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Hutchison D, Zillioux J, Ali M, Farhi J, DeNovio A, Barquin D, Rapp DE. Predictors of urinary outcomes following robotic-assisted laparoscopic prostatectomy. BJUI COMPASS 2023; 4:722-728. [PMID: 37818018 PMCID: PMC10560616 DOI: 10.1002/bco2.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/04/2023] [Accepted: 04/16/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Incontinence and urgency are common after prostatectomy. The University of Virginia prostatectomy functional outcomes program (PFOP) was developed to comprehensively assess and optimise continence outcomes following robotic-assisted laparoscopic prostatectomy (RALP). Patients are prospectively evaluated by a Female Pelvic Medicine and Reconstructive Surgery specialist. This study assessed for predictors of 3- and 6-month stress urinary incontinence (SUI) and urgency symptom outcomes following RALP. Methods We performed a post hoc review of patients from our PFOP receiving a minimum of 6-month follow-up. Urinary symptoms are prospectively assessed using the validated International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) questionnaire and daily pad use (pads per day [PPD]). Primary study outcomes included ICIQ-MLUTS SUI and urgency domain scores and PPD. Multivariable linear regression was performed to identify variables associated with outcomes at 3 and 6 months postoperatively. Variables included patient, oncologic and surgical factors. Each variable was run in a separate model with pelvic floor muscle therapy and surgeon to reduce confounding and prevent overfitting. Results Forty men were included. In assessment of ICIQ-MLUTS SUI domain score, at 3 months, body mass index (BMI) was associated with worse scores, and at 6 months, BMI, hypertension and estimated blood loss (EBL) were associated with worse scores, whereas bilateral nerve-sparing technique was associated with better scores. For ICIQ-MLUTS Urgency domain score, at 3 months, preoperative use of benign prostatic hyperplasia (BPH) medication was associated with better scores. No covariates predicted 6-month ICIQ-MLUTS Urgency domain scores. For PPD use, at both 3 and 6 months, BMI was a positive predictor, while preoperative use of BPH medication was a negative predictor. Conclusion Increased BMI, EBL and hypertension are associated with worsened SUI outcomes following RALP, whereas bilateral nerve-sparing technique and preoperative BPH medication are associated with improved SUI outcomes. These data may inform patient counselling and help identify patients who may benefit from closer surveillance and earlier anti-incontinence intervention.
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Affiliation(s)
- Dylan Hutchison
- Department of UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - Marwan Ali
- Department of UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Jacques Farhi
- Department of UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Anthony DeNovio
- School of MedicineUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - David Barquin
- School of MedicineUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - David E. Rapp
- Department of UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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2
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Bole R, Hebert KJ, Gottlich HC, Bearrick E, Kohler TS, Viers BR. Narrative review of male urethral sling for post-prostatectomy stress incontinence: sling type, patient selection, and clinical applications. Transl Androl Urol 2021; 10:2682-2694. [PMID: 34295753 PMCID: PMC8261433 DOI: 10.21037/tau-20-1459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Male stress urinary incontinence (SUI) following prostate treatment is a devastating complaint for many patients. While the artificial urinary sphincter is the gold standard treatment for male SUI, the urethral sling is also popular due to ease of placement, lack of mechanical complexity, and absence of manual dexterity requirement. A literature review was performed of male urethral sling articles spanning the last zz20 years using the PubMed search engine. Clinical practice guidelines were also reviewed for comparison. Four categories of male urethral sling were evaluated: the transobturator AdVance and AdVance XP, the bone-anchored InVance, the quadratic Virtue, and the adjustable sling series. Well selected patients with mild to moderate urinary incontinence and no prior history of radiation experienced the highest success rates at long-term follow up. Patients with post-prostatectomy climacturia also reported improvement in leakage after sling. Concurrent penile prosthesis and sling techniques were reviewed, with favorable short-term outcomes demonstrated. Male urethral sling is a user-friendly surgical procedure with durable long-term outcomes in carefully selected men with mild stress urinary incontinence. Multiple sling types are available with varying degrees of efficacy and complication rates. Longer follow-up and larger cohort sizes are needed for treatment of newer indications such as climacturia as well as techniques involving dual placement of sling and penile prosthesis.
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Affiliation(s)
- Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN, USA
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3
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Rahnama'i MS, Marcelissen T, Geavlete B, Tutolo M, Hüsch T. Current Management of Post-radical Prostatectomy Urinary Incontinence. Front Surg 2021; 8:647656. [PMID: 33898508 PMCID: PMC8063855 DOI: 10.3389/fsurg.2021.647656] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
Prostate cancer is the second most common cancer in men worldwide. Radical prostatectomy and radiation beam therapy are the most common treatment options for localized prostate cancer and have different associated complications. The etiology of post prostatectomy incontinence is multifactorial. There is evidence in the literature that anatomic support and pelvic innervation are important factors in the etiology of post-prostatectomy incontinence. Among the many surgical and technical factors proposed in the literature, extensive dissection during surgery, damage to the neurovascular bundle and the development of postoperative fibrosis have a substantial negative impact on the continence status of men undergoing RP. Sparing of the bladder neck and anterior, and possibly posterior, fixation of the bladder-urethra anastomosis are associated with better continence rates. Overactive bladder syndrome (OAB) is multifactorial and the exact role of prostate surgery in the development of OAB is still under debate. There are several variables that could contribute to detrusor overactivity. Detrusor overactivity in patients after radical prostatectomy has been mainly attributed to a partial denervation of the bladder during surgery. However, together with bladder denervation, other hypotheses, such as the urethrovesical mechanism, have been described. Although there is conflicting evidence regarding the importance of conservative treatment after post-prostatectomy urinary incontinence, pelvic floor muscle training (PFMT) is still considered as the first treatment choice. Duloxetin, either alone or in combination with PFMT, may hasten recovery of urinary incontinence but is often associated with severe gastrointestinal and central nervous side effects. However, neither PFMT nor duloxetine may cure male stress urinary incontinence. The therapeutic decision and the chosen treatment option must be individualized for each patient according to clinical and social factors. During the recent years, the development of new therapeutic choices such as male sling techniques provided a more acceptable management pathway for less severe forms of urinary incontinence related to radical prostatectomy. Following this perspective, technological improvements and the emergence of new dedicated devices currently create the premises for a continuously positive evolution of clinical outcomes in this particular category of patients.
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Affiliation(s)
| | - Tom Marcelissen
- Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | | | - Manuela Tutolo
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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4
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Torres L, Puerto A, Bravo A, Acuña M, Sánchez J, Bejarano O, Peña P, Cataño JG. Analysis of Correlation and Agreement between the Uroflowmetry and the International Prostate Symptom Score in Patients after retropubic Radical Prostatectomy: A Multicenter Prospective Study. UROLOGÍA COLOMBIANA 2020. [DOI: 10.1055/s-0039-1697998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Abstract
Objectives Patients undergoing retropubic radical prostatectomy (RRP) may suffer from lower urinary tract symptoms (LUTS). We aim to characterize LUTS and to evaluate the correlation and agreement between uroflowmetry and the International Prostate Symptom Score (IPSS) in patients after RRP in two reference centers.
Methods An observational multicenter prospective study was conducted between December 2015 and September 2016. Patients with at least 12-months of follow-up after RRP were included; these were evaluated with uroflowmetry and the IPSS.
Results A total of 90 patients were included. The mean follow-up was of 54.6 months (standard deviation [SD] = 27.52), and the mean age was 65 (SD = 6.85) years old. The mean IPSS was 7.41 (SD = 6.29), with 33.3% (n = 54) of the patients with moderate symptoms and 6.7% (n = 6) with severe symptoms. A total of 50% (n = 45) of the patients had normal uroflowmetry. Patients with an abnormal/equivocal result in the uroflowmetry had a mean of 9.31 (SD = 7.03) points in the IPSS versus 5.51 (SD = 4.82) in patients with a normal uroflowmetry result (p < 0.01). The level of agreement between mild versus moderate-to-severe LUTS and normal uroflowmetry versus abnormal/equivocal was 61.1% (k = 0.22, p = 0.04). We found that a score ≥ 10 in the IPSS had a level of agreement of 65.6% (k = 0.31, p = 0.0004).
Conclusions We consider that although the IPSS cannot replace uroflowmetry and vice versa, these tests are complementary and may be useful tools in the evaluation of patients with LUTS after RRP.
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Affiliation(s)
- Lynda Torres
- Department of Urology, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá DC, Colombia
| | - Angie Puerto
- Department of Urology, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá DC, Colombia
| | - Alejandra Bravo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Miguel Acuña
- Department of Urology, Fundación Cardioinfantil, Bogotá DC, Colombia
| | - Juan Sánchez
- Department of Urology, Fundación Cardioinfantil, Bogotá DC, Colombia
| | - Olga Bejarano
- Department of Urology, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá DC, Colombia
| | - Paula Peña
- Department of Urology, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá DC, Colombia
| | - Juan Guillermo Cataño
- Department of Urology, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá DC, Colombia
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Management of Urinary Incontinence With Underactive Bladder: A Review. Int Neurourol J 2020; 24:111-117. [PMID: 32615672 PMCID: PMC7332822 DOI: 10.5213/inj.2040076.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/16/2020] [Indexed: 01/24/2023] Open
Abstract
Urinary incontinence is caused by storage function failure, while underactive bladder (UAB) is caused by a decline in detrusor contractility and voiding dysfunction. As the treatment mechanisms for incontinence and UAB are contrary to each other, it is difficult to treat both incontinence and UAB, and the patient’s quality of life can be further degraded. Conventional midurethral sling (MUS), such as transobturator tape or retropubic MUS, introduces a risk of postoperative voiding dysfunction in stress urinary incontinence with UAB. However, there have been several reports about the efficacy and safety of conventional MUS. Adjustable sling procedures, such as transobturator adjustable tape or the Remeex system, have better outcomes than conventional MUS because they control tension both during and after surgery. When voiding dysfunction occurs after incontinence treatment with UAB, voiding symptoms can be improved by various therapeutic modalities. Clean intermittent catheterization is recommended for patients with significant increased postvoid residual volumes or urinary retention. Although pharmacotherapy such as with alpha-blockers or parasympathomimetics can be considered for UAB, there is insufficient evidence of their effect on incontinence with UAB. Future therapies, such as stem cell therapy or gene therapy, may be used to treat incontinence with UAB. The possibility of management urgency urinary incontinence that related to detrusor hyperactivity with impaired contractility using sacral neuromodulation has been suggested. Further research is needed to establish evidence for the efficacy and safety of treatments for incontinence with UAB and improve patient quality of life.
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6
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Hodges PW, Stafford RE, Hall L, Neumann P, Morrison S, Frawley H, Doorbar-Baptist S, Nahon I, Crow J, Thompson J, Cameron AP. Reconsideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy. Urol Oncol 2019; 38:354-371. [PMID: 31882228 DOI: 10.1016/j.urolonc.2019.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/08/2019] [Accepted: 12/02/2019] [Indexed: 01/20/2023]
Abstract
Urinary incontinence is common after radical prostatectomy. Pelvic floor muscle training provides a plausible solution. Although early trials provided promising results, systematic reviews have questioned the efficacy of this intervention. A major consideration is that most clinical trials in men have applied principles developed for pelvic floor muscle training for stress urinary incontinence in women, despite differences in anatomy between sexes and differences in the mechanisms for continence/incontinence. Literature regarding continence control in men has been conflicting and often based on erroneous anatomy. New understanding of continence mechanisms in men, including the complex contribution of multiple layers of striated pelvic floor muscles, and detailed consideration of the impact of radical prostatectomy on continence anatomy and physiology, have provided foundations for a new approach to pelvic floor muscle training to prevent and treat incontinence after prostatectomy. An approach to training can be designed to target the pathophysiology of incontinence. This approach relies on principles of motor learning and exercise physiology, in a manner that is tailored to the individual patient. The aims of this review are to consider new understanding of continence control in men, the mechanisms for incontinence after radical prostatectomy, and to review the characteristics of a pelvic floor muscle training program designed to specifically target recovery of continence after prostatectomy.
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Affiliation(s)
- Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Ryan E Stafford
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Leanne Hall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | | | - Shan Morrison
- Women's and Men's Health Physiotherapy, Melbourne, Australia
| | | | | | | | - Jason Crow
- Active Rehabilitation, Brisbane, Australia
| | | | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, MI
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7
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Ahn T, Roberts MJ, Strahan A, Malone G, Paterdis J, Wood G, Heathcote P. Improved lower urinary tract symptoms after robot-assisted radical prostatectomy: implications for survivorship, treatment selection and patient counselling. BJU Int 2019; 123 Suppl 5:47-53. [DOI: 10.1111/bju.14717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Ahn
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
| | - Matthew J. Roberts
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Department of Urology; Princess Alexandra Hospital; Brisbane Qld Australia
| | - Andrew Strahan
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
| | - Greg Malone
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
- Department of Urology; Princess Alexandra Hospital; Brisbane Qld Australia
- Brisbane Urology Clinic; Brisbane Qld Australia
| | - Jason Paterdis
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
- Brisbane Urology Clinic; Brisbane Qld Australia
- Department of Urology; QEII Jubilee Hospital; Brisbane Qld Australia
| | - Glen Wood
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Brisbane Urology Clinic; Brisbane Qld Australia
| | - Peter Heathcote
- Department of Urology; Greenslopes Private Hospital; Brisbane Qld Australia
- Department of Urology; Princess Alexandra Hospital; Brisbane Qld Australia
- Brisbane Urology Clinic; Brisbane Qld Australia
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8
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Hennessey DB, Hoag N, Gani J. Impact of bladder dysfunction in the management of post radical prostatectomy stress urinary incontinence-a review. Transl Androl Urol 2017; 6:S103-S111. [PMID: 28791229 PMCID: PMC5522793 DOI: 10.21037/tau.2017.04.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Bladder dysfunction is a relatively common urodynamic finding post radical prostatectomy (RP). It can be the sole cause of post prostatectomy incontinence (PPI) or may be found in association with stress urinary incontinence (SUI). The aim of this review is to provide a comprehensive review of the diagnosis and different treatments of post RP bladder dysfunction. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, PPI, detrusor overactivity (DO), detrusor underactivity (DU), impaired compliance, anticholinergic, onabotulinumtoxinA (Botox®) and sacral neuromodulation (SNM). Definitions, general overview and management options were extracted from the relevant medical literature. DO, DU and impaired compliance are common and may occur alone or in combination with SUI. In some patients the conditions exist pre RP, in others they arise due to denervation and surgical changes. DO can be treated with anticholinergics, Botox® and SNM. DO may need to be treated before SUI surgery. DU may be a contraindication to male sling surgery as some patients may go into urinary retention. Severely impaired bladder compliance may be a contraindication to SUI surgery as the upper tracts may be at risk. Each individual dysfunction may affect the outcome of PPI treatments and clinicians should be alert to managing bladder dysfunction in PPI patients.
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Affiliation(s)
- Derek B Hennessey
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Nathan Hoag
- Department of Urology, Victoria General Hospital, Victoria, British Columbia, Canada
| | - Johan Gani
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Urology, Western Health, Footscray, Victoria, Australia
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9
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Kitta T, Kanno Y, Chiba H, Moriya K, Maruyama S, Abe T, Shinohara N. Radical prostatectomy restores detrusor contraction pattern according to pressure flow parameters. Int J Urol 2017; 24:301-307. [DOI: 10.1111/iju.13295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 12/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Takeya Kitta
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
| | - Yukiko Kanno
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
| | - Hiroki Chiba
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
| | - Satoru Maruyama
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery; Graduate School of Medicine, Hokkaido University; Sapporo Hokkaido Japan
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10
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Jazayeri SB, Sebrow D, Lavery H, Hobbs A, Levinson A, Samadi DB. Improvement of severe baseline lower urinary tract symptoms following robotic-assisted laparoscopic prostatectomy. Neurourol Urodyn 2016; 36:1382-1386. [DOI: 10.1002/nau.23118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/19/2016] [Indexed: 11/05/2022]
Affiliation(s)
| | - Dov Sebrow
- Department of Urology; The Mount Sinai Medical Center; New York New York
| | - Hugh Lavery
- Department of Urology; The Mount Sinai Medical Center; New York New York
| | - Adele Hobbs
- Department of Urology; The Mount Sinai Medical Center; New York New York
| | - Adam Levinson
- Department of Urology; The Mount Sinai Medical Center; New York New York
| | - David B. Samadi
- Department of Urology; Lenox Hill Hospital; New York New York
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11
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Giberti C, Gallo F, Schenone M, Cortese P, Ninotta G. Stem Cell Therapy for Male Urinary Incontinence. Urol Int 2016; 90:249-52. [PMID: 23221307 DOI: 10.1159/000342415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Among the medical and surgical options which have been proposed in the last years for the management of male stress urinary incontinence (SUI), stem cell therapy represents a new frontier treatment. The aim of this paper is to update the current status of stem cell therapy in animal and human studies for the management of iatrogenic male SUI. MATERIAL AND METHODS A PubMed review of the literature on stem cell therapy for the treatment of male SUI was performed. RESULTS Regarding animal studies, bone marrow-, muscle- and adipose-derived stem cells have been widely studied, showing regeneration of the urethral sphincter and recovery of the damaged pelvic nerves. With regard to human studies, only four papers are available in the literature using muscle- and adipose-derived stem cells which reported a significant improvement in sphincteric function and incontinence with no severe side effects. CONCLUSIONS In spite of these promising results, further studies are needed with longer follow-ups and larger numbers of patients in order to clarify the potential role of stem cell therapy for the treatment of male SUI.
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Affiliation(s)
- C Giberti
- Department of Surgery, Division of Urology, San Paolo Hospital, Savona, Italy
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12
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Kaiho Y, Mitsuzuka K, Yamada S, Saito H, Adachi H, Yamashita S, Izumi H, Ito A, Arai Y. Urinary straining contributes to inguinal hernia after radical retropubic prostatectomy. Int J Urol 2016; 23:478-83. [DOI: 10.1111/iju.13078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Yasuhiro Kaiho
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Miyagi Japan
| | - Koji Mitsuzuka
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Miyagi Japan
| | - Shigeyuki Yamada
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Miyagi Japan
| | - Hideo Saito
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Miyagi Japan
| | - Hisanobu Adachi
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Miyagi Japan
| | - Shinichi Yamashita
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Miyagi Japan
| | - Hideaki Izumi
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Miyagi Japan
| | - Akihiro Ito
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Miyagi Japan
| | - Yoichi Arai
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Miyagi Japan
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13
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Ostrowski I, Śledź E, Ciechan J, Golabek T, Bukowczan J, Przydacz M, Wiatr T, Stangel-Wojcikiewicz K, Chłosta PL. Current interventional management of male stress urinary incontinence following urological procedures. Cent European J Urol 2015; 68:340-7. [PMID: 26568879 PMCID: PMC4643709 DOI: 10.5173/ceju.2015.616] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/09/2015] [Accepted: 07/17/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Despite improvements in surgical techniques and implementation of minimally invasive procedures, male stress urinary incontinence affects a substantial number of patients after prostatic surgery. In response to increasing demand of optimal treatment modality, new alternatives to artificial urinary sphincter have recently been introduced. This review summarises the therapeutic surgical options with their outcomes in management of postprostatectomy stress incontinence. Material and methods We performed a literature review by searching the PubMed, Web of Science and Embase databases for articles published from January 2000 until April 2015 based on clinical relevance. Results Artificial urinary sphincter is currently considered the “gold standard” treatment of male stress urinary incontinence. Although the new devices in this group have recently been investigated, the AMS 800 remains the only widely used implant. Male slings and adjustable continence devices, achieve the social continence rates up to 60%. Periurethral injections of bulking agents, have limited efficacy of male stress incontinence. Argus sling and ProACT are both associated with substantial explantation rates. Stem cell therapy is a promising option but still requires additional testing. Conclusions The development of new alternatives to artificial urinary sphincter is constantly progressing. Although recently introduced minimally invasive treatment options have not yet surpassed the outcomes of the artificial urinary sphincter they should continue to be evaluated and compared against the gold standard.
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Affiliation(s)
| | - Emil Śledź
- Department of Urology, Regional Hospital in Puławy, Poland
| | - Janusz Ciechan
- Department of Urology, Regional Hospital in Puławy, Poland
| | - Tomasz Golabek
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | - Jakub Bukowczan
- Department of Endocrinology and Diabetes Mellitus, Northumbria NHS Foundation Trust, North Shields, United Kingdom
| | - Mikolaj Przydacz
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | - Tomasz Wiatr
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | | | - Piotr L Chłosta
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
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14
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Barnoiu O, Vozmediano-Chicharro R, García-Galisteo E, Soler-Martinez J, del Rosa-Samaniego J, Machuca-Santacruz J, Baena-Gonzalez V. Urodynamic assessment of bladder and urethral sphincter function before and after robot-assisted radical prostatectomy. Actas Urol Esp 2014; 38:78-83. [PMID: 24119381 DOI: 10.1016/j.acuro.2013.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/03/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Affectation of the bladder after open prostatectomy is demonstrated. Decrease in bladder capacity and bladder compliance, detrusor hyper-or hypo-activity and voiding dysfunction are observed. We propose to investigate the effects of robotic surgery on bladder and sphincter function through the comparative study of preoperative and postoperative urodynamic values 3 months after prostatectomy. MATERIAL AND METHODS Prospective study of 32 consecutive patients undergoing robotic prostatectomy. They all underwent urodynamic study one month before the intervention and 3 months after the radical prostatectomy. RESULTS Twenty five percent of patients undergoing robotic prostatectomy showed detrusor hyperactivity accompanied by a decrease in bladder compliance of 30.2 to 21.8 ml/cmH2O. Urethral profile showed diminished functional length of 67 to 44 mm and decreased maximum urethral pressure of 48.5 to 29.3 cmH2O. After robotic prostatectomy 21.8% of patients had detrusor hypoactivity, obstruction decreased between 28.1% to 12.5%. CONCLUSIONS Decreased bladder compliance, detrusor hypo- or hyperactivity and obstruction improvement observed in the study of the flow pressure have been associated with sphincter involvement. It is part of the complex of lower urinary tract dysfunction that occurs after robotic prostatectomy.
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Elliott CS, Comiter CV. Detrusor Underactivity in Men Following Radical Retropubic Prostatectomy - Prevalence, Importance and Evaluation. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chung DE, Dillon B, Kurta J, Maschino A, Cronin A, Sandhu JS. Detrusor underactivity is prevalent after radical prostatectomy: A urodynamic study including risk factors. Can Urol Assoc J 2013; 7:E33-7. [PMID: 22277630 DOI: 10.5489/cuaj.11038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The objective was to determine the prevalence of, and factors that predict, detrusor underactivity (DU) in patients presenting with incontinence or lower urinary tract symptoms (LUTS) following radical prostatectomy (RP). We also determined the prevalence of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in this population. METHODS Patients who underwent urodynamics post-RP were identified. Detrusor underactivity was defined as a maximum flow rate (Qmax) of ≤15 mL/s and detrusor pressure (Pdet) Qmax <20 cmH20 or maximum Pdet <20 cmH20 during attempted voiding. Abdominal voiding (AV) was defined as sustained increase in abdominal pressure during voiding. Bladder outlet obstruction and DO were identified using the Abrams-Griffiths nomogram and the International Continence Society criteria. Univariate logistic regression was used to determine factors predicting DU. The following factors were analyzed: age, year of RP, procedure type (minimally-invasive surgery [MIS] or open), postoperative radiation, nerve-sparing, clinical stage, biopsy Gleason grade and interval between RP and evaluation. RESULTS Between 2005 and 2008, 264 patients underwent urodynamics post-RP. Detrusor underactivity was observed in 108 patients (41%; 95% CI 35%, 47%), of whom 48% demonstrated AV. Overall, BOO and DO were present in 17% (95% CI 12%, 22%) and 27% (95% CI 22%, 33%), respectively. On univariate analysis, only MIS RP was predictive of DU (univariate odds ratio 2.05 for MIS vs. open; p = 0.009). CONCLUSIONS Detrusor underactivity and AV are common in patients presenting for evaluation of incontinence or LUTS following RP. The etiology of DU in this setting is likely related to the surgical approach. Because DU may affect the success of male incontinence treatment with the male sling or artificial urinary sphincter, it is useful to document its presence prior to treatment. More studies are needed to elucidate the influence of DU on treatment success for male urinary incontinence following RP.
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Affiliation(s)
- Doreen E Chung
- Sidney Kimmel Center for Prostate and Urologic Cancers, Division of Urology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; ; Section of Urology, University of Chicago Mount Sinai Hospital, Chicago, IL
| | - Benjamin Dillon
- Department of Urology, The Mount Sinai Medical Center, New York, NY
| | - Jordan Kurta
- Department of Urology, The University of Tennessee Health Sciences Center, Memphis, TN
| | - Alexandra Maschino
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Angel Cronin
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jaspreet S Sandhu
- Sidney Kimmel Center for Prostate and Urologic Cancers, Division of Urology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; ; James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, New York, NY
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Elliott CS, Comiter CV. Maximum isometric detrusor pressure to measure bladder strength in men with postprostatectomy incontinence. Urology 2012; 80:1111-5. [PMID: 22990061 DOI: 10.1016/j.urology.2012.07.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 07/03/2012] [Accepted: 07/17/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the use of isovolumetric detrusor pressure (Piso) in men with postprostatectomy incontinence and compare the rates of detrusor underactivity using Piso versus other common measurements/surrogates of bladder strength. METHODS We evaluated 62 men referred to our institution during a 3-year period for workup of postprostatectomy incontinence. During videourodynamic evaluation, the maximum Piso was measured using a mechanical stop test--with the examiner gently occluding the penile urethra during volitional voiding. Statistical analysis was performed to evaluate the effect of patient variables on Piso. RESULTS The mean Piso was 54.6 ± 25.4 cm H(2)O. The Piso was <50 cm H(2)O in 40%. Isometric strength did not significantly correlate with age, interval since radical prostatectomy, abdominal leak point pressure, maximal urethral closure pressure, or pad use. The bladder contractility index and other approximations of detrusor underactivity were not predictive of low isometric pressure. CONCLUSION Detrusor underactivity is relatively common in men with postprostatectomy incontinence, with 40% demonstrating a Piso <50 cm H(2)O. Our data do suggest, however, that the use of common bladder contractility nomograms, such as the bladder contractility index, might not be appropriate in this population.
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Hutchinson RC, Thiel DD, Tavlarides AM, Diehl NN, Parker AS. The Effect of Robot-Assisted Laparoscopic Prostatectomy on Nocturia. J Endourol 2012; 26:861-5. [DOI: 10.1089/end.2011.0611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - David D. Thiel
- Department of Urology, Mayo Clinic, Jacksonville, Florida
| | | | - Nancy N. Diehl
- Department of Urology, Mayo Clinic, Jacksonville, Florida
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Bladder capacity on preoperative urodynamics may impact outcomes on transobturator male slings. Neurourol Urodyn 2012; 31:1124-7. [DOI: 10.1002/nau.22233] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 01/30/2012] [Indexed: 11/07/2022]
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Grise P, Vautherin R, Njinou-Ngninkeu B, Bochereau G, Lienhart J, Saussine C. I-Stop TOMS Transobturator Male Sling, a Minimally Invasive Treatment for Post-prostatectomy Incontinence: Continence Improvement and Tolerability. Urology 2012; 79:458-63. [DOI: 10.1016/j.urology.2011.08.078] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/30/2011] [Accepted: 08/26/2011] [Indexed: 10/14/2022]
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Post-Prostatectomy Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Han JS, Brucker BM, Demirtas A, Fong E, Nitti VW. Treatment of post-prostatectomy incontinence with male slings in patients with impaired detrusor contractility on urodynamics and/or who perform Valsalva voiding. J Urol 2011; 186:1370-5. [PMID: 21855941 DOI: 10.1016/j.juro.2011.05.089] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE Male slings have emerged as a popular and efficacious treatment for men with post-prostatectomy stress urinary incontinence. Traditionally slings have been used with caution or avoided in men with impaired detrusor contractility or Valsalva voiding because of concern that patients will not be able to overcome the fixed resistance of a sling during micturition. We propose that men with post-prostatectomy urinary incontinence who have impaired contractility and/or void with abdominal straining for urodynamics can be safely treated with slings. MATERIALS AND METHODS A retrospective review of patients with post-prostatectomy urinary incontinence who underwent an initial sling procedure between January 2004 and January 2010 was conducted at a single institution. Preoperative urodynamic characteristics, and postoperative Patient Global Impression of Improvement, post-void residual and noninvasive uroflow data were examined. Patients were grouped by poor bladder contractility or Valsalva voiding status. Exclusion criteria were lack of preoperative urodynamics and/or postoperative post-void residual. A total of 92 patients were analyzed. The variables were compared using the Student t test and the chi-square test. RESULTS No statistically significant difference was shown in postoperative post-void residual (mean 4 months postoperatively) or urinary retention when comparing by bladder contractility or Valsalva voiding. In the subset of patients with available postoperative uroflow data, there were no differences in postoperative maximum flow rate or voided volume. CONCLUSIONS Men with post-prostatectomy urinary incontinence with urodynamic findings suggesting impaired contractility or Valsalva voiding can be safely treated with sling surgery if they have normal preoperative emptying.
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Affiliation(s)
- Justin S Han
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
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Umemoto Y, Tozawa K, Kojim Y, Yasui T, Kawai N, Sasaki S, Hayashi Y, Kohri K. Intra-Operative Damage to the Pelvic Diaphragm Musculature and Difficulty in Exposure of the Urethra Are Risk Factors of Postoperative Urinary Incontinence after Laparoscopic Radical Prostatectomy: Review of Surgical Video. Curr Urol 2011. [DOI: 10.1159/000327476] [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
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Matsukawa Y, Hattori R, Komatsu T, Funahashi Y, Sassa N, Gotoh M. De novo detrusor underactivity after laparoscopic radical prostatectomy. Int J Urol 2010; 17:643-8. [PMID: 20438594 DOI: 10.1111/j.1442-2042.2010.02529.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to investigate bladder function following laparoscopic radical prostatectomy, with a focus on de novo detrusor underactivity. METHODS Records on pre- and postoperative urodynamic studies were retrospectively investigated in 110 patients who underwent laparoscopic radical prostatectomy. Patients exhibiting de novo detrusor underactivity were selected on the basis of an overt strain voiding pattern during the postoperative pressure flow study with detrusor pressure at a maximum flow rate <10 cm H(2)O accompanied by an increase in abdominal pressure. In these patients, a follow-up urodynamic study was performed to assess subsequent long-term changes in the bladder function. RESULTS Of the 110 patients, 10 (9.1%) were observed to exhibit de novo detrusor underactivity during the postoperative urodynamic study. During the voiding phase of the pre- and postoperative pressure flow study in these 10 patients, the mean detrusor pressure at maximum flow rate showed a significant decrease postoperatively from 57.6 to 3.0 cm H(2)O (P < 0.001), although the mean abdominal pressure at maximum flow rate significantly increased from 23.1 to 102.5 cm H(2)O (P < 0.001). The follow-up urodynamic study performed on seven patients at 36 months following surgery revealed no significant change in each urodynamic parameter. De novo detrusor underactivity persisted even over the long term following surgery, and no improvement in bladder function was observed. CONCLUSIONS Detrusor contractility may be impaired during radical prostatectomy. Postoperative detrusor underactivity following radical prostatectomy seems to be an irreversible phenomenon persisting even over the long term.
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Affiliation(s)
- Yoshihisa Matsukawa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
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Abstract
OBJECTIVES The increasing number of prostatectomies entails an increasing number of patients suffering from iatrogenic incontinence despite improved surgical techniques. The severity of this problem often requires invasive treatments such as periurethral injection of bulking agents, artificial urinary sphincter (AUS) implantation, and sub-urethral sling positioning. The artificial urethral sphincter has represented, until today, the gold standard but, in the recent years, sling systems have been investigated as minimally invasive alternative options. Today, three different sling procedures are commonly performed: bone-anchored, readjustable, and trans-obturator slings systems. The aim of this review is to critically report the current status of sling systems in the treatment of iatrogenic male incontinence. MATERIALS AND METHODS MEDLINE and PubMed databases were searched and all articles between 1974 and 2009 were evaluated. RESULTS With regard to bone-anchored, readjustable, and trans-obturator slings systems, cure rates ranged between 58.0% and 86.0%, 55.5% and 73.0%, and 40.0% and 63.0%, respectively, while major complication rates ranged between 0 and 14.5%, 10.0 and 22.2%, and 0 and 10.0%, respectively. CONCLUSIONS Suburethral slings are the only alternative techniques which can be favorably compared with the AUS, showing more advantages with respect to AUS implantations which are mainly represented by a quick and less invasive approach, low morbidity, and low costs. In spite of the difficulty in identifying the most effective sling procedure, overall, sling systems can be recommended for patients with persistent mild or moderate incontinence. However, the indication can also be extended to patients with severe incontinence, after appropriate counseling, allowing AUS implantation in the event of sling failure.
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Affiliation(s)
- Fabrizio Gallo
- Division of Urology, Department of Surgery, San Paolo Hospital, Savona, Italy
| | - M. Schenone
- Division of Urology, Department of Surgery, San Paolo Hospital, Savona, Italy
| | - C. Giberti
- Division of Urology, Department of Surgery, San Paolo Hospital, Savona, Italy
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Lai HH, Hsu EI, Boone TB. Urodynamic Testing in Evaluation of Postradical Prostatectomy Incontinence Before Artificial Urinary Sphincter Implantation. Urology 2009; 73:1264-9. [DOI: 10.1016/j.urology.2008.10.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 10/17/2008] [Accepted: 10/20/2008] [Indexed: 11/15/2022]
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Ishizaka K, Machida T, Tanaka M, Kawamura N, Nakamura K, Kihara K. Clinical efficacy of naftopidil on lower urinary tract symptoms after radical prostatectomy. Int J Urol 2009; 16:299-302. [PMID: 19207610 DOI: 10.1111/j.1442-2042.2008.02234.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The management of lower urinary tract symptoms that persist after radical prostatectomy remains to be established. We investigated whether an alpha1-blocker, naftopidil, improves LUTS in patients >or=1 year after radical prostatectomy. METHODS A total of 29 male patients received 25 mg/day of naftopidil for the first week, then 75 mg/day for 4 weeks. The frequency-volume chart, international prostate symptom score and quality of life index (QOL) were examined before and at the end of the 5-week administration in all subjects. RESULTS Total international prostate symptom score (I-PSS) and I-PSS subtotals associated with voiding symptoms and storage symptoms were significantly decreased at 5 weeks compared with baseline (P < 0.001 each). QOL index was significantly improved with naftopidil for 5 weeks (P < 0.001). From analyses of the frequency-volume chart, mean and maximum volume/void were significantly increased (P < 0.05 each). CONCLUSION Lower urinary tract symptoms detected in patients >or=1 year after radical prostatectomy were markedly improved with administration of naftopidil at 75 mg/day. These symptoms could represent a novel target for medical treatment by improved understanding of the symptom pathology in the near future.
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Choi HS, Im CM, Kim SO, Kim MK, Kwon DD, Ryu SB. Lower Urinary Tract Symptoms after Radical Retropubic Prostatectomy: Preliminary Study. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.8.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hyang Sik Choi
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Chang Min Im
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sun Ouck Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ki Kim
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Bang Ryu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Yoon BI, Hwang TK, Kim JC. Impact of Laparoscopic Radical Prostatectomy on Urinary Incontinence and Lower Urinary Tract Symptoms. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.2.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Byung Il Yoon
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Kon Hwang
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Chul Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lukasewycz S, Nicholson A, Huckabay C. Clinical utility of urodynamics for postprostatectomy incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2007. [DOI: 10.1007/s11884-007-0025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Giannantoni A, Mearini E, Zucchi A, Costantini E, Mearini L, Bini V, Porena M. Bladder and urethral sphincter function after radical retropubic prostatectomy: a prospective long-term study. Eur Urol 2007; 54:657-64. [PMID: 18006215 DOI: 10.1016/j.eururo.2007.10.054] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Accepted: 10/25/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In a prospective study we analysed the 3-yr results of the effects of radical retropubic prostatectomy (RRP) on detrusor and sphincter function by comparing urodynamic status preoperatively with that during longitudinal follow-up. METHODS Fifty-four consecutive patients underwent urodynamics with pressure flow studies and Valsalva leak point pressure measurements 3-7 d before RRP (baseline), and then 8 mo after surgery. Thirty-two patients were studied again 3 yr later. We analysed bladder compliance, detrusor overactivity (DO), detrusor contractility, and intrinsic sphincter deficiency (ISD). RESULTS There was a significant increase in the number of patients with reduced bladder compliance at the 8-mo follow-up. De novo reduced bladder compliance was detected in 32.3% of patients and persisted in 28.1% at the 36-mo follow-up. De novo detrusor hypocontractility was observed in 51% of patients at 8 mo (p<0.05) and persisted in 25% of cases 3 yr later. No patients showed any postvoid residual volume. The associations between detrusor hypocontractility with DO and between detrusor hypocontractility with ISD were detected in 76.2% and 44% of patients, respectively, at 8 mo, and in 25% and in 34% of cases, respectively, at 36 mo of follow-up (p<0.05 and p<0.001). CONCLUSIONS Following RRP detrusor hypocontractility, decreased bladder compliance, and ISD represent de novo dysfunction probably due to bladder denervation during surgery. They become established conditions over time in about 30% of patients. Nevertheless, they do not produce voiding symptoms because patients develop new voiding behaviours.
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The bone-anchor sub-urethral sling for the treatment of iatrogenic male incontinence: subjective and objective assessment after 41 months of mean follow-up. World J Urol 2007; 26:173-8. [DOI: 10.1007/s00345-007-0222-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 10/15/2007] [Indexed: 01/22/2023] Open
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Gallagher BL, Dwyer NT, Gaynor-Krupnick DM, Latini JM, Kreder KJ. Objective and Quality-of-Life Outcomes with Bone-Anchored Male Bulbourethral Sling. Urology 2007; 69:1090-4. [PMID: 17572193 DOI: 10.1016/j.urology.2007.02.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 01/11/2007] [Accepted: 02/26/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the success rates and quality-of-life outcomes with the male bulbourethral sling using the validated Male Urogenital Distress Inventory (MUDI) and Male Urinary Symptom Impact Questionnaire (MUSIQ). These validated incontinence questionnaires for men have not been reported in the sling population. METHODS A total of 31 consecutive patients underwent placement of a male bulbourethral bone-anchoring sling from October 2002 through May 2005. The preoperative information included history and physical examination, pad history, urodynamic findings, and MUDI and MUSIQ results. Postoperatively, the patients were evaluated clinically and completed a MUDI and MUSIQ every 6 months. RESULTS Of the 31 patients, 24 completed the questionnaires and follow-up protocol. Of the other 7 patients, 4 underwent sling removal and 3 were lost to follow-up. The average follow-up time was 15 months (range 9 to 21). After surgery, the pad use decreased from a median of 3.7 pads/day (range 1 to 12) to 1.3 pads/day (range 0 to 6). Of the 24 analyzed patients, 18 (75%) were dry or using 1 pad or less per day, and 9 (38%) no longer needed pads. Subjectively, 75% of the patients were satisfied. The mean MUDI and MUSIQ scores decreased from 56.8 and 29.9 preoperatively to 44.8 (P <0.0001) and 14.6 (P = 0.002) after sling placement, respectively. When all 31 patients were included, our clinical success rate of 1 pad/day or less decreased to 58%. CONCLUSIONS Of the 24 patients with follow-up data, 75% were satisfied and were clinically cured. A significant improvement was seen after surgery in the MUDI and MUSIQ scores, severity of incontinence, and average pad use. The MUDI and MUSIQ scores paralleled patient satisfaction and clinical success after male bulbourethral sling placement.
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Affiliation(s)
- Brian L Gallagher
- Department of Urology, University of Iowa, Iowa City, Iowa 52242-1089, USA
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Thiel DD, Young PR, Broderick GA, Heckman MG, Wehle MJ, Igel TC, Petrou SP. Do Clinical or Urodynamic Parameters Predict Artificial Urinary Sphincter Outcome in Post-Radical Prostatectomy Incontinence? Urology 2007; 69:315-9. [PMID: 17320671 DOI: 10.1016/j.urology.2006.10.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 08/31/2006] [Accepted: 10/20/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine whether urodynamic or clinical parameters can predict artificial urinary sphincter (AUS) outcome in patients who were incontinent after radical prostatectomy (RP). Incontinence after RP is secondary to intrinsic sphincter deficiency, but urodynamics have been advocated before AUS placement to detect factors that could limit surgical success. METHODS We reviewed all AUSs placed for RP incontinence from January 1995 to December 2004. The preoperative clinical parameters and urodynamic parameters were correlated with surgical success using linear and logistic regression analysis, respectively. Surgical failure was defined as requiring more than one pad per day. RESULTS The data from 86 patients (mean age 72 years) were analyzed. Of these 86 patients, 15 (17%) were wearing more than 1 pad per day at the last follow-up visit; 11 patients (13%) considered their operation a failure; and 20 patients (24%) had postoperative urgency. The presence of detrusor overactivity (P = 0.92), low first sensation (P = 0.52), low bladder compliance (P = 0.38), and bladder capacity less than 300 mL (P = 0.58) in patients did not predict for AUS failure compared with patients without these findings. No clinical parameters were found that demonstrated a statistical association with the number of pads per day. Older patients considered themselves less improved (P = 0.012) than did younger patients. CONCLUSIONS No evidence has shown that patients who are incontinent after RP who have detrusor overactivity, a low first sensation, decreased compliance, or a low bladder capacity have worse post-AUS outcomes than other patients. Older patients tended to have decreased perceived improvement. We found no clinical or urodynamic parameter that would be a contraindication to AUS placement for post-RP incontinence.
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Affiliation(s)
- David D Thiel
- Department of Urology, Mayo Clinic Jacksonville, Jacksonville, Florida 32224, USA
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Hotston MR, Hurley K, Patel S, Persad R. THE USE OF DULOXETINE FOR STRESS INCONTINENCE AFTER PROSTATECTOMY. BJU Int 2006; 98:916-7. [PMID: 16978296 DOI: 10.1111/j.1464-410x.2006.06473_3.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Namiki S, Ishidoya S, Saito S, Satoh M, Tochigi T, Ioritani N, Yoshimura K, Terai A, Arai Y. Natural history of voiding function after radical retropubic prostatectomy. Urology 2006; 68:142-7. [PMID: 16777193 DOI: 10.1016/j.urology.2006.01.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2005] [Revised: 12/06/2005] [Accepted: 01/10/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To report results from a 2-year longitudinal survey of lower urinary tract function and quality of life (QOL) in men after radical retropubic prostatectomy (RP) for localized prostate cancer. METHODS Between November 2001 and September 2003, self-report assessments were provided to 225 patients who underwent RP alone. The University of California Los Angeles Prostate Cancer Index (UCLA PCI), the International Prostate Symptom Score (IPSS), and the IPSS QOL score were administered before and 3, 6, 12, 18, and 24 months after RP. RESULTS The overall mean total IPSS and IPSS QOL score progressively improved with time. The mean scores of several components improved significantly postoperatively. No significant difference was observed in nocturia between the baseline assessment and any of the postoperative follow-up assessments. The IPSS of the younger patients continued to recover significantly more rapidly than that of the older patients after RP. According to the UCLA PCI scores, urinary function substantially declined just after RP and continued to recover but scored lower than the baseline. The mean total IPSS and IPSS QOL scores observed in men with a UCLA PCI urinary function score of 80 or more were significantly better than in men with scores less than 80 at 24 months postoperatively. CONCLUSIONS Radical retropubic prostatectomy has a significant beneficial effect on lower urinary tract symptoms. The rate of improvement was lowest for nocturia among the seven symptoms of IPSS. Urinary continence after RP and age can affect the recovery of voiding function.
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Affiliation(s)
- Shunichi Namiki
- Department of Urology, Tohoku University Graduate School of Medicine, Seiryomachi, Sendai, Japan.
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Cancho Gil MJ, Díz Rodríguez R, Virseda Chamorro M, Alpuente Román C, Cabrera Cabrera JA, Paños Lozano P. [Assessment of effectiveness and security of bladder neck cerclage after transvesical prostatectomy]. Actas Urol Esp 2006; 30:53-6. [PMID: 16703730 DOI: 10.1016/s0210-4806(06)73396-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The Bladder neck cerclage diminishes the risk of bleeding after transvesical prostatectomy, but it increases the risk of suffering postoperative bladder neck sclerosis. Our objective is to value the effectiveness and therapeutic security of the temporary bladder neck cerclage after transvesical prostatectomy. MATERIAL AND METHODS It was carried out a prospective and longitudinal study in a cohort of 25 age patients mean age 68,5 years (standard deviation, 2,6 years), subjected to transvesical prostatectomy (Freyer) with bladder neck cerclage using polipropilene number 1 suture, that was retired at the 24 hours of the surgery. To value the hemostatic utility of bladder neck cerclage, it was measured the hematocrit and hemoglobin concentration at the 24 hours of the intervention. To evaluate the appearance of obstructive sequels, the maximum urinary flow was measured three months after the surgery. RESULTS It was observed a mean hematocrit at the 24 hours of surgery of 7,3%, and a mean decrease of the hemoglobin at the 24 hours of the surgery of 2,7 gr/dl. In any cases the postoperative hemoglobin concentration was inferior to 8 mg/dl, therefore, it was not necessary transfusion. The uroflowmetry carried out at 3 months of surgery showed that 24 of the 25 intervened patients presented a maximum flow superior to 15 ml/sg. CONCLUSIONS The temporary bladder neck cerclage is a good hemostatic technique. The precocious cercalge retreat avoids the late sequels (bladder neck sclerosos), that originates the permanent cerclage.
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Affiliation(s)
- M J Cancho Gil
- Servicio de Urología, Hospital Central de la Defensa, Madrid
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Namiki S, Saito S, Ishidoya S, Tochigi T, Ioritani N, Yoshimura K, Terai A, Arai Y. Adverse effect of radical prostatectomy on nocturia and voiding frequency symptoms. Urology 2005; 66:147-51. [PMID: 15992905 DOI: 10.1016/j.urology.2005.01.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Revised: 12/20/2004] [Accepted: 01/11/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the impact of retropubic radical prostatectomy (RP) on urinary incontinence and obstructive/irritative urinary symptoms, according to global self-assessment instruments. METHODS Self-report assessments were provided by 120 patients who underwent RP alone. The University of California, Los Angeles Prostate Cancer Index (UCLA PCI), the International Prostate Symptom Score (IPSS), and the IPSS quality of life (QOL) score were administered before and 12 months after RP. RESULTS Overall mean total IPSS and IPSS QOL scores showed statistically significant improvement (both P < 0.001). There were no differences between baseline and postoperative scores in "Voiding frequency" or "Nocturia" related to irritative symptoms. Moreover, RP had adverse effects on the nocturia and voiding frequency composites score when the analysis was limited to those men who reported scores of 0 or 1 for each symptom preoperatively (P < 0.001 and P = 0.001, respectively). The urinary function score according to the UCLA PCI had substantially declined at 12 months compared with baseline (P < 0.001); however, no significant differences were observed in urinary bother between the baseline and postoperative scores. CONCLUSIONS Although a significant proportion of men complained of urinary incontinence, RP significantly improved IPSS and IPSS QOL scores in men with moderate or severe urinary symptoms. However, RP seems to have a deleterious effect on nocturia and voiding frequency for some men with only mild symptoms.
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Affiliation(s)
- Shunichi Namiki
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Kielb SJ, Clemens JQ. Comprehensive urodynamics evaluation of 146 men with incontinence after radical prostatectomy. Urology 2005; 66:392-6. [PMID: 16040102 DOI: 10.1016/j.urology.2005.03.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2005] [Revised: 02/18/2005] [Accepted: 03/07/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the filling, storage, and voiding urodynamic parameters in a large group of men with urinary incontinence after radical prostatectomy. METHODS We reviewed the videourodynamics testing results for 146 consecutive men referred for urinary incontinence after radical prostatectomy. RESULTS The mean patient age was 69.0 years (range 48 to 85), and the mean interval since radical prostatectomy was 4 years (range 4 months to 19 years). All but four tests were performed more than 12 months postoperatively. Stress urinary incontinence (SUI) was demonstrated in 139 men (95%), with a mean abdominal leak point pressure of 59 cm H2O. A statistically significant correlation was found between the leak point pressure and static urethral pressure profilometry measurements (r = 0.46, P < 0.0001). The mean urethral pressure profilometry measurements in those with SUI were significantly lower than in those without (46.6 versus 69 cm H2O, P = 0.001). A total of 34 patients had diminished compliance or detrusor instability, but this was the sole finding in only 3. A hypocontractile detrusor response was seen in 49 patients, and 35 of these augmented voiding by abdominal straining. Patients with previous radiotherapy (n = 24) were more likely to have bladder outlet obstruction; the other parameters were similar to those in patients without radiotherapy. CONCLUSIONS Incontinence after radical prostatectomy is caused by intrinsic sphincter deficiency in the vast majority of patients. Urethral pressure profilometry measurements correlated with the severity of SUI, as measured by abdominal leak point pressure. Bladder outlet obstruction may coexist with SUI in a significant portion of patients. During voiding, a hypocontractile detrusor response may be seen, but the clinical significance of this finding is unclear.
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Affiliation(s)
- Stephanie J Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Huckabay C, Twiss C, Berger A, Nitti VW. A urodynamics protocol to optimally assess men with post-prostatectomy incontinence. Neurourol Urodyn 2005; 24:622-6. [PMID: 16208638 DOI: 10.1002/nau.20182] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS To propose a urodynamic protocol to comprehensively assess all parameters of post prostatectomy incontinence (PPI). METHODS Sixty men with a history of PPI after radical prostatectomy prospectively underwent a standardized video urodynamics protocol. A 7F urethral catheter was used for standard cystometry, abdominal leak point pressure (ALPP), and pressure flow measurements. The International Continence Society nomogram classified obstruction and further classification of obstruction was based on fluoro voiding cystourethrography and non-invasive flow rates (free Qmax). RESULTS Twenty-four (40%) men had detrusor overactivity with 8 (13%) also having detrusor overactivity incontinence. Only one patient had impaired compliance. All men had urodynamic stress incontinence, but 21 (35%) men demonstrated it only after removal of the urethral catheter. For men leaking with and without the urethral catheter, the respective ALPP was significantly different, 86.3 and 67 cmH2O, respectively (P = 0.002). The men who leaked only in the absence of the urethral catheter had significantly higher ALPP measurements, P < 0.001. After reclassification using the fluoroscopic images of the bladder outlet and free Qmax, only 13.3% patients were obstructed. CONCLUSIONS The proposed urodynamic protocol allows for an optimal assessment of bladder and sphincter dysfunction and outlet obstruction in men with PPI.
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Affiliation(s)
- Chad Huckabay
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
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Queipo Zaragozá JA, Chicote Pérez F, Borrell Palanca A, Beltrán Meseguer JF, García Reboll L, Pastor Sempere F. Tratamiento de la incontinencia urinaria de esfuerzo post-prostatectomía radical mediante malla anclada a ramas isquiopubianas. Actas Urol Esp 2005; 29:764-8. [PMID: 16304908 DOI: 10.1016/s0210-4806(05)73338-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We presented the results of an alternative in the treatment of the stress urinary incontinence of male radical postprostatectomy. Is a technique of renewed interest in the last years, cradle in the procedure of Stamey, consisting of placing an on guard suburetral polypropylene mesh, anchored by means of screws to the isquiopubian branches. We have applied the procedure in 4 patients and with stress urinary incontinence of long evolution. After an average pursuit of 12.5 months, two patients present total continence, one has improved significantly and in the other the incontinence persists. There have been no postoperating complications nor rejection of the mesh. From these preliminary results and the reviewed bibliography, we thought that this technique can constitute an alternative to the artificial urinary sphincter, dices its clinical results, its facility of execution, the good tolerance and his low cost.
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Abstract
PURPOSE We prospectively examined whether the fixed urethral resistance of the perineal male sling for the treatment of stress incontinence causes significant bladder outlet obstruction or de novo voiding dysfunction. MATERIALS AND METHODS A total of 22 patients (average age 67 years old) were evaluated before and after surgery with videourodynamics, the self-administered UCLA Prostate Cancer Index incontinence section and pad score. RESULTS Mean followup was 25 months (range 6 to 42). All patients complained of a moderate to severe problem before surgery. After surgery 16 (73%) reported a very small problem/no problem, 3 (14%) a moderate problem and 3 (14%) reported a big problem. Average pad use +/- SD decreased from 4.6 +/- 2.5 to 0.74 +/- 1.0 pads (p <0.01). Median UCLA Prostate Cancer Index incontinence score increased from 82 to 313, p <0.001. Mean retrograde leak point pressure (RLPP) increased from 30.4 +/- 15.9 to 59.9 +/- 9.7 cm water. Bladder outlet obstruction did not develop in any patients after surgery. Average maximum flow rate did not change significantly (17.7 +/- 6.5 vs 19.2 +/- 9.7 ml per second, p = 0.6). Nor was there a significant change in detrusor pressure at maximum flow rate (40.3 +/- 9.2 vs 45.8 +/- 14.7 cm water, p = 0.3). While de novo urgency or urge incontinence did not develop in any patients, 2 of 5 patients with a moderate/big leakage problem demonstrated postoperative detrusor overactivity on cystometry. Both individuals requiring more than 3 pads daily had a postoperative RLPP of less than 50 cm water. CONCLUSIONS Pad use, leak point pressure and urinary incontinence scores are significantly improved after sling surgery. Fixed resistance does not lead to bladder outlet obstruction. Postoperative RLPP less than 50 cm water and urodynamic detrusor overactivity are associated with increased pad use and bother.
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Affiliation(s)
- Nathan F E Ullrich
- University of Arizona Health Sciences Center and Southern Arizona Veterans Affairs Health Care System, Tucson, Arizona, USA
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Ullrich NFE, Comiter CV. THE MALE SLING FOR STRESS URINARY INCONTINENCE: 24-MONTH FOLLOWUP WITH QUESTIONNAIRE BASED ASSESSMENT. J Urol 2004; 172:207-9. [PMID: 15201775 DOI: 10.1097/01.ju.0000128652.99627.14] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Stress urinary incontinence after prostate surgery can be a bothersome problem, adversely affecting quality of life. We performed a prospective study of the male perineal sling for the treatment of stress urinary incontinence with a minimum 1-year followup. MATERIALS AND METHODS A total of 36 patients (average age 67 years old) underwent male sling surgery. Patients underwent preoperative and postoperative evaluation for bother due to urinary incontinence using the UCLA Prostate Cancer Index urinary function section as well as pad score. RESULTS Median followup was 25 months (range 12 to 42). After surgery 24 (67%) patients were pad-free, 5 (14%) used 1 pad, 4 (11%) used 2 pads and 3 (8%) continued to use 3 or more pads daily. Overall, mean pad use +/- SD decreased from 4.6 +/- 2.5 to 0.64 +/- 1.0 pads daily (p <0.001). A total of 30 (83%) patients reported a small to no bother from urine leakage after surgery, 3 (8%) considered leakage a moderate problem, while 3 (8%) continued to consider it a big problem. The median UCLA Prostate Cancer Index urinary function score was improved from 33 before surgery to 330 after surgery (p <0.001). There were no instances of erosion, infection or prolonged retention. CONCLUSIONS Medium term results for the male sling demonstrate a success rate comparable to that of the artificial urinary sphincter (67% pad-free rate and 92% improvement). This technique has established a low morbidity and has not been associated with any significant complications. Longer followup will ultimately establish whether this technique represents a viable long-term alternative to artificial urinary sphincter for the treatment of bothersome stress urinary incontinence in men.
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Affiliation(s)
- Nathan F E Ullrich
- University of Arizona Health Sciences Center and the Southern Arizona Veterans Affairs Health Care System, Tucson, Arizona, USA
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Giannantoni A, Mearini E, Di Stasi SM, Mearini L, Bini V, Pizzirusso G, Porena M. Assessment of bladder and urethral sphincter function before and after radical retropubic prostatectomy. J Urol 2004; 171:1563-6. [PMID: 15017221 DOI: 10.1097/01.ju.0000118957.24390.66] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE In a prospective study we analyzed the effects of radical retropubic prostatectomy (RRP) on detrusor and urethral sphincter function by comparing urodynamic status preoperatively with that during longitudinal followup. MATERIALS AND METHODS A total of 49 consecutive patients underwent urodynamics with pressure flow studies and Valsalva leak point pressure measurements 3 to 7 days before RRP (baseline), and then 1 and 8 months after surgery. We assessed bladder compliance, detrusor overactivity, detrusor contractility and intrinsic sphincter deficiency (ISD). RESULTS There was no significant change in detrusor overactivity at 1 and 8 months of followup. Decreased bladder compliance was observed in 20.4% of patients at baseline, and in 38.7% and 30.6% at 1 and 8 months, respectively. De novo decreased compliance was detected in 18.4% and 10.2% of patients at the same points. Impaired bladder compliance was comparable to that before surgery in 20% of cases. Impaired detrusor contractility was detected in 42.8% of patients at baseline, and in 61.2% (p <0.05) and 42.8% at 1 and 8 months, respectively. De novo hypocontractility was observed in 28.6% and 10.2% of patients at 1 and 8 months, respectively. A strong association between detrusor overactivity and ISD was observed at 1 and 8 months (p <0.01). CONCLUSIONS Following RRP detrusor hypocontractility and decreased bladder compliance represent de novo transient dysfunction probably due to bladder denervation and an established condition not influenced by the operation. The strong association between overactivity and ISD suggests that stress urinary incontinence increases urethral afferent nerve activity and induces involuntary detrusor contractions.
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Affiliation(s)
- Antonella Giannantoni
- Department of Urology, University of Perugia, Perugia and "Tor Vergata" University, Rome, Italy.
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