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Objective: To compare ultrasonographic patterns of 2-dimensional perineal ultrasonography in men in the preoperative and postoperative periods after transobturator sling deployment for the treatment of urinary incontinence after radical prostatectomy. Radiotherapy and radical prostatectomy are the primary treatments for localized prostate cancer. Studies comparing anatomic changes in men before and after radical prostatectomy based on perineal ultrasonography are scarce in the literature., Methods: Thirty-one patients from 2 centers were selected for examination and surgery. They were allocated into mild and/or moderate and severe incontinence groups who underwent the transobturator sling procedure between August 2014 and August 2018. Perineal ultrasonography was performed in the preoperative period for 21 of these patients and 3-6 months postoperatively after the transobturator sling procedure for 30 patients. Hypermobility of the proximal urethra and voluntary contraction of the pelvic floor were evaluated during the Valsalva maneuver, perineal contraction and at rest., Results: Clinical improvements of >50% were significantly more frequent in the mild and/or moderate vs severe incontinence group after male sling surgery (P = .035). Patients who demonstrated clinical improvement >50% showed a significantly greater displacement of the posterior portion of the bladder neck during contraction than those with clinical improvement <50% (P = .024)., Conclusion: The most important finding of this study was the significant difference in the posterior displacement of the bladder neck during contraction in patients who showed an improvement >50% compared with those with an improvement <50%. These data support the use of perineal ultrasonography in evaluating and selecting patients for the male sling procedure., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: Urinary incontinence remains a major concern for patients undergoing radical prostatectomy. Its prevalence can reach 20% in the late postoperative period., Materials and Methods: This clinical study investigated the differences of a dynamic evaluation of the urethra and pelvic floor contraction using perineal ultrasound in men without prostate surgery and in men submitted to radical prostatectomy with and without stress urinary incontinence. Ninety two male patients were included, which 70% of them underwent radical prostatectomy (RP) for more than one year. Thirty one men with clinically post prostatectomy incontinence were compared by two-dimensional (2D) perineal ultrasound to 34 patients without post prostatectomy incontinence and to 27 men without surgery in two centers in Brazil., Results: Our results showed that the continent group presented the urethral angle at rest significantly lower than the prostate group (p = 0.0002). We also observed that the incontinent group showed the displacement of the anterior bladder neck during contraction significantly lower than the continent group (p = 0.008)., Conclusions: We found that the continent group presented the urethral angle at rest significantly lower than the prostate group. The incontinent group also showed the anterior bladder neck displacement during contraction significantly lower than the continent group. It was more evident when the severe incontinent group and the continent group were compared.

Objectives: In this study, we present safety and efficacy data for a surgical alternative for the treatment of postprostate surgery urinary incontinence, based on the use of the periurethral constrictor, a two-part device--constrictor cuff and self-sealing valve with a tube--activated by injection of saline solution., Methods: From May 2001 to October 2007, 30 patients with postprostate surgery urinary incontinence were submitted to implantation of the periurethral constrictor., Results: The mean follow-up was 42.1 months (range, 13-72). Twenty-two (73.3%) of the patients had functional devices and were socially continent. Among them, 20 patients voided spontaneously, whereas two performed intermittent catheterization. Revisions to exchange leaking valves were necessary in 4 cases, and since then these patients have been socially continent. In this series, with the exception of 4 cases of erosion, 3 cases of infection that required complete removal of the devices, and 1 case of detrusor hyper-reflexia, there were no other major complications., Conclusion: The results of this retrospective study suggest that the implantation of the periurethral constrictor appears to be safe and effective as an alternative to the treatment of postprostate surgery urinary incontinence., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Introduction: Radical prostatectomy is the gold standard treatment for localized prostate cancer, and videolaparoscopic prostatectomy represents a new leap forward. However, the latter approach adds great technical complexity and entails a long and very slow learning curve that can be successfully completed by only a small number of highly skilled surgeons. These factors have significantly hampered a more widespread uptake of this technique. Robotic-assisted laparoscopic surgery democratized laparoscopic radical prostatectomy by allowing many surgeons, even the least experienced ones, to perform this procedure with the same expertise as experienced surgeons. Nevertheless, the high cost of this technology greatly limits its more widespread use, especially in countries in the global south. Methodology: In 2015, a discussion began on the possibility of using some concepts from laparoscopic prostatectomy to improve open prostatectomy. Based on a study of the various techniques performed using the open, laparoscopic and robotic route, we developed an innovative technique to reproduce robotic prostatectomy openly, without recourse to any new special instruments or materials. This technique is called "Open Anterograde Anatomic Radical Retropubic Prostatectomy" (AORP). Results: AORP was superior to Open Radical Prostatectomy in critical parameters: a median estimated blood loss of 300mL versus 500mL (p=0.0003); more rapid urethrovesical anastomosis, at 20min versus 25min (p=0.005); shorter duration of indwelling vesical catheterization, at 7 versus 14 days; increased surgeon perception of nerve-sparing, at 101 (87.8%) versus 71 (67.6%) (p=0.0009); increased early urinary continence, at 70 (60.9%) versus 45 (42.0%); fewer complications (p=0.007) and equivalent oncological control. Discussion: We understand that the gains of robotic surgery depend not only on the introduction of technology but also on improvements in the technique of dissection, preservation and reconstruction that can be reproduced in open surgery, thus enabling similar operations with improved procedures but without access to robotic technology. [ABSTRACT FROM AUTHOR]

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Copyright of Fisioterapia Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To evaluate lower urinary tract dysfunction (LUTD) based on questionnaire symptom scoring and ultrasound assessment of bladder wall thickness (BWT) in children with cerebral palsy (CP). Methods: A total of 97 children with CP were enrolled in the study. The patients were either symptomatic or asymptomatic with respect to lower urinary tract symptoms. All children underwent a urinary questionnaire and renal ultrasonography. Ultrasound assessment of BWT was completed in 72 cases. Results: A total of 47 patients were female and 50 were male. The mean age was 8 years 8 months (SD 3 years 1 month), with a range of 5-18 years. Urinary incontinence was present in 43 patients (44.3%). Based on the questionnaire, LUTD was found in 59 patients (60.8%). The mean BWT was 2.30 mm. There was no statistically significant difference between continent and incontinent children (2.46 vs 2.19 mm) or between children with and without LUTD (2.43 vs 2.12 mm). Conclusions: LUTD is common in children with CP and occurred in 60.8% of the patients assessed. BWT did not correlate with the presence of bladder dysfunction or incontinence. Ultrasound assessment of BWT was not relevant for diagnosis of lower urinary tract dysfunction. [ABSTRACT FROM AUTHOR]