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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.

Treatment for bladder diverticula may become necessary in case of incomplete bladder emptying or recurrent urinary tract infections (UTI). When bladder outlet obstruction is present, a simultaneous desobstructive procedure can be performed. In this video, we present our technique for a transvesical approach in robot-assisted bladder diverticulectomy (RABD) and discuss its outcomes. We retrospectively analysed the outcomes of 23 patients who underwent a transvesical RABD between March 2015 and May 2020 at the OLV hospital of Aalst. After retrograde filling, a cystotomy is performed. The orifices are identified and the bladder diverticulum is visualized. The mucosa covering the diverticular neck is incised and the plane between the mucosa and the muscularis is identified. The mucosa is separated from the surrounding structures. The base of the diverticulum is transected using cautery. The defect is closed with a barbed suture. Median age was 66 years [Interquartile range (IQR) 60-69)]. The number of diverticula removed ranged from 1 to 3. 10 patients were treated with diverticulectomy alone, 12 underwent a simultaneous adenomectomy, 1 a radical prostatectomy. Median operative was 140 min (IQR 120-180), median estimated blood loss was 250 cc (IQR 28-438). Median catheterization time was 2 days (IQR 1-5), median hospitalization time 3 days (IQR 2-4). 1 patient developed urinary leakage after catheter removal, 1 patient developed a UTI. Median follow-up was 9 months (IQR 3,5-14). No late postoperative complications nor relapse were recorded. Average postvoid residual was 42 cc (IQR 0 to 111), with a median decline of 120cc (IQR -402 to -33). Transvesical approach for RABD is a safe and reliable technique which gives the advantage of a quick localization of the diverticulum and orifices, and direct access to the prostate when simultaneous desobstruction is necessary. Catheterisation time is short. No relapse has been observed.

Objetivo: Determinar la prevalencia de incontinencia urinaria (IU) en mujeres jóvenes atletas profesionales, establecer el tipo de IU que se presenta con más frecuencia; determinar los factores de riesgo asociados e identificar el impacto sobre la calidad de vida. Metodología: Estudio observacional descriptivo tipo corte transversal; se incluyeron a mujeres atletas pertenecientes a la Casa de la Selección Ecuatoriana de Fútbol entre 16 y 35 años que cumplieron los criterios de inclusión, obteniendo una muestra final de 51 participantes. Se utilizó el Cuestionario Internacional para Incontinencia (ICIQ-SF) y se realizó la prueba de Pad-Test modificado para 1 hora de entrenamiento. Resultados: El 52,9% (n = 27) auto-reportó haber tenido episodios de poca y/o moderada cantidad de fuga urinaria; el 35,3% (n=18) tuvo un resultado positivo en el Pad-Test. Entre las deportistas que se auto-reportaron continentes el 16,67% (n=4) tuvo pad-test positivo durante el entrenamiento. 51,8% (n=14) de las atletas incontinentes (ICIQ-SF) presentan incontinencia de esfuerzo. No se encontró dependencia entre las variables consideradas como factores de riesgo y episodios de incontinencia. El 70,37 % (n=19) de las deportistas incontinentes consideró que los episodios no afectan en su calidad de vida y un 29,63 % (n=8) los consideró de poca o moderada importancia. Conclusiones: Existe alta prevalencia de incontinencia urinaria en mujeres deportistas jóvenes, siendo la de esfuerzo la más común. No se evidenció asociación entre las variables planteadas como factores de riesgo e incontinencia en esta población. Los episodios de fuga urinaria no generan impacto sobre su calidad de vida.

Background This study aimed to explore the application of CO2 lattice laser in the treatment of mild and moderate urinary incontinence in female patients. Methods We analyzed the clinical data of 33 female patients with mild to moderate urinary incontinence from a prospective cohort study, who were treated with FemiLift CO2 lattice laser instrument (Alma Laser Ltd, Caesarea, Israel) at our hospital from January 2018 to December 2018. All the female patients were married and fertile, with a mean age of (43.15±6.49) years old (35-62 years old). There were 18 participants with mild urinary incontinence and 15 with moderate urinary incontinence. All participants received laser treatment 3 times, with an interval of 30 days. The International Consultation of Incontinence Questionnaire- Short Form (ICIQ-SF) survey was conducted before the treatment, 3 months after, and 6 months after the treatment. A 1-hour urine pad test was used to quantify the leakage of urine. Residual urine and urine routine examination were performed to exclude other combined diseases. Results After 3 times of treatment with FemiLift CO2 laser, 13 cases were cured in 3 months, and 16 cases were cured in 6 months. 10 cases and 15 cases were significantly improved in 3 or 6 months, respectively. 2 patients had no significant changes, and no adverse reactions were recorded. The pad test showed that the symptom of all 33 patients were significantly improved, and the average scores of ICIQ-SF were significantly decreased (P

BACKGROUND Duplicate renal malformation is a congenital disease of the urinary system, with an incidence rate of 0.8%. Surgical treatment is suitable for symptomatic patients. Urinary fistula is one of the complications of heminephrectomy. Long-term urinary fistula has a great impact on patients' lives. CASE SUMMARY This article mainly reports on a 47-year-old man with duplication of kidney deformity, long urinary fistula after partial nephrectomy, and no improvement after conservative treatment. We have achieved positive results in the arterial embolization treatment of the residual renal artery, indicating that selective arterial embolization is a good way to treat urinary fistula after partial nephrectomy. It is worth noting that this patient violated the Weigert-Meyer law, which also gave us more consideration. CONCLUSION Renal artery embolization may be a simple and safe method to treat urinary fistula inefficacy with conservative treatment.

Background There has been a limited number of reports on the significance and risk factors of urethrovesical anastomotic urinary leakage (AUL) following robot-assisted radical prostatectomy (RARP). We aimed to analyze the clinical significance of AUL and evaluated its risk factors. Methods We conducted a multi-institutional study to review patients with prostate cancer undergoing RARP in three centers (The University of Tokyo Hospital, Mitsui Memorial Hospital, and Chiba Tokushukai Hospital). “Positive AUL” was defined as urinary extravasation at the anastomosis detected by post-operative cystogram and was further categorized into minor or major AUL. Univariate and multivariate analyses were performed to identify predictors of AUL. Postoperative continence rates and time to achieve continence were also analyzed. Results A total of 942 patients underwent RARP for prostate cancer in 3 centers. Of these patients, a cystogram after the RARP procedure was not performed in 26 patients leaving 916 patients for the final analysis. AUL was observed in 56 patients (6.1%); 34 patients (3.7%) with minor AUL and 22 patients (2.4%) with major AUL. Patients with major AUL exhibited a significantly longer time to achieve continence than those without major AUL. Multivariate analysis demonstrated that longer console time (≥ 184 min) was significantly associated with overall AUL, and higher body mass index (≥ 25 g/kg2) was a significant predictor of both major and overall AUL. Conclusions The presence of major AUL was associated with the achievement of urinary continence, suggesting clinical relevance of its diagnosis by postoperative cystogram. A selective cystogram has been proposed for high-risk cases. Furthermore, identification of the risk factors of AUL will lead to optimal application.

Urogenital fistulas are common complication of obstetric and gynecological surgery; the most common are vesicovaginal fistulas. Vesicouterine fistulas are rare, which explains the difficulties in diagnosis and treatment. The literature review and own clinical case presented in article. A 43-years-old female patient was consulted with complaint of urinary leakage from vagina, which appeared 1 month after the cesarean section and vesicouterine fistula has been diagnosed. Successful laparoscopic treatment of vesicouterine fistula was performed at the Avicenna Medical Center after 3 months. The urethral catheter was removed 7 days after surgery. At control examination after 1, 3 and 6 months, ultrasound examination of the pelvic organs confirmed the consistency of the scar on the uterus. Urination remained free and painless, the patient did not notice urine leakage. This clinical observation shows the possibility of treating a vesicouterine fistula with a laparoscopic approach with a good result and the possibility of early rehabilitation.

Background Intraoperative urinary collecting system entry (CSE) in robot-assisted partial nephrectomy (RAPN) may cause postoperative urinary leakage and extend the hospitalization. Therefore, identifying and firmly closing the entry sites are important for preventing postoperative urine leakage. In RAPN cases expected to require CSE, we insert a ureteral catheter and inject dye into the renal pelvis to identify the entry sites. We retrospectively analyzed the factors associated with intraoperative CSE in RAPN and explored the indications of intraoperative ureteral catheter indwelling in RAPN. Methods Of 104 Japanese patients who underwent RAPN at our institution from August 2016 to March 2020, 101 were analyzed. The patients were classified into CSE and non-CSE groups. The patients’ background characteristics, RENAL Nephrometry Score (RNS), and surgical outcomes were analyzed. Results Intraoperative CSE was observed in 41 patients (41%). The CSE group had a significantly longer operative time, console time, ischemic time, and hospital stay than the non-CSE group. In a multivariable analysis, the N-score (odds ratio [OR] = 3.9, P < 0.05) and RNS total score excluding the L-score (OR = 3.1, P < 0.05) were associated with CSE. In a logistic regression analysis, CSE showed a moderate correlation with the RNS total score excluding the L-score (AUC 0.848, cut-off 5, sensitivity 0.83, specificity 0.73). Conclusion A ureteral catheter should not be placed in patients with an RNS total score (excluding the L-score) of ≤ 4.

Background: Prolonged urinary leakage after nephrostomy tube removal leads to increased morbidity of PCNL and increased hospitalization. Objective: To evaluate factors affecting post nephrostomy removal urinary leakage after percutaneous nephrolithotomy. Patients and Methods: One hundred eight (108) patients older than 18 years who underwent PCNL were studied prospectively. The reasons that can affect urinary leakage postoperatively were divided into 4 categories according to individual factors including age, gender, and body mass index; Renal factors; including, previous operation, history of ESWL, parenchymal cortical thickness, and grades of hydronephrosis; stone factor (stone burden); and surgical factors including the number of tracts, presence of double J stent, nephrostomy tube diameter and stay duration. These data were compared for postoperative urine leak. Results: Urinary leakage was revealed in 76 of 108 patients (70.3%). There was no statistically significant relationship between individual factors and urinary leakage (P >0.05). Among renal factors, just parenchymal cortical thickness and grade of hydronephrosis were strongly related to the urinary leakage (P 0.05). Among surgical factors, placing of ureteral double-J stent highly minimized the incidence of urinary leakage (P

Objectives: To assess whether bladder neck angle and position on cystogram predict early urinary continence in patients scheduled for early catheter removal after radical prostatectomy (RP). Methods: A total of 103 patients undergoing open or robot-assisted RP by one expert surgeon between January and December 2019 were retrospectively analyzed. A cystogram was performed on postoperative day 3 or 4 to evaluate anastomotic leakage, and, if none or minimal, the catheter was removed. Urinary continence was evaluated with a validated questionnaire at 1 week, 1 month, and 3 months after RP. Four investigators of different experience assigned bladder neck angle and relative position of bladder neck to pubic symphysis on archived cystogram images. Association between these two parameters and urinary continence rates at different follow-up times was assessed with logistic regression analysis adjusting for patient and tumor characteristics, and surgical technique. Interobserver agreement in assigning the two parameters was measured with k statistic. Results: Catheter was removed immediately after cystogram in 101 (98%) patients. On multivariable analysis, only relative position of bladder neck to pubic symphysis was an independent predictor of 1-week (odds ratio [OR] 30. 95% confidence intervals [CIs] 6-138, p Conclusions: Relative position of bladder neck to pubic symphysis on cystogram is a strong and reproducible predictor of early urinary continence after RP.

Background This study was performed to investigate the association between cystographic anastomotic urinary leakage (UL) after radical retropubic prostatectomy (RRP) and early urinary incontinence (UI). Methods The medical records of 53 patients who had undergone cystography after RRP at our institution between January 2015 and December 2018 were retrospectively analyzed. Cystography was performed 7 to 10 days after surgery. The duration of catheterization depended on the degree of UL, which was classified as mild, moderate, or severe. The study subjects were divided into the non-UL group and the UL group. Continence was defined as the use of no pads. The prostate was dissected in an antegrade fashion, and urethrovesical anastomosis was performed with a continuous suture. Results Incontinence rates at 1 and 3 months postoperatively were significantly higher in the UL group than the non-UL group (83.3% vs. 52.2%, p=0.014 and 76.7% vs. 47.8%, p=0.030, respectively); however, those at 6 and 12 months were not significantly different (23.3% vs. 17.4%, p=0.597 and 4.3% vs. 10.0%, p=0.440, respectively). The presence of cystographic anastomotic UL was found to be predictive of UI during the first 3 postoperative months (odds ratio, 3.3; p=0.045). The continence rates during the first 3 postoperative month continence rate showed significant difference with non-UL group regardless of the degree of UL. Conclusion The presence of anastomotic UL on cystography was associated with higher rates of UI in the early postoperative period, however the grade of UL was not related to the late recovery of UI. Incontinence rates in patients with or without anastomotic UL immediately after RRP equalized at 6 months.

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.

Purpose Kidney transplantation is one of the best treatment options for end-stage renal disease with an incidence of urologic complications of 2.5 to 30%. One of the most serious and frequent urological complications is urinary leakage from ureteroneocystostomy anastomosis. The purpose of this study was to evaluate risk factors of urinary leakage from ureteroneocystostomy anastomosis after kidney transplantation. Patients and methods A retrospective study was performed on patients who received kidney transplantation and were diagnosed with urinary leakage thereafter based on renal scan or drain creatinine per serum creatinine compared with patients in control group. Risk factor assessment was based on inpatient and outpatient information from hospital database. Results From 459 patients who received kidney transplantation in 2016-2018, there were 20 patients who were diagnosed with urinary leakage after they underwent ureteroneocystostomy anastomosis. The significant risk factors for anastomosis leakage were size of suture materials and duration of ureteral stent insertion. No statistically significant difference in other factors such as underlying disease, surgical technique or duration of urinary catheter was found. About overall urological complication, gender and body mass index significantly affected the outcome. Conclusion The rate of urinary leakage complications was found to be about 4.36%. The risk factors of overall complication comprised gender and body mass index. Although a lot of previous studies revealed many risk factors that could affect urinary leakage, size of suture materials and duration of ureteral stent insertion were the significant risk factors in our study. Proper consideration should be given to the size of suture materials and optimal duration of ureteral stent.

OBJECTIVE: Our aim was to report the long-term follow-up for minimally invasive open pyeloplasty in children. MATERIAL AND METHODS: A total of 213 children with a mean age 16.33 months underwent miniature open pyeloplasty for ureteropelvic junction obstruction between January 2010 and May 2016. Anderson–Hynes dismembered pyeloplasty was performed through a subcostal miniature incision. The intraoperative and postoperative parameters including surgical operative time, incision size, intraoperative blood loss volume, postoperative analgesic use, hospital stay, complications, and success rate were documented. RESULTS: The mean surgery time was 65 min (50–85 min), and incision size was 16.99 mm (12–36 mm). None of the patients required blood transfusion or narcotic analgesics in the postoperative period. The mean hospital stay was 21.97 h (10–48 h). Minor side effects included urinary tract infection (3.8%) and urinary leakage in one case (0.004%). Major complications were not observed. The mean antero-posterior pelvic diameter before and after surgery was 28.69 ± 11.54 mm and 15.89 ± 9.29 mm, respectively with a mean difference of 12.78 mm, which shows a significant decrease (P value = 0.001). The success rate was 98.1% with a mean follow-up of 21.43 months (3–56 months). Two of the recurrences occurred in the first postoperative year, another one after 1.5 years, and the last one after 4 years. CONCLUSION: Our study confirms minimally invasive open pyeloplasty in children as a safe and efficient procedure with the least complication and hospital stay rate in comparison with other minimally invasive techniques. Moreover, long-term follow-up is a requirement in pyeloplasty surgery.

To evaluate the safety and efficacy of ureteral occlusion stents for urinary diversion in patients with inoperable urinary leakage or fistula or intractable bladder bleeding. A total of 13 ureters in 12 patients (M:F = 4:8) who underwent ureteral occlusion stenting were included in this study. The internally silicone membrane-coated occlusion stent was a self-expanding stent with constriction at the middle (M-type) or distal end (D-type) of the stent. The reasons for ureteral occlusion were surgery infeasibility for urinary leakage (n = 6), temporary ureteral occlusion for urinary leakage before surgical reconstruction (n = 2), urinary fistula (n = 3), or control of bleeding from bladder cancer (n = 1). Technical success defined as successful deployment of the occlusion stent with no contrast agent passing beyond the occlusion stent was achieved in 92.3% (12/13 ureters); in one ureter with contrast passage beyond the occlusion stent, additional n-butyl cyanoacrylate (NBCA) embolization was performed immediately so that there was no further leakage. There were no procedure-related complications. During the mean follow-up of 11.6 months, recurrence of urinary leakage was observed in two ureters (15.4%, 2/13) where a D-type occlusion stent was used on the 3-day follow-up antegrade ureterogram; the contrast agent passed through the widened constricted portion of the occlusion stent and repeat occlusion with microcoils, and NBCA was subsequently performed inside the occlusion stent and with no further urinary leakage until the last follow-up. The ureteral occlusion stent is safe and effective for ureteral occlusion. Recurrence of leakage can be managed with additional microcoil and NBCA embolization.

To observe the clinical efficacy of deep electroacupuncture (EA) at Baliao points in treating stress urinary incontinence (SUI). A total of 60 female patients with SUI were divided into two groups according to the order of consultation, with 30 cases in each group. The control group was treated with pelvic floor muscle training. The treatment group was treated with deep EA at Baliao points [Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33) and Xialiao (BL 34)]. The total effective rate was 93.3% in the treatment group, versus 33.3% in the control group, and the total effective rate of the treatment group was significantly higher than that of the control group (P

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.

INTRODUCTION AND HYPOTHESIS: The current study aims to characterize the association between pelvic floor disorder symptoms and bone strength reflecting a potential connective tissue pathophysiology in postmenopausal women. METHODS: A cross-sectional study was conducted in postmenopausal women undergoing osteoporosis evaluation from 2007 to 2010. Urinary incontinence (UI) was defined as urinary leakage ≥2–3 times/week. UI types were defined using the 3 Incontinence Questionnaire. Fecal incontinence was defined as stool leakage ≥1/month, and pelvic organ prolapse as a positive response to “Do you have a bulge or something falling out that you can see or feel in your vaginal area?” Bone quality and quantity were assessed by trabecular bone score (TBS) and bone mineral density, respectively; i) bone strength was defined by combined quality/quantity index, low strength being equivalent to moderate-severe fracture risk ii) low quality as TBS≤1.31; iii) low quantity by T-score

Aims To evaluate the diagnostic ability of different cough stress tests (CSTs) in women with pelvic organ prolapse (POP), performed during outpatient urogynaecological exams. Methods Prospective, multicentre observational study involving women on waiting lists for POP surgery. With a subjectively full bladder, patients were asked to perform five different CSTs: without prolapse reduction ([a] standing, followed by [b] semilithotomy position); keeping semilithotomy position with prolapse reduced (by [c] posterior speculum, followed by [d] pessary); [e] standing again with the pessary in place. Primary outcome was positive CST in at least one of the five CSTs. Bladder volume was measured and symptoms of stress urinary incontinence (SUI) were detected by two validated questionnaires. Results A total of 297 women completed all CSTs and were included in the analyses. Mean (SD) age, parity, and body mass index were 64.8 (9.9) years, 2.7 (1.3) deliveries, and 26.6 (3.4) kg/m2, respectively. In total, 99 women (33.3%) reported SUI symptoms. At least one positive CST was recorded in 152 patients (51.1%), and in 90 (59.2%) of these 152, a positive CST was observed only when POP was reduced (occult SUI). The CST was positive in 92 (92.9%) of the 99 patients with coexisting SUI symptoms and in 60 (30.3%) of the 205 asymptomatic patients. The percentage of patients with a positive CST was significantly lower when bladder volume was

Objective: To determine the feasibility of decellularized small intestinal submucosa (SIS) matrix in repairing ureteral strictures. Methods: Two patients with ureteral stenoses underwent ureteral reconstruction with SIS matrix at the Zhejiang Provincial Corps Hospital of Chinese People's Armed Forces between June 2014 and June 2016. The ureteral stenoses were repaired with a semi-tubular SIS matrix and the postoperative recoveries were observed. Results: Both operations were successfully completed. The average operative time was 90 min and the average length of hospital stay was 15 days. No fevers, incision infections, intestinal obstruction, graft rejection, or other serious complications were noted. After 2 months, ureteroscopic examinations showed that the surfaces of the original patches were covered by mucosa and there were no apparent stenoses in the lumens. The ureteral stents were replaced every 2 months postoperatively and removed 12 months postoperatively. No infections or urinary leakage occurred after removal of the stents. Intravenous urography was performed 6 and 12 months postoperatively. The results showed that the ureters were not obstructed and there was no apparent stenosis at the anastomosis sites. The average follow-up time was >12 months. Long-term follow-up is still ongoing, and computed tomography examinations of the urinary tract have been conducted in the outpatient department of our hospital 1, 3, and 6 months after removal of the double-J stents, suggesting the absence of hydronephrosis. The serum creatinine levels remained stable during the follow-up. Conclusion: SIS matrix reconstruction is a feasible method to repair ureters stenosis. Keywords: Ureteral stenosis, Decellularized matrix, Ureteroplasty, Ureteral reconstruction, Ureteral obstruction

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.

Purpose We retrospectively evaluated the efficacy of botulinum neurotoxin A (BoNT-A) on vesicoureteral reflux (VUR), continence status, and urodynamic parameters in children with myelodysplasia who were not responsive to standard conservative therapy. Methods The study included 31 children (13 boys, 18 girls) with a mean age of 9.2±2.3 years (range, 5–14 years) with myelodysplasia, retrospectively. All children were fully compatible with clean intermittent catheterization (CIC) and did not respond to the maximum tolerable anticholinergic dose. All children received an intradetrusor injection of 10 U/kg (maximum, 300 U) of BoNT-A into an infection-free bladder. All patients had VUR (22 unilateral, 9 bilateral) preoperatively. The grade of reflux was mild (grades 1, 2), intermediate (grade 3), and severe (grades 4, 5) in 25, 7, and 8 ureters, respectively. Results The mean maximum bladder capacity increased from 152.9±76.9 mL to 243.7±103 mL (P

Introdução: A incontinência urinária afeta 21,4% das mulheres portuguesas e tem impacto negativo na qualidade de vida e na esfera sexual. A reabilitação do pavimento pélvico é a primeira linha de tratamento na incontinência urinária de esforço e pode ser uma opção terapêutica na disfunção sexual. O objetivo desta revisão é esclarecer se o tratamento com reabilitação do pavimento pélvico apresenta efeitos benéficos na função sexual em mulheres com incontinência urinária de esforço.Material e Métodos: Realizou-se uma revisão, recorrendo à base de dados PubMed, usando os termos: ‘urinary incontinence’, ‘female sexual dysfunction’ e ‘pelvic floor physical therapy’, recolhendo informação de 12 artigos relevantes.Resultados: A reabilitação do pavimento pélvico está associada à redução dos episódios de perda de urina e à melhoria da incontinência coital. Verifica-se uma melhoria nos scores de avaliação da função sexual após tratamento. Multiparidade, maior adesão ao tratamento, melhoria na força de contração muscular do pavimento pélvico e diminuição da perda de urina são fatores associados a uma melhoria da função sexual.Discussão: A função sexual deve ser avaliada na abordagem desta patologia e a sua estandardização é fundamental na caraterização do quadro clínico e na avaliação do follow-up. São necessários estudos para avaliar o papel da reabilitação do pavimento pélvico na disfunção sexual de mulheres com incontinência urinária na população portuguesa.Conclusão: A reabilitação do pavimento pélvico melhora a função sexual nas mulheres com incontinência urinária de esforço, pela diminuição de episódios de perda de urina e pelo fortalecimento dos músculos do pavimento pélvico.

Objective To compare prospectively early outcome and complications of catheter removal after robot-assisted radical prostatectomy (RARP) on the 4th or 7th day with a standardized running barbed suture technique. Introduction The time point of removing the indwelling catheter after RARP mainly depends on institute’s/surgeon’s preferences. Removal should be late enough to avoid urinary leakage and complications such as acute urinary retention (AUR) but early enough to avoid unnecessary catheter indwelling. Materials and methods A consecutive single-institutional series of patients underwent RARP between July 2015 and August 2017 and were entered in a prospectively maintained data base. Between July 2015 and December 2016 a cystogram was performed on 7th postoperative day (group A), thereafter the cystogram was performed on 4th postoperative day (group B). Incidence of acute urinary retention (AUR), urinary tract infections (UTI) and adverse events between the two cohorts was compared. Results 425 patients were analyzed (group A: n = 231; group B: n = 194). Both cohorts were comparable regarding demographic and oncological parameters. Watertight anastomosis was present in 84.8% in group A and in 82.5% in group B, respectively. AUR within 4 weeks after RARP occurred in 2.2% (n = 3) in A and 9.4% (n = 15) in B (p = 0.001). AUR within 72 h after catheter removal occurred in group A: 1% (n = 2) and in group B: 6.3% (n = 10) (p = 0.005). Symptomatic urinary tract infections occurred in 8.2% (n = 16) in group A and in 6.9% (n = 11) in group B. There were no differences in the rate of secondary anastomosis dehiscence. Age, BMI, prostate size, surgeon, or intraoperative bladder neck reconstruction were not correlated to the occurrence of AUR or UTI. Conclusions The removal of indwelling catheter on day 4 after a RARP with a running barbed suture shows similar anastomosis leakage rates as on the 7th postoperative day. However, AUR rates are higher for early removal. Patients scheduled for early removal should be carefully informed about the increased risk for AUR. Catheter indwelling time does not represent a risk factor for UTI.

Background Our objective is to better comprehend treatment considerations for urethral stricture disease (USD) in patients requiring long-term clean intermittent catheterization (CIC). Patient characteristics, surgical outcomes and complications are unknown in this population. Methods Six members of the Trauma and Urologic Reconstruction Network of Surgeons (TURNS) participated in a prospective (2009 to present) and retrospective (prior to 2009) database recording patient demographics, surgical approach and outcomes. We included all patients undergoing urethroplasty who perform CIC. Descriptive statistics were used to analyze results. Results A total of 37 patients with 39 strictures were included. Bladder dysfunction was characterized as detrusor failure in 35% and neurogenic etiology in 65%. Median stricture length was 3 cm (IQR: 1.5-5.5) with 28% repaired with dorsal onlay buccal mucosal graft, 26% excision and primary anastomosis, 8% dorsal inlay, 8% ventral and dorsal, 8% flap based 8% non-transecting and 15% other. Functional success was 90%: 4 patients required DVIU or dilation due to recurrence, with 2 of those ultimately requiring repeat urethroplasty. 86% of patients returned to CIC; no patients reported new pad use for urinary leakage after urethroplasty. During a median follow-up period of 3.1 years (IQR: 1.0-5.3), no patients underwent urinary diversion. Conclusions Urethroplasty is suitable, safe and effective for patients dependent on CIC suffering from USD. The effect of continual CIC on long-term outcomes remains uncertain.

INTRODUÇÃO: A incontinência urinária (IU) é definida como qualquer perda involuntária de urina, sendo a tosse um fator de risco. A tosse é um sintoma frequente da Doença Pulmonar Obstrutiva Crônica (DPOC) podendo associar-se com a IU. OBJETIVO: Avaliar a frequência de perda urinária e o impacto da IU na qualidade de vida das pessoas com DPOC e caracterizar a presença de tosse. MATERIAL E MÉTODOS: Tratou-se de um estudo descritivo, realizado em pessoas com DPOC. A coleta dos dados foi realizada no Departamento de Ciências da Vida II/UNEB. Aplicou-se o International Consultation Incontinence Short-Form (ICIQ-SF) para avaliar a frequência de perda urinária e o King’s Health Questionnaire (KHQ) para o impacto na qualidade de vida. Os dados foram analisados no software SPSS (v.22.0), descritos em medida de tendência central, dispersão e proporções. Um p < 0,05 foi considerado estatisticamente significante. RESULTADOS: Das 30 pessoas avaliadas, a média da idade foi 66,7± 8,6 anos; desses 11 (36,7%) apresentaram queixa de IU, sendo sete (63,3%) mulheres. Entre esses a média de pontuação do ICIQ-SF foi de 5,9± 4,4. Vinte e oito participantes (93,3%) tinham tosse crônica. Analisando o KHQ, o domínio de maior impacto foi “percepção geral de saúde’’. CONCLUSÃO: A frequência de IU em pessoas com DPOC foi de 35,7% e a de tosse foi de 93,3%. Entre as pessoas com perda urinária, 36,7% referiram alguma interferência na vida diária. É importante incluir a avaliação da IU para ampliar o manejo clínico da condição de saúde dessas pessoas.

Background. Extraperitoneal radical prostatectomy (RP) in patients with prostate cancer is useful when there are no oncological indications to lymph node dissection (e.g. in low and intermediate-low risk of the disease), and allows to perform precise anastomosis and facilitates the early postoperative period. However, even minimally invasive approach does not avoid such factors as a urinary catheter that may disturb patients.Objective. We assessed the possibility to remove the urinary catheter as early as possible.Materials and methods. 28 patients with low (n = 22) and low-intermediate (n = 6) prostate cancer risk (according to NCCN (National Comprehensive Cancer Network) criteria) underwent an extraperitoneal laparoscopic RP from March 2017 to November 2018. All operations were performed by the same surgeon (A. Nosov). The inclusion criteria were the following: localized prostate cancer, prostate specific antigen (PSA) Results. The average patient’s age was 63 years (52–71 years). The median preoperative PSA level was 7.6 ng/ml. The intraoperative technique was unremarkable with no blood transfusion or conversion. All early postoperative complications were classified as minor – grade I, II and IIIa in 2 (7.2 %), 5 (17.8 %) and 1 (3.6 %) patients, respectively. Related to the early catheter removal complications included 1 (3.6 %) patient with urinary leakage (resolved by repeated prolonged urinary catheter insertion) and 4 (14.3 %) with urinary obstruction – resolved by single catheterization (n = 2), percutaneous suprapubic cystostomy (n = 2). No major complications were noticed during the follow-up. Totally, 22 (78.6 %) patients were discharged on the next day after the catheter removal – on the 2nd postoperative day. All discharged patients did not need readmission during the follow-up. Remained 6 (21.4 %) patients stayed at the hospital for 5–18 days. The pathological investigation showed upgrading in 9 (32.1 %) patients with low risk and in 1 (3.6 %) patient with low-intermediate risk. Upstaging to locally advanced forms was noticed in 6 (21.4 %) patients. All patients had the PSA level of Conclusion. Despite the common widespread of minimally invasive RP, there is no consensus on the terms of a urinary catheter removal. According to our data, we suggested it might be of some benefit to remove a urinary catheter early in selected and well-informed patients. A thorough vesicourethral anastomosis pursuance, nerve-sparing, bladder neck sparing and Retzius sparing procedure, intraand postoperative assessment is necessary in all cases.

Presence of microbial communities (microbiota) in an organ system depends on environmental factors, such as oxygen availability. We describe a novel technique to measure bladder urine oxygen tension (BUOT) in ambulatory women and use that technique to compare BUOT values to female urinary microbiota and participant urinary signs and symptoms. Ambulatory female urogynecology patients presenting for clinical care who were willing to undergo transurethral catheterization underwent BUOT determination with a non-invasive flow-through oxygen sensor. To detect urinary microbiota in the bladder, 16S rRNA gene sequencing was performed on catheterized urine. Multivariate statistical analyses were performed to examine potential correlations among BUOT, urinary microbiota compositions and clinical variables. Significant variation in BUOT existed between individuals (range: 0.47–51.5 mmHg; median: 23.1 ± 13.5). Microbiota compositions were associated with BUOT (p = 0.03). BUOT was significantly lower in urines that were nitrite negative on dipstick analysis (p = 0.0001) and in participants who answered yes to having urinary leakage on the validated Urinary Distress Inventory (p = 0.01). BUOTs can be measured in ambulatory women. For urogynecology patients, a wide range of values exist. BUOT may be associated with the presence of urinary microbiota and resultant signs and symptoms.

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 look at best evidence and expert opinion to provide advice in the form of a consensus statement lead by Female, Neurological and Urodynamic Urology (FNUU) section of the British Association of Urological Surgeons (BAUS) in conjunction with the British Association of Urological Nurses (BAUN). Methods Initially a literature search was performed with incorporation of aspects of the existing guidance and further informed by UK best practice by core members of the group. The document then underwent reviews by the FNUU Executive Committee members, the BAUN executive committee, a separate experienced urologist and presented at the BAUS annual meeting 2020 to ensure wider feedback was incorporated in the document. Results Complications of long-term indwelling catheters include catheter-associated urinary tract infections (CAUTI), purple urine bag syndrome, catheter blockages, bladder spasms (causing pain and urinary leakage), loss of bladder capacity, urethral erosion ("catheter hypospadias")/dilatation of bladder outlet and chronic inflammation (metaplasia and cancer risk). Conclusions We have provided a list of recommendations and a troubleshooting table to help with the management of the complications of long term catheters.

Aims To investigate the feasibility and reliability of the seven-day pad test (7DPT), the correlation between 7DPT and 24-hour pad test (24HPT), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire, and the different categorization by the severity of each pad test. Pad weighting tests have been recommended in the evaluation of post-radical prostatectomy urinary incontinence severity, being considered the 24HPT gold standard. Some authors consider that the longer the testing, the better assessment. We propose a self-filled pad weight, the 7DPT. Methods A prospective study of incontinent male patients after radical prostatectomy. We carried out the study in two phases. All patients underwent urodynamic study. The first phase evaluated the feasibility and reliability of 7DPT. The second evaluated the correlation between 7DPT, 24HPT, and ICIQ-SF questionnaire in a larger sample. Results First phase: 32 patients were recruited. Test-retest reliability was excellent, with good agreement between mean 7DPT and 24HPT. The number of pads and mean 7DPT showed a good correlation. Second phase: 72 patients were screened, 51 (71%) met inclusion criteria. Mean 7DPT and 24HPT showed a strong association. Mean 7DPT and 24HPT correlated moderately with ICIQ-SF score. 7DPT and 24HPT agreement with ICIQ-SF groups was slight. As 7DPT captures better days with maximum urinary leakage, up to 12 patients would have been misclassified according to 24HPT (number need to treat for 7DPT was seven). Conclusions 7DPT is a feasible and reliable tool to evaluate post-radical prostatectomy urinary incontinence, with a strong correlation with the 24HPT and moderate with the ICIQ-SF.

Leakage from the kidney, ureter, bladder, and urethra, which mainly occur due to trauma, forms urinoma. The best tool for diagnosis of urinoma is enhanced-computed tomography with delayed imaging. Apart from injury, ureteral stone can induce urinoma, however, it is rare. Herein, we report a case with urinoma, which probably formed as a result of overdistention of renal pelvis after a large amount of fluid intake (about 3 L) in a short period of time (about an hour) in the presence of a 3mm stone in ipsilateral ureter., Highlights • Urinoma can be the result of urine leakage from kidney, bladder, and urethra trauma. • The best tool for diagnosis of urinoma is enhanced-computed tomography with delayed imaging. • Our case urinoma is caused by the presence of a 3mm stone in ipsilateral ureter.

Copyright © 2021 The Authors. Aims: Our goal was to identify which women participating in an educational workshop on incontinence were most likely to benefit from it. Methods: We included women aged 65 or older, living in the community, and not treated for incontinence despite reporting urinary leakage at least twice a week. The workshop's aims were to change beliefs about accepting incontinence as a normal part of ageing, explain that incontinence is not irreversible, and that solutions exist. We performed structured interviews at 6 and 12 months to assess impressions of improvement (PGI-I) and changes in both continence (ICIQ-FLUTS) and quality of life (I-QOL). Results: The analysis included 392 women, 39% aged 80 or older and 57% with daily urinary incontinence. Twelve months after the workshop, 16% of women were “much better” (PGI-I); factors associated with impression of improvement were refusal to believe that incontinence is part of normal ageing at baseline and improvement of urinary symptoms. The median improvement was 4 points on the ICIQ-FLUTS and 8 on the I-QOL. Factors associated with a clinically significant improvement in urinary symptoms were more severe baseline urinary incontinence, obesity, and starting Kegel exercises. Factors associated with a clinically significant improvement in quality of life were a poor urinary quality of life at baseline and an age younger than 81 years. Conclusions: A short, inexpensive and nonmedical intervention can change the mind-set and behavior of older women with incontinence who are not seeking care. A clinically significant improvement is possible even in women with severe symptoms. European Research Area on Ageing2 program; Canadian Institutes of Health Research; Fonds de la Recherche en Santé du Québe; Economic and Social Research Council (UK); Institut National de Prévention et Éducation pour la Santé (France); Agence Régionale de Santé de Poitou-Charentes (France).

Case presentation A case of a 57 years old woman came with the chief complaint of urinary incontinence since 20 years ago. After labor, she complained of urinary incontinence and left untreated. Physical examination and urethrocystoscopy revealed vaginal stone sized 90 × 70 mm and urethrovaginal fistula. We performed hysterectomy and vaginal stone removal, continued with fistula closure and vaginal repair. Up to 2 months follow up, no sign of urinary leakage and incontinence was found. Conclusion Vaginal stone is a rare Case that might be present in a case of long term urethrovaginal fistula with neglected contraceptive device.

Background The aim of this study was to demonstrate the effect of surface electrical stimulation in a seated position (SESSP), as pelvic floor muscle (PFM) training, on PFM functions (time to reach maximal pressure [TRMP], muscle strength, power and endurance), urinary leakage and quality of life in patients with stress urinary incontinence (SUI).Methods Women with SUI were randomized into an SESSP group (n = 18) or control group (n = 18). Quality of life were assessed by the Incontinence Quality of Life Questionnaire (I-QOL). Ultra-short pad test results and PFM functions were measured by perineometer. Changes in the outcomes were assessed before and 8 weeks after SESSP training.Results Thirty-three participants were included in the analysis. There were significant differences in I-QOL (avoidance and limiting behaviors, psychosocial impacts, social embarrassment and total score) in between (SESSP vs. control group) and within (pre vs. post) group analyses. Significant increases in PFM strength, power, and endurance, and significant decreases in the TRMP and pad weight, were observed between (SESSP vs. control group) and within (pre vs. post) groups.Conclusion SESSP in a seated position can be recommended to improve QOL, urinary leakage, and PFM functions in SUI patients. Trial registration Current Controlled Trials KCT0003357 (the date of registration: 2018.11.16) and retrospectively registered.

Purpose: We present a new approach for urine drainage in pediatric patients following laparoscopic pyeloplasty, the trans-uretero-cystic external urethral stent (TEUS). Methods: We retrospectively identified 85 children who underwent laparoscopic pyeloplasty from July 2015 to June 2017. The included children were assigned to group A (double-J stent) or group B (TEUS). In group A, the double-J stent was removed by a cystoscopy under anesthesia after 1 month, while in group B, the external stent was removed after 5 to 7 days. We examined the durations of operation, hospital stay and the frequency of stent-related complications including urinary leakage, stent dislocation, stent occlusion, and urinary tract infection. Results: The operation time was significantly longer for patients in group B than for those in group A. No significant difference was observed between the groups regarding stent-related complications. In group A, 4 patients need auxiliary stent re-insertion for the management of complications, 2 developed urinary tract infection, and 2 had stent occlusion. In group B, none needed auxiliary stent re-insertion for complications and avoided re-operation. Conclusions: In children, the outcome of external stent implantation was similar to that using double-J stent, and the use of the former approach may be beneficial for younger children.

Introduction: Percutaneous treatment of persistent urinary fistula after partial nephrectomy using N-butyl-2-cyanoacrylate and gelatin sponge (Spongostan®) is an effective and relatively non-invasive procedure that should be considered when a conservative approach fails. Three successful cases of percutaneous embolization by using N-butyl-2-cyanoacrylate have been reported in the literature. To our knowledge, the use of Spongostan for the treatment of urinary fistula after partial nephrectomy has not been previously described. Case report: We present the case of an 82-year old man who underwent percutaneous closure of a urinary fistula following partial nephrectomy by using gelatin sponge (Spongostan®) and N-butyl-2-cyanoacrylate.Conclusions: We encourage the use of this technique in selected cases. Collaboration amongst urologists and skilled interventional radiologist is strongly recommended.

The aim of this survey was to investigate the prevalence of stress urinary incontinence (SUI) among women (primigravida, multigravida, and nulligravida) in high-impact exercise groups&mdash, CrossFit, kickboxing, and boot camp. Incontinence Survey was modified to an anonymous online questionnaire. A total of 17 participants, 64.2% reported at least some urinary leakage during exercise. About 85.7% of participants in each of the 3 high-intensity exercise groups exercised &gt, 3 h/week. There was no significant difference in the likelihood of urinary leakage between participants who have had at least 1 pregnancy and those who had never been pregnant. CrossFit group were significantly more likely to report urinary leakage than those in the kickboxing and boot camp groups combined (p = 0.023). The participants did not exhibit typical risk factors, as they were premenopausal, active, and had an average body mass index within the normal range. This pilot survey indicates that all women those who do high-impact exercises are susceptible to stress urinary incontinence (SUI), and that CrossFit poses a greater risk for SUI in terms of more jumping resulting in increased intra-abdominal pressure and ground reaction forces compared to others. Our pilot study indicates that a higher risk of SUI during high impact exercises may exist associated with previous pregnancy but also in nulliparous women.

Six patients (mean age, 57.7 y ± 19.7) with persistent urinary fistulae underwent 7 urinary tract embolizations with AMPLATZER Vascular Plugs (AVPs) and glue: 5 with concomitant cavity obliteration with glue and 2 without. A single procedure was successful in resolving urinary leakage in 5 patients (71%) at a mean follow-up of 27.3 wk ± 31.5 (median, 9.7 wk; range, 4.9-80 wk). Repeat cavity embolization was required in 2 instances to achieve clinical success. Mean survival was 42.3 wk (median, 16.4 wk; range, 11.7-104 wk). Combined AVP and glue embolization may prove to be a primary approach in the control of persistent fistulae.

INTRODUCTION AND HYPOTHESIS: The effect of incontinence pessaries for urine incontinence (UI) has previously been described in studies from high-income countries, where they have been documented to reduce urinary leakage significantly. However, there is a profound literature gap in these data in low- and middle-income countries. This study, therefore, aims to describe the acceptance, impact and complications of pessary treatment among Tanzanian women diagnosed with stress UI.METHODS: Women who reported stress UI underwent a stress test, and if positive they were offered an incontinence pessary. Swahili versions of the Urinary Distress Inventory-6 (UDI-6) and the Urinary Impact Questionnaire (UIQ) were administered at 3- and 12-18-month follow-ups in addition to questions regarding pessary acceptance and pelvic examination for complications.RESULTS: A total of 48 women were fitted with an incontinence pessary. The frequency and amount of leakage were reduced significantly at 3- and 12-18-month follow-up. Additionally, a significant reduction in the overall UDI-6 score from 29.2 to 25.0 and overall UIQ score from 52.1 to 25.0 was observed from baseline to 3-month follow-up. Thirty-seven per cent of the women reported vaginal discharge at 12-18 months while signs of infection were found in 11.5%. In all, 32/48 (67%) wanted to continue the pessary treatment at 12-18-month follow-up.CONCLUSIONS: In the setting studied, pessaries for stress UI can be successfully fitted in most women with considerable acceptance and satisfaction rates and minimal complications.

INTRODUCTION AND OBJECTIVE:Persistent urinary leakage from the stoma after undergoing an Indiana pouch formation is reported to occur in 5% of patients and is a complication that can adversely affe...

Stress urinary incontinence (SUI), which is defined as an involuntary loss of urine upon physical exertion coughing, sneezing or laughing, has a significant negative impact on the quality of life of many women. Multi-center, large-scale and randomized clinical trials have illustrated that non-invasive electroacupuncture is an effective treatment for SUI, but its therapeutic mechanism in treating SUI remains unknown. Here, gas chromatography-mass spectrometry based serum metabolomics was performed to reveal metabolic profiles and diagnostic biomarkers from recruitment of 25 patients and 25 healthy women before and after electroacupuncture. We identified 10 differentially abundant metabolites, including butantriol, 3,4-dihydroxybutanoic acid, succinic acid, 1-deoxypentitol, psicose, citric acid, 3-hydroxybutyric acid, hydracrylic acid, 3-hydroxyphenylacetic acid and D-mannitol, from patients between before and after electroacupuncture. The electroacupuncture therapy altered propanoate metabolism, butanoate metabolism and the tricarboxylic acid cycle. A panel of 8 biomarkers (butantriol, 3,4-dihydroxybutanoic acid, succinic acid, 1-deoxypentitol, psicose, citric acid, 3-hydroxybutyric acid and hydracrylic acid) was evaluated to determine the effect of electroacupuncture on SUI and differentiated well between before and after treatment. The area under the receiver operating characteristic curve was 0.962. The sensitivity, specificity and coincidence rate were 92 %, 92 % and 96 %, respectively, at a 95 % confidence interval ranging from 0.9053 to 1. Furthermore, the levels of these diagnostic biomarkers were not significantly altered in healthy subjects after sham electroacupuncture. It was indicated that an 8-biomarker panel might be constructed for the therapeutic evaluation of electroacupuncture treatment for SUI.

Male stress urinary incontinence (SUI) is most commonly a consequence of prostatic surgery except when symptoms are driven by a neurological concomitant condition. Hence, compared to what urologists know about current clinical practice in female SUI, the diagnostic phase in men is a very particular and important step in the management of the disease, with accurate evaluation of the clinical context, SUI cause, quality of life assessment, and patient complaints [1, 2]. Improvements in urinary leakage after prostatic surgery (RP and TURP) may occur spontaneously or with conservative measures within the first 12 months after surgery. However, management of persistent incontinence is often challenging and may be frustrating for both a patient and his doctor, and as a consequence, it can negatively affect patients’ quality of life and doctor–patient relationship [3]. Urinary incontinence causes problems, such as poor hygiene and loss of self-confidence that directly affect the quality of life of patients. The mechanism for male SUI after prostate surgery appears to be internal sphincter deficiency. The probable mechanism for internal sphincter deficiency after prostate surgery includes rhabdo-sphincter injury during apical dissection, large and deep sutures during vesico-urethral anastomosis, or injury of the neurovascular bundles [3].

Duplex kidney is a congenital anomaly of urinary system with incidence rate of 0.8% [1]. Some patients with duplex kidney are asymptomatic, they can be followed up without active intervention. Heminephrectomy is one the recommended treatment for patients presenting with recurrent urinary tract infection or urinary incontinence [2]. After the first laparoscopic heminephrectomy was reported by Jordan et al. in 1993 [3], this surgery had been widely performed through either transperitoneal or retroperitoneal approach to treat duplex kidney [4, 5]. We prefer the retroperitoneal approach to avoid manipulation with intraperitoneal organs. In view of high risk of urinary leakage from heminephrectomy, we have modified heminephrectomy by excision of urothelium from upper moiety remnant and closure of upper moiety remnant. In our experience, this technique effectively prevents the postoperative urinary leakage.

Introduction Describing the surgical and oncological outcome of bladder-preserving ureter reconstruction (BPUR) with segmental ureteral resection after major gynecologic surgery. Matherials and methods Patients with BPUR admitted at a single institution between March 2012 and July 2018 were retrospectively analyzed. Surgical and oncological data were assessed. Results Forty-six women with gynecologic tumors involving the ureter were treated with BPUR. R0 resection was achieved in 40/46 patients (86.9%), while pathologic margins were microscopically positive in 6 women (13.1%). Overall, 12 women (26.0%) received radiotherapy before surgery: among them, 8 patients received neoadjuvant chemoradiotherapy. Twenty-six women underwent BPUR during primary surgery, whereas 20 (43.4%) required BPUR upon recurrence. Twenty-six patients (56.2%) were found to have hydronephrosis at pre-operative workup. The psoas bladder hitch was the most common procedure performed for urinary reconstruction (63%) with respect to direct reimplantation (37%). Fourteen patients (14/46 = 30.4%) experienced urological complications. Urinary leakage occurred in 9 patients (19.5%), specifically: 5 uretero-vaginal fistula, 3 uroperitoneum, 1 uretero-enteral fistula. There were 3 cases (6.5%) of hydronephrosis at the side of ureteroneocystostomy and 2 cases (4.3%) of unilateral renal impairment requiring nephrectomy. At multivariate analysis only pre-operative radiotherapy (p = 0.047) and a history of pelvic irradiation (p = 0.025) were independently associated with an increased risk of developing severe urinary complications. Conclusions BPUR is feasible in gynecologic cancer with invasion of the urinary tract. However, since a slight increase of post-operative urological complications was observed in the previously irradiated fields, a personalized surgical planning is recommended for these women in the next future.

Only a small proportion of children with urinary tract malformations are incontinent, but it is important to identify those children for whom surgical treatment can eliminate or reduce urinary leakage.

Urinary incontinence (UI) and pelvic organ prolapse are common conditions with a profound impact upon the quality of life. Observational and experimental data demonstrate that obesity is associated with higher abdominal pressure that predisposes to stress incontinence. Large epidemiological studies have shown that obesity carries an approximately twofold increased risk of UI, both stress incontinence and overactive bladder symptoms (urgency, frequency, and urge incontinence). Fecal incontinence and prolapse symptoms are subject to similar increased risk in the obese woman. Weight loss has a profound effect upon urinary, anal, and prolapse symptoms: achieving a target weight loss of 5%–10% of baseline body weight is associated with 30%–70% cure of urinary leakage, around 65% improvement of anal symptoms, and 75% resolution of prolapse symptoms. Weight loss should be recommended as first-line intervention for obese incontinent women. Surgery for incontinence carries a slightly lower cure rate in obese women but no higher risk of complications. Data on prolapse cure are not available.

Introduction The aim of this review was to assess the prevalence of gastrointestinal (GI) and lower urinary tract symptoms (LUTS) in sportswomen having high intensity training and to determine whether the type of sport might also affect LUTS and GI symptoms. Evidence acquisition A systematic review of the literature was performed by searching PubMed, CINAHL, Cochrane Library and Web of Science up to November 2018. The search strategy included several keywords concerning pelvic floor disorders, urinary dysfunction, bowel dysfunction, sportswomen, and elite sports. Inclusion criteria were studies of women who performed any kind of sport with a prevalence of LUTS and/or bowel symptoms without any restriction for age, sport modality or frequency of training. Outcomes were prevalence of LUTS and GI symptoms and meta-analyses and moderator analyses to identify risk factors for the occurrence of these symptoms in female athletes. Evidence synthesis During the search, 1263 records were screened, 31 of which met the methodological criteria for qualitative analysis and 5 for meta-analysis. Sportswomen during daily activity showed a threefold higher risk to develop urinary incontinence (UI) than controls (OR 3.13; 95% CI: 2.39-4.00). No differences were found stratifying data for UI types. Cumulative prevalence rates were: 58.7% of all kinds of UI (daily life together with sport time), 32.8% at rest (during daily life out of sport time), 36.3% during sport time; 23% of stress urinary incontinence (SUI) during sport time versus 38.6% at rest; 11% of urge urinary incontinence (UUI) during sport time versus 17.8% at rest; 11.9% of mixed urinary incontinence (MUI) during sport time versus 20.7% at rest. Prevalence rates of GI symptoms before sport time were 57.6%, during sport competition 35.2% and 58.2% after competition. Conclusions All the analyzed studies showed bias. This meta-analysis indicated that competitive sport activities represent a risk factor for urinary incontinence and gastrointestinal disorders. To prevent urinary leakage athletes should be instructed to strengthen the pelvic floor muscles.