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Context: Excision of urethral diverticulum in females has been reported to be associated with new onset urodynamic stress urinary incontinence (USUI) in up to 49%. Aims: We have assessed the incidence of new onset USUI in all patients having urethral diverticulum excision with Martius fat pad interposition under the care of a single surgeon between May 1, 2007, and December 1, 2011. The incidence of new onset USUI has been correlated with the preoperative magnetic resonance imaging (MRI) appearance of the urethral diverticulum. Patients and Methods: All 33 patients (mean age 42) having urethral diverticulum with Martius fat pad interposition had prospective data tabulated on demographics, preoperative MRI appearance, and pre- and post-operative videocystometrogram. Statistical Analysis Used: Statistical analysis was performed by Chi-squared and Fisher's exact. Results: Of the 33 patients, 10 (30%) had preoperative USUI and have been excluded from this study. Other preoperative urodynamic findings included idiopathic detrusor overactivity in ten (30%) and bladder outflow obstruction in five (16%). Two (10%) of the patients had a simple diverticulum, 16 (73%) had a horseshoe diverticulum, and 5 (17%) had a circumferential diverticulum. The rate of new onset USUI was 0% for simple, 6% for saddle, and 20% for circumferential. Conclusions: New onset USUI occurs in 9% of patients having excision of urethral diverticulum with Martius fat pad interposition. The incidence appears to increase with increasing complexity of urethral diverticulum on preoperative MRI – rising from 0% following simple urethral diverticulum excision to 20% following circumferential diverticulum excision.

Introduction: There is a multiplicity of treatments currently available for patients with symptomatic refractory urodynamic idiopathic detrusor overactivity (SRU IDO). We have assessed patient treatment preferences and their outcomes over a 12-month period from January 1 2009 to December 31 2009. Patients and Methods: A retrospective database of all patients with SRU IDO was reviewed for patient demographics, treatment preference, and outcome. All patients attending for treatment in the time period were offered: no further treatment, repeat bladder training ± antimuscarinic (BT ± AM), acupuncture, intravesical botulinum toxin injection, sacral neuromodulation (SNM), clam cystoplasty ± Mitrofanoff channel formation, and ileal conduit. Statistical Analysis Used: Statistical analysis of outcomes was done by Chi–square test, and statistical significance was determined as P< 0.05. Results: A total of 217 patients with SRU IDO underwent primary treatment in this time period, with a median age of 56 years and follow-up for a minimum of 12 months' posttreatment to determine outcome. No patients opted for any further treatment or an ileal conduit. The majority of patients opted for intravesical botulinum toxin injections and SNM with similar success rates (approximately 70%). A small number of patients decided to have nonsurgical interventions (BT ± AM or acupuncture) and had a broadly similar success rate (50%). A minority opted for clam cystoplasty ± Mitrofanoff channel formation – this group reported the highest success rate at 86%. Conclusions: Treatment options in SRU IDO are diverse, with the majority of patients opting for minimally invasive surgery. Clinicians should be familiar with all treatment options for management of SRU IDO.

INTRODUCTION AND OBJECTIVES: Sacral neuromodulation (SNM) is an effective treatment modality for medically refractory overactive bladder (OAB). Standard selection criteria are based on frequency-volume charts, pad weight (objective) assessments, and patient reported (subjective) outcomes. Little is reported of the utility of urodynamic study in selecting patients for SNM therapy. We assessed whether the urodynamic parameters during filling cystometry correlated with successful outcome from first stage SNM testing. METHODS: All OAB patients were screened prior to first stage testing with urodynamics to confirm (idiopathic) detrusor overactivity (IDO). The mean voided volumes, peak amplitude of IDO contraction, compliance and end fill pressure was recorded. Primary outcomes were assessed using frequency-volume charts, pad testing and ICIQ/EQ5D questionnaires. Success was considered if patients achieved >50% improvement in urinary symptoms. Conversion to a permanent SNM implant was undertaken according to response. The predictive value of the four parameters was assessed using binary logistic regression analysis. RESULTS: 177 consecutive IDO patients had first stage SNM evaluation between 2010 and 2013. The mean voided volume for patients with successful response was 184 (147-223) mls and for those with failed response 171 (128-214) mls, peak DO pressure was 41.0 (29-52) cmH20 compared to 40 (28-52) cmH20, compliance pressure 12 (7-16) cmH20 compared to 49 (3-95) cmH20, and end fill pressure 25 (19-30) cmH20 compared to 24 (14-33) cmH20. Logistic regression analysis did not demonstrate any significant relationship between peak detrusor pressure and outcome (B 1⁄4 -0.005, 0.001, 0.026, 0.016 respectively) (Figure 1). Figure 1: Box plots representing the distribution of mean void volume, peak DO, compliance and end-fill pressures with first stage SNM testing. Box borders illustrate the upper, median and lower quartiles; whiskers depict the 99% interval. Extreme (star) and mild (circle) outliers are also shown. CONCLUSIONS: There was no correlation between any urodynamic parameter and successful SNM outcome. SNM is an option for all IDO patients, regardless of their dynamic bladder function on filling cystometry.

Objective To review pelvic fracture urethral injuries in women, generally regarded as rare and thus discussed infrequently. Patients and methods Twelve patients (age range 7–51 years) with such injuries were reviewed; most had associated injuries, generally more severe than seen in males with urethral injuries. Results Patients with milder injuries, perhaps damaging just the innervation of the urethra, presented with incontinence; more severe injuries seemed to cause a longitudinal tear in the urethra but again patients presented mainly with incontinence problems. The most severe injuries were associated with complete rupture of the urethra and a distraction defect suggesting an avulsion injury. These problems were difficult to treat both reconstructively and in providing continence. Conclusions Pelvic fracture urethral injuries occur in females, but less often than in males. The female urethra seems relatively resistant to injury; differing degrees of severity of pelvic trauma cause different types of urethral injury but in general, a more severe injury is needed to damage it than is necessary in males.

Objective To assess the use of unenhanced spiral computed tomography (CT) as the primary investigation of choice for suspected acute renal colic in clinical urological practice. Patients and Methods Between 1 August 1997 and 31 July 1998, all patients attending a hospital accident and emergency department with acute loin pain suggestive of renal colic underwent a physical examination, urine analysis, plain abdominal radiography (if clinically indicated) and unenhanced spiral CT. The effective radiation dose and financial cost of unenhanced spiral CT and standard three-film emergency intravenous urography (IVU) were calculated. Results In all, 116 patients were assessed, 63 of whom had calculi and related secondary phenomena of obstruction identified on unenhanced spiral CT. There were two false-positive and one false-negative result. An alternative urinary tract diagnosis was made in four patients, including two with renal cell carcinoma and one ureteric transitional cell carcinoma. Causes other than in the urinary tract were diagnosed in three patients, i.e. two with ovarian cyst and one with sigmoid diverticulitis. The effective radiation dose of unenhanced spiral CT was 4.7 mSv and that for three-film IVU was 1.5 mSv. The costs of both IVU and unenhanced spiral CT were identical. Conclusions Unenhanced spiral CT allows a rapid, contrast-medium-free, anatomically accurate diagnosis of urinary tract calculi and in the present series had a sensitivity of 98% and a specificity of 97%. CT provided an alternative diagnosis in 6% of patients. These advantages must be weighed against the threefold greater radiation dose of unenhanced spiral CT than with three-film IVU, and in practice the requirement for a radiologist to interpret routine axial scans.

Objective To establish the presence or absence of any diurnal or long-term variation in N-nitrosamine levels (which might be important in the development of cancer in enterocystoplasties) in enterocystoplasty urine, and to assess other factors that might alter enterocystoplasty N-nitrosamine levels. Patients, subjects and methods Thirty-six patients with enterocystoplasties and six normal controls were assessed. Urine samples were collected every 4 h over a 24-h period and N-nitrosamine levels determined using a modification of the Pignatelli method. An additional urine sample was assessed by microscopy, culture and sensitivity. In a subgroup of 16 patients with an enterocystoplasty, the urinary N-nitrosamine levels were re-measured at 3-monthly intervals. Results No diurnal or long-term variation in urinary N-nitrosamine levels was identified. The mean N-nitrosamine levels were significantly higher in the cystoplasty group than in the controls (1.7 vs 1.0 µmol/L; P = 0.008). Mean N-nitrosamine levels were also significantly higher in enterocystoplasty patients with sterile pyuria than in those with no pyuria (P = 0.01). Those taking prophylactic antibiotics had significantly lower mean N-nitrosamine levels than those not doing so (P = 0.05). Individuals with infected urine and those needing to intermittently catheterize had higher N-nitrosamine levels than their counterparts, but this difference was not significant. Conclusion There were no diurnal or long-term variations in urinary N-nitrosamine levels. Levels were consistently higher in patients with inflamed or infected cystoplasties, those using intermittent self-catheterization and those not taking antibiotic prophylaxis.

Purpose: We reviewed the outcome of artificial urinary sphincters inserted more than 10 years ago.Materials and Methods: We analyzed the records of 100 patients and mailed a questionnaire to those without recent followup.Results: Overall 84 patients were continent, including 36 with the original artificial urinary sphincter in place who were dry at a median followup of 11 years and 27 in whom the device was successfully replaced due to mechanical failure who were previously continent for a median of 7 years. In 21 patients it was removed due to infection or erosion and reimplantation was successful 3 to 6 months later or they remained dry without another artificial urinary sphincter. Of the male patients with a bulbar and bladder neck sphincter 92% and 84%, respectively, were continent at 10 years as well as 73% of the females. Device survival was 66% at 10 years. Overall 37% of the prostheses were removed due to infection or erosion in the 10-year period with the highest risk in females (56%) and lowest ...

This paper describes the anatomy of the kidney and ureter. It begins with the embryological development and the mechanism for some congenital anomalies. The microscopic anatomy is described; as well as the gross anatomy of the kidneys, ureters and suprarenal (adrenal) glands including anatomical relations, arterial supply and venous and lymphatic drainage. Nerve supply and pain are also discussed.

Objectifs L’utilisation de l’agoniste des recepteurs s3 adrenergiques mirabegron chez les patients neurologiques ayant une hyperactivite vesicale a fait l’objet de peu d’etudes. Ces etudes ont rapporte son efficacite dans la reduction des symptomes d’hyperactivite vesicale. Cependant, le retentissement sur la qualite de vie des patients n’a jamais ete evalue. Notre objectif etait d’evaluer l’effet sur la qualite de vie du mirabegron chez les patients neurologiques. Methodes Dans une etude prospective, les patients neurologiques ayant une hyperactivite vesicale refractaires aux anticholinergiques (echec, intolerance ou contre-indication) ont ete identifies. Tous les patients souhaitant un traitement medical alternatif ont ete traites par mirabegron 50 mg/jour en monotherapie. L’analyse des resultats du questionnaire ICIQ-OAB administre avant le traitement, 4 semaines apres et au terme du suivi a ete realisee (test de Student, seuil de significativite p Resultats Au total, 29 patients (13 hommes, 16 femmes), d’âge median 54 ans (IQR 48-61) ont ete inclus : 21 sclerose en plaques, 2 blesses medullaires, 1 spina bifida, 1 maladie de Parkinson, 2 hypoxie neonatale, 1 tumeur cerebrale, 1 hematome sous dural. La duree mediane d’evolution de la maladie neurologique etait de 9 ans (IQR 3,7–22,2). Vingt-six patients avaient une miction spontanee par les voies naturelles et 3 pratiquaient les auto-sondages intermittents. Seize patients avaient une hyperactivite detrusorienne. La Fig. 1 montre le devenir des patients. Seul le score global de l’ICIQ-OAB etait significativement ameliore apres 4 semaines de traitement ( Tableau 1 ). Cependant, seulement 7 patients ont poursuivi le mirabegron au-dela et avec une amelioration significative du score global de l’ICIQ-OAB au terme du suivi median de 12 mois (IQR 3,5–8) ( Tableau 2 ). Conclusion Le mirabegron ameliore le score global de qualite de vie specifique urologique des patients neurologiques. Cependant, cette amelioration est insuffisante pour que les patients poursuivent le traitement a long terme. Une etude randomisee controlee evaluant specifiquement la qualite de vie est necessaire.

Aggressive angiomyxoma is a rare mesenchymal tumour predominantly affecting the female pelvis and perineum but has also been described in males. This tumour can often present a diagnostic challenge and has a propensity for local recurrence after surgical excision. We present an unusual case of aggressive angiomyxoma arising from the bladder of a female patient which required local excision and Mitrofanoff formation.

had yet requested re-tx in cycles 4 and 5 for an accurate estimate). Large improvements from BL in HRQOL that exceeded the minimally important difference were seen following each onabotA tx. The most common AE in each tx cycle was uncomplicated urinary tract infection (26.9, 24.2, 24.5, 20.4, and 14.9%). The proportion of pts requiring CIC due to elevated PVR was 4.6, 4.1, 4.7, 5.3, and 2.1% in onabotA 100U cycles 1 through 5. No change in the AE profile was observed. CONCLUSIONS: Repeated onabotA tx in OAB pts with UI inadequately managed with ACHs showed sustained improvements in OAB symptoms, pt perception of improvement in their condition, and HRQOL. A consistent safety profile was also seen, with no new safety signals.

INTRODUCTION AND OBJECTIVES: Excision of urethral diverticulum in females is associated with new onset urodynamic stress urinary incontinence (USUI) in up to 65%. We have assessed the incidence of new onset USUI in all patients having urethral diverticulum excision with Martius fat pad interposition under the care of a single surgeon between 1/5/2007 and 1/9/2012 and correlated this with the pre-operative MRI appearance of the urethral diverticulum. METHODS: 39 patients of median age 43, having urethral diverticulum with Martius fat pad interposition had prospective data tabulated on: demographics, pre-operative MRI appearance and pre and post-operative VCMG. RESULTS: Of these 39 patients, 12 (31%) had pre-operative USUI and are not included in this study. Other pre-operative urodynamic findings included IDO in 9 (23 %) and BOO in 17 (44%). The details regarding the incidence of new onset USUI in the remaining 27 patients are as tabulated. CONCLUSIONS: New onset USUI occurs in 11% of patients having excision of urethral diverticulum with Martius fat pad interposition. The incidence appears to increase with increasing complexity of urethral diverticulum on pre-operative MRI rising from 0% following simple urethral diverticulum excision to 22% following circumferential diverticulum excision.

We developed an algorithm for the management of urethral stricture based on cost-effectiveness.United Kingdom medical and hospital costs associated with the current management of urethral stricture were calculated using private medical insurance schedules of reimbursement and clean intermittent self-catheterization supply costs. These costs were applied to 126 new patients treated endoscopically for urethral stricture in a general urological setting between January 1, 1991 and December 31, 1999. Treatment failure was defined as recurrent symptomatic stricture requiring further operative intervention following initial intervention. Mean followup available was 25 months (range 1 to 132).The costs were urethrotomy/urethral dilation 2,250.00 pounds sterling (3,375.00 dollars, ratio 1.00), simple 1-stage urethroplasty 5,015.00 pounds sterling (7,522.50 dollars, ratio 2.23), complex 1-stage urethroplasty 5,335.00 pounds sterling (8,002.50 dollars, ratio 2.37) and 2-stage urethroplasty 10,370 pounds sterling (15,555.00 dollars, ratio 4.61). Of the 126 patients assessed 60 (47.6%) required more than 1 endoscopic retreatments (mean 3.13 each), 50 performed biweekly clean intermittent self-catheterization and 7 underwent urethroplasty during followup. The total cost per patient for all 126 patients for stricture treatment during followup was 6,113 pounds sterling (9,170 dollars). This cost was calculated by multiplying procedure cost by the number of procedures performed. A strategy of urethrotomy or urethral dilation as first line treatment, followed by urethroplasty for recurrence yielded a total cost per patient of 5,866 pounds sterling (8,799 dollars).A strategy of initial urethrotomy or urethral dilation followed by urethroplasty in patients with recurrent stricture proves to be the most cost-effective strategy. This financially based strategy concurs with evidence based best practice for urethral stricture management.

Purpose: We update our long-term data on the effectiveness of urethroplasty.Materials and Methods: A total of 166 patients operated on before 1990 are currently under followup or lived at least 10 years after surgery. Anastomotic urethroplasty was performed in 82 patients and substitution urethroplasty in 84.Results: The 5, 10 and 15-year re-stricture rates after anastomotic urethroplasty were 12%, 13% and 14%, respectively, and the complication rate was 7%. The 5, 10 and 15-year re-stricture rates after substitution urethroplasty were 21%, 31% and 58%, respectively, and the complication rate was 33%.Conclusions: The results of anastomotic urethroplasty are good and sustained in the long term, while the results of substitution urethroplasty deteriorate steadily with time and there is definite room for improvement. An anastomotic repair should be performed in preference to a substitution repair when possible.

A high power 805 nm diode laser with advantages of compact size, portability and ease of installation and use has recently been introduced. This unit has comparable laser-tissue interactions to the Nd-YAG in contact mode, however the maximum power output of 25 W has limited its clinical applications. We have compared 805 nm with 1064 nm laser energy in noncontact mode before and after the addition of a chromophore (intravenous indocyanine green). There is equivalency of laser-tissue interactions of 805 and 1064 nm in non-contact mode up to a maximum power output of 20 W. Laser-tissue interactions of the 805 nm laser are significantly potentiated by indocyanine green, as shown by a significant increase in diameter of tissue thermal injury. The 805 nm diode may therefore provide an alternative to the 1064 nm laser in non-contact as well as contact mode.

Urological practice includes several chronic conditions, which greatly impact patients’ lifestyles. For those patients who are disappointed by conventional medical treatments, or for those who just wishto optimize or contribute to their own healthcare, numerous alternative therapies are available. Many are ineffective, some are promising, but as yet, very few have sufficient clinical evidence to justify widespread adoption. Evidence-based medicine will help discriminate between therapies, so appropriately and carefully designed trials of each treatment should be welcomed by all practitioners. A variety of alternative medical therapies are discussed in this chapter, primarily concentrating on their use in benign and malignant conditions of the prostate.

OBJECTIVE To review the outcomes of all patients referred with vesico-vaginal (V VF) and urethro-vaginal (UVF) fistulae to a tertiary centre, and to investigate the patient, fistula and surgical factors relevant to success. PATIENTS AND METHODS We reviewed retrospectively the case-notes of 41 consecutive patients (32 with V VF; nine with UVF) treated between January 2000 and January 2006. RESULTS All patients were tertiary referrals, eight after failed local repairs. Four patients were unsalvageable and had a supravesical diversion. In all there were 47 repairs (23 transvaginal; 24 transabdominal) on 37 patients by two specialist surgeons. The fistula was closed in 92%; five V VF and one UVF required a second procedure, and one V VF a third procedure. One patient with a V VF awaits a second attempt at repair. In one V VF (one attempt) and one UVF (three attempts) the procedure failed and the patient had a diversion. A transvaginal approach cured all 11 patients with a V VF and eight of nine with a UVF, whilst an abdominal approach used for larger/complex fistulae was successful in 18 of 24 (75%) attempts (P = 0.13). The major determinants of success were fistula size (>3 cm; P = 0.02) and the availability of tissue for interposition. V VF repairs using Martius/omental interposition were mostly successful, whilst abdominal repairs in which omentum was unavailable tended to fail (37.5% cure; P = 0.002). CONCLUSIONS Despite varied aetiology, V VF/UVF were repaired successfully in 92% of patients. Complex (V VF) fistulae were challenging and a quarter of these required more than one attempt. Failure of repair was more likely in larger fistulae (>3 cm) requiring an abdominal approach, if omental interposition was not possible. Good-quality tissue interposition for complex fistula is essential for a successful outcome.

Resumen Introduccion Difundir el concepto de un nuevo esfinter urinario artificial con oclusion condicional para el tratamiento de la incontinencia urinaria de esfuerzo. El prototipo fue concebido y disenado por los profesores Craggs M. y Mundy A.R. en el Instituto de Urologia y Nefrologia de Londres. Materiales y Metodos El esfinter FlowSecure es un prototipo de una sola pieza de silicona llena de suero salino que consta de: 1) Un reservorio regulador de presion, 2) un reservorio de asistencia al estres, 3) una bomba de control con un puerto autosellable y 4) un manguito. El reservorio regulador determina la presion de la protesis y se puede ajustar desde 0 a 80 cm H2O mediante la inyeccion o extraccion de liquido a traves del puerto autosellable (oclusion basal). El reservorio de asistencia al estres transmite de forma reversible los aumentos de la presion intra-abdominal durante los periodos de esfuerzo (oclusion condicional). Resultados La tecnica quirurgica de implantacion es simple, reduciendo la posibilidad de infeccion y errores de ensamblaje. La asociacion en serie de un reservorio regulador de presion con un reservorio de asistencia al estres permite establecer presiones de oclusion basal bajas y el aumento condicional de la misma durante los periodos de estres, reduciendo el riesgo de atrofia y erosion. Tras la implantacion, la presion es ajustable dependiendo de las necesidades clinicas del paciente. Discusion El esfinter FlowSecure esta disenado para corregir la incontinencia ajustando la presion de oclusion segun las necesidades individuales de cada paciente, asi como para reducir las complicaciones asociadas al exceso de presion de oclusion y los fallos mecanicos.

OBJECTIVE To quantify experience of pelvic fracture-related urethral trauma (PFUT), a condition not often encountered and managed by urologists. METHODS The consultant urologists of the UK and Ireland were contacted informally to establish their experience with PFUT and its management, both immediate and delayed. In addition, particular individuals thought to have a specific interest in PFUT were targeted for more data. RESULTS The overall response rate was 49% (235 responders), representing 78% of urological departments, including all the targeted individuals. Of the responders, 129 (55%) had never seen PFUT in 1-25 years of consultant practice. Only four urologists (2% of responders) saw three or more cases a year. Another four (2%) saw one or two cases per year and the remaining 98 (41%) saw PFUT less frequently. Acutely, 69% of urologists who treated PFUT did so by placing a urethral catheter. Subsequent strictures were treated endoscopically for as long as this was possible. The other 31% inserted a suprapubic catheter and referred the patient for reconstructive surgery if needed. Those who used urethroplasty for strictures after PFUT were identified and targeted; half used urethral mobilization and spatulated anastomosis alone. Only three surgeons performed more than five procedures a year. CONCLUSION Whatever a specialist reconstructive unit might do, practice in the wider urological community is different. Even within specialized units, PFUT is rare and the surgical management is often significantly different from published 'expert' opinion.

OBJECTIVE To report the long-term outcome over 12 years of using the urethral Urolume wallstent (AMS, Minnetonka, MI, USA) for treating recurrent bulbar urethral stricture disease. PATIENTS AND METHODS The case-notes of 60 consecutive men with urethral Urolume wallstents placed for treating recurrent bulbar strictures were reviewed retrospectively. Information was collected on patient demographics, stricture aetiology, stent-related complications and the need for further surgery to treat stent- or stricture-related complications. RESULTS The mean (range) age of the men was 58 (32-76) years. The most common cause of stricture was iatrogenic, arising after previous endoscopic surgery or after an indwelling catheter (45%). Thirty-five men had complications, with re-operation required in 27 (45%) of them. The most frequent nonsurgical complications were post-micturition dribble (32%) and recurrent urinary tract infections (27%). The most common surgical interventions required were transurethral resection of obstructing stent hyperplasia (32%), urethral dilatation or urethrotomy for stent obstruction or stricture (25%) and endoscopic litholapaxy for stent encrustation or stone (17%). CONCLUSIONS The Urolume wallstent should only be used in patients who are unfit for or who refuse a bulbar urethroplasty.

OBJECTIVE To evaluate the outcome of renal denervation for the treatment of loin pain-haematuria syndrome (LPHS), a rare syndrome of unknown cause associated with debilitating and intractable loin pain. PATIENTS AND METHODS The case notes of 32 patients having 41 renal denervations were reviewed. Data collected included patient demographics, possible causes, cure or not after renal denervation, time to recurrence of pain after denervation and further operative intervention for managing LPHS. RESULTS Full data were available for 24 patients (13 women; median age 43 years, range 28-74) having 33 denervations (eight bilateral and one repeat) with a median follow-up of 39.5 months. Most patients had no identifiable underlying cause although many had initially been diagnosed as having stone disease (42%) or pyelonephritis (25%), but with no corroborative evidence. All patients had been extensively investigated and had normal urine samples and cytology, and no abnormality on intravenous urography, renal tract ultrasonography and isotopic renography. Twenty-four renal denervations (73%) were followed by recurrent ipsilateral pain at a median (range) of 11 (0-120) months after surgery. Nine denervations (25%) in six men and two women were curative (median follow-up 16.5 months). Of those with recurrent pain, nine (38%) proceeded to nephrectomy, of whom three then developed loin pain on the contralateral side and two developed disabling wound pain. The analgesic requirement was less after eight non-curative denervations. There were no significant postoperative complications. CONCLUSIONS Renal denervation has only a 25% success rate for managing pain associated with LPHS and should be used cautiously for this indication. Men had more benefit from the treatment; a third of patients had less requirement for analgesic after non-curative denervation.

Purpose: We evaluate the anecdotal high revision rate of 2-stage urethroplasty.Materials and Methods: The short-term revision rates after 1-stage (139 cases) and 2-stage (103) urethroplasties were compared.Results: There were 4 revisions after 1-stage urethroplasty (4 of 139, 3%) and all involved the penile urethra (20%). The revision rate was 37.8% after stage 1 and 25.3% after stage 2 and of 2-stage urethroplasty 85%, involved the penile urethra.Conclusions: Although 2-stage has a significantly lower re-stricture rate than 1-stage urethroplasty for complex strictures in the penile urethra, it does so at the expense of a significantly higher revision rate particularly of the penile urethra.

s / International Journal of Surgery 12 (2014) S13eS117 S106 Results: 111 patients were assessed; only 63 patients were eligible for randomization (exclusions radiotherapy 38, severe SUI 20 patients). 10 patients agreed to be randomized (16%); 53 patients declined randomization. Three-month follow-up data is currently available on 36 patients. 17/20 (85%) patients treated by sling were cured or significantly improved; all but one with pad weight > 400mls. 3 patients (pad weight 143,500,890mls) were not improved. 14/16 (87.5%) patients treated by AUS were cured or significantly improved; eleven (69%) had severe SUI and six (37.5%) radiotherapy. 2 AUS patients were not improved (bladder over activity, pad weight 1100mls) Conclusions: AUS satisfaction rates were similar to sling. 0787: RETROGRADE LEAK POINT PRESSURE CORRELATES WITH 24 H PAD WEIGHT FOR ASSESSING POST PROSTATECTOMY INCONTINENCE Antoine Kass-Iliyya , Eskinder Solomon, Ishaan Chaudhury, Rizwan Hamid, Daniella E. Andrich, Tamsin J. Greenwell, Ockrim L. Jeremy. University College London Hospital, London, UK. Introduction: Twenty-four hour pad-weight is the standard measurement of stress urinary incontinence (SUI) in men after radical prostatectomy. Poor patient compliance, variability according to patients’ activity and fluid intake represent major disadvantages in reliability of this test. Retrograde leak point pressure (RLPP) measurement is a simple adjunct to urodynamic assessment and gives an objective measure of external urethral sphincter’s closure pressure. We evaluated the correlation between RLPP and 24h pad weight within a randomized study setting. Methods: 53 consecutive men between February-October 2013 were evaluated for surgical intervention. Patients collected 24h pad tests in two separate periods and the mean calculated. Severe incontinence was considered pad weight >400mls. RLPP were performed using a standardized and reproducible (Comiter) technique using a paediatric cuff and 5ml/min perfusion rate. The pressure plateau reached when the sphincter pressure was exceeded was recorded. Results: Mean 24h pad weight was 402±425 mls (range 9-3500), and mean retrograde leak point pressure was 35.7±15.3cm water (range 1283). The degree of individual pad weight variability was not significant. Patients with higher pad weights had significantly lower RLPP measurements, Spearman’s correlation coefficient r1⁄40.59, p

Background: A new technique of 805 nm semiconductor diode laser–tissue interaction potentiation using indocyanine green (ICG) as an exogenous chromophore has been assessed for use in the palliation of advanced gastrointestinal malignancy. Materials and Methods: The tissue effects of ICG potentiated 805 nm laser were assessed bothin-vivo using rat stomach and colon, and in vitro using normal and neoplastic human gastric and colonic mucosa.Results: Intravenous ICG did not potentiate the laser–tissue effects of the 805 nm laser in in-vivo studies. Local techniques of ICG application (submucosal injection±surface painting of 0.1% ICG solution) enhanced the total depth and diameter of laser induced thermal injury in all in-vitro tissues. Without ICG enhancement thermal tissue injury was minimal in normal gastric and colonic mucosa. Conclusion: Local techniques of ICG application enhance laser induced thermal injury in normal and neoplastic gastric and colonic mucosa. This may permit targeting of 805 nm laser–tissue effects with minimal collateral damage during endoscopic laser palliation of advanced gastrointestinal malignancy.

AIM: The purpose of this study was to define and compare the radiation doses to patients undergoing computed tomography (CT) or intravenous urography (IVU) for the investigation of renal colic. METHODS: The IVU dose was calculated from dose area product measurements for 27 abdominal films (AXR) and a review of 30 IVUs performed to investigate renal colic. The effective dose to a patient undergoing CT was calculated using anthropomorphic model data. Fifty patients underwent CT for the investigation of renal colic over a 6-week period. RESULTS: CT following our protocol confers an average effective dose of 4.7 m5v. An IVU to investigate renal colic used 2.5 AXRs. A 3 film IVU gives an average dose of 1.5 mSv. Forty-two CT examinations were abnormal and the findings are described in the text. CONCLUSION: Although unenhanced CT confers diagnostic advantages and avoids the risks of intravenous contrast medium, this should be considered against the increased radiation dose to the patient which in our institution is over three times that of an IVU.