scholarly journals Stemming the tide of mild to moderate post-prostatectomy incontinence: A retrospective comparison of transobturator male slings and the artificial urinary sphincter

2014 ◽  
Vol 8 (7-8) ◽  
pp. 273 ◽  
Author(s):  
Nathan Y. Hoy ◽  
Keith F. Rourke
Keyword(s):  
Patient Satisfaction ◽  
Artificial Urinary Sphincter ◽  
Complication Rates ◽  
Retrospective Comparison ◽  
Urinary Sphincter ◽  
Significant Difference ◽  
Comorbidity Scores ◽  
Clavien Grade ◽  
Grade 3

Introduction: The AUS remains the gold standard treatment for post-prostatectomy incontinence (PPI), although most patients with mild-moderate PPI prefer a sling without strong evidence of procedural equivalence. This study compares outcomes of 2 procedures for the treatment of mild-moderate PPI.Methods: A retrospective review of 124 patients (76 transobturator sling, 48 AUS) with mild-moderate PPI requiring intervention over an 8-year period. The primary outcome was continence. Secondary outcomes included global patient satisfaction, improvement, and complication rates. Mild to moderate incontinence was defined as requiring ≤5 pads/day.Results: There was no significant difference in age (66.2 vs. 68.1 years; p = 0.17) or prostate cancer characteristics for slings and AUS, respectively. AUS patients had higher Charlson comorbidity scores and were more likely to have previous radiotherapy. Median length of follow up was 24 months for slings and 42 months for AUS. There was no difference in continence rates, 88.2% vs. 87.5% (p = 0.79), rate of improvement, 94.7% vs. 95.8% (p = 1.00), or patient satisfaction, 93.4% vs. 91.7% (p = 0.73), for slings and AUS, respectively. Complication rates were equivalent (19.7% vs.16.7%; p = 1.00), though a significantly higher proportion of complications with AUS were Clavien Grade 3 (0% vs. 75%; p = 0.006).Conclusions: For mild to moderate PPI there is no difference incontinence, satisfaction, or improvement rates, between AUS and slings. AUS complications tend to be more severe. Our study supports the use of slings as first-line treatment for mild-moderate PPI.

scholarly journals Prior Placement of Male Urethral Slings Can Increase the Need for Revision of Artificial Urinary Sphincters

2021 ◽  
Vol 10 (24) ◽  
pp. 5842
Author(s):  
Emily M. Yura ◽  
Christopher J. Staniorski ◽  
Jason E. Cohen ◽  
Liqi Chen ◽  
Ashima Singal ◽  
...  
Keyword(s):  
Retrospective Studies ◽  
Artificial Urinary Sphincter ◽  
Demographic Characteristics ◽  
Male Sling ◽  
Sling Procedure ◽  
Replacement Surgery ◽  
Academic Center ◽  
Urinary Sphincter ◽  
Significant Difference

Background: Recurrent stress urinary incontinence (SUI) following male sling can be managed surgically with artificial urinary sphincter (AUS) insertion. Prior small, single-center retrospective studies have not demonstrated an association between having failed a sling procedure and worse AUS outcomes. The aim of this study was to compare outcomes of primary AUS placement in men who had or had not undergone a previous sling procedure. Methods: A retrospective review of all AUS devices implanted at a single academic center during 2000–2018 was performed. After excluding secondary AUS placements, revision and explant procedures, 135 patients were included in this study, of which 19 (14.1%) patients had undergone prior sling procedures. Results: There was no significant difference in demographic characteristics between patients undergoing AUS placement with or without a prior sling procedure. Average follow up time was 28.0 months. Prior sling was associated with shorter overall device survival, with an increased likelihood of requiring revision or replacement of the device (OR 4.2 (1.3–13.2), p = 0.015) as well as reoperation for any reason (OR 3.5 (1.2–9.9), p = 0.019). While not statistically significant, patients with a prior sling were more likely to note persistent incontinence at most recent follow up (68.8% vs. 42.7%, p = 0.10). Conclusions: Having undergone a prior sling procedure is associated with shorter device survival and need for revision or replacement surgery. When considering patients for sling procedures, patients should be counseled regarding the potential for worse AUS outcomes should they require additional anti-incontinence procedures following a failed sling.

Long-term follow-up after bilateral percutaneous epiphysiodesis around the knee to reduce excessive predicted final height

2017 ◽  
Vol 103 (3) ◽  
pp. 219-223 ◽  
Author(s):  
Wesley J Goedegebuure ◽  
Frank Jonkers ◽  
Annemieke M Boot ◽  
Willie M Bakker-van Waarde ◽  
Vera van Tellingen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Final Height ◽  
Treated Group ◽  
Knee Function ◽  
Tall Stature ◽  
Complication Rates ◽  
Significant Difference ◽  
Close Relatives

ContextPercutaneous epiphysiodesis (PE) around the knee to reduce predicted excessive final height. Studies until now included small numbers of patients and short follow-up periods.Objective and designThis Dutch multicentre, long-term, retrospective, follow-up study aimed to assess adult height (AH), complications, knee function and patient satisfaction after PE. The primary hypothesis was that PE around the knee in constitutionally tall boys and girls is an effective treatment for reducing final height with low complication rates and a high level of patient satisfaction.Participants77 treated adolescents and 60 comparisons.InterventionPercutaneous epiphysiodesis.OutcomeAH, complications, knee function, satisfaction.ResultsIn the PE-treated group, final height was 7.0 cm (±6.3 cm) lower than predicted in boys and 5.9 cm (±3.7 cm) lower than predicted in girls. Short-term complications in file search were seen in 5.1% (three infections, one temporary nerve injury), one requiring reoperation. Long-term complications in file search were seen in 2.6% (axis deformity 1.3%, prominent head of fibula 1.3%). No significant difference in knee function was found between treated cases and comparisons. Satisfaction was high in both the comparison and PE groups; most patients in the PE group recommended PE as the treatment for close relatives with tall stature.ConclusionPE is safe and effective in children with predicted excessive AH. There was no difference in patient satisfaction between the PE and comparison group. Careful and detailed counselling is needed before embarking on treatment.

scholarly journals Continence and Complication Rates of Artificial Urinary Sphincter Devices (AMS 800) for Parkinson and Stroke Patients with Incontinence after Prostate Surgery: Retrospective Analysis of a Prospective Database

2021 ◽  
pp. 1-7
Author(s):  
Valentin Maurer ◽  
Justus Stahlberg ◽  
Insa Schiffmann ◽  
Phillip Marks ◽  
Clemens M. Rosenbaum ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Artificial Urinary Sphincter ◽  
Manual Dexterity ◽  
Life Questionnaire ◽  
Complication Rates ◽  
International Consultation ◽  
Urinary Sphincter ◽  
Significant Difference ◽  
Neurological Patients ◽  
History Of

<b><i>Objectives:</i></b> The artificial urinary sphincter (AUS) is the gold standard treatment for severe stress urinary incontinence (SUI). According to the literature, patients suffering from Parkinson’s disease (PD) or stroke (ST) show adverse continence outcomes after prostate surgery and, therefore, constitute a challenging cohort for continence surgery. However, little is known with respect to the results of AUS surgery in these patients. A retrospective analysis of our institutional, prospectively maintained AUS database aims to address this aspect with a focus on surgical and functional outcomes. <b><i>Methods and Patients:</i></b> All data of patients with an AUS implantation were prospectively collected in our database since 2009. The AUS was implanted according to a standardized protocol and activated at 6 weeks postoperatively at our institution. Further follow-up (FU) consisted of pad-test, uroflowmetry, residual urine, and radiography as well as a standardized questionnaire including the Incontinence Quality of Life questionnaire (I-Quol) and International Consultation on Incontinence questionnaire (ICIQ-SF) and is scheduled at 6 and 24 months and every 2 years thereafter. Patients received a preoperative urodynamic evaluation (UD). Patients with normal voiding and storage function were considered for AUS implantation. All patients performed a preoperative test for manual dexterity. Patients with a history of ST or PD were grouped and compared to nonneurological patients. Primary/secondary endpoints of the study were complications/continence. <b><i>Results:</i></b> 234 patients were available for analysis. The median FU was 24 months (interquartile range 7–36). Twenty-four patients (10%) had a neurological history (PD and ST). Neurological patients showed significantly worse outcomes regarding continence (objective/subjective/social continence; <i>p</i> = 0.04/<i>p</i> = 0.02/<i>p</i> = 0.1). Significant differences concerning explantation rates were not observed (<i>p</i> = 1). Kaplan-Meier analysis showed no significant difference regarding explantation-free survival (log-rank <i>p</i> = 0.53). <b><i>Conclusion:</i></b> AUS implantation shows significantly worse continence rates for neurological patients, despite the fact that all patients showed normal UD results and sufficient manual dexterity. Although neurological patients showed worse outcomes for continence, AUS implantation seems to be a safe and viable treatment for patients with a history of neurological disease.

Risk factors for urological prosthetic infection

1997 ◽  
Vol 64 (1) ◽  
pp. 65-69 ◽  
Author(s):  
P. Fortunato ◽  
M. Schettini ◽  
M. Gallucci
Keyword(s):  
Risk Factors ◽  
Infection Rate ◽  
Artificial Urinary Sphincter ◽  
Prosthetic Infection ◽  
Penile Prostheses ◽  
Urinary Sphincter ◽  
Significant Difference ◽  
The Mean ◽  
Revision Operations

We reviewed our experience of 91 procedures for implant and revision of urological prostheses from 1989 to 1996. The aim of the study was to determine the risk factors for urological prostheses. The procedures consisted of 48 implants of artificial urinary sphincters AMS 800 (35 primary implants and 13 revisions) and 43 penile prostheses (40 primary implants and 3 revisions). Simultaneous penile reconstruction was performed in 5 cases. The mean follow-up was 2 years (range 1-6 years) for artificial urinary sphincter and 1.8 years (range 1-4) for penile prostheses. Infection occurred in 7 cases (4 urinary sphincter and 3 penile prostheses). The infection rate after primary uncomplicated implant of AMS 800 was 8.5% compared to 7.6% for revision procedures (p=n.s.). The infection rate after primary implant of penile prostheses was 5% compared to 33% for revision procedures. There was a similar significant difference between the penile prostheses implant group with reconstruction of the corpora (2 out 5 patients) and the primary uncomplicated implant group (p=0.001). The risk of infection is significantly greater when penile reconstruction is required and is associated with revision operations.

scholarly journals Quality of life and patient satisfaction after artificial urinary sphincter

2013 ◽  
Vol 5 (4) ◽  
pp. 268
Author(s):  
Bhavneet Kahlon ◽  
Richard J. Baverstock ◽  
Kevin V. Carlson
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Chart Review ◽  
Short Form ◽  
Artificial Urinary Sphincter ◽  
Complication Rates ◽  
International Consultation ◽  
Urinary Sphincter ◽  
Patient Reported

Background: We assessed satisfaction and quality of life (QOL) inmen with artificial urinary sphincter (AUS) placement.Methods: We identified 39 men who had AUS placement. Aretrospective chart review was conducted. Validated questionnaires,including the International Consultation on IncontinenceQuestionnaire-Short Form (ICIQ-SF), Post-Operative PatientGlobal Impression of Improvement (PGI-I), Incontinence ImpactQuestionnaire-Short Form (IIQ-SF), and Urogenital Distress Index(UDI-SF), were used to measure patient-reported outcome. Globalsatisfaction was also assessed.Results: At chart review, 34 of 39 questionnaires were assessedfor QOL, satisfaction and surgical outcome. Follow-up rangedfrom 7 to 60 months (median = 24 months). Surgical revisionswere required in 6 (17.6%) patients due to infection (1), erosion(1), combined infection and erosion (1), device failure (1) andsecond cuff placement (2). Quality of life was assessed using theIIQ-SF and UDI-SF, with mean scores of 15.4 and 24.8, respectively;these scores indicated a low negative impact on QOL. TheICIQ-SF mean score was 8.2, well below the worst possible score.The number of men using more than 1 pad per day dropped from27 preoperatively to 10 postoperatively. Most patients (31/34)described their urinary condition as better, 2 had no changeand 1 was worse. Most patients (31/34, 91.2%) would be willingto undergo the procedure again, 2 were undecided, and 1would not. Similarly, 28 patients (82.4%) would recommend theprocedure to a friend, 3 respondents would “with reservation,”1 respondent was undecided, and 2 would not recommend theAUS placement.Conclusion: Treatment of urinary incontinence with the AUS hasa positive effect on QOL with high patient satisfaction and reasonablylow complication rates.

1340: Patient Satisfaction Following Dual Implantation of Inflatable Penile and Artificial Urinary Sphincter Prostheses via Transverse Scrotal Approach

2007 ◽  
Vol 177 (4S) ◽  
pp. 442-442
Author(s):  
William S. Kizer ◽  
John A. Mancini ◽  
LeRoy A. Jones ◽  
Rafael V. Mora ◽  
Allen F. Morey
Keyword(s):  
Patient Satisfaction ◽  
Artificial Urinary Sphincter ◽  
Urinary Sphincter

scholarly journals Pediatric endoscopic pilonidal sinus treatment (PEPSiT): what we learned after a 3-year experience in the pediatric population

2021 ◽  
Author(s):  
Ciro Esposito ◽  
Ernesto Montaruli ◽  
Giuseppe Autorino ◽  
Mario Mendoza-Sagaon ◽  
Maria Escolino
Keyword(s):  
Patient Satisfaction ◽  
Laser Therapy ◽  
Pilonidal Sinus ◽  
Pediatric Population ◽  
Treatment Protocol ◽  
Pilonidal Sinus Disease ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Clavien Grade

AbstractThis paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017–2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient’s age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1–36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16–31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure.

scholarly journals Intracameral Bevacizumab Versus Sub-Tenon’s Mitomycin C as Adjuncts to Trabeculectomy: 3-Year Results of a Prospective Randomized Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2054
Author(s):  
Gerasimos Kopsinis ◽  
Dimitrios Tsoukanas ◽  
Dimitra Kopsini ◽  
Theodoros Filippopoulos
Keyword(s):  
Mitomycin C ◽  
Primary Outcome ◽  
Randomized Study ◽  
Primary Outcome Measure ◽  
Complication Rates ◽  
Filtration Surgery ◽  
Significant Difference ◽  
Exfoliative Glaucoma

Conjunctival wound healing determines success after filtration surgery and the quest for better antifibrotic agents remains active. This study compares intracameral bevacizumab to sub-Tenon’s mitomycin C (MMC) in trabeculectomy. Primary open-angle or exfoliative glaucoma patients were randomized to either bevacizumab (n = 50 eyes) or MMC (n = 50 eyes). The primary outcome measure was complete success, defined as Intraocular Pressure (IOP) > 5 mmHg and ≤ 21 mmHg with a minimum 20% reduction from baseline without medications. Average IOP and glaucoma medications decreased significantly in both groups at all follow-up points compared to baseline (p < 0.001), without significant difference between groups at 3 years (IOP: bevacizumab group from 29 ± 9.4 to 15 ± 3.4 mmHg, MMC group from 28.3 ± 8.7 to 15.4 ± 3.8 mmHg, p = 0.60; Medications: bevacizumab group from 3.5 ± 0.9 to 0.5 ± 1, MMC group from 3.6 ± 0.7 to 0.6 ± 1.1, p = 0.70). Complete success, although similar between groups at 3 years (66% vs. 64%), was significantly higher for bevacizumab at months 6 and 12 (96% vs. 82%, p = 0.03; 88% vs. 72%, p = 0.04, respectively) with fewer patients requiring medications at months 6, 9 and 12 (4% vs. 18%, p = 0.03; 6% vs. 20%, p = 0.04; 8% vs. 24%, p = 0.03, respectively). Complication rates were similar between groups. In conclusion, intracameral bevacizumab appears to provide similar long-term efficacy and safety results as sub-Tenon’s MMC after trabeculectomy.

scholarly journals 439 Conservative Versus Surgical Management of Complicated Diverticulitis - A Retrospective Study of Long-Term Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Durity ◽  
G Elliott ◽  
T Gana
Keyword(s):  
Complicated Diverticulitis ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Female Ratio ◽  
Stoma Reversal ◽  
Group A ◽  
Grade 3 ◽  
Group B

Abstract Introduction Management of complicated diverticulitis has shifted towards a conservative approach over time. This study evaluates the feasibility and long-term outcomes of conservative management. Method We retrospectively evaluated a consecutive series of patients managed with perforated colonic diverticulitis from 2013-2017. Results Seventy-three (73) patients were included with a male to female ratio of 1:2. Thirty-one (31) underwent Hartmann’s procedure (Group A) and 42 patients were managed with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years). CT Grade 3 and 4 disease was observed in 64.5% and 40.4% of Group A and Group B patients, respectively. During follow-up, 9 (21.4%) Group B patients required Hartmann’s. Group A had longer median length of stay compared to Group B (25.1 vs 9.2 days). Post-operative complications occurred in 80.6% with 40% being Clavien-Dindo grade III or higher in group A. Stoma reversal was performed in 8 patients (25.8%). Conclusions In carefully selected cases, complicated diverticulitis including CT grade 3 and 4 disease, can be managed conservatively with acceptable recurrence rates (16.7% at 30 days, 4.8% at 90 days, 19.0% at 5 years). Surgical intervention on the other hand, carries high post-operative complication rates and low stoma reversal rates.

scholarly journals Slowly resorbable biosynthetic mesh: 2-year results in VHWG grade 3 hernia repair

Hernia ◽  
2021 ◽  
Author(s):  
M. M. J. Van Rooijen ◽  
T. Tollens ◽  
L. N. Jørgensen ◽  
T. S. de Vries Reilingh ◽  
G. Piessen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hernia Repair ◽  
Hernia Recurrence ◽  
Recurrence Rates ◽  
Elective Repair ◽  
Significant Difference ◽  
Grade 3

Abstract Introduction Information on the long-term performance of biosynthetic meshes is scarce. This study analyses the performance of biosynthetic mesh (Phasix™) over 24 months. Methods A prospective, international European multi-center trial is described. Adult patients with a Ventral Hernia Working Group (VHWG) grade 3 incisional hernia larger than 10 cm2, scheduled for elective repair, were included. Biosynthetic mesh was placed in sublay position. Short-term outcomes included 3-month surgical site occurrences (SSO), and long-term outcomes comprised hernia recurrence, reoperation, and quality of life assessments until 24 months. Results Eighty-four patients were treated with biosynthetic mesh. Twenty-two patients (26.2%) developed 34 SSOs, of which 32 occurred within 3 months (primary endpoint). Eight patients (11.0%) developed a hernia recurrence. In 13 patients (15.5%), 14 reoperations took place, of which 6 were performed for hernia recurrence (42.9%), 3 for mesh infection (21.4%), and in 7 of which the mesh was explanted (50%). Compared to baseline, quality of life outcomes showed no significant difference after 24 months. Despite theoretical resorption, 10.7% of patients reported presence of mesh sensation in daily life 24 months after surgery. Conclusion After 2 years of follow-up, hernia repair with biosynthetic mesh shows manageable SSO rates and favorable recurrence rates in VHWG grade 3 patients. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report lasting presence of mesh sensation. Results of biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations. Trial registration Registered on clinicaltrials.gov (NCT02720042), March 25, 2016.

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