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Overactive bladder (OAB), clinically defined as urinary urgency, with or without incontinence, generally accompanied by an increase in urinary frequency and nocturia, after any local disease or metabolic disorder that would explain these symptoms have been ruled out, is a highly prevalent condition that affects millions of men and women worldwide. Not only can the symptoms of OAB be very bothersome, but OAB can have significant detrimental effects on many aspects of individuals' lives, representing a particularly impactful health burden to quality of life and productivity. Besides a wide range of conservative treatments, the clinical efficacy of which remains an open issue, antimuscarinics are the mainstay of pharmacotherapy for this condition but anticholinergic troublesome side effects like dry mouth, and the patient's perception of lack of efficacy and poor adherence, are common reasons of abandonment of treatment. An alternative to oral administration treatment, with a lower incidence of dry mouth and other anticholinergic adverse effects, might be attractive to patients and a real treatment option for physicians. Delivery of oxybutynin directly through the skin with oxybutynin transdermal (OXY-TDS) avoids the first-pass hepatic metabolism that occurs with orally administered oxybutynin and prevents the appearance of anticholinergic adverse events. OXY-TDS being equally effective than oral treatment improves adherence, persistence, and patient satisfaction. The aim of this review is to focus on evidence available of the use of OXY-TDS in the management of patients with OAB, and to help clinicians in the challenges involved in the treatment options for patients with this condition.

Aim: The aim of this study is to evaluate long-term durability and effectiveness of the adjustable transobturator male system (ATOMS). Materials and methods: The retrospective multicenter Iberian ATOMS study (n = 215) was updated to evaluate long-term continence status, complications, explants, and secondary treatments. Mean follow-up from surgery to March 2020 was 60.6 ± 18.4 months (range, 39-91). Eleven patients deceased of an unrelated causes. Kaplan-Meier curves were performed to evaluate device durability and incontinence free of recurrence interval. The multivariate analysis defined the population at risk of device explant. Results: A total of 155 patients were dry at the last follow-up visit (72.1%); 99 (46%) used no pads and 56 (26%) used a security pad/day with urine loss less than 10 mL; 96% of dry patients after adjustment remained free of incontinence 1 year later, 93.6% 2 years later, 91.1% 3 years later, 89.2% 5 years later, and 86.7% 8 years later. Complications during follow-up occurred in 43 of 215 (20%). In total, 25 (11.6%) devices were explanted and causes were inefficacy 11 (44%), inefficacy and pain 3 (12%), port erosion 10 (40%), and wound infection 1 (4%). The secondary implant was performed in 11 (5.1%) cases, 6 artificial urinary sphincter and 5 repeated ATOMS. Time to explant was associated to complications (P < .0001), baseline stress urinary incontinence (SUI) severity (P = .01), and former irradiation (P = .03). Multivariate analysis revealed complications (hazard ratio [HR] = 8.71; 3.83-19.82), baseline SUI severity (>5 compared to 1-2 pads/day; HR = 14.9; 1.87-125), and irradiation before ATOMS (HR = 2.26; 1.02-5.18) predicted earlier ATOMS explant. Three cases received radiation after implant without complication. Conclusions: ATOMS device is efficacious and safe in the long term. Determinants for device explant include complications, baseline severity of incontinence, and previous irradiation. Currently, the durability of the device after 5 years is reassuring. Sin financiación 2.696 JCR (2020) Q3, 50/89 Urology & Nephrology 0.918 SJR (2020) Q1, 27/107 Urology No data IDR 2020 UEM

The human being is the only mammal capable of walking and simultaneously maintaining an upright position. This fact, implies somewhat unfavorable repercussions for the pelvic region that must support the weight of the abdominal organs. A prime example of the aforementioned adverse effects of the standing position are pelvic organ prolapses (POP). POP surgery is an increasingly important therapeutic aspect in clinical practice due to the aging of our population, and is increasingly prevalent as a therapeutic option. Surgical techniques can be performed using an abdominal or vaginal approach, depending on the medical history, physical examination, and experience of the surgeon. Laparoscopic sacrocolpopexy is an adequate therapeutic option with a high success rate in 80–100% of cases. However, this technique is not always appropriate, especially for patients who are at high risk for anesthesia, a multi-operated abdomen, or in recurrent prolapse. In these cases, a vaginal approach offers an interesting surgical alternative. In this review, we added our experience with transvaginal single-incision mesh under locoregional anesthesia for correction of female POP. We retrospectively analyzed 78 patients showing a success rate of 92% after more than 12 months of follow up. Transvaginal mesh was developed to maintain the advantage of a vaginal procedure, while reducing the risk of recurrent prolapse compared to native tissue repair and simplifying the surgery compared to sacrocolpopexy.

Backgrounds Patient-reported outcome measurements are important for urinary incontinence. We analyze self-assessed patient satisfaction and defne the clinical profle of patient with highest satisfaction with the adjustable transobturator male system (ATOMS). Methods Patient perception of results was evaluated in a series of 181 patients after ATOMS adjustment. Baseline incontinence severity was defned in pads-per-day (PPD) as mild (2), moderate (3–5) or severe (≥6), and dryness as use of none or one security PPD. Post-operative pain at discharge was evaluated by 0–10 visual analogue scale and complications by Clavien–Dindo classifcation. Multivariate analysis was performed to anticipate “very much better” than baseline perception on patient global impression of improvement and a predictive nomogram was developed. Results Dryness was achieved in 80.7% (94.9% mild, 80.8% moderate and 65.8% severe groups). Mean pad-test and padcount decrease with respect to baseline was 458±330 ml and 3.2±1.9 PPD, respectively (both p

INTRODUCTION AND OBJECTIVES:Objective: to report the experience in 4 tertiary hospitals with the pre-connected, pre-filled and refillable artificial urinary sphincter (AUS) ZSI 375 PF (Zephyr Surgi...

Objectives. Evaluation of changes in symptoms among patients with overactive bladder syndrome treated with transdermal oxybutynin and tolerability after 12 months of follow-up. Methods. This was a multicenter, retrospective, single-cohort, observational study. Changes in symptoms were evaluated primarily with a 3-day voiding diary. Results were compared to baseline. Subgroup analyses were performed in patients previously treated for OAB or not and aged Results. Clinical records of 105 patients were examined; 92.4% were women. At 12 months, 58 patients continued to receive transdermal oxybutynin. Changes in symptoms according to the voiding diary were evaluated in 47 patients. Significant improvements from baseline were observed in urinary frequency (−2.6 voids/24 hours (95% CI: −3.5; −1.8), p<0.001); daily number of urgent episodes (−4.7 episodes/day (95% CI: −6.1; −3.6), p<0.001); and urge incontinence (−1.9 episodes/day (95% CI: −2.9; −1.3), p<0.001). No statistically significant differences were found in subgroup analyses. In total, 38.1% of patients had adverse events, primarily in the application site (27.6%). No severe systemic adverse events occurred. Only 6 patients (5.7%) reported dry mouth. Conclusions. Improved symptoms and good tolerability observed after 1 year of treatment with transdermal oxybutynin shows that it currently has a place in the treatment of OAB patients.

Aim: To evaluate effectiveness and safety of the adjustable transobturator male system (ATOMS) for male stress urinary incontinence (SUI). Material and Methods: A retrospective multicenter study was conducted in nine Iberian institutions using a board‐approved database for 215 patients intervened between 2012 and 2017, with no case excluded. Continence status, patient satisfaction, number, and grade of complications (Clavien‐Dindo) and factors affecting dry rate at adjustment were evaluated. Multivariate analysis defined the population at best success rate. Incontinence recurrence due to device failure and/or explant was evaluated and Kaplan‐Meier curve for durability performed. Results: Adjustment was achieved at a mean 1.4 ± 1.9 fillings. Dry‐rate after adjustment was 80.5% (96.2% mild and 75.3% moderate‐severe), 121 (56.3%) used no pads, and 52 (24.2%) a security pad with urine loss under 10 mL. Mean basal daily pad‐test and pad‐count decreased from 484 ± 372.3 mL and 3.9 ± 2 pads to 63.5 ± 201.2 mL and 0.9 ± 1.5pads (both P

AimsTo evaluate the feasibility (% of completion), reliability (test-retest and inter-observer) and validity (convergent vs. questionnaires and vs. urodynamic study-UDS) of the 3-day bladder diary (3dBD) in women with lower urinary tract symptoms (LUTS). MethodsEpidemiological, descriptive, cross-sectional and prospective study. Fourteen Functional Urology and Urodynamic Units participated. One hundred thirty-six women with mean age (SD) 55.2 (13.8) years with LUTS, without bladder catheterization and who were able to fill in the 3dBD were included. An UDS was performed. They filled in the 3dBD in two times separated by 15 days (test and retest), the International Consultation on IncontinenceShort Form (ICIQ-UI SF) and the Bladder Control Self-Assessment Questionnaire (BSAQ). ResultsOne hundred ten women completed 3dBD for test and retest. Feasibility: each 3dBD has 42 variables, 77.2% women completed 80%. Test-retest reliability: there were not differences in the proportion of patients classified as positive for each symptom (urgency: P=0.3173; incontinence: P=1; nocturia: P=0.0522; frequency: P=0.4386). The Intraclass Correlation Coefficient (ICC) ranged from 0.67 to 0.92, except for night time VVmax which was lower (0.54). Inter-observer reliability: ICC ranged from 0.64 to 0.99, except for day time VVmax (0.29) and the number of urgency episodes (0.45). Validity: Spearman correlation coefficients for ICIQ-UI SF and BSAQ ranged from 0.4 to 0.6 (P