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INTRODUCTION AND OBJECTIVE:Sacral neuromodulation is an effective treatment for refractory overactive bladder. Based on standard culture, about 25% of explanted stimulators have been shown to be co...

INTRODUCTION AND OBJECTIVE:Evaluate whether inflatable penile prosthesis (IPP) after radical cystectomy (RC) is associated with higher complication rates compared to IPP for other etiologies of ere...

INTRODUCTION AND OBJECTIVE:The pulse width (PW) parameter in sacral neuromodulation (SNM) is understudied, with no evidence-based guidance available on alternative PW for bladder indications. The a...

INTRODUCTION AND OBJECTIVE:Lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) are common. Per the American Urologic Association guidelines, there are two prostate size-independe...

INTRODUCTION AND OBJECTIVE:The Urologic Disease in America project found the prevalence of benign prostatic hyperplasia (BPH) grew over time (24.5% in 2004 to 28% in 2013 – a 14.3% increase). Given...

We sought to determine the usefulness of motor responses during sacral neuromodulation lead placement by testing the hypothesis that a greater number of motor responses during intraoperative electrode testing would be associated with more durable therapy.We retrospectively reviewed all sacral neuromodulation lead placements at a large academic center from 2010 to 2015. Included in study were all unilateral sacral lead placements for which the presence or absence of a motor response was documented discretely for each electrode. Motor responses were quantified into separate subscores, including bellows and toe response subscores (each range 0 to 4) for a possible maximum total score of 8 when combined. Revision surgery was the primary outcome. Univariate and multivariate analyses were performed for factors associated with lead revision.A total of 176 lead placements qualified for analysis. Mean ± SD cohort age was 58.4 ± 15.9 years, 86.4% of the patients were female and 93.2% had undergone implantation for overactive bladder. Median followup was 10.5 months (range 2 to 36). Overall 34 patients (19%) required lead revision. Revision was negatively associated with the total electrode response score (p = 0.027) and the toe subscore (p = 0.033) but not with the bellows subscore (p = 0.183). Predictors of revision on logistic regression included age less than 59 years at implantation (OR 5.5, 95% CI 2-14) and a total electrode response score less than 4 (OR 4.2, 95% CI 1.4-12.8).Fewer total electrode responses and specifically fewer toe responses were associated with sacral neuromodulation lead revision. These data suggest that placing a lead with more toe responses during testing may result in more durable sacral neuromodulation therapy.

We investigated the influence of patient age on sacral nerve stimulation trial outcomes, device implantation and treatment durability.We analyzed a database of all sacral nerve stimulation procedures performed between 2012 and 2014 at a high volume institution for associations of patient age with sacral nerve stimulation indication, trial stimulation success, device revision and device explantation.In a cohort of 356 patients those with nonobstructive urinary retention and urgency-frequency were younger than patients with urgency urinary incontinence. Trial stimulation success did not differ by age in stage 1 and percutaneous nerve evaluation trials (p = 0.51 and 0.84, respectively). Logistic regression identified greater odds of trial success in females compared to males (OR 2.97, 95% CI 1.32-6.04, p = 0.009) and for urgency urinary incontinence compared to urgency-frequency (OR 3.02, 95% CI 1.39-6.50, p = 0.006). In analyzed patients there were 119 surgical revisions, including battery replacement, and 53 explantations. Age was associated with a decreased risk of revision with 3% lower odds per each additional year of age (OR 0.97, 95% CI 0.95-0.98, p 0.0001). While age did not influence explantation, for each body mass index unit there was a 5% decrease in the odds of explantation (OR 0.95, 95% CI 0.91-0.98).In contrast to previous studies, older patients experienced no difference in the sacral nerve stimulation response in stimulation trials and no difference in the implantation rate. Furthermore, age was modestly protective against device revision. This suggests that age alone should not negatively predict sacral nerve stimulation responses.

INTRODUCTION AND OBJECTIVES:Renal artery clamping during partial nephrectomy causes ischemia-reperfusion injury (IRI), which can lead to acute kidney injury and exacerbate chronic kidney disease. N...

INTRODUCTION AND OBJECTIVES:The prevalence of bothersome overactive bladder (OAB) symptoms in men does not differ notably from that in women, but men are much less likely to receive treatment with ...

INTRODUCTION AND OBJECTIVES:Renal artery clamping during partial nephrectomy causes ischemia-reperfusion injury (IRI), which can lead to chronic kidney disease. No therapies for renal IRI exist, an...

INTRODUCTION AND OBJECTIVES:Surgeries for benign prostatic hyperplasia (BPH) are commonly performed by urologists worldwide. Durability of these surgeries is reflected by the need for repeat endosc...

INTRODUCTION AND OBJECTIVES:It is unclear what intraoperative factors predict progression from Stage I to Stage II in sacral neuromodulation (SNM), as well as the durability of the subsequent thera...

INTRODUCTION AND OBJECTIVES: Although early Sacral Neuromodulation (SNM) trials excluded patients with neurologic lower urinary tract dysfunction (NLUTD), an increasing number of small studies show outcomes in these patients are similar to those without NLUTD. The use of SNM in NLUTD remains off label. The aim of this study was to compare SNM in patients with NLUTD to those without NLUTD and determine clinical factors associated with successful utilization of SNM. METHODS: A retrospective review of patients who underwent SNM between 2011 and 2015 was completed. Patients with a neurologic diagnosis in the electronic chart were identified and placed in the NLUTD cohort. Demographic and clinical characteristics of the NLUTD and non-NLUTD cohort were identified. Rates of progression to stage 2, revision and explant were analyzed. The data were examined using Pearson’s chi-square and Fisher exact tests as appropriate. RESULTS: Out of 412 patients, 80 (19.4%) had NLUTD at time of SNM with a mean age was 54 17 years. 75% of the NLUTD group was female (N1⁄460). The neurogenic diagnoses were: spinal cord injury 28.8% (N1⁄423), multiple sclerosis 23.8% (N1⁄419), Stroke 15% (N1⁄412), cerebral palsy12.5% (N1⁄410), peripheral nervous system disorders 12.5% (N1⁄410) and Parkinson’s disease 7.5% (N1⁄46). The primary indication for SNM was urgency incontinence in 62.5% of the NLUTD group (N1⁄450) and 59.5% in the non-NLUTD group (N1⁄4197). Progression to stage 2 SNM was similar in both groups, 90% in NLUTD versus 87% in non-NLUTD. Revision rates were higher in the NLUTD cohort compared to non-NLTUD, 46% versus 35%, but this trend did not reach statistical significance (p1⁄40.09). There was a statistically significant higher explant rate in the NLUTD group, 33% vs 20% (p1⁄40.0194) and the most common reason for explant in both groups was loss of efficacy. Progression to stage 2, revision rates, and explant rates for each type of neurologic diagnosis did not have any statistically significant difference. CONCLUSIONS: The primary indication for SNM in both NLUTD and non-NLUTD was urgency incontinence. The specific neurologic diagnosis is not predictive of SNM success, revision, or explants rates. However, patients with NLUTD appear more likely to need the device explanted when compared to patients with nonNLUTD.

INTRODUCTION AND OBJECTIVES: Sacral neuromodulation is a highly effective therapy; however, up to 30% of patients who undergo sacral nerve stimulator (SNS) implantation will require lead revision within 5 years. Lead breakage can occur during revision, but the rate of breakage and the risk factors associated with it are not well described in the literature. The aim of this study is to describe the rate of lead breakage in our institution and identify potential risk factors for breakage. METHODS: A retrospective review of all SNS lead revisions or explantations performed in the urology department at a tertiary care center between 2010 and 2015 was performed. The clinical, demographic characteristics and lead breakage rate were analyzed. Descriptive statistics are presented as percentages, mean SD or median (interquartile range). T-test, Mann-Whitney U, Chi-Square or Fisher exact tests were used as appropriate. A logistic regression analysis was performed for incomplete lead removal as the dependent variable that included variables with p values < 0.1 in the univariate analysis as well as other clinically relevant variables. p

Most animal models of stress urinary incontinence simulate maternal injuries of childbirth since delivery is a major risk factor but they do not reproduce the nerve stretch known to occur during human childbirth. We hypothesized that pudendal nerve stretch produces reversible dysfunction of the external urethral sphincter.Female virgin Sprague-Dawley® rats were anesthetized with urethane. Bilateral pudendal nerve stretch or sham injury was performed for 5 minutes. External urethral sphincter electromyography and leak point pressure were recorded immediately before and after, and 10, 30, 60 and 120 minutes after pudendal nerve stretch. Post-pudendal nerve stretch results were compared to prestretch values and to values in sham injured animals. The pudendal nerves underwent qualitative histological assessment. The nucleus of Onuf was evaluated by immunohistochemistry and polymerase chain reaction for β-APP and c-Fos expression as markers of neuronal activity and injury.A total of 14 rats underwent bilateral pudendal nerve stretch (9) or sham injury (5). Each nerve was stretched a mean ± SEM of 74% ± 18% on the left side and 63% ± 13% on the right side. Electromyography amplitude decreased significantly immediately after stretch compared to before stretch and after sham injury (p = 0.003) but it recovered by 30 minutes after stretch. There was no significant change in leak point pressure at any time. Two hours after injury histology showed occasional neuronal degeneration. β-APP and c-Fos expression was similar in the 2 groups.Acute pudendal nerve stretch produces reversible electrophysiological dysfunction but without leak point pressure impairment. Pudendal nerve stretch shows promise in modeling injury. It should be tested as part of a multi-injury, chronic, physiological model of human childbirth injury.

Objective measures show the AdVance() sling provides some benefit in post-prostatectomy incontinence. To our knowledge no validated, patient determined outcomes have been used to assess this procedure. We described the patient perceived effectiveness and postoperative complications.A retrospective chart review was followed by a telephone survey consisting of the Patient Global Impression of Improvement, Patient Global Impression of Severity, and questions about recommending the surgery, daily pad use and complications. Successful outcomes were Patient Global Impression of Improvement responses of very much better or much better without further incontinence treatment. Objective success is defined as pad-free or a reduction to 2 or less pads daily.A total of 35 patients received the sling a median of 25 months after prostatectomy. Telephone surveys were administered a mean of 35 weeks after the sling procedure and 33 patients were contacted. Of the cases 18 (51.4%) and 21 (60%) were patient determined and objective successes, respectively. Of the patients with subjective treatment failure 3 would recommend the surgery to a friend and 12 were undecided or would not. Furthermore, no patients with subjective treatment failure were pad-free and 10 (58.8%) had pads that were mostly wet on changing. For the entire population a reduction in median daily pad use from 2.5 to 1 was observed as well as a strong association (p0.01) between Patient Global Impression of Improvement and Patient Global Impression of Severity responses. Three individuals pursued further treatment with bulking agents and 3 had retention that resolved.The AdVance sling is safe, and demonstrates similar subjective and objective outcomes. The procedure can benefit some individuals with post-prostatectomy incontinence and, therefore, may be another treatment option for this condition.

INTRODUCTION AND OBJECTIVES: The purpose of this study was to investigate parental perception of evaluation for pediatric urinary tract infection (UTI) to better understand the factors that impede appropriate urine testing prior to treatment of suspected UTI in children. METHODS: We conducted an electronic, cross-sectional survey via social media targeting parents of children with a history of UTI. Participants were queried regarding parental and child demographics, urine specimen collection method, factors influencing urine collection method, and perception of the experience. We used multivariable logistic regression to assess for factors associated with urine testing and distress with catheterization. RESULTS: Of 2,726 parental respondents, >80% were female and White. The majority of parents reported having a female child (74%); 23% of male children were uncircumcised. Controlling for income and race, parents who had a college education were less likely to not be offered catheterization (OR 0.1, 95%CI 0.1-0.2, compared with high school education). Other factors associated with decreased odds for not being offered catheterization were circumcision (OR 0.5, 95% CI 0.3-0.8) and having a history of few ( 1) UTIs (OR 0.6, 95%CI 0.4-0.8). Overall, 55% of parents reported extreme distress with catheterization. Among parents whose children had been catheterized, extreme distress was less likely associated with catheterization if there was a family history of UTI (OR 0.3, 95%CI 0.2-0.4), the parent was White (OR 0.6, 95%CI 0.4-0.9), and if the child was circumcised (OR 0.7, 95%CI 0.40.98). Among parents whose children had not been exposed to catheterization, parents with a college degree (OR 3.2, 95%CI 2.2-4.5, compared with high school education) and children 1-2 years (OR 1.7, 95%CI 1.2-2.5) and 2-5 years (OR 1.4, 95%CI 1.0-2.0) compared with children

INTRODUCTION AND OBJECTIVES: Sacral nerve stimulation (SNS) is FDA-approved for refractory lower urinary tract and bowel dysfunction. Improved surgical technique and stimulator programming have reduced complications and extended device life. Troubleshooting methods and case series of complications have been documented, but shed little insight into physical lead failures. This study described patterns and rates of physical lead failures with abnormal impedances in a multi-surgeon, single-center experience to formulate potential recommendations for programming, implantation, and improvements in lead manufacturing. METHODS: All cases between September 2007 and 2011 with abnormal lead impedances were identified. A manual review of the electronic medical record was conducted to collect patient demographics, comorbidities, procedural details, program settings, and device interrogation results. RESULTS: A total of 24 hardware-related lead failures were identified by abnormal impedance readings, of which 92% (22/24) were open-circuit (impedance 4000 Ohms) and 8% (2/24) were shortcircuit (impedance 400 Ohms) failures. Coincidentally, all patients had a primary indication of refractory urgency-frequency and underwent a staged, unilateral implantation. Median age at implant was 48[IQR: 42-64] years and BMI was 28.7[24.1-33.5] kg/m2. Failure was noted at 84[26-152] weeks after implant, with 1 patient having a second failure 74 weeks after re-implantation. Amplitude after permanent implantation was 1.7[0.9-2.2] V and 2[1.1-4.1] V at the time of failure. A single electrode accounted for 45.8% of failures, while 54.2% had multi-electrode failures. Electrode 0 (most distal) and 3 (most proximal) each accounted for 33% of failures, while electrodes 1 and 2 accounted for 17.8% and 15.6%, respectively. CONCLUSIONS: Electrode 0 (most distal) and 3 (most proximal) appear to have the highest risk of open-circuit and short-circuit failure in this retrospective series. Moving forward, optimization of the other electrode (i.e. 1 and 2) responses during implantation and reprogramming around electrodes 0 and 3, if damaged, may help minimize lead-related therapeutic failures necessitating surgical revision.