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Abstract Objectives Implantation of an artificial urinary sphincter (AUS) to treat post‐prostatectomy incontinence (PPI) has been traditionally offered with an overnight hospital stay. The aim of this prospective, comparative pilot study was to assess the feasibility and outcomes of the AUS procedure in a day‐case setting. Patients and methods We included consecutive patients having primary or redo AUS surgery over an 18‐month period. We excluded patients with previous urethral erosion of AUS, urethroplasty or high anaesthetic risk. All patients were offered day‐case surgery. Patients who declined or could not have day‐case surgery for logistical reasons had standard care with overnight stay and formed the control group for the study. Primary outcome was the proportion of successful same day‐discharges in the day‐case group. We also compared baseline characteristics, complications and continence at 1 year post surgery. Results Twelve patients consented for day‐case procedure, and 13 patients had standard overnight care. Mean age was 69.5 years (range 58–79). Twenty‐one patients (84%) had primary AUS, whereas 4 (16%) had a redo procedure. There were no significant differences between the groups in baseline demographics. Median number of pads/24 h was 5 in the day‐case group and 4 in the overnight group. Eight of 12 patients (66.7%) in the day‐case group were successfully discharged on the same day. Failed discharges were due to anaesthetic recovery (n = 2), high post‐void residuals that resolved spontaneously (n = 1) and intraoperative superficial urethral injury (n = 1). All patients in the day‐case group and all but one in the standard of care group were socially continent (0–1 pads) at 1 year post procedure. Conclusion Day‐case catheter‐free discharge of AUS patients is feasible and safe in selected patients with comparable continence outcomes and complication rates to those with standard overnight stays.

Context: Intermittent self-dilatation (ISD) is a therapeutic strategy used to stabilise a urethral stricture and postpone or avoid further treatment. Adding corticosteroids to this mode of management might further enhance its outcomes by downregulation of collagen deposition and excessive scar tissue formation. Objective: To explore whether a course of ISD with topical corticosteroids is superior at stabilising urethral stricture disease in men and improving functional outcomes over a course of ISD alone. Evidence acquisition: This systematic review and meta-analysis was undertaken by the European Association of Urology Urethral Strictures Guideline Panel according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines (CRD42021256744). The primary benefit outcome was successful stabilisation of the urethral stricture. Treatment-related complications were the primary harm outcome. Evidence synthesis: In total, 978 records were screened for eligibility, ultimately leading to five included studies, all randomised controlled trials, comprising 250 patients, of whom 124 underwent a course of ISD with corticosteroids and 126 underwent a course of ISD alone, all after direct vision internal urethrotomy (DVIU). Successful stabilisation of the stricture was achieved in 77% and 64% of patients in the group with and without corticosteroids, respectively (p = 0.04). No extra complications related to the addition of corticosteroids to the ISD regimen were reported. The risk of bias of the included studies was generally unclear to high. Conclusions: Based on the currently available data, a course of ISD with topical corticosteroids appears to be safe and superior at stabilising a urethral stricture after DVIU in the short term to a course of ISD alone. However, given the unclear to high risk of bias in the included studies, further high-quality studies are needed to fully underpin this. Patient summary: This study shows that addition of topical corticosteroids to intermittent self-dilatation after direct vision internal urethrotomy can better stabilise the stricture in the short term.

There is insufficient data to assess the effects of any of the different management strategies for recurrent or persistent stress urinary incontinence in women after failed interventional treatment. The evidence base lacks well-designed randomised trials with sufficient power to answer this hugely important issue. PURSUIT is the Proper Understanding of Recurrent Stress Urinary Incontinence Treatment study, assessing through randomisation whether endoscopic or surgical interventions achieve better cure and/or quality of life outcomes at 1 year, and will follow up to 3 years to see if responses are sustained. The manuscript provides an outline of the study, describes the challenges it has faced, and advocates the importance of ensuring its successful delivery.

Introduction: About 40% of women suffer pelvic organ prolapse (POP) in a lifetime. The current standard intervention for vault prolapse is a mesh sacrocolpopexy or sacrohysteropexy. However, patients and surgeons are increasingly hesitant to use mesh given recent the UK and Food and Drug Administration warnings and litigation. A possible alternative is to use autologous tissue to support the vault, as a mesh-free solution. We report the outcomes from an initial series of autologous rectus fascia sheath (RFS) sacrocolpopexy and sacrohysteropexy in patients with complex pelvic floor dysfunction. Patients and Methods: All patients had previous, multiple urological/gynecological surgery and declined standard mesh repairs. All had preoperative videourodynamics and defecating magnetic resonance imaging evaluation. The autologous POP repair was performed using 10–18 cm of rectus sheath with a similar technique to that employing mesh to support the anterior-posterior vaginal walls or encircle the cervix and secured to the sacral promontory. Results: Seven patients with a mean age of 52 (33–64) years underwent autologous RFS POP repair between 2014 and 2017. Mean follow-up is 16 (range 2–33) months. All patients have durable result at last follow-up. No significant complications are reported. Conclusions: This is the first report of patients with complex pelvic floor dysfunction and apical POP being managed with autologous RFS sacrocolpopexy/sacrohysteropexy, and only the second report of a free graft being utilized with success. Autologous RFS sacrocolpopexy/sacrohysteropexy avoids the 10%–15% risks of mesh-related complications. Further studies of long-term durability are needed.

Urinary incontinence remains one of the most significant complications of radical prostatectomy, known as post-prostatectomy incontinence (PPI), can have profound effects on quality of life. The correct diagnosis is critical, and the urodynamic cause of incontinence established as either stress urinary incontinence or detrusor overactivity. Patient evaluation should also include the use of quality of life questionnaires to assess severity of symptoms and a quantitative pad weight or pad usage assessment. Treatment regimes should incorporate conservative measures pelvic floor exercises, and then failing this, a discussion of the more invasive therapies, including bulking injections, the artificial urinary sphincter or the male suburethral sling. All of these options should be discussed carefully with the patient, including success rates of outcomes and potential adverse effects of treatment. Key words: Radical prostatectomy, urinary incontinence, post-prostatectomy incontinence, assessment, stress urinary incontinence, detrusor overactivity, management

Objectives: The objective of this study is to present the outcomes of men undergoing implantation of artificial urinary sphincter, after treatment for prostate cancer and also to determine the effect of radiotherapy on continence outcomes after artificial urinary sphincter (AUS) implantation. Material and Methods: A prospectively acquired database of all 184 patients having AUS insertion between 2002 and 2012 was reviewed, and demographic data, mode of prostate cancer treatment(s) before implantation, and outcome in terms of complete continence (pad free, leak free) were assessed. Statistical analysis was performed by Chi-squared and Fisher's exact tests. Results: A total of 58 (32%) men had bulbar AUS for urodynamically proven stress urinary incontinence consequent to treatment for prostate cancer in this period. Median follow-up post-AUS activation was 19 months (1–119). Forty-eight (83%) men had primary AUS insertion. Twenty-one (36%) men had radiotherapy as part of or as their sole treatment. Success rates were significantly higher in nonirradiated men having primary sphincter (89%) than in irradiated men (56%). Success rates were worse for men having revision AUS (40%), especially in irradiated men (33%). Conclusion: Radiotherapy as a treatment for prostate cancer was associated with significantly lower complete continence rates following AUS implantation.