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

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

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

Aims This prospective multicenter observational study evaluated postprostatectomy incontinence treatment outcomes with Virtue male sling at 12 and 36 months. Methods Objective assessment was based on a 24-h pad weight test with improvement defined by a decrease >50% and cure by less than 1.3 g. Subjective assessment was based on the patient global impression of improvement and International Consultation on Incontinence Questionnaire-urinary incontinence-short form (ICIQ-UI-SF) questionnaires. Subgroups were analyzed by baseline severity of incontinence on a 24-h-pad test, body mass index (BMI), and pads usage. Factors associated with treatment response were assessed using logistic regression at Months 36. Complications were reported. Results We analyzed data from 117 men. Objective and subjective improvement were achieved in 54% and 35% and 51% and 34% at 12 and 36 months, respectively. Twenty-one percent and 19% were considered cured, respectively, at 12 and 36 months. No differences per baseline incontinence severity, BMI and pads usage were found at 36 months. Mean ICIQ-UI-SF score decreased from 15 to 9. Predictive factors were BMI, postvoid residual urine, number of nighttime urination, and ICIQ total score. Seven Clavien-Dindo Grade III (5.1%) including four Virtue sling revisions were reported. The most frequent Grade II complications were overactive bladder symptoms and pain reported in 10.3% and 2.9%, respectively. No complications required explantation. Conclusions Virtue male sling is safe and effective in males with mild to severe postprostatectomy urinary incontinence over 36 months. Virtue could be considered an interesting option for postradical prostatectomy urinary incontinence with positive results over time even in patients with high BMI. The predictive model should be validated by further studies.

Due to the COVID-19 Pandemic, all surgical activity that was not life threatening was cancelled , as well as most face-to-face consultations. Currently the beginning of the de-escalation phases that will led us to a new normal, forces us to establish some degree of priority in the interventions as well as in the medical consultations. Our objective is to establish some recommendation on Functional Urology office visits and surgical interventions that serve as a tool to facilitate decision-making. MATERIAL AND METHODS: Experts in Functional Urology from different autonomous communities of Spain were contacted to design a strategy to reorganize the activity of both, diagnosis and treatment. A modified nominal group technique has been used due to the extraordinary restrictions of assembly and mobility during the COVID pandemic. The first signer (EMC) made the first draft with the measures adopted and the strategy to be followed during the evolution of the COVID-19 pandemic. The proposal was sent to the rest of the authors, in order to unify criteria and experiences to reach a quick consensus on the relative priority of the different activities, problems and solutions. A final version was approved by all authors May 27, 2020. RESULTS: Tables of recommendation have been prepared for outpatient consultation, surgical and technical interventions, according to de-escalation phases proposed by the Spanish Associations of Surgeons. CONCLUSIONS: The change that COVID-19 Pandemich as involved in our clinical practice force us to seek alternative methods to treat our patients, some of which may already be established. Mean while, a consensusin decision making is necessary. Documents such as the current one, are intended to guide the management of patients with urological functional pathology in exceptional situations. Logically, it should be adapted to material and human availability, and to the idiosyncrasy of each Urology service.Debido a la Pandemia COVID-19 se suspendió toda actividad quirúrgica que no fuera una urgencia vital, así como la mayoría de consultas presenciales. Actualmente el inicio de las fases dedesescalada que nos llevarán a una nueva normalidad nos obliga a establecer unos grados de prioridad en las intervenciones así como en las consultas médicas. Nuestro objetivo es establecer una serie de recomendaciones sobre las consultas de Urología Funcional y las intervenciones quirúrgicas que sirva como herramientade ayuda en la toma de decisiones.MATERIAL Y MÉTODOS: Expertos en Urología Funcionalde distintas comunidades autónomas de España fueron contactados para diseñar una estrategia parareorganizar la actividad tanto de diagnóstico como de tratamiento. Se ha utilizado una técnica de grupo nominal modificada debido a las restricciones extraordinarias de reunión y movilidad durante la pandemia COVID. El primer firmante (EMC) realizó el primer borrado rcon las medidas adoptadas y la estrategia a seguir durante la evolución de la pandemia COVID19. Se remitió la propuesta al resto de autores, con el fin de unificar criterios y experiencias para llegar a un rápido consenso sobre la importancia relativa de las distintas actividades, problemas y soluciones. Se realizó una versión definitiva, aprobada por todos los autores, el día 27 de mayo de 2020. RESULTADOS: Se han elaborado tablas de recomendaciones tanto para consultas externas, como para intervenciones quirúrgicas y técnicas, de acuerdo con las fases de desescalada propuestas por la Asociación Española de Cirujanos (AEC).El cambio que ha supuesto la Pandemia COVID-19 en nuestra práctica clínica nos obliga a buscar métodos alternativos para seguir y tratar a nuestros pacientes, algunos de los cuales pueden ya quedar instaurados. Mientras, es necesario un consenso en la toma de decisiones. Documentos como el actual, pretenden orientar en el manejo de los pacientes con patología funcional urológica en situaciones excepcionales. Lógicamente, deberá adaptarse alas disponibilidades materiales y humanas, y a la idiosincrasia de cada servicio de Urología.

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

Aims The aim of this paper is to stablish de position of the Ibero-American Society of Neurourology and Urogynecology (SINUG) in relation to the use of suburethral meshes for the surgical treatment of female stress incontinence. Methods Tension-free mid-urethral slings (MUS) have become the most popular procedure for the treatment of stress urinary incontinence (SUI). In July 2018, the British government announced a pause in the use of meshes for both pelvic organ prolapse (POP) and urinary incontinence (UI) treatment without differentiating whether the meshes were used for treating UI or POP. The decision was taken to stop their use until the publication of the updated UI and POP guidelines of the British National Health Service, which is available from April 2019. SINUG has reviewed the evidence and official position of different societies in relation to the safety and efficacy of MUS in the surgical treatment of incontinence differentiating them from meshes used to repair POP. Results Data from synthetic mesh manufacturers indicate that in 2010, 300 000 women underwent surgical procedures to repair POP and approximately 260 000 were operated on for SUI. According to these estimates, approximately more than 80% of the surgical techniques for UI treatment were performed transvaginally with meshes. Conclusions Once reviewed evidence and position of different societies, the SINUG presents its vision in this communication, which is a summary of the document analysing the state of topic prepared by the society.

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

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

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

To determine the tolerability, persistenceand satisfaction of patients with overactive bladder syndrome (OAB) treated with transdermal oxybutynin (OXY-TDS).Observational, retrospective, multicenter study, in patients with OAB who had started treatment with OXY-TDS at least 12 months before their inclusion. Tolerability was evaluated by number, severity criteria, resolution type of adverse reactions, and cognitive function with Mini-Mental State Examination (MMSE), at 1 year of treatment. The patients who remained under treatment during the observation period were considered persistent. Patient satisfaction was evaluated using an ad hoc questionnaire.The clinical history of 105 patients was evaluated. 92.4% were women. The mean age of all the patients was 59.4 ± 11.8 years. After 12 months of treatment, dry mouth was present in 5.7% of patients and 27.6% had mild or moderate adverse reactions in the area of application. The persistence in treatment was 55.2%. The use of the OXY-TDS was considered comfortable or very comfortable by 92.9% of patients.The study performed in patients with OAB shows that OXY-TDS provides low incidence of systemic adverse effects, including dry mouth, high persistence, improved adherence rates and high satisfaction of patients after one year of treatment.

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

Objective To evaluate the effect of the treatment with fesoterodine fumarate in patients with overactive bladder, as an alternative in case of failure of the usual anticholinergic treatment, due to either lack of therapeutic efficacy or intolerance to side effects. Material and method A retrospective review of 158 patients with overactive bladder was carried out. The patients were divided into two groups: the first group consisting of 56 patients where the anticholinergic treatment was shown to be ineffective, and the second group; 102 patients who presented intolerance to anticholinergic side effects. Results For the first group where fesoterodine fumarate was used to improve effectiveness of the anticholinergics, improvement in the components of urinary urgency ( p = 0.001), insufficient emptying ( p = 0.001), incontinence ( p = 0.009), and in the number of pads/day ( p p p = 0.015) was seen, as well as a significant clinical improvement. Conclusion Fesoterodine fumarate is an optimal treatment option when the clinical response to anticholinergics has not been satisfactory, either by the lack of therapeutic action or by intolerance to side effects, and especially when the treatment is expected to be long.

Resumen Objetivos Valorar el efecto del empleo del fumarato de fesoterodina como rescate ante un tratamiento previo fallido con anticolinergicos en pacientes con vejiga hiperactiva, por falta de efectividad terapeutica o por intolerancia a los efectos secundarios. Material y metodos Revision retrospectiva de 158 pacientes afectos de vejiga hiperactiva que se distribuyeron en 2 grupos, uno donde el fumarato de fesoterodina se empleo como rescate ante una inefectividad del anticolinergico previo (n = 56) y otro donde se empleo ante una intolerancia manifiesta al mismo (n = 102). Resultados En el grupo en el que se empleo como rescate a una inefectividad, se aprecio una mejoria en los componentes de urgencia miccional (p = 0,001), vaciado insuficiente (p = 0,001) eincontinencia de esfuerzo (p = 0,009), y en el numero de compresas/dia (p = 0,015), ademas de una mejora clinica significativa. Conclusiones El fumarato de fesoterodina es una alternativa de tratamiento valida si los resultados con otros anticolinergicos previamente no han sido satisfactorios, bien sea por falta de efecto terapeutico esperado, bien por intolerancia a los efectos secundarios, sobre todo cuando el tratamiento se plantea prolongado.

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

Resumen Introduccion La flebitis de Mondor o trombosis de la vena dorsal del pene es una enfermedad rara, que puede resultar estresante si no se conoce, tanto para el personal facultativo asistencial, como para el propio paciente y sus familiares. Caso clinico Presentamos un caso clinico de un varon de 46 anos que acudio a urgencias por febricula, dolor e induracion del pene. Se diagnostico y se trato como trombosis dorsal del pene aislada. Revisamos la fisiopatologia de la enfermedad y su tratamiento. Actualizamos la bibliografia. Discusion Es necesario realizar un buen diagnostico diferencial. Su tratamiento puede resultar bastante simple. Debemos reservar el tratamiento quirurgico para las complicaciones. Conclusiones Se pone de manifiesto la rareza de esta enfermedad y su facil manejo. Consideramos que la eco-Doppler es la prueba de imagen idonea para realizar un buen diagnostico diferencial. Debemos optar en primer lugar por un tratamiento conservador con antiinflamatorios no esteroideos, heparina de bajo peso molecular, y si no hay respuesta, realizaremos tratamiento quirurgico.

Introduction: Laparoscopic surgery has demonstrated superiority in terms of morbidity compared to open surgery in a variety of urological procedures.1–3 With the introduction of laparoendo...