26
|
Pariser JJ, Pearce SM, Patel SG, Anderson BB, Packiam VT, Shalhav AL, Bales GT, Smith ND. Rhabdomyolysis After Major Urologic Surgery: Epidemiology, Risk Factors, and Outcomes. Urology 2015; 85:1328-32. [PMID: 26099878 DOI: 10.1016/j.urology.2015.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/19/2015] [Accepted: 03/23/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To study the epidemiology, risk factors, and outcomes of rhabdomyolysis (RM) after major urologic surgery. MATERIALS AND METHODS The National Inpatient Sample (2003-2011) was used to identify patients who underwent radical prostatectomy, radical or partial nephrectomy, or radical cystectomy. Demographics included age, sex, race, and comorbidities. Factors examined included bleeding, hospital teaching status, minimally invasive technique, and development of RM. Multivariate logistic regression was used to identify independent risk factors of RM. Outcomes of mortality, acute kidney injury (AKI), length of stay, and charges in patients with RM were compared with those of controls. RESULTS A weighted population of 1,016,074 patients was identified with 870 (0.1%) developing RM, which was significantly more likely for radical or partial nephrectomy and radical cystectomy patients compared with radical prostatectomy patients. On multivariate analysis, independent risk factors for RM included younger age, male sex, diabetes, chronic kidney disease, obesity, and bleeding. Race, minimally invasive technique, and teaching status were not associated with RM when controlling for other factors. Patients with RM experienced increases in mortality, AKI, length of stay, and hospital charges. CONCLUSION Rhabdomyolysis is a rare complication after urologic surgery. Risk factors include male sex, younger age, diabetes, chronic kidney disease, obesity, and perioperative bleeding. Patients who develop RM have a higher risk of AKI, mortality, prolonged hospital stay, and increased charges.
Collapse
|
27
|
Pariser JJ, Saltzman GB, Bales GT, Steinberg GD, Smith ND. Reply: To PMID 26142714. Urology 2015; 86:617. [PMID: 26260743 DOI: 10.1016/j.urology.2015.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
28
|
Pariser JJ, Saltzman GB, Bales GT, Steinberg GD, Smith ND. Outcomes of the Endoscopic Treatment of Bladder Neck Contractures in the Orthotopic Neobladder. Urology 2015; 86:613-7. [PMID: 26142714 DOI: 10.1016/j.urology.2015.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 05/27/2015] [Accepted: 06/01/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the outcomes of endoscopic procedures for bladder neck contracture (BNC) in the orthotopic neobladder (ONB) after radical cystectomy focusing on success rates for patients who require multiple treatments. MATERIALS AND METHODS Patients who underwent treatment for cystoscopically confirmed BNC in an ONB from 2007 to 2014 were studied. Treatment information included procedure type, use of adjuvant clean intermittent catheterization (CIC), and follow-up procedures. Procedures followed by additional interventions were categorized as failures. Success was defined as no additional surgical procedure with at least 1 year of follow-up. Procedures were classified by a number of prior endoscopic treatments. RESULTS Seventy-one patients underwent 155 individual endoscopic procedures (146 urethrotomy, 3 dilation, and 6 transurethral resection of bladder neck). All patients were male without prior radiation. Median follow-up after initial endoscopic treatment was 26.8 months (interquartile range: 16.6-51.7), and time to recurrence was 3.5 months (1.6-6.3). Success was experienced for 50 of 136 individual procedures (37%) after excluding 19 procedures for inadequate follow-up. Success rates remained 25%-43% even after multiple prior interventions. Adjuvant CIC was associated with a higher success rate (14/24 or 58%) compared to procedures without CIC (36/112 or 32%, P = .02). Successful outcomes were seen in 50 of 71 patients (73%) with 2 patients requiring ONB removal. CONCLUSION Individual endoscopic treatments of BNC in the ONB were met with 37% success. The rate did not decrease with subsequent procedures. Adjuvant CIC improved the outcomes. Overall, a successful outcome was achieved for most patients, but the majority required more than one procedure.
Collapse
|
29
|
Pariser JJ, Pearce SM, Patel SG, Bales GT. Reply. Urology 2015; 86:186. [DOI: 10.1016/j.urology.2015.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
30
|
Pariser JJ, Pearce SM, Patel SG, Packiam VT, Anderson BB, Shalhav AL, Bales GT, Smith ND. MP29-10 RHABDOMYOLYSIS AFTER MAJOR UROLOGIC SURGERY: INCIDENCE, RISK FACTORS AND OUTCOMES. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
31
|
Pariser JJ, Pearce SM, Patel SG, Bales GT. MP18-03 PENILE FRACTURE: NATIONAL TRENDS IN URETHRAL EVALUATION AND RISK FACTORS FOR URETHRAL INJURY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
32
|
Pariser JJ, Cohn JA, Gottlieb LJ, Bales GT. Buccal Mucosal Graft Urethroplasty for the Treatment of Urethral Stricture in the Neophallus. Urology 2015; 85:927-31. [DOI: 10.1016/j.urology.2014.12.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/26/2014] [Accepted: 12/29/2014] [Indexed: 11/27/2022]
|
33
|
Pariser JJ, Malik RD, Gottlieb LJ, Bales GT. PD26-12 PENILE PROSTHESIS INSERTION AFTER RADIAL FOREARM FREE FLAP NEOPHALLUS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
34
|
Malik RD, Cohn JA, Bales GT. Urinary Retention in Elderly Women: Diagnosis & Management. Curr Urol Rep 2014; 15:454. [DOI: 10.1007/s11934-014-0454-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
35
|
Richards KA, Cohn JA, Large MC, Bales GT, Smith ND, Steinberg GD. The effect of length of ureteral resection on benign ureterointestinal stricture rate in ileal conduit or ileal neobladder urinary diversion following radical cystectomy. Urol Oncol 2014; 33:65.e1-8. [PMID: 25023788 DOI: 10.1016/j.urolonc.2014.05.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/17/2014] [Accepted: 05/07/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the effect of the length of the ureter resected and other clinical variables on ureterointestinal anastomotic (UIA) stricture rate following radical cystectomy and ileal segment urinary diversion. METHODS AND MATERIALS We identified 519 consecutive patients who underwent cystectomy and ileal conduit or ileal orthotopic neobladder diversion from January 2007 to August 2012. The length of the ureter resected was defined as the length of the ureter in the cystectomy specimen plus the length of the distal ureter submitted for pathologic analysis. The primary end point was the risk of UIA stricture formation, assessed by Cox proportional hazards analysis. RESULTS A total of 463 patients met the inclusion criteria with complete data. Median follow-up was 459 days (interquartile range [IQR]: 211-927). Median time to stricture formation was 235 (IQR: 134-352) and 232 days (IQR: 132-351) on the right and the left ureter, respectively. Overall stricture rate per ureter was 5.9% on the right vs. 10.0% on the left (P = 0.03). There was no difference in demographic, operative, or perioperative variables between patients with and without UIA strictures. On multivariate analysis adjusted for age, sex, anastomosis technique (running vs. interrupted), and length of ureter resected, only a Clavien complication≥III (hazard ratio = 2.11, 1.01-4.40) and urine leak (hazard ratio = 3.37, 1.08-10.46) significantly predicted for left- and right-sided stricture formation, respectively. The length of the ureter resected did not predict UIA stricture formation on either side. CONCLUSIONS The etiology of benign UIA strictures following ileal urinary diversion is likely multifactorial. Our data suggest that a complicated postoperative course and urine leak are risk factors for UIA stricture formation. The length of the distal ureter resected did not significantly affect stricture rate.
Collapse
|
36
|
Sturm RM, Guralnick ML, Stone AR, Bales GT, Dangle PP, O'Connor RC. Comparison of clinical outcomes between "ideal" and "nonideal" transobturator male sling patients for treatment of postprostatectomy incontinence. Urology 2014; 83:1186-8. [PMID: 24767526 DOI: 10.1016/j.urology.2013.12.061] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 12/20/2013] [Accepted: 12/24/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To review the clinical outcomes of "ideal" vs "nonideal" postprostatectomy stress urinary incontinence (PPI) patients who underwent male sling placement. METHODS The medical records of 95 consecutive patients with PPI who underwent male sling insertion (AdVance male sling, American Medical Systems, Minnetonka, MN) were reviewed. Patients were divided into "ideal" vs "nonideal" cohorts. The ideal group consisted of patients with mild to moderate incontinence (<4 pads/day or <300 g daily pad weight), ability to volitionally contract the external urinary sphincter, no history of pelvic radiation or cryotherapy, no history of previous anti-incontinence surgical procedures, the ability to generate a volitional detrusor contraction when voiding, and a postvoid residual urine volume <100 mL. Patients in the nonideal group did not satisfy all these criteria. RESULTS Significant reductions in daily pad usage and weight were noted in both cohorts. In the ideal patient group, 66 of 72 patients (92%) would undergo the procedure again. Conversely, only 7 of 23 nonideal men (30%) would undergo the procedure again. CONCLUSION Preoperative patient selection can influence favorable outcomes after the treatment of PPI with AdVance male slings. Attention to ideal vs nonideal patient characteristics should be used when counseling men considering male sling surgery.
Collapse
|
37
|
Malik RD, Cohn JA, Chang C, Anderson L, Randall B, Bales GT, Chung DE. MP76-19 A MODERN COMPARISON OF URODYNAMIC FINDINGS IN NONDIABETIC VERSUS DIABETIC FEMALES. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
38
|
Cohn JA, Large MC, Richards KA, Steinberg GD, Bales GT. Cystectomy and urinary diversion as management of treatment-refractory benign disease: The impact of preoperative urological conditions on perioperative outcomes. Int J Urol 2013; 21:382-6. [DOI: 10.1111/iju.12284] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 08/18/2013] [Indexed: 11/30/2022]
|
39
|
Large MC, Reichard C, Williams JTB, Chang C, Prasad S, Leung Y, DuBeau C, Bales GT, Steinberg GD. Incidence, risk factors, and complications of postoperative delirium in elderly patients undergoing radical cystectomy. Urology 2012; 81:123-8. [PMID: 23153950 DOI: 10.1016/j.urology.2012.07.086] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 07/20/2012] [Accepted: 07/25/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify the risk factors for, and complications associated with, the development of delirium after radical cystectomy. MATERIALS AND METHODS From July 2008 to December 2009, 59 patients, aged ≥65 years and undergoing radical cystectomy, were prospectively enrolled. The baseline cognitive status was assessed using the Mini-Mental Status Examination. Postoperative delirium was assessed using the Confusion Assessment Method. RESULTS A total of 49 patients completed the surgery and all assessments. The incidence of postoperative delirium was 29%, with duration of 1-5 days. On univariate analysis, older age and preoperative Mini-Mental Status Examination score were associated with postoperative delirium. On multivariate analysis, only age was associated with postoperative delirium (odds ratio 1.52, 95% confidence interval 1.04-2.22, P=.03). The 2 groups did not differ in pathologic stage, length of surgery, intraoperative and postoperative narcotic usage, body mass index, age-adjusted Charlson comorbidity index, activities of daily living scores, smoking history, preoperative hematocrit, estimated blood loss, urinary tract infection, interval to a regular diet, or length of hospital stay. The patients who developed postoperative delirium were more likely to undergo readmission (odds ratio 10.7, 95% confidence interval 2.2-51.8, P=.01) and reoperation (odds ratio 9.2, 95% confidence interval 1.5-55.3, P=.03) but did not differ in the 90-day and 1-year mortality rates or incidence of postoperative complications. CONCLUSION In patients aged≥65 years, a lower preoperative Mini-Mental Status Examination score and older age were significantly associated with the development of postcystectomy delirium, as measured using the Confusion Assessment Method. The patients who developed delirium were more likely to undergo readmission and reoperation. Larger studies with multiple surgeons are needed to validate these findings.
Collapse
|
40
|
Reynolds WS, Kit LC, Kaufman MR, Karram M, Bales GT, Dmochowski RR. Obturator Foramen Dissection for Excision of Symptomatic Transobturator Mesh. J Urol 2012; 187:1680-4. [DOI: 10.1016/j.juro.2011.12.065] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Indexed: 10/28/2022]
|
41
|
Wiltz AL, Reynolds WS, Jayram G, Fedunok PA, Bales GT. Management of Vaginal Synthetic Graft Extrusion following Surgery for Stress Urinary Incontinence and Prolapse. Curr Urol 2009. [DOI: 10.1159/000189689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
42
|
Reynolds WS, Bales GT. Re: Results of Sacral Neuromodulation Therapy for Urinary Voiding Dysfunction: Outcomes of a Prospective, Worldwide Clinical Study. J Urol 2008; 179:2483-4; author reply 2484. [DOI: 10.1016/j.juro.2008.01.157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Indexed: 10/22/2022]
|
43
|
Lucioni A, Reynolds WS, Rapp DE, Katz M, Bales GT. The use of botulinum toxin for treatment of lower urinary tract symptoms. MINERVA UROL NEFROL 2008; 60:93-103. [PMID: 18500224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In the last decade we have seen the emergence of botulinum toxin (BTX) as a successful treatment of patients with neurogenic and idiopathic detrusor overactivity that are refractory to antimuscarinic medication. The success of BTX in this patient population has led to use BTX in patients with other causes of lower urinary tract symptoms such as benign prostatic hyperplasia (BPH) and urethral sphincter anomalies. Despite this success, the protocol for BTX injection has not yet been standardized. Various studies are on the way in order to determine the best injection protocol for bladder injection of BTX. The use of BTX in patients with BPH is in its early stages. Further large randomized controls trials in patients with BPH are needed to determine the efficacy of BTX in this patient population.
Collapse
|
44
|
Lucioni A, Rapp DE, Gong EM, Reynolds WS, Fedunok PA, Bales GT. The surgical technique and early postoperative complications of the Gynecare Prolift pelvic floor repair system. THE CANADIAN JOURNAL OF UROLOGY 2008; 15:4004-4008. [PMID: 18405450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The Gynecare Prolift pelvic floor repair system (GPS) comprises a synthetic mesh placed via a transvaginal, transobturator approach. We present our technique focusing on the safety and feasibility of the GPS. MATERIALS AND METHODS GPS candidates are evaluated in the office with a full history, physical examination, urinalysis and when appropriate, urodynamic evaluation. Patients were offered total vaginal vault prolapse repair or isolated anterior repair dependent of site of defect. Follow-up comprised a full history, physical examination, and global assessment of subjective satisfaction (2 and 6 weeks, 6 months postoperative). Concentration was placed on intraoperative and short-term postoperative complications and assessment of prolapse recurrence. RESULTS GPS prolapse repair has been used in 12 patients for anterior or total vault prolapse. Mean postoperative follow-up time is 42 weeks. There were no major perioperative complications. De novo enterocele development was seen in one patient without any other incidence of recurrence. No incidence of mesh erosion or sexual dysfunction has been observed. CONCLUSIONS The GPS is a safe and reproducible system for use in transvaginal repairs of vaginal vault prolapse. Long-term studies are needed to evaluate repair durability and for potential complications.
Collapse
|
45
|
Acharya SS, DuBeau CE, Bales GT. UROLOGY RESIDENT GERIATRIC EDUCATION (URGE): A MODEL FOR RESIDENT TRAINING IN GERIATRIC UROLOGY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
46
|
Reynolds WS, Lucioni A, Rapp DE, Bales GT, McGehee DS. THE EFFECT OF BOTULINUM TOXIN A ON CHEMICAL STIMULATION OF RAT DORSAL ROOT GANGLION CELLS. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60225-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
47
|
Reynolds WS, Gottlieb LJ, Lucioni A, Rapp DE, Song DH, Bales GT. VESICOVAGINAL FISTULA REPAIR WITH RECTUS ABDOMINIS MYOFASCIAL INTERPOSITION FLAP. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60037-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
48
|
Lucioni A, Bales GT, Lotan TL, McGehee DS, Cook SP, Rapp DE. Botulinum toxin type A inhibits sensory neuropeptide release in rat bladder models of acute injury and chronic inflammation. BJU Int 2008; 101:366-70. [PMID: 18184328 DOI: 10.1111/j.1464-410x.2007.07312.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the effect of botulinum toxin type A (BTX-A) on the release of the neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP) from isolated bladder preparations after acute injury with HCl and the induction of cyclophosphamide (CYP)-induced cystitis, as neurogenic inflammation has been increasingly identified in urological disorders such as interstitial cystitis. MATERIALS AND METHODS Adult rats had either an intraperitoneal injection with CYP or saline over a 10-day period to induce chronic bladder inflammation, after which the bladder was harvested, or normal bladder explants were injured acutely with incubation (20 s) in HCl (0.4 m). To measure the effect of BTX-A on the release of neurotransmitters, harvested bladders were incubated in an organ bath containing BTX-A (10 U) or vehicle. Bladders were transferred to a subsequent bath (physiological saline) and incubated for 15 min, and the bathing medium analysed to measure neurotransmitter release, as determined by radioimmunoassay. Bladder specimens from sham treatment, controls and experimental rats were compared histologically. RESULTS Acute injury with HCl caused a significantly greater release of both CGRP and SP release (1235 and 1655 pg/g, respectively) than in controls (183 and 449 pg/g, respectively; P < 0.001). This increase in neurotransmitter release was partly inhibited by exposure to BTX-A (870 and 1033 pg/g (P < 0.05 and <0.01). CYP-induced chronic inflammation caused significantly greater release of SP than in the controls (1060 and 605 pg/g, respectively; P < 0.005). Exposure to BTX-A partly inhibited the release of SP after CYP-induced cystitis (709 pg/g, P < 0.05). CONCLUSIONS The application of BTX-A inhibits the release of sensory neurotransmitters from isolated bladder preparations in rat bladder models of both acute injury and chronic inflammation, suggesting a potential clinical benefit of BTX-A in the treatment of neurogenic inflammation.
Collapse
|
49
|
Rapp DE, Reynolds WS, Lucioni A, Bales GT. Surgical technique using AdVance sling placement in the treatment of post-prostatectomy urinary incontinence. Int Braz J Urol 2008; 33:231-5; discussion 236-7. [PMID: 17488544 DOI: 10.1590/s1677-55382007000200015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2006] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To describe and illustrate a new minimally invasive approach to the treatment of male stress urinary incontinence following prostatectomy. SURGICAL TECHNIQUE Our initial experience consisted of four patients treated with the Advance sling for post-prostatectomy urinary incontinence. Sling placement involves the following steps: 1. Urethral dissection and mobilization, 2. Identification of surgical landmarks, 3. Placement of needle passers through the obturator foramen, 4. Mesh advancement, 5. Mesh tensioning and fixation, 6. Incision closure. COMMENTS Based on our initial experience, we believe that the Advance Male Sling System may be a safe technique for the treatment of male stress urinary incontinence. This technique is easy to perform and may offer a reproducible, transobturator approach. Further patient accrual is ongoing to assess the safety and reproducibility of this technique. Also, additional study will focus on efficacy standards and complication rates.
Collapse
|
50
|
Reynolds WS, Patel R, Msezane L, Lucioni A, Rapp DE, Bales GT. Current Use of Artificial Urinary Sphincters in the United States. J Urol 2007; 178:578-83. [PMID: 17570407 DOI: 10.1016/j.juro.2007.03.146] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE Significant improvement and high patient satisfaction are seen after artificial urinary sphincter implantation for male stress urinary incontinence. However, only a small percent of men are treated with an artificial urinary sphincter nationally. We defined trends in current artificial urinary sphincter use in the United States, specifically focusing on regional differences in use. Current rates of radical prostatectomy and the regional distribution of urologists were analyzed as possible factors to explain these disparities. MATERIALS AND METHODS Data provided by American Medical Systems, Minnetonka, Minnesota on the number of artificial urinary sphincter units sold were analyzed by state, regional and city distribution. American Urological Association data on the number of urologists were used to estimate urologist use of artificial urinary sphincters. The number of radical prostatectomies reported by the American College of Surgeons National Cancer Database were used to estimate artificial urinary sphincter use per radical prostatectomy. RESULTS In the most populous states and cities generally the most artificial urinary sphincter units were purchased, the most urologists were reported and the most radical prostatectomies were performed. The proportional use of artificial urinary sphincters per radical prostatectomy by state varied from 1% to 10% (national average approximately 6%). The number of urologists per 100,000 men older than 50 years appeared uniform across states (national average 34). However, artificial urinary sphincter use by urologist appeared localized and concentrated. Nationally 1 artificial urinary sphincter unit was purchased for every 3 urologists in the United States. CONCLUSIONS Artificial urinary sphincter use demonstrates considerable state and regional variation even when controlled for differences in the frequency of radical prostatectomy and the distribution of urologists. Overall the data suggest that artificial urinary sphincters may be underused in some areas of the country, particularly for post-prostatectomy incontinence.
Collapse
|