nerve-sparing, patients with IH had higher ULR (14.1% versus. 5.7%, p < 0.03) as well. CONCLUSIONS This study first reported that IH may be one of the risk factors of urinary incontinence after RARP.
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Affiliation(s)
- Yu Ozawa
- Department of Urology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashi, Tokyo, 174-0051, Japan.
| | - Keisuke Aoki
- Department of Urology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashi, Tokyo, 174-0051, Japan
| | - Shin Koike
- Department of Urology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashi, Tokyo, 174-0051, Japan
| | - Shu Gozu
- Department of Urology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashi, Tokyo, 174-0051, Japan
| | - Takaaki Yokoyama
- Department of Urology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashi, Tokyo, 174-0051, Japan
| | - Masumi Yamada
- Department of Urology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashi, Tokyo, 174-0051, Japan
| | - Yu Odagaki
- Department of Urology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashi, Tokyo, 174-0051, Japan
| | - Yuko Hisatome
- Department of Urology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashi, Tokyo, 174-0051, Japan
| | - Hideo Sakamoto
- Department of Urology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashi, Tokyo, 174-0051, Japan
| | - Kunihiko Yoshioka
- Department of Urology, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashi, Tokyo, 174-0051, Japan
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21
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Borg MA, O'Callaghan ME, Moretti KL, Vincent AD. External validation of predictive models of sexual, urinary, bowel and hormonal function after surgery in prostate cancer subjects. BMC Urol 2024; 24:2. [PMID: 38166977 PMCID: PMC10763035 DOI: 10.1186/s12894-023-01373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In 2020, a research group published five linear longitudinal models, predict Expanded Prostate Cancer Index Composite-26 (EPIC-26) scores post-treatment for radical prostatectomy, external beam radiotherapy and active surveillance collectively in US patients with localized prostate cancer. METHODS Our study externally validates the five prediction models for patient reported outcomes post-surgery for localised prostate cancer. The models' calibration, fit, variance explained and discrimination (concordance-indices) were assessed. Two Australian validation cohorts 1 and 2 years post-prostatectomy were constructed, consisting of 669 and 439 subjects, respectively (750 in total). Patient reported function in five domains post-prostatectomy: sexual, bowel, hormonal, urinary incontinence and other urinary dysfunction (irritation/obstruction). Domain function was assessed using the EPIC-26 questionnaire. RESULTS 1 year post-surgery, R2 was highest for the sexual domain (35%, SD = 0.02), lower for the bowel (21%, SD = 0.03) and hormone (15%, SD = 0.03) domains, and close to zero for urinary incontinence (1%, SD = 0.01) and irritation/obstruction (- 5%, SD = 0.04). Calibration slopes for these five models were 1.04 (SD = 0.04), 0.84 (SD = 0.06), 0.85 (SD = 0.06), 1.16 (SD = 0.13) and 0.45 (SD = 0.04), respectively. Calibration-in-the-large values were - 2.2 (SD = 0.6), 2.1 (SD = 0.01), 5.1 (SD = 0.1), 9.6 (SD = 0.9) and 4.0 (SD = 0.2), respectively. Concordance-indices were 0.73, 0.70, 0.70, 0.58 and 0.62, respectively (all had SD = 0.01). Mean absolute error and root mean square error were similar across the validation and development cohorts. The validation measures were largely similar at 2 years post-surgery. CONCLUSIONS The sexual, bowel and hormone domain models validated well and show promise for accurately predicting patient reported outcomes in a non-US surgical population. The urinary domain models validated poorly and may require recalibration or revision.
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Affiliation(s)
- Matthew A Borg
- School of Public Health, University of Adelaide, Adelaide, SA, Australia.
| | - Michael E O'Callaghan
- Urology Unit, Flinders Medical Centre, Bedford Park, SA, Australia
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Kim L Moretti
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Adelaide, SA, Australia
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- Cancer Epidemiology and Population Health Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
- Faculty of Medicine Nursing and Health Sciences, School of Public Health and Preventative Medicine Monash University, Melbourne, Victoria, Australia
| | - Andrew D Vincent
- Freemasons Centre for Male Health & Wellbeing, University of Adelaide, Adelaide, SA, Australia
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22
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Shiota M, Tsukahara S, Takamatsu D, Tanegashima T, Ueda S, Blas L, Goto S, Kobayashi S, Matsumoto T, Inokuchi J, Shioyama Y, Eto M. Salvage robot-assisted radical prostatectomy after carbon ion radiotherapy to the prostate. Asian J Endosc Surg 2024; 17:e13279. [PMID: 38212264 DOI: 10.1111/ases.13279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/23/2023] [Accepted: 12/25/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE This study presents the surgical and oncological outcomes of salvage robot-assisted radical prostatectomy (RARP) after carbon ion radiotherapy at a single institution. METHODS Patients who underwent salvage RARP for local recurrence after carbon ion radiotherapy at Kyushu University Hospital between 2020 and 2023 were included. A single surgeon performed salvage RARP with extended pelvic lymph node dissection. Clinicopathological characteristics and perioperative and postoperative outcomes were prospectively collected and electronically recorded. RESULTS Ten cases were included. The preoperative clinical T-stage was T2, except for one case with T3a. The median console time was 171 min (range, 135-226 min). No severe perioperative or postoperative complications were noted. The pathological T-stage was T2, T3a, and T3b in four, four, and two cases, respectively. Biochemical recurrence was observed in one patient at 31.2 months after surgery. For patients with more than 1 year of follow-up, urinary continence recovery with ≤1 pad was achieved in two cases within 1 year, whereas four cases did not recover urinary continence within 1 year. CONCLUSIONS This case series demonstrated the feasibility of salvage RARP after carbon ion radiotherapy. Although the urinary continence recovery was modest, short-term disease control was favorable.
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Affiliation(s)
- Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigehiro Tsukahara
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Dai Takamatsu
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tokiyoshi Tanegashima
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shohei Ueda
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Leandro Blas
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Goto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Kobayashi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Matsumoto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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23
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Kataoka M, Yokoyama M, Waseda Y, Ito M, Kobayashi M, Fujiwara M, Nakamura Y, Ishikawa Y, Fukuda S, Tanaka H, Yoshida S, Masuda H, Fujii Y. Longitudinal deterioration in lower urinary tract symptoms after artificial urinary sphincter implantation in patients with a history of pelvic radiation therapy. Low Urin Tract Symptoms 2024; 16:e12507. [PMID: 37984074 DOI: 10.1111/luts.12507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES To evaluate longitudinal changes in lower urinary tract symptoms (LUTS) after artificial urinary sphincter (AUS) implantation in patients undergoing radiation therapy (RT) in comparison to those in non-irradiated patients. METHODS This retrospective study included 20 and 51 patients with and without a history of pelvic RT (RT and non-RT group, respectively) who were treated with primary AUS implantation for post-radical prostatectomy incontinence between 2010 and 2020. Longitudinal changes in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the International Prostate Symptom Score (IPSS), and the Overactive Bladder Symptom Score (OABSS) were calculated with a linear mixed model. RESULTS In the RT and non-RT group, 18 (90%) and 48 (94%) patients achieved social continence, defined as daily pad use ≤1 at 1 month after activation of AUS, respectively (p = .555). During the mean follow-up of 38 months, ICIQ-SF, IPSS, and OABSS significantly improved after AUS implantation in both the RT and non-RT groups. In the RT group, ICIQ-SF, IPSS, and OABSS subsequently deteriorated with a slope of 0.62/year (p = .010), 0.55/year (p = .025), and 0.30/year (p = .007), respectively. In the non-RT group, no significant longitudinal changes in subsequent IPSS and OABSS were observed, although ICIQ-SF significantly deteriorated (0.43/year, p = .006). Comparing between the groups, the slopes of IPSS and OABSS were significantly greater in the RT group than in the non-RT group (p < .001, and .015, respectively). CONCLUSIONS Longitudinal deterioration in LUTS that improved immediately after AUS implantation was observed in patients with a history of pelvic RT, but not in patients without a history of pelvic RT.
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Affiliation(s)
- Madoka Kataoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaya Ito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Kobayashi
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motohiro Fujiwara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Nakamura
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yudai Ishikawa
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hitoshi Masuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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24
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King J. Transvaginal mesh for incontinence and prolapse: Where are we now and how did we get here? Aust J Gen Pract 2024; 53:23-25. [PMID: 38316474 DOI: 10.31128/ajgp/04-23-6809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Jenny King
- OAM, FRANZCOG, CU, Head of Department, Urogynaecology and Director, Pelvic Floor Unit, Westmead Hospital, Sydney, NSW
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25
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Loh-Doyle JC, Markarian E, Boyd SD, Ginsberg D. The 51-60 cm H 2O Artificial Urinary Sphincter Pressure Regulating Balloon: Indications and Outcomes. Urology 2024; 183:221-227. [PMID: 37805051 DOI: 10.1016/j.urology.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To describe the role and long-term outcomes of using the 51-60cm H2O pressure regulating balloon (PRB) in male patients with an artificial urinary sphincter (AUS). METHODS From 2005-2021, 90 patients with a variety of urethral risk factors underwent AUS placement with use of the low-pressure 51-60 cm H2O PRB to treat stress incontinence. Patient demographics, indication for use of the 51-60 cm H2O PRB, perioperative data, and postoperative outcomes were examined and Pearson's chi squared test and Wilcoxon rank sum test were used to identify associations with future revisions, erosion, and mechanical failure. RESULTS Ninety patients were included in the study. After median follow-up of 46.6months (range: 6-146months), 4 (4.44%) patients developed an erosion-related complication that required device removal, 4 developed an infection, and 3 underwent surgery for pump relocation. One patient had a reported mechanical failure of unknown source. Thirty patients underwent revision surgery to reduce incontinence. Of the 4 patients with erosion, 1 was due to iatrogenic catheterization. The remaining 3 had numerous urethral risk factors. Univariate analysis was performed to identify predictors of cuff erosion, infection, and revision in patients with a 51-60 cm H2O PRB. No significant associations were found including prior pelvic radiation, age at AUS placement, presence of inflatable penile prosthesis (IPP), prior AUS erosion, or previous urethroplasty. CONCLUSION The low-pressure 51-60 cm H2O PRB can be used in high-risk male patients with urinary incontinence with low rates of complications including erosion, infection, and mechanical failure. While patients may choose to undergo future revisional surgery to improve continence, the 51-60 cm H2O PRB should be considered as the initial PRB in patients with urethral risk factors.
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Affiliation(s)
- Jeffrey C Loh-Doyle
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Emily Markarian
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Stuart D Boyd
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David Ginsberg
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
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26
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Brument M, Kulawik J, Cornu JN. RE: Baunacke M, et al. Insufficient utilization of care in male incontinence surgery: health care reality in Germany from 2006 to 2020 and a systematic review of the international literature. World J Urol. 2023 Jul;41(7):1813-1819. World J Urol 2023; 42:5. [PMID: 38133661 DOI: 10.1007/s00345-023-04756-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- Mathilde Brument
- Department of Urology, Charles-Nicolle Hospital, University of Rouen Normandy, 76000, Rouen, France
| | - Justine Kulawik
- Department of Urology, Charles-Nicolle Hospital, University of Rouen Normandy, 76000, Rouen, France
| | - Jean-Nicolas Cornu
- Department of Urology, Charles-Nicolle Hospital, University of Rouen Normandy, 76000, Rouen, France.
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27
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Singh F, Newton RU, Taaffe DR, Lopez P, Thavaseelan J, Brown M, Ooi E, Nosaka K, Hayne D, Galvão DA. Prehabilitative versus rehabilitative exercise in prostate cancer patients undergoing prostatectomy. J Cancer Res Clin Oncol 2023; 149:16563-16573. [PMID: 37712960 PMCID: PMC10645629 DOI: 10.1007/s00432-023-05409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE The study compared the efficacy of commencing supervised exercise in men with prostate cancer before and after prostatectomy on objective and patient-reported outcomes, hospital length of stay, and urinary incontinence. METHODS Forty-one men were randomised to a 6-week prehabilitation or rehabilitation exercise programme. Prehabilitation involved resistance and aerobic exercise thrice weekly pre-surgery, while rehabilitation comprised the same commencing 6-weeks post-surgery. Assessments included strength, function (chair rise, stair climb, 400-m, 6-m usual, fast, and backwards walk), body composition, fatigue and quality of life, undertaken at pre-surgery, early post-surgery and late post-surgery phase, with urinary incontinence (24-h pad test) assessed at 2, 6, and 12-weeks post-surgery. Intention-to-treat and sensitivity analyses were undertaken. RESULTS Of thirty-eight men (48-73 years), 29 completed all assessments with most undergoing robotic-assisted laparoscopic prostatectomy (92.1%). In the pre-surgery phase, prehabilitation improved muscle strength (leg press: 17.2 kg; chest press: 2.9 kg; p ≤ 0.001), 400-m, chair rise, 6-m fast and backward walk tests (p ≤ 0.001-0.028). Strength and function declines in the early post-surgery phase were maintained late post-surgery. Rehabilitation showed declines of these outcomes after surgery with improvement late post-surgery (leg press: 14.6 kg, p < 0.001; chest press: 6.8 kg, p < 0.001; 400-m walk: -12.0 s, p = 0.005), resulting in no difference between groups at 12 weeks. There were no significant differences between groups for patient-reported outcomes, hospital length of stay or urinary incontinence. CONCLUSION Pre-surgical exercise enhanced strength and function, protecting against post-surgery declines. Although exercise post-surgery is beneficial for recouping strength and function, where possible men undergoing prostatectomy are encouraged to exercise pre-surgery. TRIAL REGISTRATION ACTRN12617001115325 registered 31 July 2017.
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Affiliation(s)
- Favil Singh
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - Robert U Newton
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Dennis R Taaffe
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Pedro Lopez
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia
| | | | - Matthew Brown
- Perth Urology Clinic, Perth, WA, Australia
- Fiona Stanley Hospital, Murdoch, WA, Australia
- UWA Medical School, University of Western Australia, Crawley, WA, Australia
| | | | - Kazunori Nosaka
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Dickon Hayne
- Fiona Stanley Hospital, Murdoch, WA, Australia
- UWA Medical School, University of Western Australia, Crawley, WA, Australia
| | - Daniel A Galvão
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
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Yingxiu C, Xin S, Tingting L, Jin H, Zhikang C, Jianwei L. Modified Sling Midurethral Suspension+Hemolock Fixation Technique for Male Urinary Incontinence: A Pilot Study. Urology 2023; 182:196-203. [PMID: 37673407 DOI: 10.1016/j.urology.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To demonstrate the feasibility of a modified midurethral sling+hemolock fixation technique for treating male urinary incontinence. This study aims to provide a preliminary assessment of the short-term clinical efficacy of this technique. METHODS We collected the clinical data of patients treated with modified sling midurethral suspension+ hemolock fixation technique. The primary evaluation criteria were surgery-related indicators and daily urinal pad usage by patients before and after treatment, and the secondary evaluation criteria were the corresponding incontinence scores and the results of surgery-related questionnaires. RESULTS Follow-up 1-7months, eight patients achieved a clinical cure. Follow-up 1month after surgery showed that two patients (25.0%) used one pad daily and six patients (75.0%) did not need pads. The incontinence quality of life questionnaire (I-QOL) scores were (86.0 ± 7.0) and (89.0 ± 3.0) at three postoperative days and one postoperative month, respectively, which were significantly higher than the preoperative scores (26.0 ± 6.0) (P <.05). The scores of the International Continence Control Association Incontinence Questionnaire Short Form (ICI-Q-SF) at three postoperative days and one postoperative month were (4.0 ± 2.0) and (4.0 ± 1.0), respectively, which were significantly lower than the preoperative scores of (18.0 ± 1.0) (P <.05). Besides, the results of the surgery-related questionnaires were positive. CONCLUSION The short-term efficacy of the modified sling midurethral suspension+ hemolock fixation technique for the treatment of male urinary incontinence patients is safe, effective, minimally invasive, and has few complications. However, further validation in large samples, randomized, comparative, and longer-term follow-up studies is still needed.
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Affiliation(s)
- Chen Yingxiu
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, Shanghai, China; Department of Urology, Hainan Western Central Hospital, Danzhou, Hainan, China
| | - Song Xin
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, Shanghai, China
| | - Lv Tingting
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, Shanghai, China
| | - Huang Jin
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, Shanghai, China
| | - Cai Zhikang
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, Shanghai, China
| | - Lv Jianwei
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, Shanghai, China.
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Shiota M, Tsukahara S, Ueda S, Mutaguchi J, Goto S, Kobayashi S, Matsumoto T, Blas L, Monji K, Inokuchi J, Eto M. Improved urinary continence recovery after robot-assisted radical prostatectomy with lateral pelvic fascia preservation. J Robot Surg 2023; 17:2721-2728. [PMID: 37634216 DOI: 10.1007/s11701-023-01702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/19/2023] [Indexed: 08/29/2023]
Abstract
The novel technique of lateral pelvic fascia preservation (LPFP) in robot-assisted radical prostatectomy (RARP) has been reported to improve urinary continence recovery. We aimed to investigate surgical and oncological outcomes after RARP using the LPFP technique and compare them with conventional RARP. This study included patients who underwent RARP with and without the LPFP technique. Time to urinary continence recovery was compared between the LPFP and non-LPFP groups using univariate, multivariate, and propensity-score matched analysis. Perioperative and postoperative outcomes were compared between the two groups using univariate analysis. We included 139 patients who underwent RARP, 68 in the LPFP group and 71 in the non-LPFP group. The LPFP technique was associated with a shorter time to urinary continence recovery, a shorter operative time and lower estimated blood loss. Surgical and oncological outcomes, including complications, pathological T-stage, surgical margin status, and biochemical recurrence-free survival, were comparable between the two groups. This study demonstrated that the LPFP technique improves urinary continence recovery and operative times without compromising surgical and oncological outcomes. The use of this technique in patients with clinically localized prostate cancer is recommended.
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Affiliation(s)
- Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Shigehiro Tsukahara
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shohei Ueda
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Jun Mutaguchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shunsuke Goto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Kobayashi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takashi Matsumoto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Leandro Blas
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keisuke Monji
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Koh N, Kim MJ, Lee SY, Oh S, Jeon MJ. The Diagnostic Accuracy of a Retrograde Voiding Trial for Restoration of Spontaneous Voiding Function after Prolapse and Urinary Incontinence Surgery. J Minim Invasive Gynecol 2023; 30:999-1002. [PMID: 37774779 DOI: 10.1016/j.jmig.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/03/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023]
Abstract
STUDY OBJECTIVE To assess the diagnostic accuracy of a retrograde voiding trial for the restoration of spontaneous voiding function after prolapse and urinary incontinence surgery and thereby determine whether the retrograde method can be a reliable alternative to the spontaneous voiding trial. DESIGN A retrospective cohort study. SETTING A single tertiary hospital in South Korea. PATIENTS Women who underwent operations for prolapse, urinary incontinence, or both. INTERVENTION Sequential voiding trials on postoperative day 1 or 2-retrograde voiding trial followed by spontaneous voiding trial. MEASUREMENTS AND MAIN RESULTS Of the 408 women analyzed, 278 (68.1%) passed the spontaneous voiding trial on the first day of assessment and none experienced urinary retention after a successful voiding trial. Receiver operating characteristic analyses of retrograde voiding trials evaluating voided volume (VV), postvoid residual (PVR), and voiding efficiency (VE) all demonstrated high diagnostic accuracy for restoration of spontaneous voiding function, whereas measuring PVR and VE had better discriminative ability than VV (area under the curve [95% confidence interval] = 0.93 [0.90-0.95] for PVR, 0.94 [0.91-0.96] for VE, and 0.88 [0.85-0.91] for VV; DeLong's test between PVR/VE and VV p < .01). The optimal cutoffs determined by the Youden index were 200 mL for VV (sensitivity 85.0%, specificity 78.0%), 100 mL for PVR (sensitivity 84.0%, specificity 87.0%), and 66.7% for VE (sensitivity 86.0%, specificity 88.0%). CONCLUSIONS The retrograde voiding trial is an accurate predictor for restoration of spontaneous voiding function after prolapse and incontinence surgery and can be a useful alternative to the spontaneous voiding trial.
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Affiliation(s)
- Nahyun Koh
- Department of Obstetrics and Gynecology (Drs. Koh, Kim, Lee, and Jeon), Seoul National University Hospital, Seoul, Korea
| | - Min Ju Kim
- Department of Obstetrics and Gynecology (Drs. Koh, Kim, Lee, and Jeon), Seoul National University Hospital, Seoul, Korea
| | - So Yeon Lee
- Department of Obstetrics and Gynecology (Drs. Koh, Kim, Lee, and Jeon), Seoul National University Hospital, Seoul, Korea
| | - Sumin Oh
- Department of Obstetrics and Gynecology (Dr. Oh), Korea University Guro Hospital, Seoul, Korea
| | - Myung Jae Jeon
- Department of Obstetrics and Gynecology (Drs. Koh, Kim, Lee, and Jeon), Seoul National University Hospital, Seoul, Korea; Department of Obstetrics and Gynecology (Dr. Jeon), Seoul National University College of Medicine, Seoul, Korea.
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Sibert NT, Kurth T, Breidenbach C, Wesselmann S, Feick G, Carl EG, Dieng S, Albarghouth MH, Aziz A, Baltes S, Bartolf E, Bedke J, Blana A, Brock M, Conrad S, Darr C, Distler F, Drosos K, Duwe G, Gaber A, Giessing M, Harke NN, Heidenreich A, Hijazi S, Hinkel A, Kaftan BT, Kheiderov S, Knoll T, Lümmen G, Peters I, Polat B, Schrodi V, Stolzenburg JU, Varga Z, von Süßkind-Schwendi J, Zugor V, Kowalski C. Prediction models of incontinence and sexual function one year after radical prostatectomy based on data from 20 164 prostate cancer patients. PLoS One 2023; 18:e0295179. [PMID: 38039308 PMCID: PMC10691723 DOI: 10.1371/journal.pone.0295179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Incontinence and sexual dysfunction are long-lasting side effects after surgical treatment (radical prostatectomy, RP) of prostate cancer (PC). For an informed treatment decision, physicians and patients should discuss expected impairments. Therefore, this paper firstly aims to develop and validate prognostic models that predict incontinence and sexual function of PC patients one year after RP and secondly to provide an online decision making tool. METHODS Observational cohorts of PC patients treated between July 2016 and March 2021 in Germany were used. Models to predict functional outcomes one year after RP measured by the EPIC-26 questionnaire were developed using lasso regression, 80-20 splitting of the data set and 10-fold cross validation. To assess performance, R2, RMSE, analysis of residuals and calibration-in-the-large were applied. Final models were externally temporally validated. Additionally, percentages of functional impairment (pad use for incontinence and firmness of erection for sexual score) per score decile were calculated to be used together with the prediction models. RESULTS For model development and internal as well as external validation, samples of 11 355 and 8 809 patients were analysed. Results from the internal validation (incontinence: R2 = 0.12, RMSE = 25.40, sexual function: R2 = 0.23, RMSE = 21.44) were comparable with those of the external validation. Residual analysis and calibration-in-the-large showed good results. The prediction tool is freely accessible: https://nora-tabea.shinyapps.io/EPIC-26-Prediction/. CONCLUSION The final models showed appropriate predictive properties and can be used together with the calculated risks for specific functional impairments. Main strengths are the large study sample (> 20 000) and the inclusion of an external validation. The models incorporate meaningful and clinically available predictors ensuring an easy implementation. All predictions are displayed together with risks of frequent impairments such as pad use or erectile dysfunction such that the developed online tool provides a detailed and informative overview for clinicians as well as patients.
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Affiliation(s)
| | - Tobias Kurth
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Günther Feick
- Bundesverband Prostatakrebs Selbsthilfe, Bonn, Germany
| | | | | | | | | | - Stefan Baltes
- KRH Klinikum Region Hannover, Klinikum Siloah—Oststadt—Heidehaus, Hannover, Germany
| | | | - Jens Bedke
- University Hospital Tübingen, Tübingen, Germany
| | | | - Marko Brock
- Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | | | | | | | | | | | - Amr Gaber
- Carl-Thiem-Klinikum, Cottbus, Germany
| | | | | | | | | | | | | | | | - Thomas Knoll
- Klinikum Sindelfingen-Böblingen, Sindelfingen, Germany
| | | | - Inga Peters
- Krankenhaus Nordwest, Frankfurt am Main, Germany
| | | | | | | | - Zoltan Varga
- SRH Kliniken Landkreis Sigmaringen, Sigmaringen, Germany
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Wenk MJ, Westhoff N, Liedl B, Michel MS, Grüne B, Kriegmair MC. Evaluation of sexual function and vaginal prolapse after radical cystectomy in women: a study to explore an under-evaluated problem. Int Urogynecol J 2023; 34:2933-2943. [PMID: 37581629 PMCID: PMC10756865 DOI: 10.1007/s00192-023-05611-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/27/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate sexual function, vaginal prolapse, and quality of life (QoL) in women after radical cystectomy (RC) using validated questionnaires and pelvic organ prolapse quantification (POP-Q) measurement. METHODS Female bladder cancer patients who underwent RC at our tertiary care center were included (January 2008 to March 2022). Patients received three validated questionnaires (International Consultation on Incontinence Questionnaire Vaginal Symptoms [ICIQ-VS] Part A, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA revised [PISQ], European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC] C30/BLM30). Patients who consented were examined with vaginal POP-Q measurement. RESULTS Out of 322 patients, 193 were still alive, 54 patients were lost to follow-up, and 43 were excluded, resulting in 96 patients who received the questionnaire. Finally, 35 patients were included, of whom 17 patients consented to vaginal examination. Complaints due to vaginal symptoms were low (ICIQ-VS 6.17 + 5.37). Sexual activity was reported by 12 patients (34.3%); 23 patients (65.71%) were not sexually active. No apical prolapse was found in POP-Q measurement; 6 patients (35.3%) had anterior, and 14 patients (82.4%) posterior prolapse; the highest prolapse stage was 2. No significant differences were found regarding POP stages, sexual function, and QoL (all p > 0.05) when comparing continent and incontinent urinary diversions. Comparing the vaginal approach (no sparing vs sparing), significant differences were found in only two PISQ subscales (significantly higher scores after vagina sparing, p = 0.01 and p = 0.02). CONCLUSIONS The type of urinary diversion, POP-Q stages, and tumor stages did not show significant differences regarding sexual function, QoL, and prolapse complaints in women after RC, whereas a vagina- sparing approach showed significant differences only in two subscales without clinical relevance.
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Affiliation(s)
- Maren Juliane Wenk
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - N Westhoff
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - B Liedl
- Center of Reconstructive Urogenital Surgery, Urologische Klinik Planegg, Germeringer Str. 32, 82152, Planegg, Germany
| | - M S Michel
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - B Grüne
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - M C Kriegmair
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Chien CH, Liu KL, Wu CT, Chuang CK, Yu KJ, Lin PH, Huang XY, Pang ST. Development and assessment of a self-management intervention for urinary incontinence among patients with prostate cancer: protocol for a randomized feasibility study. BMC Urol 2023; 23:193. [PMID: 37980490 PMCID: PMC10657576 DOI: 10.1186/s12894-023-01367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Urinary incontinence is a common complication among patients with prostate cancer who have undergone radical prostatectomy. Guided by social cognitive theory and a framework for the recovery of health and well-being, we propose to develop and test a self-management intervention for patients with prostate cancer who experience urinary incontinence after undergoing radical prostatectomy. METHODS In this study, a self-management intervention for urinary incontinence (SMI-UI) is developed, comprising a mobile self-management application, a self-management handbook, and professional support. The feasibility, acceptability, and effectiveness of this intervention will be assessed. Patient data from the urology departments of two hospitals will be collected through convenience sampling by adopting an experimental, parallel, and random assignment research design. Patients experiencing urinary incontinence after undergoing radical prostatectomy will be invited to participate. After completing the pretest questionnaire, patients will be randomly divided into the experimental and attention control groups. The experimental group will undergo a 12-week SMI-UI, whereas the attention control group will receive an intervention consisting of a single dietetic education information package. The two groups will be tested 12 and 16 weeks after the pretest. In this study, we recorded the sociodemographic and clinical variables; recruitment rate; retention rate; satisfaction with the intervention; cancer-related self-efficacy; urination symptoms and disturbance; social participation and satisfaction; resilience; and demoralization. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05335967 [date of registration 04-04-2022].
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Affiliation(s)
- Ching Hui Chien
- School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Ming-te Road, Peitou District, Taipei City, 112, Taiwan.
| | - Kuan Lin Liu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Keelung, Keelung City, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chun Te Wu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Cheng Keng Chuang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Kai Jie Yu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Po Hung Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Xuan Yi Huang
- School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Ming-te Road, Peitou District, Taipei City, 112, Taiwan
| | - See Tong Pang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.
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Temtanakitpaisan T, Chongsomchai C, Buppasiri P. Fractional CO 2 laser treatment for women with stress predominant urinary incontinence: a randomized controlled trial. Int Urogynecol J 2023; 34:2827-2832. [PMID: 37787809 DOI: 10.1007/s00192-023-05655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate the efficacy of vaginal CO2 laser in women with stress predominant urinary incontinence (SUI) compared with the sham treatment. METHODS A randomized controlled trial with sham treatment was conducted between January 2019 and April 2021. Women with predominant SUI were recruited and randomized into two groups: the CO2 laser group (n = 29) and the sham group (n = 30). The International Consultation on Continence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was used to evaluate the efficacy at 3 months postoperatively. All participants in both groups were advised to perform pelvic floor muscle training (PFMT) after the intervention. RESULTS A total of 59 women were studied. A total of 29 women were included in the CO2 laser group and 30 women were included in the sham group. The baseline scores of the ICIQ-UI SF were similar in both groups. A significant improvement in urinary incontinence scores was found in both groups 3 months after treatment (p < 0.001). However, there were no statistically significant differences between the two groups at 3 months (p = 0.8281). There were no changes in bladder neck descent or levator hiatal area immediately after intervention or 3 months after completion of treatment in either group. Most participants who received the active intervention reported mild vaginal pain during the procedure that resolved spontaneously at the end of treatment. CONCLUSIONS Fractional CO2 laser treatment does not provide any benefit over the sham technique in alleviating SUI symptoms. The improvement in SUI symptoms in both groups might be related to PFMT. This study was registered with the Thai Clinical Trial Register (TCTR20190131004).
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Affiliation(s)
- Teerayut Temtanakitpaisan
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Highway, Muang Khon Kaen, Khon Kaen, 40002, Thailand.
| | - Chompilas Chongsomchai
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Highway, Muang Khon Kaen, Khon Kaen, 40002, Thailand
| | - Pranom Buppasiri
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Highway, Muang Khon Kaen, Khon Kaen, 40002, Thailand
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Davuluri M, DeMeo G, Penukonda S, Zahid B, Hu JC. Guiding Clinical Decision Making for Surgical Incontinence Treatment After Prostatectomy: A Review of the Literature. Curr Urol Rep 2023; 24:527-532. [PMID: 37768551 DOI: 10.1007/s11934-023-01181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE OF REVIEW Stress urinary incontinence after prostatectomy is a common and debilitating side effect. Immediate post-prostatectomy management emphasizes pelvic floor muscle exercises. Per American Urologic Association guidelines, if incontinence persists for more than 12 months postoperatively, surgical interventions are the mainstay of treatment. Treatment decisions depend on a multitude of factors. The goal of this paper is to review recent literature updates regarding the diagnosis of male SUI to better guide surgical treatment decision-making. RECENT FINDINGS Patient history is a critical component in guiding surgical decision making with severity and bother being primary factors driving treatment decisions. Recent studies indicate that a history of pelvic radiation continues to impact the overall duration and complication rate associated with artificial urinary sphincters (AUS). Cystoscopy should be done on every patient preparing to undergo surgical SUI treatment. Urodynamics and standing cough stress tests are additional diagnostic testing options; these tests may augment the diagnosis of SUI and better delineate which patients may benefit from a male sling versus AUS. Treatment of SUI after prostatectomy can improve health-related quality of life. A patient history focused on severity and degree of bother in addition to the use of ancillary office testing can help guide surgical treatment decisions to optimize patient continence goals.
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Affiliation(s)
- Meenakshi Davuluri
- Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, NY, USA.
| | - Gina DeMeo
- Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, NY, USA
- College of Osteopathic Medicine, Touro University, New York, NY, USA
| | | | - Basimah Zahid
- City University of New York, Brooklyn College, Brooklyn, NY, USA
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, NY, USA
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Wang M, Liao Y, Liu Y, Zhou W, Yu H. Development and future prospects of the artificial urinary sphincter. Artif Organs 2023; 47:1688-1699. [PMID: 37424277 DOI: 10.1111/aor.14606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Urinary incontinence is a urinary disorder in which urine leaks out involuntarily. This disorder seriously affects the quality of life of patients. For patients with mild incontinence, conservative treatment and medication may be the ideal treatment modality, but for patients with severe incontinence, an artificial urinary sphincter is currently a better treatment option. METHODS In order to design an ideal artificial urinary sphincter, this article first searched and collected literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses searched strategy by selecting specific subject terms and reviewed the artificial urinary sphincters that are currently in the research stage based on different activation methods. RESULTS In response to the deficiencies of the existing artificial urinary sphincter, this article discusses the future optimization of the artificial urinary sphincter from three aspects: individual improvement of the artificial urinary sphincter, engineering design elements, and optimization of the artificial urinary sphincter manufacturing process. CONCLUSIONS The manufacture of an idealized artificial urinary sphincter capable of meeting clinical needs is of great importance to improve the quality of life of patients. However, this approach is a reasonable option to explore and should not be overestimated until further evidence is available.
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Affiliation(s)
- Minghui Wang
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yucheng Liao
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yunlong Liu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Wei Zhou
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Mihalsky KP, Tran R, Moreno-Garcia F, Stenberg C, Mier Giraud F, Hare A, Quiroz LH, Fischer LE. Urinary incontinence in women who have undergone bariatric surgery. Surg Endosc 2023; 37:8791-8798. [PMID: 37587240 DOI: 10.1007/s00464-023-10299-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/12/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Obesity is a known risk factor for urinary incontinence (UI). As bariatric surgery can result in significant and sustainable weight loss, many chronic diseases closely linked to obesity have likewise shown improvement after surgical weight loss. We propose that bariatric surgery may significantly improve obesity-related UI symptoms as well as improve quality of life. METHODS AND PROCEDURES This is an interim analysis of an ongoing, prospective, single-institution observational study looking at UI in women enrolled in a bariatric surgery program. Participants completed the Pelvic Floor Distress Inventory (PFDI-20), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), King's Health Questionnaire (KHQ), and Patient Global Impression of Improvement (PGI-I). Questionnaires were administered upon enrollment, pre-operatively, and at 3, 6, and 12 months post-operatively. Demographic data were collected at each interval and analyzed with descriptive statistics. RESULTS At analysis, 108 patients had enrolled in the study and 60% had progressed to surgery. We analyzed the following surveys: enrollment (n = 108), pre-operative (n = 43), 3-month (n = 29), 6-month (n = 26), and 1-year (n = 27). Mean BMI decreased from 49.8 to 31.1 at 1-year. All surveys showed significant improvement in UI symptoms over time. Overall, UI symptoms (PDFI-20) are correlated with BMI at time of survey and %TBWL (p = 0.03, p = 0.019). Additionally, perception of symptom improvement with surgery (PGI-I) improved over time (3-month p = 0.0289, 6-month p = 0.0024, 12-month p = 0.0035). Quality of life related to UI symptoms (KHQ) significantly improved after surgery (p = 0.0047 3-month, p = 0.0042 6-month, p = 0.0165 1-year). CONCLUSIONS Although the relationship is complex and likely depends on many factors, weight loss after bariatric surgery is associated with improvement in UI symptoms and UI-related quality of life. Bariatric surgery can play a role in the long-term treatment of UI in women with obesity that may negate the need for further invasive UI procedures.
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Affiliation(s)
- K Paige Mihalsky
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
| | - Rachel Tran
- University of Oklahoma School of Medicine, Oklahoma City, OK, USA
| | | | - Caitlin Stenberg
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Fernando Mier Giraud
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Adam Hare
- Department of Obstetrics and Gynecology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Lieschen H Quiroz
- Department of Obstetrics and Gynecology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Laura E Fischer
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
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Rechberger E, Wróbel A, Kulik-Rechberger B, Miotla P, Ziętek A, Rechberger T. The clinical efficacy and safety of outside-in transobturator sling with additional paraurethral fixation - The prospective longitudinal study. Eur J Obstet Gynecol Reprod Biol 2023; 290:22-26. [PMID: 37713944 DOI: 10.1016/j.ejogrb.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023]
Abstract
Stress urinary incontinence (SUI) is a common condition that affect 30-40% of women in their lifetime. Midurethral slings (MUS) either suprapubic or transobturator can be safely used in the surgical treatment of SUI. The aim of this study was to collect clinical long-term data regarding safety and performance of transobturator sling with an additional tape fixation in women with urinary incontinence. This prospective longitudinal study was conducted on a group of 2086 female patients diagnosed with stress urinary incontinence. Follow up visits where scheduled 6 weeks, 6 and 12 months after surgery followed by annual checking when possible. Patients underwent transobturator sling procedure from 01.01.2011 to 31.12.2021. All patients had a monofilament tape inserted at the mid-urethra using outside-in technique (TOT) with 2 absorbable sutures parallel to the urethra. Success of surgery was defined as lack of any leakage during cough stress test whereas the subjective cure rate was determined by Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF). 87% of patients who were operated at least 10 years before assessment reported ICIQ -SF < 6. Main postoperative complications were storage symptoms - de novo urgency and voiding difficulties. TOT is safe and highly effective surgical treatment for (SUI) in a long-term observation.
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Affiliation(s)
- Ewa Rechberger
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Andrzej Wróbel
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Beata Kulik-Rechberger
- Department of Paediatric Propedeutics, Medical University of Lublin, ul. A. Gebali 9, 20-091 Lublin, Poland
| | - Pawel Miotla
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland.
| | - Alicja Ziętek
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Tomasz Rechberger
- 2(nd) Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
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Krughoff K, Foreman J, Peterson AC. Preoperative Bladder Mechanics Forecast Time to Artificial Urinary Sphincter Revision. Urol Pract 2023; 10:640-645. [PMID: 37586100 DOI: 10.1097/upj.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023]
Affiliation(s)
| | - Jordan Foreman
- Department of Urology, Duke University Medical Center, Durham, North Carolina
| | - Andrew C Peterson
- Department of Urology, Duke University Medical Center, Durham, North Carolina
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Carter E, Johnson EE, Still M, Al-Assaf AS, Bryant A, Aluko P, Jeffery ST, Nambiar A. Single-incision sling operations for urinary incontinence in women. Cochrane Database Syst Rev 2023; 10:CD008709. [PMID: 37888839 PMCID: PMC10604512 DOI: 10.1002/14651858.cd008709.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Stress urinary incontinence imposes a significant health and economic burden on individuals and society. Single-incision slings are a minimally-invasive treatment option for stress urinary incontinence. They involve passing a short synthetic device through the anterior vaginal wall to support the mid-urethra. The use of polypropylene mesh in urogynaecology, including mid-urethral slings, is restricted in many countries. This is a review update (previous search date 2012). OBJECTIVES To assess the effects of single-incision sling operations for treating urinary incontinence in women, and to summarise the principal findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from: CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, and two trials registers. We handsearched journals, conference proceedings, and reference lists of relevant articles to 20 September 2022. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials in women with stress (or stress-predominant mixed) urinary incontinence in which at least one, but not all, trial arms included a single-incision sling. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. The primary outcome was subjective cure or improvement of urinary incontinence. MAIN RESULTS We included 62 studies with a total of 8051 women in this review. We did not identify any studies comparing single-incision slings to no treatment, conservative treatment, colposuspension, or laparoscopic procedures. We assessed most studies as being at low or unclear risk of bias, with five studies at high risk of bias for outcome assessment. Sixteen trials used TVT-Secur, a single-incision sling withdrawn from the market in 2013. The primary analysis in this review excludes trials using TVT-Secur. We report separate analyses for these trials, which did not substantially alter the effect estimates. We identified two cost-effectiveness analyses and one cost-minimisation analysis. Single-incision sling versus autologous fascial sling One study (70 women) compared single-incision slings to autologous fascial slings. It is uncertain if single-incision slings have any effect on risk of dyspareunia (painful sex) or mesh exposure, extrusion or erosion compared with autologous fascial slings. Subjective cure or improvement of urinary incontinence at 12 months, patient-reported pain at 24 months or longer, number of women with urinary retention, quality of life at 12 months and the number of women requiring repeat continence surgery or sling revision were not reported for this comparison. Single-incision sling versus retropubic sling Ten studies compared single-incision slings to retropubic slings. There may be little to no difference between single-incision slings and retropubic slings in subjective cure or improvement of incontinence at 12 months (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.91 to 1.07; 2 trials, 297 women; low-certainty evidence). It is uncertain whether single-incision slings increase the risk of mesh exposure, extrusion or erosion compared with retropubic minimally-invasive slings; the wide confidence interval is consistent with both benefit and harm (RR 1.55, 95% CI 0.24 to 9.82; 3 trials, 267 women; low-certainty evidence). It is uncertain whether single-incision slings lead to fewer women having postoperative urinary retention compared with retropubic slings; the wide confidence interval is consistent with possible benefit and harm (RR 0.47, 95% CI 0.12 to 1.84; 2 trials, 209 women; low-certainty evidence). The effect of single-incision slings on the risk of repeat continence surgery or mesh revision compared with retropubic slings is uncertain (RR 4.19, 95% CI 0.31 to 57.28; 2 trials, 182 women; very low-certainty evidence). One study reported quality of life, but not in a suitable format for analysis. Patient-reported pain at more than 24 months and the number of women with dyspareunia were not reported for this comparison. We downgraded the evidence due to concerns about risks of bias, imprecision and inconsistency. Single-incision sling versus transobturator sling Fifty-one studies compared single-incision slings to transobturator slings. The evidence ranged from high to low certainty. There is no evidence of a difference in subjective cure or improvement of incontinence at 12 months when comparing single-incision slings with transobturator slings (RR 1.00, 95% CI 0.97 to 1.03; 17 trials, 2359 women; high-certainty evidence). Single-incision slings probably have a reduced risk of patient-reported pain at 24 months post-surgery compared with transobturator slings (RR 0.12, 95% CI 0.02 to 0.68; 2 trials, 250 women; moderate-certainty evidence). The effect of single-incision slings on the risk of dyspareunia is uncertain compared with transobturator slings, as the wide confidence interval is consistent with possible benefit and possible harm (RR 0.78, 95% CI 0.41 to 1.48; 8 trials, 810 women; moderate-certainty evidence). There are a similar number of mesh exposures, extrusions or erosions with single-incision slings compared with transobturator slings (RR 0.61, 95% CI 0.39 to 0.96; 16 trials, 2378 women; high-certainty evidence). Single-incision slings probably result in similar or reduced cases of postoperative urinary retention compared with transobturator slings (RR 0.68, 95% CI 0.47 to 0.97; 23 trials, 2891 women; moderate-certainty evidence). Women with single-incision slings may have lower quality of life at 12 months compared to transobturator slings (standardised mean difference (SMD) 0.24, 95% CI 0.09 to 0.39; 8 trials, 698 women; low-certainty evidence). It is unclear whether single-incision slings lead to slightly more women requiring repeat continence surgery or mesh revision compared with transobturator slings (95% CI consistent with possible benefit and harm; RR 1.42, 95% CI 0.94 to 2.16; 13 trials, 1460 women; low-certainty evidence). We downgraded the evidence due to indirectness, imprecision and risks of bias. AUTHORS' CONCLUSIONS Single-incision sling operations have been extensively researched in randomised controlled trials. They may be as effective as retropubic slings and are as effective as transobturator slings for subjective cure or improvement of stress urinary incontinence at 12 months. It is uncertain if single-incision slings lead to better or worse rates of subjective cure or improvement compared with autologous fascial slings. There are still uncertainties regarding adverse events and longer-term outcomes. Therefore, longer-term data are needed to clarify the safety and long-term effectiveness of single-incision slings compared to other mid-urethral slings.
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Affiliation(s)
- Emily Carter
- The Warrell Unit, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Eugenie E Johnson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Madeleine Still
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Aalya S Al-Assaf
- National Institute for Health Research (NIHR) Innovation Observatory, Newcastle University, Newcastle Upon Tyne, UK
| | - Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Patricia Aluko
- National Institute for Health Research (NIHR) Innovation Observatory, Newcastle University, Newcastle Upon Tyne, UK
| | - Stephen T Jeffery
- Division of Urology, University of Cape Town, Cape Town, South Africa
| | - Arjun Nambiar
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
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Prządka P, Liszka B, Gąsior L, Antończyk A, Skrzypczak P, Kiełbowicz Z, Kubiak-Nowak D, Gerus S, Patkowski D. Laparoscopic ureteroneocystostomy in the treatment of urinary incontinence due to ectopy of the ureters in female dogs: A pilot study. PLoS One 2023; 18:e0292485. [PMID: 37796812 PMCID: PMC10553214 DOI: 10.1371/journal.pone.0292485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023] Open
Abstract
Ureteral ectopia is rare and requires surgical treatment after a thorough diagnostic workup. Open surgical techniques for repositioning ectopic ureters have been known for many years and are well described in the literature. However, to the best of our knowledge, no laparoscopic method of correcting this pathology has been described, which, in our opinion, would benefit the animal in terms of the healing process and overall clinical outcomes. This study aimed to evaluate the possibility of laparoscopic treatment of ureteral ectopia, which causes urinary incontinence in dogs. All of the operated ten dogs presented in this study were client-owned females with symptoms of urinary incontinence due to a unilateral intramural ectopic ureter. A three-trocar laparoscopic technique was used to perform the ureteroneocystostomy of the ectopic ureter. In this article, clinicopathological data, imaging features, procedural findings, complications, and short- and long-term outcomes are presented. The procedure was feasible in all cases. No major postoperative complications were observed. Among the minor complications, slight hematuria was observed in three dogs, which resolved spontaneously. In the period of at least one year after surgery, no negative impact of the procedure was observed. Seven of the ten operated dogs regained urinary continence. The remaining three dogs required additional surgery (urethral bulking) because of a lack of improvement after adjuvant pharmacological treatment. Overall, good-to-excellent long-term outcomes can be achieved; however, dogs that remain incontinent after laparoscopic ureteroneocystostomy may require additional treatment.
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Affiliation(s)
- Przemysław Prządka
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Bartłomiej Liszka
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Ludwika Gąsior
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Agnieszka Antończyk
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Piotr Skrzypczak
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Zdzisław Kiełbowicz
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Dominika Kubiak-Nowak
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Sylwester Gerus
- Department of Pediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland
| | - Dariusz Patkowski
- Department of Pediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland
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Yang Y, Li Z, Si K, Dai Q, Qiao Y, Li D, Zhang L, Wu F, He J, Wu G. Effectiveness of Laparoscopic Pectopexy for Pelvic Organ Prolapse Compared with Laparoscopic Sacrocolpopexy. J Minim Invasive Gynecol 2023; 30:833-840.e2. [PMID: 37369345 DOI: 10.1016/j.jmig.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
STUDY OBJECTIVE To evaluate the clinical benefits of laparoscopic pectopexy vs laparoscopic sacrocolpopexy in women with pelvic organ prolapse (POP). DESIGN Prospective cohort study. SETTING A tertiary hospital. PATIENTS We included 203 patients with POP. INTERVENTIONS Laparoscopic pectopexy or laparoscopic sacrocolpopexy. MEASUREMENTS AND MAIN RESULTS Anatomic effectiveness was measured using the POP Quantification system, both before and after operation. Functional recovery effectiveness was evaluated using complications and recurrence rates within 1 year. Quality of life was assessed by the Pelvic Floor Distress Inventory-20 and Incontinence Quality of Life questionnaires at enrollment and postoperative months 3, 6, and 12. Comparisons between groups were performed using t test, chi-square test, and mixed-effects model with repeated measures. The analysis included 203 eligible patients (sacrocolpopexy, 101; pectopexy, 102). The proportion of robotic-assisted surgeries was lower in the pectopexy group than in the sacrocolpopexy group (15.7% vs 41.6%, p <.001). The average operation time of pectopexy was shorter than that of sacrocolpopexy (174.2 vs 187.7 minutes) with a mean difference of 13.5 minutes (95% confidence interval, 3.9-23.0; p = .006). Differences of intraoperative blood loss, length of hospital stay, and postoperative 7-day complications between groups were not significant. Anatomic successes were obtained in both groups with similar improvement in POP Quantification scores. The rate of urinary symptoms recurrence was higher in the pectopexy group (13.7%) than in the sacrocolpopexy group (5.0%) at the 1-year follow-up (odds ratio, 3.1; 95% confidence interval, 1.1-8.8, p = .032). The Pelvic Floor Distress Inventory-20 and Incontinence Quality of Life scores were better improved at postoperative months 3, 6, and 12 for laparoscopic pectopexy than for sacrocolpopexy. CONCLUSION Laparoscopic pectopexy revealed comparable anatomic success, shorter operation time, and better improvement in quality of life scores of prolapse, colorectal-anal, and urinary symptoms at 1-year follow-up, possibly being an alternative when sacrocolpopexy is not practicable. However, clinicians should pay more attention to the recurrence of urinary symptoms after pectopexy.
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Affiliation(s)
- Yingying Yang
- Clinical Research Unit (Drs. Yang and Z. Li), Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhen Li
- Clinical Research Unit (Drs. Yang and Z. Li), Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Keyi Si
- Department of Military Health Statistics (Dr. Si), Naval Medical University, Shanghai, China
| | - Qingqiang Dai
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yingying Qiao
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dazhuang Li
- School of Public Health (Dr. D. Li), Fudan University, Shanghai, China
| | - Li Zhang
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fan Wu
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jia He
- School of Medicine (Dr. He), Tongji University, Shanghai, China
| | - Guizhu Wu
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
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Miao S, He Q, Zhang Y, Wang L, Jin X, Bao C, Wang W. Management of urinary incontinence after radical cystectomy and orthotopic neobladder: A scoping review of international practices. Nurs Open 2023; 10:6618-6634. [PMID: 37408112 PMCID: PMC10495704 DOI: 10.1002/nop2.1924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/17/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES To identify and describe international practice in incontinence management after radical cystectomy and orthotopic neobladder. MATERIALS AND METHODS A systematic scoping review following the methodology of the Joanne Briggs Institute was conducted in which the application searched 15 data sources to identify papers published in English, from 1979 to 2022. RESULTS Of the 16 papers that met the eligibility criteria, articles in Eastern countries mainly focus on the effect of conservative treatment, while in Western countries, more attention is paid to the effect of surgical treatment. Clinical characteristics of patients included conservative treatment failure, duration of post-operative intervention and unique differential treatment of male and female patients. Reported factors influencing the achievement of urinary incontinence (UI) include lack of evidence to guide management practice, limited value of conservative treatment, high risk of surgical treatment and uncertainty of efficacy; currently, early behavioural research and multimodal rehabilitation training have good results. CONCLUSIONS UI in neobladder patients is a distressing condition that is difficult to treat and often requires high-quality rehabilitation guidance and surgical intervention. Further research to address current knowledge gaps is important to inform practice.
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Affiliation(s)
- ShuYing Miao
- Nursing Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - QingWei He
- Nursing Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - YuanFeng Zhang
- Department of UrologyShantou Central HospitalShantouChina
| | - LiJuan Wang
- Nursing Studies, School of MedicineZhejiang UniversityHangzhouChina
| | - XiaoDong Jin
- Department of UrologyThe First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - ChunXiang Bao
- Nursing Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Wei Wang
- Nursing Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
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Fonseca J, Froes G, Moraes-Fontes MF, Rebola J, Lúcio R, Almeida M, Muresan C, Palmas A, Gaivão A, Matos C, Santos T, Dias D, Sousa I, Oliveira F, Ribeiro R, Lopez-Beltran A, Fraga A. Urinary continence recovery after Retzius-sparing robot-assisted radical prostatectomy in relation to surgeon experience. J Robot Surg 2023; 17:2503-2511. [PMID: 37528286 PMCID: PMC10492722 DOI: 10.1007/s11701-023-01687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
Urinary incontinence is one of the main concerns for patients after radical prostatectomy. Differences in surgical experience among surgeons could partly explain the wide range of frequencies observed. Our aim was to evaluate the association between the surgeons` experience and center caseload with relation to urinary continence recovery after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). Prospective observational single-center study. Five surgeons consecutively operated 405 patients between July 2017 and February 2022. Continence recovery was evaluated with pad count and by employing the short form of the International Consultation on Incontinence Questionnaire (ICIQ-SF), pre- and postoperatively at 1 year. Non-parametric tests were used. Median age was 63 years, 30% of patients presented with local advanced disease; the positive surgical margin rate (over 3 mm length) was 16%. Complication rate was 1% (Clavien-Dindo > II). One year after surgery, continence was assessed in 282 patients, of whom 87% were pad free and 51% never leaked (ICIQ-SF = 0). With respect to the mean annual number of procedures per surgeon, divided in < 20, 20-39 and ≥ 40, pad-free rates were achieved in 93%, 85%, and 84% and absence of urine leak rates in 47%, 62% and 48% of patients, respectively. Postoperative median ICIQ-SF was five. We acknowledge the limitation of a 12-month follow-up and the fact that we are a medium-volume center. There is no statistically significant association between continence recovery, surgeon's experience and center caseload. Continence recovery at 1 year after surgery is adequate and robust to surgeon's experience.
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Affiliation(s)
- Jorge Fonseca
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal.
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
| | - Gonçalo Froes
- Faculté de Médecine et Médecine Dentaire, Université Catholique de Louvain, Brussels, Belgium
| | | | - Jorge Rebola
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Rui Lúcio
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Miguel Almeida
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Ciprian Muresan
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Artur Palmas
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Ana Gaivão
- Serviço de Imagiologia, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Celso Matos
- Serviço de Imagiologia, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Tiago Santos
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Daniela Dias
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Inês Sousa
- Unidade de Investigação Clínica, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Francisco Oliveira
- Serviço de Medicina Nuclear, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Ricardo Ribeiro
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Antonio Lopez-Beltran
- Unidade de Anatomia Patológica, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Avelino Fraga
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Haudebert C, Florin M, Fatton B, Campagne-Loiseau S, Tse V. Trans-labial or introital ultrasounds for midurethral slings. Prog Urol 2023; 33:526-532. [PMID: 37500351 DOI: 10.1016/j.purol.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
Stress urinary incontinence is common in adult women. The use of introital or trans-labial ultrasound can help the surgeon (urologist or gynecologist) to better assess the type of incontinence the patient presents in order to guide him in the management of the patient. Often, surgical treatment with a mid-urethral sling (MSU) placement can be chosen in case of failure of non-invasive therapies (such as local estrogen or physical therapy) and if the clinical examination shows an urethral hypermobility. The use of ultrasound can help in this choice. Although rare, complications of MSU can sometimes cause disabling symptoms and be difficult to diagnose. Introital or trans-labial ltrasound can help diagnose them. The objective of this work was to describe the realization of ultrasound of stress urinary incontinence before or after the placement of a MSU, in order to make their realization easier for young surgeons which can use them in current practice.
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Affiliation(s)
- C Haudebert
- Department of Urology, University of Rennes, Rennes, France.
| | - M Florin
- Department of Radiology, AP-HP, Hôpital Tenon, Paris, France
| | - B Fatton
- Department of Gynecology, Nimes, France
| | | | - V Tse
- Department of Urology, Concord Hospital, University of Sydney, Sydney, Australia
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Tutolo M, Briganti A, Salonia A, Montorsi F. Re: Roselyne Choinière, Philippe D. Violette, Mélanie Morin, et al. Evaluation of Benefits and Harms of Surgical Treatments for Post-radical Prostatectomy Urinary Incontinence: A Systematic Review and Meta-analysis. Eur Urol Focus 2022;8:1042-52. Eur Urol Focus 2023; 9:849-850. [PMID: 37012087 DOI: 10.1016/j.euf.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Manuela Tutolo
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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Nakamura W, Sumitomo M, Zennami K, Takenaka M, Ichino M, Takahara K, Teramoto A, Shiroki R. Combination of deep learning and ensemble machine learning using intraoperative video images strongly predicts recovery of urinary continence after robot-assisted radical prostatectomy. Cancer Rep (Hoboken) 2023; 6:e1861. [PMID: 37449339 PMCID: PMC10480482 DOI: 10.1002/cnr2.1861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND We recently reported the importance of deep learning (DL) of pelvic magnetic resonance imaging in predicting the degree of urinary incontinence (UI) following robot-assisted radical prostatectomy (RARP). However, our results were limited because the prediction accuracy was approximately 70%. AIM To develop a more precise prediction model that can inform patients about UI recovery post-RARP surgery using a DL model based on intraoperative video images. METHODS AND RESULTS The study cohort comprised of 101 patients with localized prostate cancer undergoing RARP. Three snapshots from intraoperative video recordings showing the pelvic cavity (prior to bladder neck incision, immediately following prostate removal, and after vesicourethral anastomosis) were evaluated, including pre- and intraoperative parameters. We evaluated the DL model plus simple or ensemble machine learning (ML), and the area under the receiver operating characteristic curve (AUC) was analyzed through sensitivity and specificity. Of 101, 64 and 37 patients demonstrated "early continence (using 0 or 1 safety pad at 3 months post-RARP)" and "late continence (others)," respectively, at 3 months postoperatively. The combination of DL and simple ML using intraoperative video snapshots with clinicopathological parameters had a notably high performance (AUC, 0.683-0.749) to predict early recovery from UI after surgery. Furthermore, combining DL with ensemble artificial neural network using intraoperative video snapshots had the highest performance (AUC, 0.882; sensitivity, 92.2%; specificity, 78.4%; overall accuracy, 85.3%) to predict early recovery from post-RARP incontinence, with similar results by internal validation. The addition of clinicopathological parameters showed no additive effects for each analysis using DL, EL and simple ML. CONCLUSION Our findings suggest that the DL algorithm with intraoperative video imaging is a reliable method for informing patients about the severity of their recovery from UI after RARP, although it is not clear if our methods are reproducible for predicting long-term UI and pad-free continence.
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Affiliation(s)
- Wataru Nakamura
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
| | - Makoto Sumitomo
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
- Fujita Cancer CenterFujita Health UniversityToyoakeJapan
| | - Kenji Zennami
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
| | - Masashi Takenaka
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
| | - Manabu Ichino
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
| | - Kiyoshi Takahara
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
| | - Atsushi Teramoto
- Faculty of Radiological Technology, School of Medical SciencesFujita Health UniversityToyoakeJapan
- Faculty of Information EngineeringMeijo UniversityNagoyaJapan
| | - Ryoichi Shiroki
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
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Plassais C, Cour F, Vidart A, Bosset PO, Pettenati C, Kennel T, Neuzillet Y, Lebret T. Retropubic tape surgery for stress urinary incontinence: can women be cured without voiding dysfunction? World J Urol 2023; 41:2489-2494. [PMID: 37470812 DOI: 10.1007/s00345-023-04492-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/07/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE Retropubic tension free vaginal tape (RP-TVT) has become the gold standard for surgical management of female stress urinary incontinence but is associated with voiding dysfunction (VD). We developed for more than 10 years a reproductible and totally tension free tape procedure. Our goal is to determine efficiency of this technique compared to the incidence of VD. METHODS We retrospectively reviewed patients who underwent RP-TVT in our center between 2011 and 2019. Subjective cure, VD (determined as maximum urinary flow rate (Qmax) < 15 mL/s or post void residual (PVR) volume > 150 mL, or tape's section or resection requirement for underactive bladder (UB) with significant PVR) was assessed at 1 year. The main objective was the evaluation of subjective cure and VD at 1 year. RESULTS On the 319 patients reviewed, 93% of the patients were dry and 10.9% presented VD at one year. UB (OR = 5.01 [1.55-16.44], p = 0.008), preoperative Qmax < 15 mL/s (OR = 0.89 [0.84-0.95], p = 0.001) and previous incontinence surgery (OR = 4.20 [1.54-11.46], p = 0.005) were associated with VD. Acute urinary retention concerned 4.7% of the population and all were resolved after 6 weeks postoperatively. We reported 0.3% of de novo urgency and patients without VD showed a significant decrease of their voiding time at 1 year. CONCLUSION The placement of RP-TVT without intraoperative tightening seems to be a safe technique ensuring a high cure rate and low occurrences of bladder outlet obstruction.
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Affiliation(s)
- C Plassais
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France.
| | - F Cour
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
| | - A Vidart
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
| | - P O Bosset
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
| | - C Pettenati
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
| | - T Kennel
- Department of Research, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
| | - Y Neuzillet
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
| | - T Lebret
- Department of Urology, Foch Hospital, 40, rue Worth, 92150, Suresnes, France
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da Fonseca LC, Giarreta FBA, Peterson TV, Locali PKM, Baracat EC, Ferreira EAG, Haddad JM. A randomized trial comparing vaginal laser therapy and pelvic floor physical therapy for treating women with stress urinary incontinence. Neurourol Urodyn 2023; 42:1445-1454. [PMID: 37449372 DOI: 10.1002/nau.25244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Female stress urinary incontinence (SUI) is considered a major public health issue. Physical therapy is an important conservative treatment; however, it is primarily limited by poor long-term compliance. Furthermore, surgical treatment entails significant risks. Therefore, new treatment techniques must be identified. OBJECTIVE To compare the use of laser therapy and pelvic floor (PF) physical therapy for treating postmenopausal women with SUI. METHODS This pilot study enrolled 40 women with a clinical and urodynamic diagnosis of SUI who were randomized into two groups: those who received erbium-doped yttrium-aluminum-garnet (Er:YAG) laser therapy implemented over three sessions with a 1-month interval (n = 20) and those who received physical therapy with supervision twice a week for 3 months (n = 20). In total, 16 women completed the treatment in each group. The patients were assessed for PF function using the modified Oxford scale and for pelvic organ prolapse using the Pelvic Organ Prolapse Quantification System. The 1-h pad test and quality of life questionnaires, King's Health Questionnaire (KHQ), and Incontinence Quality of Life (IQOL) were also administered. Patients were re-evaluated at 1, 3, 6, and 12 months after treatment. RESULTS The mean patient age was 62.7 ± 9.1 and 57.9 ± 6.1 years, median Oxford score at baseline was 3 (2-4.5) and 4 (3-4), mean IQOL score was 79.8 ± 17 and 74.6 ± 18 for physical therapy group (PTG) and laser group (LG), respectively. For the amount of urine leak in the 1-h pad test evaluation, we found significance for the interaction of group and time points only for the Laser intragroup. The cure rate, that is, the rate of reaching an insignificant score in the pad test, at 6 and 12 months was 43.75% and 50% in PTG and 62.5% and 56.25% in the LG, respectively (p > 0.05). IQOL scores demonstrated considerable improvement in both groups (p > 0.05). Upon comparing the initial and follow-up results, the LG showed an improvement at all consultations, whereas the PTG showed improvements at 1, 3, and 6 months but not at 12 months after treatment. KHQ analysis revealed a considerable improvement in the quality of life (QOL) of patients over time, with no substantial difference between the groups. QOL comparison before and after treatment revealed that the vaginal LG improved more consistently in some domains. Only the PTG showed a significant increase in the mean Oxford score from pretreatment to 1 and 3 months after treatment (p < 0.001 and p = 0.002, respectively). However, no statistically significant difference was observed between the groups. CONCLUSION Both treatments are safe and have a positive influence on the impact of UI on patients' QOL. The laser caused a greater reduction in the urinary loss, as measured using the weight of pad test, at 6-month and 12-month after treatment without difference with PTG at the end of the follow-up.
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Affiliation(s)
- Lucília C da Fonseca
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Thais V Peterson
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Edmund C Baracat
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
| | - Elizabeth A Gonçalves Ferreira
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
- Department of Physical Therapy, Speech and Occupational Therapy, Medical School, Universidade de São Paulo, Sao Paulo, Brazil
| | - Jorge Milhem Haddad
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
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Gonzalez RR, Rosamilia A, Eilber K, Kahn BS, White AB, Anger JT. Three-year patient-reported outcomes of single-incision versus transobturator slings for female stress urinary incontinence are equivalent. Int Urogynecol J 2023; 34:2265-2274. [PMID: 37099159 DOI: 10.1007/s00192-023-05538-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/13/2023] [Indexed: 04/27/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Patient-reported outcome measures (PROMs) are important for understanding the success of surgery for stress urinary incontinence, as patient perception of success does not always correlate with physician perception of success. We report PROMS after single-incision slings (SIS) and transobturator mid-urethral slings (TMUS). METHODS This was a planned outcome analysis of secondary endpoints in a study in which the primary aim was to compare efficiency and safety using a non-inferiority design (results reported previously). In this analysis of quality of life (QOL), validated PROMs were collected at baseline, 6, 12, 18, 24, and 36 months to quantify incontinence severity (Incontinence Severity Index), symptom bother (Urogenital Distress Inventory), disease-specific QOL impact (Urinary Impact Questionnaire), and generic QOL impact (PGI-I; not applicable at baseline). PROMs were analyzed within treatment groups as well as between groups. Propensity score methods were used to adjust for baseline differences between groups. RESULTS A total of 281 subjects underwent the study procedure (141 SIS, 140 TMUS). Baseline characteristics were balanced after propensity score stratification. Participants had significant improvement in incontinence severity, disease-specific symptom bother, and QOL impact. Improvements persisted through the study and PROMs were similar between treatment groups in all assessment at 36 months CONCLUSIONS: Following SIS and TMUS, patients with stress urinary incontinence had significant improvement in PROMs including Urogenital Distress Inventory, Incontinence Severity Index, and Urinary Impact Questionnaire at 36 months, indicating disease-specific QOL improvement. Patients have a more positive impression of change in stress urinary incontinence symptoms at each follow-up visit, indicating generic QOL improvement.
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Affiliation(s)
- Ricardo R Gonzalez
- Urology and Female Pelvic Medicine and Reconstructive Surgery, Houston Methodist Hospital, Houston, TX, 77030, USA.
| | - Anna Rosamilia
- Department of Obstetrics and Gynaecology, Monash Medical Centre and Cabrini Hospital, Melbourne, Australia
| | - Karyn Eilber
- Division of Urology, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Bruce S Kahn
- Department of Obstetrics and Gynecology, Scripps Clinic, San Diego, CA, USA
| | - Amanda B White
- Department of Women's Health, Dell Medical School, University of Texas at Austin, TX, USA, Austin, USA
| | - Jennifer T Anger
- Department of Urology, University of California San Diego Health, San Diego, CA, USA
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