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Background: Prospective data collection for perioperative outcomes might increase awareness of surgical results obtained for patients with prostate cancer (PCa) undergoing robot-assisted radical prostatectomy (RARP). This would prompt the implementation of measures aimed at reducing the risk of adverse outcomes. Objective: To assess the efficacy of an audit and feedback process aimed at identifying the most common complications after RARP and at implementing measures to improve outcomes. Design, setting, and participants: Overall, 415 patients treated with RARP by a high-volume surgeon were included. Perioperative outcomes for 187 patients treated between September 2016 and December 2017 were prospectively collected at 30 d according to the European Association of Urology guideline recommendations (group 1). An audit and feedback process was implemented in January 2018 whereby the most common complication (anastomotic leak) was identified and measures aimed at improving outcomes (changes in the anastomotic technique) were implemented. The outcomes for group 1 were then compared to 228 patients treated after implementation of the modified surgical technique (group 2). Surgical procedure: A novel technique for posterior reconstruction and urethrovesical anastomosis was introduced. Measurements: Perioperative outcomes included blood loss, operative time, length of stay, and 30-d postoperative complications. Logistic regression models tested the effect of the novel surgical technique on anastomotic leaks. Results and limitations: Overall, 97 patients (23%) experienced postoperative complications at 30 d. The rate of anastomotic leaks was significantly lower in group 2 compared to group 1 (3.1% vs 9.6%; p < 0.01). Similarly, overall and Clavien-Dindo grade ≥2 complication rates were lower in group 2 versus group 1 (17% vs 31%, and 6% vs 20%; both p ≤ 0.001). In multivariable analyses, treatment after implementation of changes in the anastomotic technique independently predicted a lower risk of complications (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.38–0.89) and of anastomotic leaks (OR 0.43, 95% CI 0.17–0.97). The lack of randomization represents the main limitation. Conclusions: Implementation of changes in the urethrovesical anastomosis technique arising from increased awareness of surgical outcomes reduced the risk of anastomotic leaks. These findings highlight the importance of audit and feedback processes using a standardized method for reporting surgical morbidity. Patient summary: Increased awareness of surgical outcomes prompted us to change our technique for connecting the bladder to the urethra during robot-assisted surgery to remove the prostate in patients with prostate cancer. These changes resulted in significant improvements in surgical outcomes.

Background Obese renal transplant recipients (body mass index [BMI] ≥30 kg/m2) are at risk of delayed graft function and postoperative complications, such as infections or delayed wound healing. There is also a tendency to exclude extremely obese patients from transplantation (KTx). Nonetheless, no association between obesity and increased mortality has been reported. The aim of this study is to evaluate the effect of BMI on the most common surgical and infectious complications after KTx. Materials and methods An observational study in 872 patients transplanted from 2010-2017 was conducted. Median BMI was 24.6 (13.9-34.3), and 8.3% of the group was obese. Patient records were searched for early postoperative complications: lymphocele or hematoma (>33 mL), urinary leakage, or urinary tract infection (UTI). Mann-Whitney U and χ2 or Fisher exact tests were used. P Results Renal primary nonfunction was observed in 1.4% (12/872) of patients. Surgical or infectious complications occurred in 52.7% (453/860) of patients. No correlation between BMI and complication rate was noted. Complications were observed in 56.9% (41/72) of obese vs 52.3% (412/788) of nonobese patients (P = .448), including lymphocele in 15.3% vs 16.4% (P = .810), hematoma in 22.2% vs 19.2% (P = .530), urinary leakage in 1.4% vs 4.6% (P = .203), and UTI in 31.9% vs 32.9% (P = .873), respectively. Conclusions Recipient’s BMI has no significant association with the most common surgical complications after KTx. There is no need to delay KTx in moderately obese patients.

Background The adoption of robotic technology in the treatment of prostate cancer (PCa) could lead to improvement in outcomes. Objective To evaluate feasibility, to compare functional outcomes, and to assess the economic benefits of removing catheter on the postoperative day (POD) 3 versus POD 5 after robot-assisted radical prostatectomy (RARP). Design, setting, and participants From September 2016 to May 2017, patients selected to undergo RARP for clinically localized PCa at a high-volume center were prospectively randomized into group 1 (POD 3; n = 72) versus group 2 (POD 5, n = 74). Intervention All patients underwent RARP with anatomical posterior and anterior reconstruction. Outcome measurements and statistical analysis The primary endpoint was to compare acute urinary retention (AUR) and urinary leakage rate in the two groups. The secondary endpoints were early and mid-term postoperative functional outcomes assessed through questionnaires (ICIQ-MLUTS, IPSS), early continence rate, and postoperative pain/discomfort (visual analog scale score). The economic impact of early catheter removal was also assessed. Results and limitations AUR was reported in two (1.4%) cases, one for each study group (p = 0.9). One case of vesicourethral leakage was reported (0.7%) in group 1. Urethral discomfort and pain at discharge was significantly higher in group 2 (p = 0.03). In our clinical practice, POD 3 catheter removal approach would determine a saving of approximately €80 000 and 405 d of hospitalization yearly. The main limitation is the small sample size. Conclusions Early catheter removal after RARP does not lead to an increase in perioperative complications. No negative effect on early and mid-term functional outcomes was observed. A significant impact on saving economic resources was reported. Patient summary We demonstrated that early catheter removal has no negative effect on spontaneous voiding, complications, or urinary continence recovery after robot-assisted radical prostatectomy.

Purpose To retrospectively evaluate the safety and efficacy of the percutaneous obliteration of urinary leakage after partial nephrectomy (PN) using coils and N-butyl-cyanoacrylate (NBCA). Materials and Methods Data of 10 consecutive patients who underwent percutaneous obliteration of urinary leakage after PN using coil and NBCA between February 2016 and May 2018 were retrospectively reviewed. A urinary fistulography was performed via the drainage catheter. If the fistulous tract was clearly visualized, super-selective embolization of the fistulous tract with coils and urinoma cavity sealing with NBCA was performed. In cases where the fistulous tract could not be clearly visualized, only urinoma cavity sealing was performed. Outcomes and complications were assessed by reviewing medical records and computed tomography (CT). Results In 7 (70%) patients who showed obvious urinary fistulous tract, coil embolization of the urinary fistulous tract, followed by sealing of the urinoma cavity with NBCA, was performed. Obliteration of the urinoma without coil embolization of the fistula tract was performed in 3 patients (30%) in whom a distinct fistulous tract could not be visualized. The median number of treatment sessions required to achieve clinical success was 1 (range, 1–5). Four patients underwent multiple repeated procedure with successful results. All patients showed gradual decrease in size or complete disappearance of urinoma on follow-up CT without evidence of urinary leakage during the follow-up period (mean, 44.6 weeks; range, 11–117 weeks). There were no procedure-related complications. Conclusions Percutaneous obliteration of urinary leakage after PN using coils and NBCA is safe and effective.

Background and objective Urinary incontinence is the adverse effect with more impact on patients’ quality of life after undergoing radical prostatectomy. The objective of this study is to review the present evidence that describes the variations on surgical techniques which aim to preserve urinary continence after radical prostatectomy. Evidence acquisition We searched the literature on PubMed, Cochrane, and ScienceDirect according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement, using the PICO review protocol. The search terms were urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot-assisted laparoscopic prostatectomy, robotic prostatectomy. We identified 1603 registers, and 27 articles were reviewed for meeting the inclusion criteria. Six of them are randomized clinical trials and 4 of them, meta-analysis. Evidence synthesis The surgical techniques more frequently used to achieve early urinary continence are bladder neck and neurovascular bundles preservation, as well as the reconstruction of the rhabdosphincter. The latter has been presented in three randomized clinical trials. Even though some approaches have obtained improved functional outcomes, the lack of consensus on the definition of urinary incontinence and its measurement methods have not advocated for the creation of technical recommendations based on scientific evidence. Conclusions The reconstruction of the rhabdosphincter is the only technique that has shown improved functional results through randomized trials. The current evidence is limited and heterogenous, and more studies with consistent criteria are needed in order to establish a standard surgical technique.

Highlights • Inguinal bladder hernia is an unusual condition that requires a high index of clinical suspicion for diagnosis. • This case demonstrates the importance of preoperative diagnosis in avoiding surgical complications including bladder injury., Introduction Cases of inguinal bladder hernia are rare, with bladder involvement seen in 1–4% of inguinal hernias. The majority of cases are diagnosed intraoperatively, with only 7% of bladder hernias identified prior to surgery. Diagnosis may be challenging as patients are often asymptomatic or have nonspecific symptoms. Surgical repair is currently the standard treatment, and careful surgical planning is necessary to avoid complications including bladder injury. Presentation of case A 58-year-old man presented to our Emergency Department with 2-day history of progressively worsening left lower quadrant pain, groin bulge, and dysuria. Physical exam revealed an irreducible left inguinal hernia associated with urinary urgency on attempted reduction. Plain CT was ordered and demonstrated inguinal hernia with bladder protrusion into the left scrotum. The patient underwent open surgical reduction and hernia repair and made a quick postoperative recovery without complications. Discussion Inguinal bladder hernia most often presents in older, obese males and clinicians should have a high index of suspicion when assessing patients with inguinal hernia. Preoperative diagnosis based on history, physical, and radiologic imaging allow for careful surgical planning and prevention of severe complications including bladder injury and leakage. Conclusion We present a case report of inguinal bladder hernia in a middle-aged man that presented as left lower quadrant pain, groin pain, and dysuria. Diagnosis was confirmed preoperatively with radiographic imaging. The hernia was surgically reduced and the defect repaired without complications.

Urinary leakage in patients with kidney transplantation is a relatively common surgical complication that requires early diagnosis and intervention. The isotopic renogram is a non-invasive and effective method to evaluate the perfusion and function of kidney transplantation, and allows us to diagnose urological complications such as urinary leakage. In these cases, it is useful to complete the study with planar images and delayed SPECT/CT to specify the diagnosis and locate the leak. We expose two cases diagnosed with urinary leak after performing a renogram with early and delayed planar images and delayed SPECT/CT a week after transplantation. In both cases, a percutaneous nephrostomy catheter was placed, as well as a double J catheter, resolving the surgical complication.

OBJECTIVE To evaluate the effectiveness and tolerance of the AdVance Male Sling System for the treatment of male stress urinary incontinence in patients after prostatic surgery. METHODS An international, observational, prospective, multicenter study was conducted on male patients with urinary incontinence after prostatic surgery. Patients underwent a 24-hour pad test with a threshold at 250 g. All patients were operated with the same AdVance implant procedure. They were seen 6 weeks later, and examined again at 3, 6, 12, and 24 months. Incontinence was measured using 1-hour and 24-hour pad tests, the number of protective pads used, ICIQ-SF and IQoL questionnaires. Success was defined as no urinary leakage and no pad use. Patient improvement was defined as a reduction of more than 50% in leakage and no more than one pad used per day. Any perioperative and late complications were documented. RESULTS From January 2007 to November 2012, 113 patients were successfully operated on. At 24 months after surgery, the mean weight of the 1-hour pad test had decreased from 48.7 g to 6.6 g (P < 0.001) while that of the 24-hour pad test decreased to 45.0 g from 113.9 g (P < 0.001). Success and improvement occurred in 22.6% and 58.0% of the patients, respectively. Seventy-five patients (80.6%) used none or one protective pad daily, and the IQoL and ICIQ-SF scores were both significantly improved. Fourteen patients (12.4%) required a second intervention. Three patients (2.7%) had a Clavien IIIb complication. CONCLUSION The AdVance Male Sling System is an effective treatment for mild to moderate male stress urinary incontinence. Complications from its use are rare and 24-month results are satisfactory.

Objective: A midurethral sling is the gold standard surgical treatment for stress urinary incontinence (SUI), however a lower success rate has been reported in the treatment of SUI after pelvic organ prolapse surgery. The aim of this study was to compare the success rates, quality of life, and complications with treatment using tension-free vaginal tape (TVT) and transobturator tape (TOT) in these patients. Materials and Methods: We enrolled patients who had symptomatic SUI after anterior vaginal mesh repair who underwent either TVT or TOT surgery. Successfully cure was defined as the absence of urinary leakage in a stress test during filling cystometry, and a negative cough test. Quality of life was evaluated using the short form of the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). Results: We included 50 patients in the TOT group and 37 patients in the TVT group, with a median follow-up of 18.5 months. The TVT group had a significantly higher success rate than the TOT group (88% vs. 60%, p = 0.036), while there was no statistically significant difference in de novo detrusor overactivity (30% vs. 9%, p = 0.090). There was also no significant difference in postoperative quality of life (UDI-6, 5.9 ± 7.9 vs. 5.0 ± 5.9, p = 0.639; IIQ-7, 5.2 ± 12.5 vs. 4.3 ± 9.7, p = 0.766). The TVT group had a longer operative time (p

Cloacal malformations represent a uniquely complex challenge for surgeons. The surgical approach to date has been based on the common channel (CC) length with two patient groups considered: less than or greater than 3cm, which we believe is an oversimplification. We reviewed 19 patients, referred after surgery done elsewhere. Eight had postoperative urinary complications, 3 had constant urinary leakage and had been left after surgery with a urethra1cm, .5 with an original 3 to 5cm common channel, who had undergone total urogenital mobilization (TUM), experienced peri-operative urethral loss needing a vesicostomy, and later, a Mitrofanoff. These patients together with a review of the cloacal and urological literature led us to design a new algorithm where urethral length is a key determinant for care.We prospectively collected data on 31 consecutive cloaca patients referred to our team (2014 to 2016) and managed according to this new protocol. The CC length, urethral length, surgical technique employed, and initial outcomes were recorded.Of 31 primary cases, CC length was 1 to 3cm in 20, 3 to 5cm in 9, and greater than 5cm in 2. In the 1 to 3cm and the 3 to 5cm groups, a urethra less than 1.5cm led us to perform an urogenital separation. We only performed a TUM if the urethra was greater than 1.5cm. Using this protocol, we performed a urogenital separation in 1 of 20 in the 1 to 3cm CC group, 6 of 9 in the 3 to 5cm CC group, and 2 of 2 in the greater than 5cm CC group. Seven patients underwent separation, who with the previous approach, would have had a TUM. Thus far, no urinary leakage or urethral loss has occurred in any patient, but follow-up is less than 3years.Urethral length appears to be a vitally important component in cloacal reconstruction. A short urethra left after repair can lead to urinary leakage. A TUM done under the wrong circumstances can lead to urethral loss. We describe a new technical approach to cloacal repair which considers urethral length but recognize that long term urological outcomes will need to be carefully documented.Clinical cohort study with no comparative group.Level 4.

Percutaneous nephrolithotomy (PCNL) is a well-established treatment for complex or multiple renal stones. It is a safe procedure but associated with specific complications. Most are low-grade complications, such as postoperative fever or urinary leakage. Major complications, such as renal bleeding necessitating blood transfusion and pleura injury, are rare, while injuries to adjacent organs, such as the colon or liver, are very rare.1,2 In this report, we are to report a first case of duodenal perforation as a complication of supine PCNL procedure.

Summary Introduction Robotic technology has gained popularity allowing performance of several complex and difficult reconstructive procedures. This video demonstrates the advantages of the robotic approach for a “keel” bladder neck construction in an obese patient. Material and methods A 13 year-old-girl (BMI = 28) already treated elsewhere for a uro-genital sinus (Total Urogenital Mobilization) has been evaluated for disturbing persistent total urinary incontinence. Cisto-colposcopy revealed an extremely short and tortuous urethra. Bladder neck was wide open and incompetent. Video-Urodynamic evaluation showed a bladder with a capacity of 280 mL with low voiding pressures (14–16 cmH20) and continuous urinary leakage. MAG3 scan confirmed normal renal function. Thus, the girl underwent a laparoscopic robotic-assisted “keel” bladder neck construction. Results The patient was discharged on 5th post-operative day without complications. After 4 years she is voiding spontaneously (300 cc) without post-void residuals. She has presented a persistent mild stress incontinence successfully treated with subsequent endoscopic bulking agent injection. Conclusions Robotic access to the bladder neck region is an excellent option with ideal anatomical exposure compared to conventional open surgery, especially in obese patients. The “keel” procedure allows to reconfigure and tubularize a wide and incompetent bladder neck creating a continent funnel without the absolute need of concomitant ureteric reimplantation.

Objective To assess the safety and efficacy of a single intravesical injection of onabotulinumtoxinA (OnaBTA) for treating urge urinary incontinence (UUI) in women. Method We performed a prospective case-series study of consecutive patients with refractory UUI treated with an intravesical injection of OnaBTA. The patients were administered 100 units of OnaBTA injected into the bladder wall following 4 weeks of flushing with anticholinergic agents or beta-3 agonists. The urodynamic and clinical endpoints were evaluated before and 6 months after the injection of OnaBTA. The primary study endpoint was the number of episodes of urinary leakage. Results A total of 204 of the 210 selected patients conducted a valid visit 6 months after the therapeutic application. At 6 months of treatment with OnaBTA, 110 (53.9%) patients remained continent and were considered a success. However, 57 (27.9%) patients experienced one episode of urinary leakage per day, and 37 (18.2%) had 2 or more. In terms of the urodynamic parameters, we observed the following changes: increase in maximum bladder capacity ( p p Conclusions This study supports the use of OnabotulinumtoxinA in patients with urge urinary incontinence that does not respond to medical treatment.

Objective To investigate if leakage circumstances collected using the Urinary Leakage Circumstances Questionnaire (ULCQ) are correlated with physician diagnosis and urodynamic results and resolve after surgery. Materials and Methods The ULCQ was developed to investigate leakage circumstances encountered by women with incontinence. Women completed both the ULCQ and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form before clinical and urodynamic examination. Those who underwent a suburethral sling procedure completed both questionnaires postoperatively. We performed a principal component analysis and evaluated the questionnaire's external properties including construct validity and responsiveness. Results One hundred and eighty-six women were included in the validation phase, and 168 underwent suburethral sling procedure. Mean postoperative follow-up was 51 months. Principal component analysis identified 4 dimensions from the 23 leakage circumstances listed in the ULCQ: effort, stimulation, postural, and intercourse; the internal consistency of each dimension was excellent (Cronbach alpha: 0.87, 0.86, 0.82, and 0.79, respectively). Effort (+0.39), stimulation (+0.24), and postural (+0.47) dimensions were correlated with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score; the effort dimension was correlated with greater stress incontinence severity assessed by the physician; the stimulation dimension with urgency and urge incontinence severity assessed by the physician, and with lower volumes during cystometry; and the postural dimension with higher age and lower urethral closure pressure. Each dimension recorded a significant improvement after surgery, with the largest effect size for effort dimension (2.29 [confidence interval 95%: 1.96-2.62]). Conclusion The ULCQ is a useful tool for investigating female urinary incontinence and detecting changes after surgery.

We aimed to evaluate the impact of preoperative ureteral catheter insertion on urinary leakage after partial nephrectomy (PN) in patients with renal cell carcinoma.We reviewed the data of 893 patients with renal cell carcinoma who underwent PN and divided them according to ureteral catheter placement. The impact of ureteral catheter placement on postoperative urinary leakage was evaluated by using multivariate analysis.Ureteral catheters were inserted in 397 (44.5%) patients. Patients with ureteral catheter insertion had larger tumors (2.4 vs. 2.6 cm; P = .031); however, the RENAL nephrometry scores were comparable (P = .131). Robotic PN was more common in patients with ureteral catheters (11.1 vs. 53.9%; P .001). Urinary leakage did not differ according to ureteral catheter placement (3.4 vs. 3.5%; P = .936). Although tumor size (P = .002), ureteral catheter insertion (P .001), and operative methods (P .001) were significantly different according to surgeons, the rate of urinary leakage was similar (surgeon A: 4.0%, surgeon B: 4.6%, surgeon C: 1.5%, others: 2.9%; P = .294). In multivariate analysis of preoperative variables, age and RENAL nephrometry scores were associated with urinary leakage. In multivariate analysis of preoperative and intraoperative variables, the operative method, collecting system status, and intraoperative transfusion, but not ureteral catheter insertion, were related to urinary leakage.Ureteral catheter insertion does not appear to reduce the risk of urinary leakage after PN, and visibility during PN with meticulous bleeding control is important in preventing urinary leakage after PN.

Objective Our aim was to analyze our five-year experience in the diagnosis and treatment of occult urinary incontinence in women with pelvic organ prolapse. Study design The medical records of all patients who were admitted to the Division of Urogynecology of Istanbul Faculty of Medicine between January 2008 and December 2013; in total, 1600 patients were retrospectively evaluated. The study population included 287 patients who had prolapse beyond the hymen and underwent two consecutive urodynamic studies with and without prolapse reduction. Demographic data, medical records, physical examination, full urogynecologic examination, urodynamic investigations, treatment modality, the results of the treatment and King’s Health Questionnaire scores before treatment and at one-year follow-up were recorded. Results Eighty-five of 287 patients (29.6%) were continent, 20 (23.5%) of whom had occult stress urinary incontinence during cystometry. Among these 20 patients, 17 underwent anti-incontinence surgery; 12 were satisfied with their surgery and had no postoperative urinary leakage. Twenty (23.5%) patients had overactive bladder symptoms during urodynamic studies after prolapse reduction. King’s Health Questionnaire scores before and after the operation, showed that health status of 12 patients was better, 1 patient was unsatisfied after the treatment, 2 patients’ scores did not change and 2 patients were lost to follow up. Conclusions In conclusion, the prevalence of occult urinary incontinence was 23.5% when using urodynamics with prolapse reduction. 12 of the 17 patients diagnosed with occult urinary incontinence were satisfied with surgery and had no postoperative urinary leakage.

Summary Introduction Neurogenic lower urinary tract dysfunction (LUTD) has been reported in 20–50% of children with anorectal malformations (ARM). As neurogenic LUTD represents an inherent risk of renal deterioration and urinary tract infections, an early diagnosis is important. The gold standard for evaluating neurogenic LUTD involves invasive urodynamic testing but a useful addition should be an easy-to-perform, non-invasive method of screening. Objective In this study, we evaluate non-invasive 4 h voiding observations as a screening method for neurogenic LUTD in ARM children. Study design Thirty-four patients with ARM, excluding those with perineal fistulas, were evaluated using both 4 h voiding observation and urodynamic testing before and after posterior sagittal anorectoplasty (PSARP) at median ages of 0.3 and 1.1 years. In the urodynamic assessment, the gold standard for neurogenic LUTD, nine children received the diagnosis, eight innate and one post-surgery. Results Five boys with a high urethral fistula and anomalies of the spinal cord had urodynamically diagnosed neurogenic LUTD, a dysfunction also identified in the 4 h voiding observations. The pattern was characterised both by an increase in the number of voiding and the number of interrupted voiding, urinary leakage and elevated residual urine (Figure). In three girls with a vestibular fistula and tethered cord, an urodynamic investigation identified suspected mild neurogenic LUTD. In the voiding observations, an abnormal voiding pattern was not as obvious in the girls as in the five males. One girl with cloaca showed signs of postsurgical denervation damage, which was easily identified in the 4 h voiding observations (high capacity and elevated residual urine). Discussion In the present study, gender differences in the severity of dysfunction reflected in the free voiding pattern in infants with ARM and neurogenic LUTD is probably the result of the different underlying causes of neurogenic LUTD in boys and girls. Boys with the condition have a congenital malformation of the caudal part of the spinal cord and girls a tethering of the cord. The most obvious limitation of the study was the low number of patients. Despite this, we consider the results worth reporting, since we found that results in the free voiding observations effectively confirmed what was established in the urodynamic investigations. Conclusion In pre-PSARP patients, 4 h voiding observations can be used to screen for severe neurogenic LUTD requiring attention and treatment. When post-surgical denervation is suspected, the voiding observation is also a good method for indicating the diagnosis. Download : Download high-res image (240KB) Download : Download full-size image Summary Figure . Four-hour voiding observation studies in A: a three-month-old boy with anorectal malformation and neurogenic lower urinary tract dysfunction diagnosed by urodynamic tests, and B: a healthy infant of the same age.

Objective Although placement of a retropubic mid-urethral slings (MUS) is one of the gold standard surgical treatments for stress urinary incontinence, new devices are poorly evaluated before marketing. We compared TVT-EXACT™ (TVT-E), a new device expected to reduce bladder injuries, with the historically described bottom-to-top TVT™ (TVT). Study design This retrospective study compared TVT-E ( n = 49) and TVT ( n = 49). The main outcomes were the prevalence of complications (bladder injuries, immediate postoperative pain, perioperative complications, etc.) and the short-term success rate (no reported urinary leakage and negative cough test) of both MUSs. Results Minimum follow-up was 12 months. The characteristics of the two groups were comparable. The prevalence of bladder injury for TVT-E and TVT was 8% and 6%, respectively ( p = 1). The intensity of immediate postoperative pain (VAS/100) was lower following TVT-E than after TVT (8.0 vs. 15.9, p = 0.01). The first post-void residual was increased in the TVT-E group (153.9 vs. 78.9 mL, p = 0.045), and there were more postoperative bladder outlet obstruction (BOO) symptoms in the TVT-E group (24% vs. 6%, p = 0.02). However, there was no difference when considering only de novo BOO (14% vs. 4%, p = 0.16). The prevalence of peri- and post-operative complications was equal in the two groups. The success rate was similar at 12 months of follow-up (80 vs. 82%, p = 1). Conclusion The prevalence of bladder injury was unchanged with TVT-EXACT™ compared with TVT™, but post-operative pain was decreased. The success rate of both retropubic MUSs was similar at 12 months of follow-up.

A rare case of nephrococutaneous fistula due to spontaneous expulsion of renal calculi is described. A 45-year-old man presented with urinary leakage from an ulcer over the left lumbar region for the last 3 months after a history of spontaneous expulsion of stones from this area. Ultrasonography abdomen revealed a small contracted kidney with multiple calculi in the kidney and renal pelvis, sinus tract from the lower pole of the left kidney with a ruptured calyceal calculus in the sinus tract. CT urography revealed a non excreting left kidney with multiple renal calculi, with hyperdense collection in the renal parenchyma extending to the subcutaneous tissue and left lung suggesting a xenthogranulomatous pyelonephritis (XGP). We performed a left-sided simple nephrectomy with excision of the fistulous tract. Histopathological examination revealed XGP. There have been a few case reports of XGP forming nephrocutaneous fistula in the back.

Background Urine leak following pelvic exenteration for locally advanced pelvic malignancy is a major complication leading to increased mortality, morbidity and length of stay. We reviewed our experience and developed a diagnostic and management algorithm for urine leaks in this patient population. Methods Consecutive patients who underwent en bloc cystectomy and conduit formation as part of pelvic exenteration at a single quaternary referral centre from 1995 to 2012 were reviewed. Patients with urine leak were identified. Medical records were reviewed to extract data on diagnosis and management and a suggested clinical algorithm was developed. Results Of 325 exenterations, there were 102 conduits, of which 15 patients (15%) developed a conduit related urine leak. Most (14/15) patients were symptomatic. Diagnosis was made by drain creatinine studies (12/15) and/or imaging (15/15). Management comprised of conservative management, radiologic urinary diversion, early surgical revision and late surgical revision in 3, 11, 2 and 1 patients respectively. Important lessons from our 17 year experience include a high index of suspicion in a patient who is persistently septic despite appropriate treatment, the importance of regular drain creatinine studies, CT (computer tomography) with delayed images (CT intravenous pyelogram) when performing a CT for investigation of sepsis and early aggressive management with radiologic urinary diversion to facilitate early healing. Conclusion Urine leak after pelvic exenteration is a complex problem. Conservative management usually fails and early diagnosis and intervention is the key. It is hoped that our algorithms will facilitate diagnosis and subsequent management of this group of patients.

ObjectiveTo evaluate the effects of surface electrical stimulation (SES) and to compare them with the effects of the intravaginal electrical stimulation (IVES) in women with stress urinary incontinence (SUI).Study designThis randomized controlled study included 48 women aged over 50 years, who complained of SUI evaluated according to two structured questions of King's Health Questionnaire (KHQ) and who had not previously undergone physical therapy for SUI. The calculation of the sample size estimated a sample of 45 volunteers with a significance level of 5% and statistical power of 90%. The women were randomized to: Surface Electrical Stimulation Group (SESG) (n=15), Intravaginal Electrical Stimulation Group (IVESG) (n=15) and Control Group (CG) (n=15). Subjects in the intervention groups were treated with the same parameters of electrical stimulation for 12 sessions. The SESG had four silicone electrodes fixed in the suprapubic and ischial tuberosity regions. The IVES group used an intravaginal electrode. The CG did not receive any treatment during the corresponding time. They were evaluated before and after treatment by a physical therapist who was blind to group allocation. The primary outcomes were urinary leakage, pressure and strength of pelvic floor muscle (PFM) contraction. The secondary outcome was quality of life (QOL) evaluated by KHQ. Forty-five women completed the study and were included in the analysis. Statistical analysis was performed using the Wilcoxon test for intragroup analysis and Kruskal–Wallis and Mann–Whitney tests for intergroup analysis (p

Introduction To describe an original method for managing prolonged urinary leakage after partial nephrectomy. We placed a Malecot catheter in the ureter to improve the urinary drainage and therefore avoid the renal percutaneous treatment of the fistula or potential open surgery. Technical Considerations We performed ureteral stenting using a 16F Malecot catheter in 3 patients who had a prolonged urinary fistula after partial nephrectomy in which the placement of a ureteral stent could not resolve the urine leak. Drainage using 2 ureteral catheters was performed, which proved to be insufficient for the urinary fistula to resolve. We subsequently placed in the dilated ureter a 16F Malecot catheter into the renal pelvis using a cystoscopic approach and a bladder catheter to complete the drainage. In all cases, the urine leak stopped after stenting with the Malecot catheter. At 1 month after the stenting, computed tomography and magnetic resonance imaging showed complete healing of the fistula. No infection or secondary ureteral stricture was reported. Conclusion This technique with a low complication profile can be used as an additional endoscopic step, before more invasive procedures.

Objectives: To evaluate the impact of trans-vaginal fractional CO2 laser treatment on symptoms of stress urinary incontinence (SUI) in women. Study design: Women clinically diagnosed with SUI preferring non-surgical treatment were recruited to the study. Fractional CO2 laser system (MonaLisa T, DEKA) treatments were administered trans-vaginally every 4–6 weeks for a total of three treatments. Response to treatment was assessed at baseline (T1), at 3 months after treatment completion (T2) and at 12–24-month follow-up (T3) using the Australian Pelvic Floor Questionnaire (APFQ). The primary outcome was changes in reported symptoms of SUI. Secondary outcomes assessed included bladder function, urgency, urge urinary incontinence (UUI), pad usage, impact of urinary incontinence on quality of life (QOL) and degree of bothersome bladder. Results: Fifty-eight women were recruited and received the study treatment protocol. Eighty-two percent of participants reported an improvement in symptoms of SUI at completion of treatment (mild to no SUI) (p =

Objective The objective of this study was to evaluate the effects of surface electrical stimulation in elderly women with stress urinary incontinence (SUI) as compared to no treatment. Materials and methods This randomized controlled pilot study included women over the age of 60 years, with at least one episode of stress urinary leakage during the previous month. Fourteen women were allocated according to a computer generated randomization list in two groups: surface electrical stimulation (SES), and control group (CG). The women in the SES group were treated with surface electrical stimulation using four electrodes, during six weeks with two weekly sessions of 20 min each. They were evaluated before and after treatment primary outcome, urinary leakage, and secondary outcomes, King's Health Questionnaire, pressure perineometry, and subjective satisfaction. Results For the urinary leakage, there was a significant decrease in SES group after treatment ( p = .017). Significant differences were observed between the SES group and CG in the evaluation after treatment ( p p = .017). Conclusion The results of this study showed that surface electrical stimulation in elderly women with SUI can be an effective method for the improvement of urinary leakage.

A bulking agent is a material injected into the wall of the urethra to improve urethral coaptation in women suffering from stress incontinence. The concept was initially described in the 1930s when sodium morrhuate and paraffin were used to augment urethral resistance. Sclerosing agents were also used for inducing permanent urethral scaring to improve urinary leakage. Eventually, collagen and autologous fat were found to be efficacious, and only collagen demonstrated proven safety and endured extensive testing, becoming the gold standard for injectable agents. Since then, multiple other products have been developed by the industry, each with its particular success rates and complications.

ObjectiveTo compare the effects of pelvic floor muscle training (PFMT) performed during group treatment sessions (GT) and individual treatment sessions (IT) to a control group (CG) of women with stress urinary incontinence (SUI).HypothesisThe group treatment sessions would have better effects compared to individual treatment sessions.Study designThis randomized controlled pilot study included women aged over 18 years, who complained of urinary leakage on stress and who had not undergone physical therapy for SUI before. Forty-nine women were randomly allocated to the PFMT in group treatment session (GT) (n=17), PFMT in individual treatment session (IT) (n=17) and control group (CG) (n=15). The study was carried out in an outpatient physical therapy department in São Carlos, Brazil. Subjects on intervention groups were treated with the same PFMT protocol for 6 weeks, with two 1-h weekly sessions. The GT group carried out the PFMT in group treatment session and IT group in individual treatment session. The CG did not receive any treatment during the corresponding time. They were evaluated before and after treatment for primary outcome, urinary loss, and secondary outcomes, King's Health Questionnaire, pressure perineometry, pelvic floor muscle strength by digital palpation and subjective satisfaction. Participants, evaluator and the physical therapist were not blinded. Forty-five women completed the study and were included in the analysis. The statistical analysis was performed using Wilcoxon test for intragroup analysis and Kruskal–Wallis and Mann–Whitney test for intergroup analysis (p

Urinary incontinence can have a major effect on quality of life, and may contribute to overall disability in patients with abdominal and pelvic malignancy. It can lead to isolation and depression, and delay rehabilitation and integration within family and society. With prompt assessment and correct management, urinary leakage can be controlled and many of the problems associated with urinary incontinence can be prevented to the patient's satisfaction. In oncological patients, this is best achieved in a multidisciplinary approach. This involves close co-operation between the oncologist, urologist, specialist nurses and individual patient, setting realistic expectations, guided by the patient's views and wishes. This paper reviews the management of urinary incontinence and its surgical treatment in the palliative setting.

Radiofrequency ablation (RFA) is a safe and minimally invasive procedure for the local treatment of solid renal tumors in selected patients, but sometimes complications can occur. Nontarget ureteral thermal injury is a known risk of the procedure. Herein, we report a case of a patient who underwent a simultaneous treatment of surgical sigma resection and percutaneous RFA of the inferior pole renal lesion and who developed a proximal ureteric lesion secondary to thermal injury, with urinary leakage and an abscess formation of ileo psoas muscle. This report describes a successful management of the interventional radiologist team with a rendezvous procedure of these complications after RFA procedure.

novel treatment of incontinence, this possibility strikes me as highly unlikely. Rather, I suspect that the definition of incontinence used in the study itself was problematic. Although pad tests are thought to be objective, patients may change their activity level or make other behavioral alterations to prevent leakage. These changes, in turn, may influence the results of the pad test. One could see patients in the postoperative period adjusting their activities to cope with changes in urinary control. While they might then be considered dry using the pad test, we should ask if they are truly continent, given that they may have been forced to change their daily routines and limit their activities. Centemero et al. [3] used a different primary outcome in their study that may explain why they found an advantage to the addition of preoperative PFMT. They defined continence as no urinary leakage reported in a patientcompleted bladder diary coupled with an in-office negative stress test. In contrast to Geraerts et al. [2], who report 3-mo postoperative continence rates of 73.3% and 70.9% in the experimental and control groups, respectively, Centemero and colleagues [3] report 3-mo postoperative continence rates of 59.3% and 37.3%, respectively. While considerably worse, these rates are more reflective of rates from prior large multicenter studies [1], supporting the validity of the results. This characteristic may be because the definition used by Centemero et al. [3] incorporated an element of patient perception in the outcome assessment that many might consider somewhat subjective but that also might make the end point more relevant to the clinical scenario. Which is the ‘‘better’’ way to define incontinence after

STUDY OBJECTIVE: To estimate the frequency of vaginal voiding as the cause of daytime urinary leakage in girls, and to study the effect of instructions intended to alleviate the problem. SETTING: Girls with vaginal voiding were identified in a group of girls referred because of daytime urinary leakage. They were evaluated by a noninvasive screening protocol. Girls with vaginal voiding were instructed on how to achieve better toilet habits. PARTICIPANTS: Twelve girls with vaginal voiding. RESULTS: Vaginal voiding was found in 12 of 39 girls with daytime urinary leakage. Their age ranged between 8.5 and 13.9 years. They all had history of small leakage immediately after voiding. A body mass index greater than the corresponding 85th percentile was noted in 5 girls, and labial fusion was noted in 2 girls. The complaint disappeared in 10 girls and improved in the remaining 2 girls after instructions on how to achieve better toilet habits. CONCLUSIONS: Vaginal voiding is common in girls. It occurs in girls at risk of overweight, in girls with labial fusion, and in girls adopting a hairpin posture while sitting on the toilet. The diagnosis is obtained by an adequate history. Proper voiding instructions resolve the problem.

Objective Urinary incontinence is an established complication of obesity in adult women. We examined the prevalence, severity, and impact of incontinence in obese compared to non-obese girls. Methods Subjects aged 12–17 years each completed a 29-item questionnaire assessing urinary symptoms and their impact. Clinically significant urinary incontinence was defined as involuntary urine leakage at least once weekly. Results 40 obese adolescent girls and 20 non-obese control girls were recruited. Among the obese girls, five (12.5%, 95% confidence interval: 4–28%) reported incontinence, and two of these five reported daily leakage. None of the 20 non-obese subjects reported leakage meeting the definition of incontinence. Incontinence severity scores (leakage frequency multiplied by leakage volume) averaged 1.3 in the obese group and 0.3 in the non-obese group (P = 0.009) and were associated with symptom impact (P

OBJECTIVES To assess the feasibility and efficacy of retroperitoneal laparoscopic dismembered Anderson-Hynes pyeloplasty in the treatment of ureteropelvic junction obstruction (UPJO). METHODS Between August 2003 and June 2007, retroperitoneal laparoscopic dismembered Anderson-Hynes pyeloplasty was performed in 150 patients diagnosed with UPJO. All patients were assessed preoperatively by imaging examinations (ultrasonography, computerized tomography, and intravenous or retrograde urography) and isotope diuretic renography. Additionally, of the 150 cases, 16 patients with renal calculi underwent concomitant pyelolithotomy. RESULTS All surgeries were successful. No conversion to open surgery was observed. The average operating time, blood loss, and postoperative hospital stay was 105 minutes (range 95-190), 35 mL (range 20-80), and 7.4 days (range 6-12), respectively. A crossing vessel was encountered in 70 (46.7%) patients. Concomitant renal calculi were successfully removed in 11 patients. Two cases presented with urinary leakage that disappeared on the 11th and 12th postoperative day, respectively. Success rate was 98% at a mean follow-up of 16 months (range 12-24). CONCLUSIONS Retroperitoneal laparoscopic pyeloplasty provides a minimal invasive treatment modality with low morbidity, short hospital stay, and quick postoperative recovery for patients with UPJO. In experienced hands, laparoscopic pyeloplasty is an effective alternative treatment for UPJO.

Background/aims The objective of this study is to examine if interpersonal support and digital vaginal palpation (DVP) as part of the pelvic floor muscle exercise (PFME) training is more effective for stress urinary incontinence (SUI) than PFME with a printed handout instruction. Methods 108 women who presented to the family medicine outpatient clinic without having urine leakage as a chief complaint were selected. They were randomized to either the group who received interpersonal support and DVP as part of the PFME training (experimental group), or the group who received PFME with a printed handout instruction (control group). The effects were assessed with 1-h pad tests. Results A total of 99 patients (50 experimental, 49 control) completed the study. The patients' mean age was 55.35±9.60 years, ranging from 20 to 80 years. All patients without urinary leakage listed as a chief complaint exhibited more or less urine leakage during the 1-h pad test. A significant decrease in the weight of 1-h pad test from baseline was observed in the experimental group ( p p =0.514). Conclusion Interpersonal support and DVP as part of the PFME training is more effective than PFME with a printed handout instruction. PFME, performed correctly and consistently, is effective even in patients who have very few symptoms of SUI.

OBJECTIVES The most recognized complications after urethral diverticulum repair are urethrovaginal fistula, diverticula recurrence, and de novo urinary incontinence. Our objective was to determine the rate of de novo stress urinary incontinence (SUI) after urethral diverticulum repair. METHODS We conducted a retrospective review of female patients who underwent urethral diverticulum repair without a simultaneous anti-incontinence procedure over 4.5 years. To determine the rate of SUI, we looked at responses to domain 3 of the urogenital distress inventory-short form (UDI-6), and the rate of subsequent procedures for the treatment of SUI. RESULTS A total of 50 female patients underwent urethral diverticulum repair. The median age was 44 years (range, 24 to 73) years. Median follow up was 23 months (range, 3 to 67 months). A total of 34 (68%) were white and 16 (32%) were black; 29 (58%) had simple diverticulum, 19 (38%) had horseshoe diverticulum, and 2 (4%) had circumferential diverticulum. Six (12%) had a history of recurrent diverticulum. Of 50 patients, 5 (10%) underwent a subsequent sling for SUI. Thirty-five patients completed the UDI-6. Eighteen (51%) patients reported no SUI, 10 (29%) reported "a little bit," 5 (14%) reported "moderate," and 2 (6%) reported being "greatly" bothered by SUI. Of patients with no preoperative urinary leakage, 5 of 15 (33%) had de novo SUI postoperatively. Of patients with preoperative urinary leakage, 8 of 11 (73%) had postoperative SUI. CONCLUSIONS De novo rate of SUI after diverticulum repair was 49% by UDI-6, although most often the SUI was mild. Twenty percent of patients reported moderate to severe bothersome SUI symptoms after diverticulum repair. Ten percent had a subsequent anti-incontinence procedure.

Study Objective To evaluate the midterm therapeutic results of a minimally invasive anti-incontinence operative procedure, the tension-free vaginal tape (TVT) obturator. Design With this prospective, observational, and consecutive patient series, the TVT obturator procedure was performed by the same surgeon on 100 patients. Follow-up lasted 30 to 36 months. Setting Operative theaters of Assuta medical centers private hospitals. Patients One hundred female patients with urodynamically proven stress urinary incontinence. Interventions TVT obturator operations were performed for all patients. Measurements and Main Results Demographic and therapeutic aspects of the patient group data were evaluated. Clinical signs for bowel, urethral, or bladder injuries were undetectable with this TVT obturator patient group. Intraoperative bleeding, postoperative field infections, or postoperative pelvic floor relaxations were not noted. The therapeutic failure rate for the TVT obturator procedure was 8.0% (8 of 100 patients) after 1 year, whereas the midterm failure rate was 10.8% (10 of 93 patients). Six of the 10 patients with TVT obturator failure underwent interval TVT operations with satisfactory results. The overall midterm satisfaction rate for this study group of patients was 89.2% (83 of 93 patients), 6 (6.5%) of those patients were improved only, yet still with minimal residual urinary leakage. Conclusion Use of the TVT obturator, a midurethral sling, did not involve bladder penetration and was complicated by a low rate of postoperative outlet obstruction. The midterm therapeutic results and the cost-effectiveness of the TVT obturator appear similar to previously reported midurethral sling operations. Long-term comparative data collection is required to enable drawing solid conclusions regarding the appropriate position of this operative technique within the spectrum of antiincontinence operations.

Summary Introduction Despite of the tissue engineering efforts to substitute the bladder, almost all the urinary diversion techniques still need gastrointestinal segments that have many well documented complications including the life threatening ones such as renal insufficiency and electrolytes imbalances. In this preliminary incomplete animal model, we aimed to introduce the idea of the possibility of scrotal urinary diversion via inguinal canal and speculate its clinical advantages with its low morbidity and surgical technique of human application. Technical considerations After a laporotomy and its left ureter dissection, a male rabbit underwent urinary diversion from kidney to the scrotum via catheter through the inguinal canal. Abdominal and scrotal incision closed with sutures but a potential gap was left at the scrotum for urinary leakage. Urinary leakage was observed from the ipsilateral scrotum postoperatively. The Hypothesis Although this study can be regarded as just a hypothesis, we would like to introduce the idea of scrotal pouch as a urinary reservoir. We speculated that scrotal urinary diversion is better and applicable technique with many advantages and low morbidity, mortality and short operation time over the intestinal ones especially in selected patients. Further human studies may improve this novel technique.

Stress urinary incontinence (SUI) causes significant distress for women and is an important component of mixed urinary incontinence (MUI). Conservative treatment is noninvasive, but is time-consuming and of variable efficacy. Surgery can be effective but is associated with morbidity and mortality. Varying levels of evidence support the use of pharmacotherapy in SUI and MUI. Oestrogens have an important effect on female urogenital tissues and may provide benefits; however, concerns about the safety of hormone replacement therapy may limit this approach. Phenylpropanolamine has improved outcomes in women with SUI, but it is associated with limited efficacy and increased risk of stroke. Imipramine has demonstrated benefits, but trials have not proved methodologically rigorous. Desmopressin may be useful to control urinary leakage, with effects lasting 4–8h. Duloxetine is the first pharmacologic treatment specifically aimed at SUI and is associated with improved urinary incontinence and quality of life.

Objective: To present the initial results of Botulinum-A toxin (BTA) injection in patients with long-standing multiple sclerosis (MS) and urethral leakage of urine in spite of indwelling suprapubic catheters (catheter bypassing). Methods: Study of three patients treated with cystoscopic injection of BTA IU (Allergan). Telephone interviews were made at four- to six-week intervals. Continence status and patient satisfaction were recorded before and after treatment. Results: Patient 1 remained dry at 48 weeks post injection. Patient 2 became incontinent again after 40 weeks. The third patient was continent when interviewed at 27 weeks following injection, but died two weeks later. The patients were very satisfied with the procedure and there were no complications related to BTA. Conclusions: Intradetrusor BTA injection is a very effective and safe treatment for intractable catheter bypassing in patients with neurogenic detrusor overactivity.

Objectives To review and characterize two groups of men who report being pad-free after robot-assisted laparoscopic prostatectomy (RLRP): those with occasional incontinence and those with complete control. Methods The study included 106 out of a total of 195 men who underwent RLRP. Inclusion requirements were adequate follow-up and no-pad continence status. All patients completed self-administered American Urological Association symptom score (AUAss) and continence questionnaires and underwent measurement of peak urinary flow rates, postvoid residual volumes, and voided volumes (VV) before and 3 months after surgery. All data and standard clinical characteristics were entered prospectively into an electronic database. Results Two distinct groups reported wearing no pads: the “perfect” group (n = 32) reported never leaking, and the “imperfect” group (n = 74) reported occasional leakage but did not wear pads. Preoperatively, the “imperfect” group was older (62.2 versus 59 years) and had more urinary symptoms (all P

Background: With few reports in the field, we wanted to assess the long-term outcome of vaginal repair by objective and subjective measures. Methods: One hundred and sixty-seven women underwent surgical repair during a five-year period from 1990. Five years or more after surgery, 93 women were interviewed and underwent a physical examination to evaluate the post-operative results. Results: Sixty-eight women (72%) stated that they were satisfied with the operative result. Five women (5.4%) had undergone relapse surgery. The examination revealed relapse in seven women (7.5%). Persistent sensation of vaginal pressure and heaviness was the most frequent symptom among those who were not satisfied with the operative result. The mean age was 67.8 years. The frequency of “de novo” urinary leakage post-operatively does not seem to exceed the expected development of leakage attributable to ageing in the population. Conclusions: The results in this study reveals that the need for relapse surgery is twice the reported figure when thorough anatomical examination is performed. There is also a discrepancy between the anatomical findings and the subjective symptoms reported by the patient.

Objectives To assess prospectively the degree of urethral mobility in the preoperative and postoperative periods after the transobturator tape procedure and correlate the findings with surgical outcome. Methods Thirty-six consecutive patients with stress urinary incontinence underwent the transobturator tape procedure. A cotton-swab test was performed before the procedure and at the 6-week postoperative follow-up visit to evaluate proximal urethral mobility. Cure was defined as the absence of leak during cough stress testing at cystometric capacity. Results Of the 36 patients, 26 were available for the complete follow-up evaluation. The mean preoperative and postoperative resting cotton-swab test values were 11.7° and 13.6°, respectively ( P = 0.347). The mean preoperative and postoperative straining cotton-swab test values were 57.3° and 48.4°, respectively ( P = 0.047). Of the 36 patients, 21 had a straining cotton-swab test result of 30° or greater after surgery, and 19 (90.4%) of these 21 patients were objectively cured by the procedure. Overall, 21 patients (84%) were objectively cured of stress urinary incontinence. Four patients had urinary leakage during stress testing at cystometric capacity. Three of these patients reported subjective cure and one noted improvement. Of the 5 patients with a negative cotton-swab test after surgery, 2 were cured (50%), 2 were not cured, and 1 did not undergo cough stress testing at cystometric capacity because of urgency at 200-mL limiting bladder filling. Conclusions The cure of urodynamic stress incontinence using the transobturator tape procedure does not require the correction of proximal urethral mobility.

Objective The purpose of this study was to evaluate the effect of Burch colposuspension for stress urinary incontinence on concomitant coital incontinence. Study design The urogynecology database was searched for sexually active women, who experienced coital incontinence on vaginal penetration, orgasm, or both and who had subsequently undergone Burch colposuspension for urodynamic stress incontinence. The women were interviewed or sent a questionnaire on postoperative bladder and sexual function after a minimum follow-up time of 6 months. Results Thirty of 43 women answered the questionnaire. Preoperatively, 22 women (73%) experienced urinary leakage during penetration, 3 (10%) during orgasm and 5 (17%) at both. Stress incontinence symptoms were successfully treated in 23 (77%). Coital incontinence was cured in 21 of 30 (70%) and improved in 2. Conclusion The results of this small series suggest that coital incontinence is likely to be cured or improved when stress incontinence has been successfully treated by Burch colposuspension.

Background . The simultaneous occurrence of advanced cervical cancer and a pelvic kidney is uncommonly reported. It is an interesting clinical problem because the pelvic kidney lies within the radiation field. Case . A patient found to have bilateral pelvic kidneys and stage II-B cervical cancer underwent an anterior exenteration. This was complicated by urinary conduit leakage and eventual nephrectomy for hemorrhage. She has been followed for 14 months with normal renal function and no evidence of disease. Conclusion . A primary surgical approach to stage II-B cervical carcinoma was offered to this patient because of bilateral pelvic kidneys. Anastomotic breakdown with urinary leakage after an ileal conduit remains a significantly morbid problem.

Aim: This study was performed with the aim of evaluating gastrocystoplasty as a method of management of patients with an areflexic low compliant bladder. Patients and Methods: We performed gastrocystoplasty in 30 patients (19 males and 11 females) with an areflexic low compliant bladder. The mean age of the patients was 23.4±11 years (range 4–32). The etiology of lower urinary tract dysfunction was myelodysplasia in 26 patients and spinal cord injury in 4. Twenty-three patients had normal renal function and 7 had impaired renal function (creatinine 2.0–5.0mg%). Additionally, 4 patients had an artificial urinary sphincter implanted and seven had an antireflux procedure performed. Results: Renal function remained stable or improved in 29 patients. Postoperatively, there was a 225% increase from mean preoperative capacity and a 52% decrease from the preoperative end filling pressure. Nineteen patients voided spontaneously and 11 used clean intermittent catheterization to empty the bladder. Twenty-five patients were continent with augmentation alone, four with augmentation and artificial sphincter implantation while one remained incontinent, as sphincter implantation could not be performed due to the young age of the patient. Five patients (17%) had transient hematuria and dysuria after augmentation. There were no mortalities and complications included prolonged urinary leakage in one patient and mild gastric bleeding in another two. Conclusion: The use of the stomach for augmenting the areflexic low compliant bladder is clearly advantageous over other tissues as it increases bladder capacity and compliance with consequent achievement of continence and preservation of upper tracts. An artificial urinary sphincter can be safely implanted in the same session. Because of its inherent fibromuscular properties, the gastric patch contributes to the force of urination resulting in better bladder emptying. Patients with impaired renal function are protected from hyperchloremic metabolic acidosis.

OBJETIVO: Verificar o efeito da eletroestimulação transvaginal no tratamento de mulheres com incontinência urinária de esforço (IUE) adequadamente selecionadas. MÉTODOS: Vinte e duas mulheres com IUE, diagnosticadas através de estudo urodinâmico, foram submetidas à eletroestimulação transvaginal do assoalho pélvico. A média das idades foi de 49 anos (22 a 74 anos). Foram realizadas duas sessões semanais, com duração de 20 minutos cada, durante oito semanas. Todas as mulheres foram avaliadas por anamnese, exames clínico e uroginecológico, registro semanal dos episódios de perda urinária, teste de esforço e ultra-sonografia transperineal antes e após o tratamento. Os parâmetros elétricos utilizados foram: pulso de 700 microssegundos, freqüência de 50 Hertz e intensidade com variação entre 12 e 53 miliamperes, de acordo com a sensibilidade da mulher. RESULTADOS: Consideraram-se satisfeitas com a eletroestimulação 18 mulheres (81,7%), havendo redução significativa do número de perdas urinárias (p

Vesico-uterine fistulae (VUF) lead to an abnormal breech between the bladder and the womb. They are responsible for urinary incontinence and/or cyclic hematuria. They are rare and, in most cases, lead to complications following caesarean deliveries. We report observations of 3 vesico-uterine fistulae treated over a 5 years period at university maternity based at Casablanca, Morocco; they all occurred following caesarean deliveries. These patients were consulted for urinary leakage occurring few weeks up to many years following surgical traumatism. Diagnosis was evoked clinically in all cases and confirmed by intravenous urography and/or hysterography. These VUF were successfully treated by simple breech suture at laparotomy. Treatment is very simple and efficient when the diagnosis is made early and fistula simple. Surgery is recommended after medical treatment failure aiming at fistula drainage.

Introduction To describe a novel partial nephrectomy technique that uses small intestine submucosa (SIS) to ensure a watertight closure of the collecting system and minimize parenchymal bleeding. The indications for nephron-sparing surgery have increased in recent years. The most prevalent complications after partial nephrectomy include urinary leakage/fistula and parenchymal bleeding. Porcine SIS has been used in animal models to reconstruct portions of the urinary tract successfully. Technical considerations Twenty-two consecutive patients underwent 24 partial nephrectomies that required entry into the collecting system for presumed renal cell carcinoma. After temporary occlusion of the renal vessels and renal hypothermia, the tumor and a margin of normal parenchyma were excised. The cut surface was cauterized with an argon beam coagulator, and visible vessels were suture ligated. The collecting system was reapproximated with interrupted, absorbable sutures. A multilayer piece of hydrated SIS was sutured in place over the exposed collecting system and parenchymal defect with several figure-of-eight chromic sutures. With a mean follow-up of 18.4 months, none of the 22 patients experienced postoperative urinary leaks/fistulas or postoperative hemorrhage requiring transfusion. The serum creatinine returned to within 0.2 mg/dL of baseline in all patients after surgery. Conclusions We describe a novel technique of partial nephrectomy using SIS, which, we believe, aids in closure of the collecting system and decreases parenchymal bleeding.

To analyze the feasibility and perioperative results of patients undergoing robot-assisted cystectomy with intracorporeal urinary diversion and robot-sewn ileoileal anastomosis. This is a mono-centric analysis of perioperative data from 48 consecutive patients undergoing robot-assisted cystectomy with intracorporeal urinary diversion and robot-sewn ileoileal anastomosis. Data include the preoperative variables, operative and postoperative course and complication rates related to bowel anastomosis. End points were time spent for anastomosis and intra- and postoperative complication rates. Median operating time was 23.0 (13–60) min for the ileoileal anastomosis. Median overall operating time was 295 (200–780) min, with a median of 282 (200–418) min and 414.0 (225–780) min for the ileum conduit (N = 35) and ileal neobladder (N = 13). Two patients developed paralytic ileus; in another patient acute peritonitis occurred, but was caused by urinary leakage and therefore unrelated to the bowel anastomosis. No anastomotic leakage was noticed. Costs for the robot-sewn anastomosis was 8€ compared to 1250€ for a stapled anastomosis which was performed in previous cases. Limitations are the non-comparative nature of the analysis and the limited number of patients. Robot-sewn ileoileal anastomosis is feasible with low complication rates. Compared to the stapled anastomosis, a robot-sewn ileoileal anastomosis may serve as an alternative and cost-saving approach.

This article reviews the contemporary literature related to the measurement of the Valsalva leak point pressure, which is currently the best-established indicator in routine clinical practice of stress urinary incontinence. The primary emphasis of this article is on clinical data that are related to detection of urinary leakage. Currently, there are no adequate methods to detect the exact initiation of urinary leakage. The method used to detect urinary leakage in women with stress urinary incontinence should be standardized, because this measurement is closely related to the accuracy of leak point pressure measurement.

Objectives: The aim was to assess the prevalence of any urinary leakage in an unselected female population in Norway, and to estimate the prevalence of significant incontinence. Methods: The EPINCONT Study is part of a large survey (HUNT 2) performed in a county in Norway during 1995–97. Everyone aged 20 years or more was invited. 27,936 (80%) of 34,755 community-dwelling women answered a questionnaire. A validated severity index was used to assess severity. Results: Twenty-five percent of the participating women had urinary leakage. Nearly 7% had significant incontinence, defined as moderate or severe incontinence that was experienced as bothersome. The prevalence of incontinence increased with increasing age. Half of the incontinence was of stress type, 11% had urge and 36% mixed incontinence. Conclusions: Urinary leakage is highly prevalent. Seven percent have significant incontinence and should be regarded as potential patients.