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Introduction The commonest cause of stress urinary incontinence in men is radical prostatectomy. We aimed to determine the efficacy, complication rate and need for salvage surgery in the medium-long term for male sling insertion. Method Retrospective review of all patients undergoing male sling insertion at one centre between 2009-2018. Data was collected on complications, patient satisfaction and need for further surgery. Preoperative severity was categorized as mild, moderate, or severe. We assessed ICIQ score, 24h-pad usage, patient satisfaction and identified risk factors for treatment success/failure. Results 91 men had slings inserted (median age- 67.3). Three months success rates in mild, moderate and severe SUI groups were 96%, 86% and 80% respectively which dropped to 65%, 62% and 47% in the medium term. The rate of AUS implantation was 6%, 15% and 33% respectively. Complications included pain, infection, retention and OAB. Patient satisfaction at 5-years was 57%. Only factor predicting success or failure was pre-operative ICIQ-UI(SF) score. Conclusions Male sling success rates deteriorate over time. 15% will have an AUS. The risk of complications is low and transient. A pre-operative ICIQ-UI(SF) score of > 18 is a predictor of failure. Sling insertion remains a reasonable treatment option for male patients suffering with SUI.

There is minimal data published on the longevity of the transobturator retrobulbar male sling (AdVance™). We aimed to determine the efficacy, the complication rate and need for salvage SUI surgery in the medium to long term for male sling insertion.We performed a retrospective review of all patients undergoing male sling insertion at a single centre between 2009 and 2018. Data on patient demographics, pre and post-operative International Consultation on Continence Questionnaire - Urinary Incontinence (Short Form) (ICIQ-UI(SF)) scores and 24 h pad usage were collected. Success was calculated as a combination of the cured rate (0-1 security pad use) and the improved rate (50% reduction in pad usage). Data was also collected on complications, patient satisfaction as well as need for further SUI surgery.A total of 91 patients underwent male sling insertion in the period specified; median follow up was 69 months. Success rates at 3 months in mild SUI, moderate SUI and severe SUI groups were 96, 86 and 80%, respectively. In the medium to long term, this drops to 65, 62 and 47%, respectively. The overall rate of artificial urinary sphincter (AUS) implantation was 15%. Common complications included groin pain (3%), infection (3%), urinary retention (10%) and de novo overactive bladder (OAB) (11%). The only factor predicting success or failure was pre-operative ICIQ-UI(SF) score.AdVance™ male sling success rates deteriorate from 89% at 3 months to 61% at 5 years. The risk of complications is low and, for the most part, transient. Sling insertion remains a reasonable treatment option for male patients suffering with stress urinary incontinence (SUI).

A 69-year-old woman presented to her local head and neck clinic with a 6-month history of right-sided sore throat and intermittent dysphagia, with a normal voice. On examination, a longitudinal, pulsatile lesion in the right posterolateral pharyngeal wall commenced at the junction of the oropharynx

BackgroundPatients with temporal lobe epilepsy and hippocampal sclerosis (TLE-HS) have increased hippocampal 5-hydroxytryptamine (5HT)-3 receptors versus controls. 5HT-3 antagonists may therefore be efficacious in TLE-HS. However, rare case reports have described seizures in patients treated with 5HT-3 antagonists. We retrospectively investigated seizure episodes in patients with a seizure predisposition treated with ondansetron.MethodsInpatients admitted to the West Midlands regional neurosciences centre from 08/09/2015–31/01/2017 with an epilepsy diagnosis or prescribed ≥1 antiepileptic drug and treated with ondansetron for ≥4 days were included. Patient notes were reviewed to identify seizure episodes during ondansetron treatment.Results50 patients were identified; 14 had epilepsy, 36 had other diagnoses predisposing to seizures. During ondansetron treatment, 21.4% epilepsy patients and 11.1% with other diagnoses experienced ≥1 seizure; all seizures were deemed unlikely to be ondansetron related. Patients with seizures had similar treatment duration versus patients without (median 8 vs 6 days) and a lower cumulative dose (median 56 vs 72 mg).ConclusionThree patients with epilepsy and four with other diagnoses experienced seizures during ondansetron treatment; none of the seizures were thought to be ondansetron related. A randomised controlled study is needed to assess the efficacy and safety of ondansetron in patients with epilepsy.