1
|
Tarcan T, Hashim H, Malde S, Sinha S, Sahai A, Acar O, Selai C, Agro EF, Abrams P, Wein A. Can we predict and manage persistent storage and voiding LUTS following bladder outflow resistance reduction surgery in men? ICI-RS 2023. Neurourol Urodyn 2024. [PMID: 38477358 DOI: 10.1002/nau.25435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
AIMS Lower urinary tract symptoms (LUTS) persist in up to 50% of patients after bladder outflow resistance reduction surgery (BORRS) in men. Our think tank aims to address the predictive factors for persistent LUTS after BORRS and to propose the recommendations for future research to enable improved better patient counseling and selection by more accurate prediction of treatment outcome. METHODS A think tank of ICI-RS gathered in 2023, Bristol, UK, to discuss the pre and postsurgical clinical and urodynamic evaluation of men undergoing BORRS and whether it is possible to predict which men will have persistent LUTS after BORRS. RESULTS Our think tank agrees that due to the multifactorial, and still not fully understood, etiology of male LUTS it is not possible to precisely predict in many men who will have persistent LUTS after BORRS. However, severe storage symptoms (overactive bladder, OAB) in association with low volume and high amplitude detrusor overactivity and low bladder capacity in preoperative urodynamics, increase the likelihood of persistent OAB/storage symptoms after BORRS. Furthermore, patients who are clearly obstructed and have good bladder contractility on preoperative pressure flow studies do better postoperatively compared to their counterparts. However, the benefit of pressure flow studies is decreased in patients who do not acceptably void during the study. Poor voiding after BORRS may occur due to persistent obstruction or detrusor underactivity. CONCLUSION Future research is needed to increase our understanding of why male LUTS persist after surgery, and to enable better patient selection and more precise patient counseling before BORRS.
Collapse
Affiliation(s)
- Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust & King's College London, London, UK
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | - Arun Sahai
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Omer Acar
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
- College of Medicine, Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Caroline Selai
- University College London - Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery/UCLH NHS Foundation Trust, London, UK
| | - Enrico Finazzi Agro
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Alan Wein
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
2
|
Mirnezami AH, Drami I, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Denys A, Pape E, van Ramshorst GH, Baker D, Bignall E, Blair I, Davis P, Edwards T, Jackson K, Leendertse PG, Love-Mott E, MacKenzie L, Martens F, Meredith D, Nettleton SE, Trotman MP, van Hecke JJM, Weemaes AMJ, Abecasis N, Angenete E, Aziz O, Bacalbasa N, Barton D, Baseckas G, Beggs A, Brown K, Buchwald P, Burling D, Burns E, Caycedo-Marulanda A, Chang GJ, Coyne PE, Croner RS, Daniels IR, Denost QD, Drozdov E, Eglinton T, Espín-Basany E, Evans MD, Flatmark K, Folkesson J, Frizelle FA, Gallego MA, Gil-Moreno A, Goffredo P, Griffiths B, Gwenaël F, Harris DA, Iversen LH, Kandaswamy GV, Kazi M, Kelly ME, Kokelaar R, Kusters M, Langheinrich MC, Larach T, Lydrup ML, Lyons A, Mann C, McDermott FD, Monson JRT, Neeff H, Negoi I, Ng JL, Nicolaou M, Palmer G, Parnaby C, Pellino G, Peterson AC, Quyn A, Rogers A, Rothbarth J, Abu Saadeh F, Saklani A, Sammour T, Sayyed R, Smart NJ, Smith T, Sorrentino L, Steele SR, Stitzenberg K, Taylor C, Teras J, Thanapal MR, Thorgersen E, Vasquez-Jimenez W, Waller J, Weber K, Wolthuis A, Winter DC, Brangan G, Vimalachandran D, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Baker RP, Bali M, Baransi S, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Bui A, Burgess A, Burger JWA, Campain N, Carvalhal S, Castro L, Ceelen W, Chan KKL, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Damjanovic L, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Egger E, Enrique-Navascues JM, Espín-Basany E, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Fleming F, Flor B, Foskett K, Funder J, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Giner F, Ginther N, Glover T, Golda T, Gomez CM, Harris C, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Jenkins JT, Jourand K, Kaffenberger S, Kapur S, Kanemitsu Y, Kaufman M, Kelley SR, Keller DS, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Lago V, Lakkis Z, Lampe B, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lynch AC, Mackintosh M, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Morton JR, Mullaney TG, Navarro AS, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Pappou E, Park J, Patsouras D, Peacock O, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steffens D, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor D, Tejedor P, Tekin A, Tekkis PP, Thaysen HV, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Yano H, Yip B, Yip J, Yoo RN, Zappa MA. The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
Collapse
|
3
|
MacAskill F, Shabbir M, Sahai A. Survivorship in prostate cancer following robotic assisted radical prostatectomy-the time to act is now! Prostate Cancer Prostatic Dis 2024; 27:46-47. [PMID: 36065059 PMCID: PMC10876470 DOI: 10.1038/s41391-022-00589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Findlay MacAskill
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- King's College London, London, UK.
| | - Majed Shabbir
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| |
Collapse
|
4
|
Tarcan T, Acar Ö, Malde S, Sinha S, Sahai A, Perrouin-Verbe MA, Hashim H, Agro EF, Wein A, Abrams P. Can we predict whether a man with acute or chronic urinary retention will void after bladder outflow resistance reduction surgery? ICI-RS 2023. Neurourol Urodyn 2024. [PMID: 38291822 DOI: 10.1002/nau.25404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
AIMS To address the predictive factors of a successful voiding after bladder outflow resistance reduction surgery (BORRS) in men presenting with acute or chronic urinary retention (UR). METHODS A think tank (TT) of ICI-RS was gathered in 2023, Bristol, UK, to discuss several aspects of the problem, such as the pathophysiology of UR, the clinical and urodynamic evaluation of men with UR and whether it is possible to predict which men will be able to successfully void after treatment with contemporary surgical options. RESULTS The TT agreed that successful voiding after BORRS depends on several factors but that a strong recommendation cannot be made regarding preoperative evaluation and whether there are predictive factors of success because of the heterogeneity of patients and methodology in published trials. The diagnosis of obstruction in men with UR may be challenging when there is apparent reduced detrusor contraction during urodynamic studies. Even in the absence of bladder contractility there is documentation of such cases that have voided adequately after BORRS. Still, detrusor underactivity and inadequate relief of prostatic obstruction are the main causes of an unsuccessful voiding after BORRS. Conventional resection and enucleation methods remain the most successful surgeries in relieving UR in men, whereas the efficacy of minimally invasive surgical treatments needs to be assessed further. CONCLUSION Research is needed to understand the pathophysiology of UR and the predictors of successful voiding after different types of BORRS in men with UR.
Collapse
Affiliation(s)
- Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Ömer Acar
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust and King's College, London, UK
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust and King's College, London, UK
| | | | - Hashim Hashim
- Bristol Urological Institute, Southmead hospital, Bristol, UK
| | - Enrico Finazzi Agro
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Alan Wein
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Paul Abrams
- Bristol Urological Institute, Southmead hospital, Bristol, UK
| |
Collapse
|
5
|
Sahai A, Robinson D, Abrams P, Wein A, Malde S. What is the best first choice oral drug therapy for OAB? Neurourol Urodyn 2024. [PMID: 38270332 DOI: 10.1002/nau.25397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
AIMS The management of overactive bladder (OAB) involves lifestyle changes and conservative measures in the first instance with the use of liquid/dietary advice, weight loss, and bladder training. Thereafter oral pharmacotherapy is instigated in symptomatic patients. Antimuscarinics and beta 3 agonists form the main classes of drug therapy in this field. Views on what is the best first line OAB treatment is changing based on recent evidence and adverse event profiles of these medications. METHODS At the ICI-RS meeting 2023, Bristol, UK this topic was discussed and debated as a proposal. The following article summarizes the concepts presented that day as well as the interactive discussion that took place thereafter. RESULTS OAB guidelines are moving in many circumstances to an either antimuscarinic or beta 3 agonist approach based on patient factors. Several studies have raised concerns on the long-term impact of antimuscarinics, in relation to cognition, dementia, cardiovascular events, and mortality all related to antimuscarinic load. Neither antimuscarinics nor beta 3 agonists have good persistence and adherence rates in the medium to long term. Several barriers also exist to prescribing including guidelines recommending utilizing drugs with the lowest acquisition cost and "step therapy." A newer approach to managing OAB is personalized therapy in view of the many possible etiological factors and phenotypes. These concepts are highlighted in this article. CONCLUSIONS Current oral pharmacotherapy in managing OAB is limited by adverse events, adherence and persistence problems. Both antimuscarinics and beta 3 agonists are efficacious but most clinical trials demonstrate significant placebo effects in this field. Personalizing treatment to the individual seems a logical approach to OAB. There is a need for better treatments and further studies are required of existing treatments with high quality longer term outcomes.
Collapse
Affiliation(s)
- Arun Sahai
- Department of Urology, Guy's Hospital & King's College, London, UK
| | - Dudley Robinson
- Department of Urogynaecology, King's College Hospital & King's College, London, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
- University of Bristol, Bristol, UK
| | - Alan Wein
- Desai Sethi Urology Institute, University of Miami Miller School of medicine, Miami, Florida, USA
- University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sachin Malde
- Department of Urology, Guy's Hospital & King's College, London, UK
| |
Collapse
|
6
|
West CT, West MA, Mirnezami AH, Drami I, Denys A, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Pape E, van Ramshorst GH, Aalbers AGJ, Abdul AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Angenete E, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brown K, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelen W, Chan KKL, Chang GJ, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Denost QD, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Egger E, Eglinton T, Enrique-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Flatmark K, Fleming F, Flor B, Folkesson J, Foskett K, Frizelle FA, Funder J, Gallego MA, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther N, Glover T, Goffredo P, Golda T, Gomez CM, Griffiths B, Gwenaël F, Harris C, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kaufman M, Kazi M, Kelley SR, Keller DS, Kelly ME, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Kusters M, Lago V, Lakkis Z, Lampe B, Langheinrich MC, Larach T, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Mackintosh M, Mann C, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McDermott FD, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Monson JRT, Morton JR, Mullaney TG, Navarro AS, Neeff H, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock A, Pellino G, Peterson AC, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Quyn A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Smith T, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor C, Taylor D, Tejedor P, Tekin A, Tekkis PP, Teras J, Thanapal MR, Thaysen HV, Thorgersen E, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Empty pelvis syndrome: PelvEx Collaborative guideline proposal. Br J Surg 2023; 110:1730-1731. [PMID: 37757457 PMCID: PMC10805575 DOI: 10.1093/bjs/znad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
|
7
|
Michel MC, Cardozo L, Chermansky CJ, Cruz F, Igawa Y, Lee KS, Sahai A, Wein AJ, Andersson KE. Current and emerging pharmacological targets and treatments of urinary incontinence and related disorders. Pharmacol Rev 2023:pharmrev.121.000523. [PMID: 36918261 DOI: 10.1124/pharmrev.121.000523] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/16/2023] Open
Abstract
The overactive bladder syndrome with and without urinary incontinence and related conditions, signs, and disorders such as detrusor overactivity, neurogenic voiding dysfunction, underactive bladder, stress urinary incontinence, and nocturia are common in the general population and have a major impact on the quality of life of the affected patients and their partners. Based on the deliberations of the subcommittee on pharmacological treatments of the 7th International Consultation on Incontinence, we present a comprehensive review of established drug targets in the treatment of overactive bladder syndrome and the above-mentioned related conditions and the approved drugs used in its treatment. Investigational drug targets and compounds are also reviewed. We conclude that despite a range of available medical treatment options, a considerable medical need continues to exist. This is largely because the existing treatments are symptomatic and have limited efficacy and/or tolerability, which leads to poor long-term adherence. Significance Statement Urinary incontinence and related disorders are prevalent in the general population. While many treatments have been approved, few patients stay on long-term treatment despite none of them being curative. This manuscript provides a comprehensive discussion of existing and emerging treatment options for various types of incontinence and related disorders.
Collapse
Affiliation(s)
| | - Linda Cardozo
- Urogynaecology, King's College Hospital, United Kingdom
| | | | | | | | - Kyu-Sung Lee
- Urology, Sungkyunkwan University, Korea, Republic of
| | | | - Alan J Wein
- Urology, University of Pennsylvania, United States
| | - Karl-Erik Andersson
- Institute for Regenerative Medicine, Wake Forest University Medical School, United States
| |
Collapse
|
8
|
Greig J, Mak Q, Furrer MA, Sahai A, Raison N. Sacral neuromodulation in the management of chronic pelvic pain: A systematic review and meta-analysis. Neurourol Urodyn 2023; 42:822-836. [PMID: 36877182 DOI: 10.1002/nau.25167] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Sacral neuromodulation (SNM) is a treatment approved for use in several conditions including refractory overactive bladder (OAB) and voiding dysfunction. Chronic pelvic pain (CPP) is a debilitating condition for which treatment is often challenging. SNM shows promising effect in patients with refractory CPP. However, there is a lack of clear evidence, especially in long-term outcomes. This systematic review will assess outcomes of SNM for treating CPP. METHODS A systematic search of MEDLINE, Embase, Cochrane Central and clinical trial databases was completed from database inception until January 14, 2022. Studies using original data investigating SNM in an adult population with CPP which recorded pre and posttreatment pain scores were selected. Primary outcome was numerical change in pain score. Secondary outcomes were quality of life assessment and change in medication use and all-time complications of SNM. Risk of bias was assessed using the Newcastle Ottawa Tool for cohort studies. RESULTS Twenty-six of 1026 identified articles were selected evaluating 853 patients with CPP. The implantation rate after test-phase success was 64.3%. Significant improvement of pain scores was reported in 13 studies; three studies reported no significant change. WMD in pain scores on a 10-point scale was -4.64 (95% confidence interval [CI] = -5.32 to -3.95, p < 0.00001) across 20 studies which were quantitatively synthesized: effects were maintained at long-term follow-up. Mean follow-up was 42.5 months (0-59). Quality of life was measured by RAND SF-36 and EQ-5D questionnaires and all studies reported improvement in quality of life. One hundred and eighty-nine complications were reported in 1555 patients (Clavien-Dindo Grade I-IIIb). Risk of bias ranged from low to high risk. Studies were case series and bias stemmed from selection bias and loss to follow-up. CONCLUSION Sacral Neuromodulation is a reasonably effective treatment of Chronic Pelvic Pain and significantly reduces pain and increases patients' quality of life with immediate to long-term effects.
Collapse
Affiliation(s)
- Julian Greig
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Quentin Mak
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Marc A Furrer
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Urology, University of Bern, Bern, Switzerland
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas Raison
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
| |
Collapse
|
9
|
Raison N, Malde S, Sahai A. Inheritance in overactive bladder syndrome. Nat Rev Urol 2023; 20:61-62. [PMID: 36344652 DOI: 10.1038/s41585-022-00667-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nicholas Raison
- Department of Urology, Guy's and St Thomas' NHS Trust, London, UK
- Faculty and Life Sciences and Medicine, King's College London, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Trust, London, UK
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' NHS Trust, London, UK.
- Faculty and Life Sciences and Medicine, King's College London, London, UK.
| |
Collapse
|
10
|
Sheimar K, Chedid Y, Solomon E, Guest K, Taylor C, Malde S, Sahai A. Patient reported objective and experience measures to assess satisfaction, service evaluation and outcomes following surgery for bothersome stress urinary incontinence in men. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00816-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
11
|
MacAskill F, Sahai A, Shabbir M, Yap T. Is it time to rethink the current patient-reported outcome measures? Nat Rev Urol 2023; 20:1-2. [PMID: 36192501 DOI: 10.1038/s41585-022-00661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Findlay MacAskill
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- King's College London, London, UK.
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Majed Shabbir
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | | | - Tet Yap
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| |
Collapse
|
12
|
Ferrari L, Cuinas K, Igbedioh C, Hainsworth A, Solanki D, Williams A, Sahai A, Kelleher C, Schizas A. Patient pathway in a tertiary referral pelvic floor unit: Telephone triage assessment clinic. Neurourol Urodyn 2023; 42:168-176. [PMID: 36317396 DOI: 10.1002/nau.25063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/31/2022] [Accepted: 10/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND To meet the increasing demands for colorectal pelvic floor services, a dedicated telephone triage assessment clinic (TTAC) was set up to establish a more efficient pathway, and reduce waiting times and patient's visits to the hospital. The primary aim of this study was to review TTAC in patients suffering from pelvic floor dysfunction and assess its feasibility. Secondary aims include measurement of waiting times for TTAC, main presenting complaints, and main treatment outcomes, including the need for review by a consultant surgeon. METHODS Review of data collected retrospectively in a single tertiary referral center collected from an institutional database. KEY RESULTS Between January 2016 and October 2017, 1192 patients referred to our pelvic floor unit were suitable for TTAC. Of these, 694 patients had complete records. There were 66 without follow-up after the initial TTAC, leaving 628 patients for analysis. In all, 86% were females and 14% were males, with a mean age of 52 years (range: 18-89). The median waiting time for TTAC was 31 days (range: 0-184). The main presenting complaint during the TTAC was obstructive defecation in 69.4%, fecal incontinence in 28.5%, and rectal prolapse in 2.1%. In our study, 611 patients had conservative management (97.3%), with a median of three sessions per patient (range: 1-16), while 82 patients (13.1%) needed a surgical intervention. Only 223 patients (35.5%) were reviewed by a consultant at some stage during the study period. CONCLUSIONS AND INFERENCES To optimize resources, an adequate triage system allowed us to streamline the pathway for each individual patient with pelvic floor dysfunction according to their symptoms and/or test results with the aim of reducing waiting times and expediting treatment.
Collapse
Affiliation(s)
- Linda Ferrari
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Karina Cuinas
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Carlene Igbedioh
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Alison Hainsworth
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Deepa Solanki
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Andrew Williams
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Arun Sahai
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | | | - Alexis Schizas
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| |
Collapse
|
13
|
Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
Collapse
|
14
|
Kapriniotis K, Jenks J, Toia B, Pakzad M, Gresty H, Stephens R, Malde S, Sahai A, Greenwell T, Ockrim J. Does response to percutaneous tibial nerve stimulation predict similar outcome to sacral nerve stimulation? Neurourol Urodyn 2022; 41:1172-1176. [PMID: 35481714 DOI: 10.1002/nau.24944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/31/2022] [Accepted: 03/15/2022] [Indexed: 11/07/2022]
Abstract
AIMS Percutaneous tibial nerve stimulation (PTNS) is a simple neuromodulation technique to treat an overactive bladder. It is unclear whether the response to PTNS would suggest a similar response to sacral nerve stimulation (SNS), and whether PTNS could be utilized as an alternative test phase for an SNS implant. This study assessed whether PTNS response was a reliable indicator for subsequent SNS trials. METHODS We performed a retrospective review of the hospital databases to collect all patients who had PTNS and who subsequently had an SNS trial in two tertiary hospitals from 2014 to 2020. Response to both interventions was assessed. A 50% reduction in overactive symptoms (frequency-volume charts) was considered a positive response. McNemar's tests using exact binomial probability calculations were used. The statistical significance level was set to 0.05. RESULTS Twenty-three patients who had PTNS subsequently went on to a trial of SNS. All patients except one had previously poor response to PTNS treatment. Eight of them also failed the SNS trial. However, 15 patients (including the PTNS responder) had a successful SNS trial and proceeded with the second-stage battery implantation. The difference in response rates between the PTNS and SNS trial was statistically significant (p < 0.001). CONCLUSIONS Poor response to PTNS does not seem to predict the likelihood of patients responding to SNS. A negative PTNS trial should not preclude a trial of a sacral nerve implant. The predictive factors for good and poor responses will be the subject of a larger study.
Collapse
Affiliation(s)
| | - Julie Jenks
- Department of Urology, University College London Hospital, London, UK
| | - Bogdan Toia
- Department of Urology, University College London Hospital, London, UK
| | - Mahreen Pakzad
- Department of Urology, University College London Hospital, London, UK
| | - Helena Gresty
- Department of Urology, University College London Hospital, London, UK
| | - Ross Stephens
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Jeremy Ockrim
- Department of Urology, University College London Hospital, London, UK
| |
Collapse
|
15
|
Oza P, Walker NF, Rottenberg G, MacAskill F, Malde S, Taylor C, Sahai A. Pre-prostatectomy membranous urethral length as a predictive factor of post prostatectomy incontinence requiring surgical intervention with an artificial urinary sphincter or a male sling. Neurourol Urodyn 2022; 41:973-979. [PMID: 35266177 PMCID: PMC9313820 DOI: 10.1002/nau.24904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/30/2021] [Accepted: 01/15/2022] [Indexed: 11/10/2022]
Abstract
AIMS To ascertain whether the membranous urethral length (MUL) is predictive of postprostatectomy incontinence (PPI) that requires surgery such as artificial urinary sphincter (AUS) or male sling (MS). METHODS Men who had undergone AUS or MS for PPI were identified from a prospectively maintained database and compared to a control group of men who were continent at 12 months after radical prostatectomy. MUL in sagittal and coronal planes, sphincter height and width were measured on prebiopsy T2-weighted MRI scans. Sphincter volume was estimated as an ellipsoid cylinder. RESULTS A total of 95 patients (64 AUS and 31 MS) were compared to 60 continent controls. There was no statistical difference in presenting PSA, prostate volume, and T-stage. The mean MUL in sagittal and coronal planes was 11.31 mm (SD: 2.6, range: 6-17 mm) and 11.43 mm (SD: 2.94, range: 5-17 mm) in patients who had AUS and MS, respectively; 15.23 mm (SD: 4.2, range: 8.25-25 mm) and 15.75 mm (SD: 4.1, range: 8-24 mm) in controls (p < 0.01). No men in the PPI surgery group had an MUL >17 mm compared to 35% (20/57 sagittal, 20/58 coronal) of controls. The odds ratio for requiring surgery for PPI was 13.4 for sagittal MUL <9 mm and 3.2 if the MUL <12 mm. CONCLUSIONS Patients who had surgery for PPI had a significantly shorter MUL and sphincter volume than continent controls. Men with an MUL >17 mm are unlikely to require surgery for PPI whereas an MUL <12 mm significantly increases the risk of requiring surgery for PPI. MUL should be considered when discussing treatment options for prostate cancer.
Collapse
Affiliation(s)
- Priyanka Oza
- Department of Urology, Guy's HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK,Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | | | - Giles Rottenberg
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Findlay MacAskill
- Department of Urology, Guy's HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Sachin Malde
- Department of Urology, Guy's HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Claire Taylor
- Department of Urology, Guy's HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Arun Sahai
- Department of Urology, Guy's HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK,Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| |
Collapse
|
16
|
Faure Walker N, Oza P, Rottenberg G, Malde S, Macaskill F, Solomon E, Taylor C, Sahai A. Membranous urethral length (MUL) in patients who have had male sling or artificial urinary sphincter surgery for bothersome post prostatectomy stress incontinence. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Salfity L, Dekel E, Sahai A, Faure Walker N. Late urological manifestation of stress incontinence surgery. BMJ Case Rep 2021; 14:14/5/e241660. [PMID: 34020989 DOI: 10.1136/bcr-2021-241660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The Stamey procedure was a popular procedure for female stress incontinence practiced widely in the 1980s before it was abandoned owing to high complication rates. The procedure aimed to suspend the bladder neck by placing two transvaginal Dacron buttress grafts either side of the bladder neck and suspending them with sutures passed through the retropubic space and tied suprapubically. Erosion of the graft into the bladder was a recognised complication. We report a case of an 84-year-old lady who presented with urinary symptoms forty years after an unspecified stress incontinence procedure. Imaging and cystoscopy revealed an eroded graft in her bladder wall. Further investigation revealed the graft was a Dacron buttress from a Stamey procedure. This case highlights the importance of having a working knowledge of historical techniques that may present with complications many years later and recognising the symptoms that should prompt early investigation.
Collapse
Affiliation(s)
- Louay Salfity
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Etay Dekel
- King's College London School of Medicine, London, UK
| | - Arun Sahai
- Urology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | | |
Collapse
|
18
|
Sahai A, Ali A, Barratt R, Belal M, Biers S, Hamid R, Harding C, Parkinson R, Reid S, Thiruchelvam N. British Association of Urological Surgeons (BAUS) consensus document: management of bladder and ureteric injury. BJU Int 2021; 128:539-547. [PMID: 33835614 DOI: 10.1111/bju.15404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Injuries to the bladder and ureter are uncommon but usually require prompt urological management. Due to their infrequent nature, Urologists maybe unfamiliar with managing these acute problems and may not work in specialist centres with readily available expertise in open and abdominal surgery. We aim to provide advice in the form of a consensus statement led by the Female, Neurological and Urodynamic Urology (FNUU) Section of the British Association of Urological Surgeons (BAUS), in consultation with BAUS members and consultants working in units throughout the UK, to create a comprehensive management pathway and a series of statements to aid clinicians.
Collapse
Affiliation(s)
- Arun Sahai
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ased Ali
- Pinderfields Hospital, Wakefield, UK
| | | | | | | | - Rizwan Hamid
- University College London Hospitals and London Spinal Injuries Unit, Stanmore, UK
| | | | | | - Sheilagh Reid
- Princess Royal Spinal Injuries Unit, Northern General Hospital, Sheffield, UK
| | | | | |
Collapse
|
19
|
Reid S, Brocksom J, Hamid R, Ali A, Thiruchelvam N, Sahai A, Harding C, Biers S, Belal M, Barrett R, Taylor J, Parkinson R. British Association of Urological Surgeons (BAUS) and Nurses (BAUN) consensus document: management of the complications of long-term indwelling catheters. BJU Int 2021; 128:667-677. [PMID: 33811741 DOI: 10.1111/bju.15406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To look at best evidence and expert opinion to provide advice in the form of a consensus statement lead by Female, Neurological and Urodynamic Urology (FNUU) section of the British Association of Urological Surgeons (BAUS) in conjunction with the British Association of Urological Nurses (BAUN). METHODS Initially a literature search was performed with incorporation of aspects of the existing guidance and further informed by UK best practice by core members of the group. The document then underwent reviews by the FNUU Executive Committee members, the BAUN executive committee, a separate experienced urologist and presented at the BAUS annual meeting 2020 to ensure wider feedback was incorporated in the document. RESULTS Complications of long-term indwelling catheters include catheter-associated urinary tract infections (CAUTI), purple urine bag syndrome, catheter blockages, bladder spasms (causing pain and urinary leakage), loss of bladder capacity, urethral erosion ("catheter hypospadias")/dilatation of bladder outlet and chronic inflammation (metaplasia and cancer risk). CONCLUSIONS We have provided a list of recommendations and a troubleshooting table to help with the management of the complications of long term catheters.
Collapse
Affiliation(s)
- Sheilagh Reid
- Princess Royal Spinal Injuries Unit, Northern General Hospital, Sheffield, UK
| | | | - Rizwan Hamid
- University College London Hospitals and London Spinal Injuries Unit, Stanmore, UK
| | - Ased Ali
- Pinderfields Hospital, Wakefield, UK
| | | | - Arun Sahai
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Chris Harding
- Newcastle upon Tyne Hospitals - NHS Foundation Trust, Newcastle, UK
| | | | - Mo Belal
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - Julia Taylor
- Clinical Governance Lead, Salford Royal Hospital, Manchester, UK
| | | |
Collapse
|
20
|
Sahai A, Belal M, Hamid R, Toozs-Hobson P, Granitsiotis P, Robinson D. Shifting the treatment paradigm in idiopathic overactive bladder. Int J Clin Pract 2021; 75:e13847. [PMID: 33220129 DOI: 10.1111/ijcp.13847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/16/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Overactive Bladder (OAB) is a common condition that is known to have a significant impact on Health Related Quality of Life (HRQoL). Whilst all patients will initially benefit from lifestyle modifications and behavioural therapy in the first instance drug therapy remains integral in management pathways. The purpose of this review paper is to reappraise the evidence based approach to the management of OAB in addition to exploring a new treatment algorithm for the escalation of treatment in those patients with refractory symptoms. DESIGN Literature Review RESULTS: Antimuscarinic drugs are currently the most commonly used medication although the introduction of mirabegron, a β3 agonist, has provided an alternative and also allowed combination therapy in those patients who have failed to improve on primary therapy or who have troublesome side effects. For those patients with symptoms of refractory OAB more invasive therapies including OnabotulinumtoxinA, sacral neuromodulation and Percutaneous Tibial Nerve Stimulation (PTNS) may be indicated. CONCLUSION We propose a new, evidence based, treatment algorithm for the management of OAB in patients who remain refractory to first line therapy.
Collapse
Affiliation(s)
- Arun Sahai
- Consultant Urologist, Guy's and St Thomas' Hospital, London, UK
| | - Mo Belal
- Consultant Urological Surgeon, Queen Elizabeth Hospital, Birmingham, UK
| | - Rizwan Hamid
- Consultant Urologist, University College Hospital, London, UK
| | - Phillip Toozs-Hobson
- Consultant Urogynaecologist, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Dudley Robinson
- Consultant Urogynaecologist, Kings College Hospital, London, UK
| |
Collapse
|
21
|
MacAskill F, Sheimar K, Toia B, Sri D, Seth J, Sharma D, Hamid R, Greenwell T, Ockrim J, Taylor C, Malde S, Sahai A. Prevalence of chronic pain following suburethral mesh sling implantation for post-prostatectomy incontinence. Neurourol Urodyn 2021; 40:1048-1055. [PMID: 33792985 DOI: 10.1002/nau.24666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/22/2021] [Accepted: 03/13/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE To evaluate postoperative pain and complications following AdVance™/AdVance™ XP male sling implantation. MATERIALS AND METHODS A multi-center retrospective medical notes review of patients implanted for bothersome post-prostatectomy incontinence was conducted. All patients were telephoned to provide further information on pain or further complications related to their surgery. Statistical evaluation utilized logistical regression analysis. Additionally, a literature review was conducted reviewing pain outcomes following AdVance™/AdVance™ XP implantation. RESULTS One-hundred and twenty-seven men were reviewed over an 8-year period. The mean age was 70 years, with mean follow up 52 months. Of those with mild stress urinary incontinence, 45 (79%) had a successful outcome compared to 42 (72%) in the moderate group. Twenty-nine (23%) men reported postoperative pain, with a mean maximal pain score of 6 (range: 0-10). The majority of pain resolved within 4 weeks (19/29 men). A further seven patients resolved by 3 months. Only three men (2.3%) had chronic pain greater than 3 months, which all resolved by 1 year. Men less than 65 years were more likely to suffer pain (p = 0.009). Acute urinary retention occurred in 23 (18%) men and correlated significantly with postoperative pain (p = 0.04). Overactive bladder symptoms, severity of incontinence or radiotherapy were not correlated with postoperative pain. In our cohort, there were no extrusions, divisions, or explantations. CONCLUSION Approximately a quarter of men experience pain in the early postoperative period. However, the severity and rates of chronic pain (>3 months) are low (2.3%) but all settle within a year.
Collapse
Affiliation(s)
- Findlay MacAskill
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Bogdan Toia
- Department of Urology, University College London Hospital, London, UK
| | - Denosshan Sri
- Department of Urology, St George's University Hospital, London, UK
| | - Jai Seth
- Department of Urology, St George's University Hospital, London, UK
| | - Davendra Sharma
- Department of Urology, St George's University Hospital, London, UK
| | - Rizwan Hamid
- Department of Urology, University College London Hospital, London, UK
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Jeremy Ockrim
- Department of Urology, University College London Hospital, London, UK
| | - Claire Taylor
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
22
|
Biers SM, Harding C, Belal M, Thiruchelvam N, Hamid R, Sahai A, Parkinson R, Barratt R, Ali A, Reid S. British Association of Urological Surgeons (BAUS) consensus document: Management of female voiding dysfunction. BJU Int 2021; 129:151-159. [PMID: 33772995 DOI: 10.1111/bju.15402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To report the British Association of Urological Surgeon's (BAUS) guidance on the assessment and management of female voiding dysfunction. METHODS A contemporary literature search was conducted to identify the evidence base. The BAUS Section of Female, Neurological and Urodynamic Urology (FNUU) Executive Committee formed a guideline development group to draw up and review the recommendations. Where there was no supporting evidence, expert opinion of the BAUS FNUU executive committee, FNUU Section and BAUS members, including urology consultants working in units throughout the UK, was used. RESULTS Female patients with voiding dysfunction can present with mixed urinary symptoms or urinary retention in both elective and emergency settings. Voiding dysfunction is caused by a wide range of conditions which can be categorized into bladder outlet obstruction (attributable to functional or anatomical causes) or detrusor underactivity. Guidance on the assessment, investigation and treatment of women with voiding dysfunction and urinary retention, in the absence of a known underlying neurological condition, is provided. CONCLUSION Wa have produced a BAUS approved consensus on the management pathway for female voiding dysfunction with the aim to optimize assessment and treatment pathways for patients.
Collapse
Affiliation(s)
| | - Chris Harding
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Mo Belal
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - Rizwan Hamid
- London and London Spinal Injuries Unit, University College London Hospitals, Stanmore, UK
| | - Arun Sahai
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Rachel Barratt
- London and London Spinal Injuries Unit, University College London Hospitals, Stanmore, UK
| | - Ased Ali
- Mid Yorkshire NHS Hospitals Trust, Wakefield, UK
| | | | | |
Collapse
|
23
|
McLatchie L, Sahai A, Caldwell A, Dasgupta P, Fry C. ATP shows more potential as a urinary biomarker than acetylcholine and PGE 2 , but its concentration in urine is not a simple function of dilution. Neurourol Urodyn 2021; 40:753-762. [PMID: 33538358 DOI: 10.1002/nau.24620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/11/2022]
Abstract
AIMS To determine whether the amount of ATP, prostaglandin E2 (PGE2 ), and acetylcholine (ACh) in voided urine are influenced enough by that released within the lower urinary tract (LUT) for them to be useful biomarkers of bladder function. METHODS Participants without LUT symptoms collected total urine voids at 15, 30, 60, and 120 min (20 males/23 females) and 240 min (18 males/26 females) following the previous void. Aliquots of urine were immediately frozen at -20°C and later used to measure ATP (luciferin-luciferase), PGE2 (enzyme-linked immunosorbent assay), ACh (mass spectrometry), creatinine (colorimetric), and lactose dehydrogenase (colorimetric). RESULTS The amount of ATP in voided urine correlated strongly with the rate of urine production, suggesting that the majority, if not all, the ATP in voided urine has an LUT, and likely bladder, origin. In contrast, there appeared to be no significant net LUTs release of creatinine or ACh into the urine. PGE2 was intermediate with an LUT component that increased with urine production rate and contributed about 25% of the total at 1 ml/min in women but a smaller fraction in men. CONCLUSION Whereas the majority of the ATP measured within the voided urine originates in the LUT, ACh reflects that extracted from the plasma in the kidneys and PGE2 is a mixture of both sources. ATP has the most potential as a biomarker of benign bladder disorders. Expressing urinary ATP concentration relative to creatinine concentration is questioned in light of these results.
Collapse
Affiliation(s)
| | - Arun Sahai
- Department of Urology, Guy's Hospital, London, UK
| | - Anna Caldwell
- Mass Spectrometry Facility, King's College London, London, UK
| | - Prokar Dasgupta
- Faculty for Life Sciences and Medicine, King's College London, King's Health Partners, London, UK
| | - Chris Fry
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK
| |
Collapse
|
24
|
Stroman L, Russell B, Kotecha P, Kantartzi A, Ribeiro L, Jackson B, Ismaylov V, Debo-Aina AO, MacAskill F, Kum F, Kulkarni M, Sandher R, Walsh A, Doerge E, Guest K, Kailash Y, Simson N, McDonald C, Mensah E, June Tay L, Chalokia R, Clovis S, Eversden E, Cossins J, Rusere J, Zisengwe G, Fleure L, Cooper L, Chatterton K, Barber A, Roberts C, Azavedo T, Ritualo J, Omana H, Mills L, Studd L, El Hage O, Nair R, Malde S, Sahai A, Fernando A, Taylor C, Challacombe B, Thurairaja R, Popert R, Olsburgh J, Cathcart P, Brown C, Hadjipavlou M, Di Benedetto E, Bultitude M, Glass J, Yap T, Zakri R, Shabbir M, Willis S, Thomas K, O'Brien T, Khan MS, Dasgupta P. Safety of "hot" and "cold" site admissions within a high-volume urology department in the United Kingdom at the peak of the COVID-19 pandemic. BJUI Compass 2021; 2:97-104. [PMID: 33821256 PMCID: PMC8013895 DOI: 10.1002/bco2.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/25/2020] [Accepted: 10/10/2020] [Indexed: 01/13/2023] Open
Abstract
Objectives To determine the safety of urological admissions and procedures during the height of the COVID‐19 pandemic using “hot” and “cold” sites. The secondary objective is to determine risk factors of contracting COVID‐19 within our cohort. Patients and methods A retrospective cohort study of all consecutive patients admitted from March 1 to May 31, 2020 at a high‐volume tertiary urology department in London, United Kingdom. Elective surgery was carried out at a “cold” site requiring a negative COVID‐19 swab 72‐hours prior to admission and patients were required to self‐isolate for 14‐days preoperatively, while all acute admissions were admitted to the “hot” site. Complications related to COVID‐19 were presented as percentages. Risk factors for developing COVID‐19 infection were determined using multivariate logistic regression analysis. Results A total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44‐70) were admitted under the urology team; 101 (16.5%) on the “cold” site and 510 (83.5%) on the “hot” site. Procedures were performed in 495 patients of which eight (1.6%) contracted COVID‐19 postoperatively with one (0.2%) postoperative mortality due to COVID‐19. Overall, COVID‐19 was detected in 20 (3.3%) patients with two (0.3%) deaths. Length of stay was associated with contracting COVID‐19 in our cohort (OR 1.25, 95% CI 1.13‐1.39). Conclusions Continuation of urological procedures using “hot” and “cold” sites throughout the COVID‐19 pandemic was safe practice, although the risk of COVID‐19 remained and is underlined by a postoperative mortality.
Collapse
|
25
|
Al-Imam A, Abdul-Wahaab IT, Konuri VK, Sahai A. Reconciling artificial intelligence and non-Bayesian models for pterygomaxillary morphometrics. Folia Morphol (Warsz) 2021; 80:625-641. [PMID: 33438189 DOI: 10.5603/fm.a2020.0149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The base of the skull, particularly the pterygomaxillary region, has a sophisticated topography, the morphometry of which interests pathologists, maxillofacial and plastic surgeons. The aim of the study was to conduct pterygomaxillary morphometrics and test relevant hypotheses on sexual and laterality-based dimorphism, and causality relationships. MATERIALS AND METHODS We handled 60 dry skulls of adult Asian males (36.7%) and females (63.3%). We calculated the prime distance D [prime] for the imaginary line from the maxillary tuberosity to the midpoint of the pterygoid process between the upper and the lower part of the pterygomaxillary fissure, as well as the parasagittal D [x-y inclin.] and coronal inclination of D [x-z inclin.] of the same line. We also took other morphometrics concerning the reference point, the maxillary tuberosity. RESULTS Significant sexual as well as laterality-based dimorphism and bivariate correlations existed. The univariate models could not detect any significant effect of the predictors. On the contrary, summative multivariate tests in congruence with neural networks, detected a significant effect of laterality on D [x-y inclin.] (p-value = 0.066, partial eta squared = 0.030), and the interaction of laterality and sex on D [x-z inclin.] (p-value = 0.050, partial eta squared = 0.034). K-means clustering generated three clusters highlighting the significant classifier effect of D [prime] and its three-dimensional inclination. CONCLUSIONS Although the predictors in our analytics had weak-to-moderate effect size underlining the existence of unknown explanatory factors, it provided novel results on the spatial inclination of the pterygoid process, and reconciled machine learning with non-Bayesian models, the application of which belongs to the realm of oral-maxillofacial surgery.
Collapse
Affiliation(s)
- A Al-Imam
- University of London, London, United Kingdom. .,University of Baghdad / College of Medicine, Bab Almu'adam, 10047 Baghdad, Iraq.
| | - I T Abdul-Wahaab
- University of Baghdad / College of Medicine, Bab Almu'adam, 10047 Baghdad, Iraq
| | - V K Konuri
- Department of Anatomy, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India, India
| | - A Sahai
- Dayalbagh Educational Institution, Deemed University, Dayalbagh, Agra, India, India.,International Federation of Associations of Anatomists, Seattle, United States of America, United States
| |
Collapse
|
26
|
Abstract
To review all published evidence regarding the use of Electromotive Drug Administration (EMDA) for the management of urological conditions, focusing on efficacy and safety, and highlighting areas that require further study. The PubMed and Medline databases were searched up to July 23, 2019. All studies reporting the use of EMDA to enhance the intravesical administration of therapeutic drugs for urological conditions were included. Two reviewers independently screened all articles, searched the reference lists of retrieved articles, and performed the data extraction. Thirty-two studies were included. The use of EMDA has been reported in the following urological conditions: (1) nonmuscle-invasive bladder cancer (NMIBC); (2) overactive bladder; (3) bladder pain syndrome; (4) radiation cystitis; (5) detrusor acontractility; and (6) for analgesia prior to transurethral procedures. Overall, most studies are nonrandomized trials with small numbers of patients. The use of EMDA is reported to be safe and effective in all these conditions, with the highest level of evidence in NMIBC in the neoadjuvant and adjuvant setting. However, the low overall quality of evidence limits the conclusions that can be reached. The use of EMDA to improve the efficacy of intravesical treatments is promising, but the low overall quality of the evidence base has limited its widespread use. Future studies should compare EMDA to passive diffusion and current standard of care in large, randomized, and long-term studies to determine the efficacy, safety, and cost-effectiveness of this modality.
Collapse
Affiliation(s)
| | - Arun Sahai
- Department of Urology, Guy's Hospital, London, UK
| | - Sachin Malde
- Department of Urology, Guy's Hospital, London, UK
| |
Collapse
|
27
|
Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham‐Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angenete E, Antoniou A, Auer R, Austin KK, Aziz O, Baker RP, Bali M, Baseckas G, Bebington B, Bednarski BK, Beets GL, Berg PL, Beynon J, Biondo S, Boyle K, Bordeianou L, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo‐Marulanda A, Chan KKL, Chang GJ, Chew MH, Chong PC, Christensen HK, Clouston H, Codd M, Collins D, Colquhoun A, Corr A, Coscia M, Coyne PE, Creavin B, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Eglinton T, Enrique‐Navascues JM, Espin‐Basany E, Evans MD, Fearnhead NS, Flatmark K, Fleming F, Frizelle FA, Gallego MA, Garcia‐Granero E, Garcia‐Sabrido JL, Gentilini L, George ML, Ghouti L, Giner F, Ginther N, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Jenkins JT, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kelley SR, Keller DS, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kristensen HØ, Kroon HM, Kusters M, Lago V, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Lydrup ML, Lyons A, Lynch AC, Mantyh C, Mathis KL, Margues CFS, Martling A, Meijerink WJHJ, Merkel S, Mehta AM, McArthur DR, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Morton JR, Mullaney TG, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, O’Connell PR, O’Dwyer ST, Palmer G, Pappou E, Park J, Patsouras D, Pellino G, Peterson AC, Poggioli G, Proud D, Quinn M, Quyn A, Radwan RW, van Ramshorst GH, Rasheed S, Rasmussen PC, Regenbogen SE, Renehan A, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Ryan ÉJ, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu V, Selvasekar C, Shaikh I, Hellawell G, Shida D, Simpson A, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Sumrien H, Sutton PA, Swartking T, Taylor C, Tekkis PP, Teras J, Thurairaja R, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Vasquez‐Jimenez W, Verhoef C, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Wheeler JMD, Wild J, Wilson M, de Wilt JHW, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, van Zoggel D, Winter DC. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative. Colorectal Dis 2020; 22:1258-1262. [PMID: 32294308 DOI: 10.1111/codi.15064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/24/2020] [Indexed: 02/08/2023]
Abstract
AIM At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. METHOD Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. RESULTS Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). CONCLUSION Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.
Collapse
|
28
|
Stroman L, Robinson D, Malde S, Sahai A. Time for a botulinum toxin passport? Neurourol Urodyn 2020; 39:2546-2549. [PMID: 32985718 DOI: 10.1002/nau.24514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Luke Stroman
- Department of Urology, Guy's Hospital, London, UK
| | - Dudley Robinson
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Sachin Malde
- Department of Urology, Guy's Hospital, London, UK
| | - Arun Sahai
- Department of Urology, Guy's Hospital, London, UK
| |
Collapse
|
29
|
Malde S, Sahai A, Solomon E. Re: Marcus J. Drake, Amanda L. Lewis, Grace J. Young, et al. Diagnostic Assessment of Lower Urinary Tract Symptoms in Men Considering Prostate Surgery: A Noninferiority Randomised Controlled Trial of Urodynamics in 26 Hospitals. Eur Urol 2020;78:701-10. Eur Urol 2020; 78:e232-e233. [PMID: 32900553 DOI: 10.1016/j.eururo.2020.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Sachin Malde
- Department of Urology, Guy's Hospital, London, UK.
| | - Arun Sahai
- Department of Urology, Guy's Hospital, London, UK
| | | |
Collapse
|
30
|
Neale A, Malik N, Taylor C, Sahai A, Malde S. Bladder pain syndrome/interstitial cystitis in contemporary UK practice: Outcomes of phenotype-directed management. Low Urin Tract Symptoms 2020; 13:123-128. [PMID: 32869495 DOI: 10.1111/luts.12343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/16/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Problem bladder pain syndrome/interstitial cystitis (BPS/IC) is a heterogeneous disorder with variation in management worldwide. Phenotyping aims to personalize therapy and optimize outcomes. The most well-described phenotype is Hunner lesion disease (HLD). The prevalence of HLD and outcome of phenotype-directed management in the UK is not well-studied. We describe the management of a contemporary cohort of patients with BPS/IC in the UK. METHODS Retrospective analysis of all patients with BPS/IC from January 2015-November 2018. Outcomes of patients who underwent laser ablation to Hunner lesions were collected using the Global Response Assessment tool. RESULTS One hundred and sixty-three patients (mean age of 43 years [20-85]) were included. 78% were female and patients had experienced symptoms for an average 6 years (1-30) prior to specialist assessment. Eighty-three percent of patients had pelvic imaging (44% ultrasound, 42% magnetic resonance imaging and 14% computed tomography), and a relevant abnormality was found in five (4%). Twenty-two patients (14%) had HLD (International Society for the Study of BPS [ESSIC] 3), with a mean bladder capacity of 373 mL (175-650 mL); 77% were ESSIC C on histopathology. All patients with HLD underwent laser ablation, with 55% experiencing a moderate/marked improvement in symptoms, with a mean duration of effect of 10 months (3-36); 27% of patients had a repeat treatment. CONCLUSIONS The presence of HLD in patients with BPS/IC is not uncommon. Pelvic imaging rarely identifies any cause for pain and so cystoscopy under anesthesia is essential for accurate phenotyping. Phenotype-directed management with holmium laser ablation to Hunner lesions has good short-term efficacy in improving pain, but re-intervention is often required.
Collapse
Affiliation(s)
| | - Nabiah Malik
- Department of Urology, Guy's Hospital, London, UK
| | | | - Arun Sahai
- Department of Urology, Guy's Hospital, London, UK
| | - Sachin Malde
- Department of Urology, Guy's Hospital, London, UK
| |
Collapse
|
31
|
Colemeadow J, Sahai A, Malde S. Clinical Management of Bladder Pain Syndrome/Interstitial Cystitis: A Review on Current Recommendations and Emerging Treatment Options. Res Rep Urol 2020; 12:331-343. [PMID: 32904438 PMCID: PMC7455607 DOI: 10.2147/rru.s238746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/29/2020] [Indexed: 12/30/2022] Open
Abstract
Bladder pain syndrome (BPS) is a chronic condition characterized by pelvic pain or pressure which is perceived to be originating from the bladder, accompanied by one or more urinary symptoms, including frequency, urgency and nocturia. The precise etiology of BPS is not fully understood. Chronic bacterial infection, defective glycosaminoglycan (GAG) layer of the bladder urothelium, inappropriate activation of mast cells in the suburothelial layer of the bladder, autoimmune-mediated mechanisms and autonomic nervous system dysfunction have all been implicated. Treatments targeted at each of these mechanisms have been developed with mixed outcomes. High-quality research into the treatment options is lacking and it is difficult to draw definite conclusions. The treatment approach is multimodal and should be patient specific, targeting the symptoms which they find most bothersome. Conservative treatment, including patient education, behavioural modification, dietary advice, stress relief and physical therapy is an essential initial management strategy for all patients. If no response is observed, oral treatments such as amitriptyline are likely to offer the greatest response. Cystoscopy is essential to phenotype patients, and Hunner lesion directed therapy with fulguration or resection can be performed at the same time. Intravesical instillation of DMSO or lidocaine, detrusor injections of botulinum toxin A and neuromodulation can be used if initial management fails to improve symptoms. Oral cyclosporin can be trialled in those experienced with its use; however, it is associated with significant adverse events and requires intense monitoring. Lastly, radical surgery should be reserved for those with severe, unremitting BPS, in which quality of life is severely affected and not improved by previously mentioned interventions. Future work investigating exact aetiological factors will help target the development of efficacious treatment options, and several promising oral and intravesical treatments are emerging.
Collapse
Affiliation(s)
- Josie Colemeadow
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Arun Sahai
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sachin Malde
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| |
Collapse
|
32
|
Khan O, Patsouras D, Ravindraanandan M, Abrar MM, Schizas A, George M, Malde S, Thurairaja R, Khan MS, Sahai A. Total Pelvic Exenteration for Locally Advanced and Recurrent Rectal Cancer: Urological Outcomes and Adverse Events. Eur Urol Focus 2020; 7:638-643. [PMID: 32622667 DOI: 10.1016/j.euf.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/25/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little has been reported on urological complications of total pelvic exenteration (TPE) for locally advanced or recurrent rectal cancer. OBJECTIVE To assess urological reconstructive outcomes and adverse events in this setting. DESIGN, SETTING, AND PARTICIPANTS A total of 104 patients underwent TPE from 2004 to 2016 in this single-centre, retrospective study. Electronic and paper records were evaluated for data extraction. Mean follow-up was 36.5 mo. INTERVENTION TPE. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Urological complications were analysed using two-tailed t and chi-square tests, binary logistic regression analysis. RESULTS AND LIMITATIONS Sixty-three (61%) patients received radiotherapy prior to TPE. Incontinent diversions included ileal conduit (n = 95), colonic conduits (n = 4), wet colostomy (n = 1), and cutaneous ureterostomy (n = 1). Three patients had a continent diversion. The overall urological complication rate was 54%. According to Clavien-Dindo classification, 30 patients, five patients, and one patient had grade III, IV, and V complications, respectively. The commonest complication was urinary tract infection (in 32 [31%] patients). Anastomotic leaks were seen in 14 (13%) cases, of which eight (8%) were urinary leaks. Fistulas were seen in three (3%) patients, involving the urinary system. A return to theatre was required in 12 (12%) patients. Ureteroenteric strictures were seen in seven (7%). No differences were seen in urological outcomes in patients with primary or recurrent rectal cancer (p = 0.69), or by radiation status (p = 0.24). The main limitation is the retrospective nature of the study. CONCLUSIONS TPE is complex with recognised high risk of morbidity. In this cohort, there was no significant difference in outcomes between primary and recurrent disease, and surgery after radiation. PATIENT SUMMARY In this study, we assessed urological complications following total pelvic exenteration. Urinary complications affected more than half of patients. Urinary tract infection is the commonest risk. Approximately one-third of patients required surgical, radiological, or endoscopic intervention ± intensive care admission. Radiation prior to the operation did not affect urinary complications.
Collapse
Affiliation(s)
- Omeair Khan
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dimitrios Patsouras
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | - Alexis Schizas
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark George
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ramesh Thurairaja
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mohammed S Khan
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| |
Collapse
|
33
|
Toia B, Leung L, Saigal R, Solomon E, Malde S, Taylor C, Sahai A, Hamid R, Greenwell T, Seth J, Sharma D, Ockrim J. Urodynamic predictors of surgical outcomes following male sling implantation. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
34
|
Abrar M, Pindoria N, Malde S, Chancellor M, DeRidder D, Sahai A. Predictors of Poor Response and Adverse Events Following Botulinum Toxin A for Refractory Idiopathic Overactive Bladder: A Systematic Review. Eur Urol Focus 2020; 7:1448-1467. [PMID: 32616412 DOI: 10.1016/j.euf.2020.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT Botulinum toxin A (BTX-A) injections are effective in managing refractory overactive bladder (OAB). However, some patients exhibit a poor response and/or experience adverse events (AEs) such as voiding dysfunction necessitating clean intermittent self-catheterisation (CISC) and urinary tract infections (UTIs). OBJECTIVE To systematically evaluate whether poor response/AEs to BTX-A for idiopathic OAB are predictable. EVIDENCE ACQUISITION MEDLINE, EMBASE, and Google Scholar database were searched in March 2020. Studies reporting predictive factors for poor response or AEs were included. Two reviewers independently screened articles, searched references, and extracted data. Risk of bias (Quality in Prognosis Studies [QUIPS]) and quality of evidence (Grading of Recommendations Assessment, Development and Evaluation [GRADE]) tools were utilised. EVIDENCE SYNTHESIS Of 1579 articles, 17 met the inclusion criteria. These were cohort studies with predominantly level 3 evidence. Factors including male gender, frailty, comorbidity, increasing age, smoking, baseline leakage episodes, and various urodynamic parameters (bladder outlet obstruction index [BOOI], high pretreatment maximum detrusor pressure, and poor bladder compliance) were proposed as predictors of nonresponse. In predicting CISC use, male gender, comorbidity, increasing age, number of vaginal deliveries, hysterectomy, and urodynamic parameters (bladder capacity, postvoid residual volume, projected isovolumetric pressure value, bladder contractility index, and BOOI) were implicated. Female gender, males with their prostates in situ, and CISC were suggested to increase UTIs after BTX-A. CONCLUSIONS This review has identified factors that may predict poor response/AEs following bladder BTX-A and help in counselling of patients. Overall, the quality of individual studies included was poor, limiting the certainty of evidence reported. Larger-scale, better-designed trials with uniform definitions of poor response are required to confirm these preliminary findings. PATIENT SUMMARY This review assessed whether we could predict poor response or side effects to bladder botulinum toxin A injections in managing overactive bladder. Many different factors based on the patient, medical conditions, previous surgery, and pretreatment investigations were identified. However, the quality of included studies was generally poor, limiting their conclusions.
Collapse
Affiliation(s)
- Mohammad Abrar
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - Nisha Pindoria
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - Michael Chancellor
- Department of Urology, Oakland University William Beaumont School of Medicine and Beaumont Health System, Detroit, MI, USA
| | - Dirk DeRidder
- Department of Development and Regeneration, Organ Systems, KU Leuven, Leuven, Belgium
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK.
| |
Collapse
|
35
|
Kotecha P, Sahai A, Malde S. Use of Duloxetine for Postprostatectomy Stress Urinary Incontinence: A Systematic Review. Eur Urol Focus 2020; 7:618-628. [PMID: 32605820 DOI: 10.1016/j.euf.2020.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 01/21/2023]
Abstract
CONTEXT The recommended treatment of postprostatectomy stress urinary incontinence (PPSUI) after failure of pelvic floor muscle training is primarily surgical intervention with a male sling or artificial urinary sphincter. The use of pharmacological therapy in this setting is unlicensed and controversial. OBJECTIVE To systematically review the available evidence regarding the efficacy and safety of duloxetine for the treatment of stress urinary incontinence following prostate surgery (radical or endoscopic). EVIDENCE ACQUISITION The EMBASE, MEDLINE/PubMed, and Cochrane Central Register of Controlled Trials were searched from inception up until April 17, 2020. All studies evaluating the role of duloxetine in men with PPSUI were included. Two reviewers independently screened all articles, searched the reference lists of retrieved articles, and performed data extraction. The quality of evidence and risk of bias were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE); Cochrane; and Risk of Bias in Nonrandomised Studies of Interventions (ROBINS-I) tools. EVIDENCE SYNTHESIS The search yielded 234 studies. After excluding duplicates, 140 titles and abstracts were screened, and eight reports (348 patients) were eligible for inclusion in the final review. Duloxetine was assessed in two scenarios: (1) early use to reduce the time to attain continence and (2) treatment of persistent PPSUI. Most men had mild-to-moderate incontinence at baseline. Overall, duloxetine resulted in a mean dry rate of 58% (25-89%), mean improvement in pad number of 61% (12-100%), and mean improvement in 1-h pad weight of 68% (53-90%) at short-term follow-up (mean 1-9 mo; low to moderate certainty of evidence). However, mean adverse event rates were relatively high, and treatment was discontinued in 38% (low certainty of evidence). CONCLUSIONS Duloxetine has demonstrated good short-term cure and/or improvement in treating men with persistent PPSUI, as well as in reducing the time to attain continence. However, a proportion of men discontinue treatment due to adverse events. The overall certainty evidence is moderate to low, with heterogeneity between studies and methodological limitations. However, we have highlighted the need for further randomised trials with longer follow-up, utilising consistent outcome reporting measures. Despite these limitations, the findings from this review will aid patient counselling regarding this less invasive treatment option, thereby allowing personalisation of care centred around the values and preferences of individual patients. PATIENT SUMMARY Duloxetine has good success rates in the short term, in terms of improving incontinence symptoms in men who have undergone prostate surgery. However, some men experience side effects bad enough to require cessation of treatment. Further studies are needed to determine whether duloxetine maintains its effectiveness in the long term.
Collapse
Affiliation(s)
- Pinky Kotecha
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| |
Collapse
|
36
|
Toia B, Leung LY, Saigal R, Solomon E, Malde S, Taylor C, Sahai A, Hamid R, Seth JH, Sharma D, Greenwell TJ, Ockrim JL. Is pre-operative urodynamic bladder function the true predictor of outcome of male sling for post prostatectomy incontinence? World J Urol 2020; 39:1227-1232. [PMID: 32506387 PMCID: PMC8124059 DOI: 10.1007/s00345-020-03288-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/28/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate pre-operative urodynamic parameters in male sling patients to ascertain whether this might better predict surgical outcomes and facilitate patient selection. METHODS We performed a retrospective, case notes and video-urodynamics, review of men who underwent AdVanceXP male sling in three London hospitals between 2012 and 2019. Urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was performed in one centre. RESULTS Successful outcome was seen in 99/130 (76%) of men who required one pad or less per day. The dry rate was 51%. Pad usage was linked to worse surgical outcomes, mean 2.6 (range 1-6.5) for success vs 3.6 (range 1-10) although the ranges were wide (p = 0.002). 24 h pad weight also reached statistical significance (p = 0.05), with a mean of 181 g for success group versus 475 g for the non-successful group. The incidence of DO in the non-successful group was significantly higher than in successful group (55% versus 29%, p = 0.0009). Bladder capacity less than 250 ml was also associated with worse outcomes (p = 0.003). Reduced compliance was not correlated with outcomes (31% for success groups vs 45% for non-successful group, p = 0.15). Preoperative RLPP was performed in 60/130 patients but did not independently reach statistical significance (p = 0.25). CONCLUSION Urodynamic parameters related to bladder function-detrusor overactivity and reduced maximum cystometric capacity predict male sling outcomes and may help in patient selection for male sling (or sphincter) surgery; whereas urodynamic parameters of sphincter incompetency (RLPP) were not predictive. Further larger scale studies are required to confirm these findings.
Collapse
Affiliation(s)
- Bogdan Toia
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK. .,Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK.
| | - Lap Yan Leung
- St George's University Hospital, Blackshaw Rd., Tooting, London, SW17 0QT, UK
| | - Raveen Saigal
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Eskinder Solomon
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Sachin Malde
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Claire Taylor
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Arun Sahai
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Rizwan Hamid
- Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Jai H Seth
- St George's University Hospital, Blackshaw Rd., Tooting, London, SW17 0QT, UK
| | - Davendra Sharma
- St George's University Hospital, Blackshaw Rd., Tooting, London, SW17 0QT, UK
| | - Tamsin J Greenwell
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK.,Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Jeremy L Ockrim
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK.,Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| |
Collapse
|
37
|
Averbeck MA, Marcelissen T, Anding R, Rahnama'i MS, Sahai A, Tubaro A. How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence-Research Society 2018. Neurourol Urodyn 2020; 38 Suppl 5:S119-S126. [PMID: 31821626 DOI: 10.1002/nau.23972] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/19/2019] [Accepted: 02/25/2019] [Indexed: 02/01/2023]
Abstract
AIMS To review current prevention strategies for urinary incontinence among patients undergoing radical prostatectomy (RP). METHODS This is a consensus report of the proceedings of a research proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?" RESULTS Several baseline parameters were proposed as predicting factors for postprostatectomy urinary incontinence (PPUI), including age, tumor stage, prostate volume, preoperative lower urinary tract symptoms, maximum urethral closure pressure, and previous transurethral resection of the prostate. More recently, magnetic resonance imaging has been used to measure the membranous urethral length and sphincter volume. Peroperative techniques include preservative and reconstructive approaches. Bladder neck preservation improved early (6 months), as well as long-term (>12 months) continence rates. Several prospective studies have reported earlier return of continence following preservation of puboprostatic ligaments, although no long-term data are available. Preservation of the urethral length yielded controversial outcomes. Concerning postoperative strategies, it is probably optimal to remove the catheter in a window between 4 and 7 days if clinically appropriate; however, more research in this regard is still required. Postoperative PFME (preoperative pelvic floor muscle exercise) appears to speed up the recovery of continence after RP. CONCLUSIONS Conservative strategies to prevent PPUI include proper patient selection and PFME. Peroperative techniques have largely shown benefit in the short term. Postoperative complications and timing of trial without catheter can influence continence status. Future research initiatives must assess peroperative and postoperative measures, with longer-term follow-up.
Collapse
Affiliation(s)
- Marcio A Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ralf Anding
- Department of Neurourology, University Hospital Bonn, Bonn, Germany
| | - Mohammad S Rahnama'i
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arun Sahai
- Department of Urology, Guy's Hospital, London, UK
| | - Andrea Tubaro
- Department of Urology, La Sapienza University 2nd School of Medicine, Sant Andrea Hospital, Rome, Italy
| |
Collapse
|
38
|
Khullar V, Digesu GA, Veit-Rubin N, Sahai A, Rahnama'i MS, Tarcan T, Chermansky C, Dmochowski R. How can we improve the diagnosis and management of bladder pain syndrome? Part 2:ICI-RS 2018. Neurourol Urodyn 2020; 38 Suppl 5:S71-S81. [PMID: 31821630 DOI: 10.1002/nau.24245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/21/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND This paper summarises the discussion in a think tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2018 about the treatment of bladder pain syndrome. AIMS To review the treatments of bladder pain syndrome from behavioural treatments to surgical interventions. MATERIALS AND METHODS Review the literature in the light of the think tank discussions. RESULTS All guidelines recommend different levels of treatment starting with conservative behavioral treatments then introducing oral treatments followed by intravesical instillations. If these treatments fail then more invasive treatments such as botulinum toxin injections, neuromodulation, or surgery could be suggested. CONCLUSION Unfortunately for all treatments, the numbers are limited and, therefore, the evidence base is not strong. Further suggestions for research are suggested.
Collapse
Affiliation(s)
- Vik Khullar
- Department of Urogynaecology, St Mary's Hospital, Imperial College, London, UK
| | - G Alessandro Digesu
- Department of Urogynaecology, St Mary's Hospital, Imperial College, London, UK
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Arun Sahai
- Department of Urology, Guy's Hospital, MRC Centre for Transplantation, King's College London, London, UK
| | | | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.,School of Medicine, Koc University, Istanbul, Turkey
| | - Christopher Chermansky
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
39
|
Palmieri V, Ramana-Kumar A, Martel M, Forbes N, Mohamed R, Chatterjee A, Kenshil S, Desilets E, Donnellan F, Gan I, Lam E, Telford JJ, Sandha GS, Teshima CW, May G, Mosko J, Paquin S, Sahai A, Barkun AN, Chen Y. A279 EUS-GUIDED BILIARY DRAINAGE IN MALIGNANT DISTAL BILIARY OBSTRUCTION: AN INTERNATIONAL SURVEY TO IDENTIFY BARRIERS OF TECHNOLOGY IMPLEMENTATION. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a promising alternative to endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction (MDBO). Recent small randomized controlled trials comparing EUS-BD with ERCP suggest that EUS-BD achieves a similar technical success rate and safety profile while potentially being associated with lower rates of stent dysfunction However, its application in clinical practice has been impeded by various undefined barriers.
Aims
To evaluate the current practice of EUS-BD and the determinants for its clinical implementation in MDBO.
Methods
An online survey was generated using Google Forms. Five endoscopy societies have distributed the survey as of October 10th, 2019. Survey questions measured participant characteristics, EUS-BD in different clinical scenarios, and potential barriers to implementation. Descriptive statistics were calculated using frequencies, chi-square statistics were used for inferential analysis, and a standard step-wise multivariable analysis was performed to identify independent variables for and against the use of EUS-BD.
Results
To date, 102 physicians have participated in the survey (response rate 7.97%). The majority of participants are from North America (39.2%), Asia (31.4%), and Europe (19.6%). Most participants are gastroenterologists with formal therapeutic endoscopy training (66.7%), though only 28.4% have received EUS-BD training. In unresectable cancer, 85.1% of respondents favoured EUS-BD over percutaneous biliary drainage following ERCP failure (p<0.0001), while in borderline resectable disease, 72.3% preferred EUS-BD. On multivariable analysis, male gender, formal training in EUS-BD, and unresectable cancer were independent variables for the use of EUS-BD. Conversely, independent discouraging factors for EUS-BD included fear of adverse events, limited high-quality data, lack of local expertise, and inadequate access to EUS technology.
Conclusions
In this international survey, it appears that EUS-BD is gaining traction, especially in the setting of unresectable disease following ERCP failure. However, barriers to implementation include the lack of high-quality data, fear for adverse events, limited experts in the field, and inadequate access to EUS technology. This suggest the need for high-quality clinical trials, increased endoscopist training in this field, and further technology development in EUS-BD in order to increase its uptake in clinical practice.
Funding Agencies
None
Collapse
Affiliation(s)
- V Palmieri
- Gastroenterology and Hepatology, McGill University, Montreal, QC, Canada
| | - A Ramana-Kumar
- Gastroenterology and Hepatology, McGill University, Montreal, QC, Canada
| | - M Martel
- Gastroenterology and Hepatology, McGill University, Montreal, QC, Canada
| | - N Forbes
- Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - R Mohamed
- Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - A Chatterjee
- Gastroenterology and Hepatology, University of Ottawa, Ottawa, ON, Canada
| | - S Kenshil
- Gastroenterology and Hepatology, University of Ottawa, Ottawa, ON, Canada
| | - E Desilets
- Gastroenterology, Université de Sherbrooke, St-Basile-le-Grand, QC, Canada
| | - F Donnellan
- Gastroenterology and Hepatology, University of British Columbia, Vancouver, BC, Canada
| | - I Gan
- Gastroenterology and Hepatology, University of British Columbia, Vancouver, BC, Canada
| | - E Lam
- Gastroenterology and Hepatology, University of British Columbia, Vancouver, BC, Canada
| | - J J Telford
- Gastroenterology and Hepatology, University of British Columbia, Vancouver, BC, Canada
| | - G S Sandha
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - C W Teshima
- Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - G May
- Medicine, University of Toronto, Toronto, ON, Canada
| | - J Mosko
- Medicine, University of Toronto, Toronto, ON, Canada
| | - S Paquin
- Gastroenterology, Université de Montréal, Montreal, QC, Canada
| | - A Sahai
- Gastroenterology, Université de Montréal, Montreal, QC, Canada
| | - A N Barkun
- Gastroenterology and Hepatology, McGill University, Montreal, QC, Canada
| | - Y Chen
- Gastroenterology and Hepatology, McGill University, Montreal, QC, Canada
| |
Collapse
|
40
|
Malde S, Kelly S, Saad S, Sahai A. Case‐finding tools for the diagnosis of OAB in women: A narrative review. Neurourol Urodyn 2020; 39:13-24. [DOI: 10.1002/nau.24171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/11/2019] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Sanad Saad
- Department of Urology Guy's Hospital London UK
| | - Arun Sahai
- Department of Urology Guy's Hospital London UK
| |
Collapse
|
41
|
Abrar M, Stroman L, Malde S, Solomon E, Sahai A. Predictors of Poor Response and Adverse Events Following Botulinum Toxin-A for Refractory Idiopathic Overactive Bladder. Urology 2020; 135:32-37. [DOI: 10.1016/j.urology.2019.08.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022]
|
42
|
Chermansky C, Schurch B, Rahnama'i MS, Averbeck MA, Malde S, Mancini V, Valentini F, Sahai A. How can we better manage drug‐resistant OAB/DO? ICI‐RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S46-S55. [DOI: 10.1002/nau.24055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/31/2019] [Accepted: 05/19/2019] [Indexed: 01/20/2023]
Affiliation(s)
| | - Brigitte Schurch
- Department of Clinical Neurosciences, Neuropsychology and Neurorehabilitation ServiceVaudois University Hospital of LausanneLausanne Switzerland
| | - Mohammad S. Rahnama'i
- Department of UrologyUniversity Hospital RWTH AachenAachen Germany
- Maastricht UniversityMaastricht The Netherlands
| | | | - Sachin Malde
- Department of UrologyGuy's Hospital & King's College School of MedicineLondon United Kingdom
| | - Vito Mancini
- Urology and Renal Transplant Unit, Ospedali RiunitiUniversity of FoggiaFoggia Italy
| | - Francoise Valentini
- Department of Physical Medicine and RehabilitationHôpital RothschildParis France
| | - Arun Sahai
- Department of UrologyGuy's Hospital & King's College School of MedicineLondon United Kingdom
| |
Collapse
|
43
|
Al-Jabir A, Aydın A, Ahmed K, McCabe JE, Khan MS, Dasgupta P, Sahai A. The role of dry-lab and cadaveric simulation for cystoscopy and intravesical Botulinum toxin injections. Transl Androl Urol 2019; 8:673-677. [PMID: 32038963 DOI: 10.21037/tau.2019.11.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The aim of this study is to assess validity of the ETXY Multifunctional trainer (ProDelphus, Olinda, Pernambuco, Brazil), a bench-top dry-lab model for simulation of cystoscopy and intravesical injections of Botulinum Toxin A (BTX-A) injections, in terms of educational value, feasibility and acceptability as well as evaluating the use of fresh frozen cadavers for intravesical BTX-A injections. Methods Prospective study with novice trainees and urologists (n=58) trained by experts (n=14) in a 30-min hands-on training session in intravesical administration of BTX-A over 6 training sessions throughout one year. Outcome measures were demonstrated through distribution and analysis of evaluation surveys on a 5-point Likert scale. Results There were 56 participants (96.6%) believed that the model has a role in training for the procedure. Participants also reported the training being an important confidence-booster for performing BTX-A injections (mean: 4.05/5) and useful for teaching procedural steps (mean: 3.89). Experts highly rated the realism of the simulator especially in simulation of needle penetration (mean: 3.98) and delivery (mean 4.03). Fresh frozen cadavers had a mean realism rating of 4.54 and participants affirmed that they should be routinely used for training and assessment (mean: 3.92). Conclusions This study demonstrated face and content validity in addition to establishing the feasibility and acceptability of the ETXY Multifunctional model in the training of intravesical BTX-A administration. Additionally, the simulator demonstrated educational value and fresh frozen cadavers were shown to be the preferred simulation modality for this procedure. Further evaluation in randomised controlled studies is needed to demonstrate higher evidence quality.
Collapse
Affiliation(s)
- Ahmed Al-Jabir
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
| | - Abdullatif Aydın
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK.,Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | - John E McCabe
- Department of Urology, St Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside, UK
| | - M Shamim Khan
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK.,Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK.,Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Arun Sahai
- MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK.,Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| |
Collapse
|
44
|
Khullar V, Chermansky C, Tarcan T, Rahnama'i MS, Digesu A, Sahai A, Veit-Rubin N, Dmochowski R. How can we improve the diagnosis and management of bladder pain syndrome? Part 1: ICI-RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S66-S70. [PMID: 31578775 DOI: 10.1002/nau.24166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/05/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND This paper summarizes the discussion in a think tank at the ICI-RS 2018 about the diagnosis of bladder pain syndrome (BPS). AIMS To review the guidelines, investigations and subtypes of BPS. MATERIALS AND METHODS Review of literature in the light of the think tank discussion. RESULTS All guidelines recommend completing history, physical examination, urine analysis, urine culture, and urine cytology to define the BPS phenotype but there are differences on further investigations. In those guidelines which recommend cystoscopy, the identification of Hunner's lesions (HLs) is recommended as this changes the treatment plan and outcome. CONCLUSION We propose that the differentiation of Hunner's ulcers is an important step in the assessment of these patients. Further suggestions for research are suggested.
Collapse
Affiliation(s)
- Vik Khullar
- Department of Urogynaecology, St. Mary's Hospital, Imperial College, London, UK
| | - Christopher Chermansky
- Department of Female Pelvic Medicine and Reconstructive Urology, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Tufan Tarcan
- Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey.,Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | | | - Alex Digesu
- Department of Urogynaecology, St. Mary's Hospital, Imperial College, London, UK
| | - Arun Sahai
- Department of Urology, Guy's Hospital, London, UK.,Department of Urology, MRC Centre for Transplantation, King's College London, London, UK
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Universitätsklinik für Frauenheilkunde, University of Vienna, Wien, Austria
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
45
|
Hall S, Ahmed S, Reid S, Thiruchelvam N, Sahai A, Hamid R, Harding C, Biers S, Parkinson R. A national UK audit of suprapubic catheter insertion practice and rate of bowel injury with comparison to a systematic review and meta‐analysis of available research. Neurourol Urodyn 2019; 38:2194-2199. [DOI: 10.1002/nau.24114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/05/2019] [Indexed: 11/10/2022]
Affiliation(s)
- S. Hall
- Department of UrologyNottingham City Hospital Nottingham UK
| | - S. Ahmed
- Department of UrologyRoyal Derby Hospital Derby UK
| | - S. Reid
- Department of UrologyNorthern General Hospital Sheffield UK
| | | | - A. Sahai
- Department of UrologyGuys Hospital London UK
| | - R. Hamid
- Department of UrologyUniversity College Hospital London UK
| | - C. Harding
- Department of UrologyFreeman Hospital Newcastle upon Tyne UK
| | - S. Biers
- Department of UrologyAddenbrookes Hospital Cambridge UK
| | - R. Parkinson
- Department of UrologyNottingham City Hospital Nottingham UK
| |
Collapse
|
46
|
Chong JJY, Seth J, Hazell E, Nugent W, Malde S, Taylor C, Sahai A, Olsburgh J. The MIC-KEY button vesicostomy: a superior alternative for suprapubic drainage? BJU Int 2019; 125:299-303. [PMID: 31379054 DOI: 10.1111/bju.14890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the MIC-KEY button vesicostomy as an alternative to indwelling suprapubic catheters (SPCs) for bladder drainage in adults. PATIENTS AND METHODS Phase II pilot study prospectively evaluating patients with indwelling SPCs that were converted to MIC-KEY buttons, or cystoscopic-guided de novo insertion, between November 2014 and February 2019. In all, 15 patients (14 female, one male) had indwelling SPCs that had conversion or attempted conversion to MIC-KEY button, and one (male) had a cystoscopic-guided de novo insertion with a history of previous suprapubic catheterisation. The mean (range) age was 44.2 (13-73) years. Catheter-related quality-of-life (C-IQoL) questionnaire data were collected at baseline and 3 months. RESULTS Two patients had attempted conversion but were abandoned perioperatively due to sizing issues and insertion difficulties, respectively. Three patients were subsequently converted back to a SPC; due to button sizing (18 days), leaking (3 months), and recurrent infection (13 months). The remaining 11 patients have remained well with continued drainage via the MIC-KEY button; mean (range) duration since conversion was 34.2 (5-105) months. The C-IQoL score improved 3 months after insertion, from 50.0 to 75.4. Changes were performed dependent on patient's personalised management, typically every 3 months, under local or general anaesthetic. CONCLUSION The MIC-KEY button is a safe alternative to SPC drainage in adults in the short- to medium-term, in a selected cohort.
Collapse
Affiliation(s)
- James J Y Chong
- Department of Urology, Guy's and St Thomas' Hospitals, London, UK
| | - Jai Seth
- Department of Urology, Guy's and St Thomas' Hospitals, London, UK
| | - Elaine Hazell
- Department of Urology, Guy's and St Thomas' Hospitals, London, UK
| | - Winnie Nugent
- Department of Urology, Guy's and St Thomas' Hospitals, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' Hospitals, London, UK
| | - Claire Taylor
- Department of Urology, Guy's and St Thomas' Hospitals, London, UK
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' Hospitals, London, UK
| | | |
Collapse
|
47
|
Abstract
The management of female stress urinary incontinence (SUI) has come under scrutiny in recent years following growing reports of mesh-related complications. Patients require thorough evaluation and management as part of a multidisciplinary team, and extensive counselling about the surgical treatment options is imperative. There is no clear consensus on the optimal management of the complex group of patients with mesh-related complications or recurrent SUI. We present two cases of female SUI to highlight the key factors to be considered when managing these patients. Level of evidence: Level 5.
Collapse
Affiliation(s)
- Néha Sihra
- Department of Urology, St George’s Hospital, London, UK
| | - Magda Kujawa
- Department of Urology, Stockport NHS Foundation Trust, Stepping Hill Hospital, UK
| | - Eskinder Solomon
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
| | | | - Arun Sahai
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
| | - Sachin Malde
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
| |
Collapse
|
48
|
Seth JH, Gonzales G, Haslam C, Pakzad M, Vashisht A, Sahai A, Knowles C, Tucker A, Panicker J. Feasibility of using a novel non-invasive ambulatory tibial nerve stimulation device for the home-based treatment of overactive bladder symptoms. Transl Androl Urol 2018; 7:912-919. [PMID: 30505727 PMCID: PMC6256042 DOI: 10.21037/tau.2018.09.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background To evaluate safety, acceptability and pilot efficacy of transcutaneous low-frequency tibial nerve stimulation (TNS) using a novel device as home-based neuromodulation. Methods In this single-centre pilot study, 48 patients with overactive bladder (OAB) (24 with neurogenic and 24 with idiopathic OAB) were randomized to use a self-applicating ambulatory skin-adhering device stimulating transcutaneously the tibial nerve at 1 Hz for 30 minutes, either once daily or once weekly, for 12 weeks. Changes in OAB symptoms and QoL were measured at baseline, weeks 4, 8, and 12 using validated scoring instruments (ICIQ-OAB and ICIQ-LUTSqol), 3-day bladder diary and a Global Response Assessment (GRA) at week 12. Results Thirty-four patients completed the study (idiopathic n=15, neurogenic n=19). No significant adverse effects were noted. Patients found the device acceptable. Eighteen patients (53%) reported a moderate or marked improvement in symptoms from the GRA. Between baseline and week-12, ICIQ-OAB part A sub-scores improved from mean (SD) 9.3 (2.5) to 7.5 (3.1), and from 9.1 (1.9) to 5.9 (1.7) in the daily and the weekly arms, respectively. ICIQ-LUTSqol part A sub-scores improved from mean (SD) 51 (12.8) to 44.2 (13.1) and 44.9 (9.0) to 35.9 (8.8) in the daily and the weekly arms, respectively. Bladder diary mean 24-hour frequency episodes improved from 11.5 to 8.8 at week 12 for both arms. Conclusions This novel ambulatory transcutaneous TNS (TTNS) device is safe and acceptable for use in patients reporting OAB symptoms as a form of home-based neuromodulation. A larger study however is required to confirm clinical efficacy.
Collapse
Affiliation(s)
- Jai H Seth
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Gwen Gonzales
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Collette Haslam
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Mahreen Pakzad
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Arvind Vashisht
- Department of Uro-gynaecology, University College Hospital, London, UK
| | - Arun Sahai
- Department of Urology, Guy's Hospital, Kings College London, London, UK
| | - Charles Knowles
- Barts & The London SMD, Queen Mary University of London, London, UK
| | - Arthur Tucker
- Barts & The London SMD, Queen Mary University of London, London, UK
| | - Jalesh Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| |
Collapse
|
49
|
Malde S, Fry C, Schurch B, Marcelissen T, Averbeck M, Digesu A, Sahai A. What is the exact working mechanism of botulinum toxin A and sacral nerve stimulation in the treatment of overactive bladder/detrusor overactivity? ICI-RS 2017. Neurourol Urodyn 2018; 37:S108-S116. [DOI: 10.1002/nau.23552] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/19/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Sachin Malde
- Department of Urology; Guy's Hospital; London United Kingdom
| | - Christopher Fry
- School of Physiology, Pharmacology & Neuroscience; University of Bristol; Bristol United Kingdom
| | - Brigitte Schurch
- Department of Clinical Neurosciences; Neuropsychology and Neurorehabilitation Service Vaudois University Hospital of Lausanne; Switzerland
| | - Tom Marcelissen
- Department of Urology; Maastricht University Medical Centre; Netherlands
| | | | - Alex Digesu
- Department of Urogynaecology; St. Mary's Hospital; United Kingdom
| | - Arun Sahai
- Department of Urology; Guy's Hospital; London United Kingdom
- King's College London; King's Health Partners; United Kingdom
| |
Collapse
|
50
|
Abstract
OBJECTIVES Bladder pain syndrome (BPS) is a debilitating condition which can be difficult to diagnose and treat due to the lack of consensus on aetiology, definition, and management. The aim of this review is to summarise the findings from major national and international guidelines on the management of BPS, highlighting areas of disagreement and uncertainty. METHODS We performed a Medline/PubMed search from 1st January 2000 to 31st December 2017 in order to identify relevant guidelines addressing BPS/interstitial cystitis. We also manually searched the websites of major national and international societies. The following guidelines were included in this review: European Association of Urology, American Urological Association, International Society for the Study of BPS, International Consultation on Incontinence, International Continence Society, East Asian guideline, Royal College of Obstetricians and Gynaecologists/British Society of Urogynaecology, and the Canadian Urological Association. RESULTS There is disagreement between guidelines on the exact definition of BPS and the nomenclature to use to describe this condition. However, all agree that the diagnosis is dependent on the presence of pain, pressure, or discomfort, in addition to at least one urinary symptom, in the absence of other diseases that could cause pain. Exclusion of other pathology that could cause similar symptoms requires thorough evaluation, and is recommended in all guidelines. There is also disparity in the recommended diagnostic investigation of BPS, with hydrodistension and bladder biopsy either recommended, considered optional, or not recommended, by different guidelines. It is accepted that BPS can be diagnosed clinically, without invasive investigation, but cystoscopy and diagnostic hydrodistension aids sub-typing of patients and may help direct treatment strategies. Patients should be phenotyped in order to direct multimodal treatment (including behavioural, physical, emotional, and psychological therapy), and treatments should follow a stepwise approach starting with the most conservative. Although widely performed, hydrodistension as a therapeutic strategy has a limited evidence base and is unlikely to provide long-term resolution of symptoms CONCLUSION: There are multiple national and international guidelines for the diagnosis and management of BPS, and this review has highlighted the differences in nomenclature, definitions, and recommended diagnostic tests between guidelines. The overall evidence base for the majority of treatments for BPS/IC is of low-quality, and larger randomised trials are required to more accurately inform guideline recommendations and clinical management of this complex group of patients.
Collapse
Affiliation(s)
- Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stefano Palmisani
- Department ofPain Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Adnan Al-Kaisy
- Department ofPain Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|