1,720,995 research outputs found
Surgery complications and their management
No full textAs there are very few data in literature on the resolution of complications post incontinence surgery after prostate surgery, the following treatise is based on experiences of reconstructive surgeons working in this field
Could the sling position influence the clinical outcome in male patients treated for incontinence? An MR imaging study with a 3 Tesla system.
No full textOBJECTIVE:
To analyze the morphologic changes visible on magnetic resonance imaging (MRI) after sling procedure in continent patients and to compare MRI findings with the incontinent ones, to detect possible factors explaining the different clinical outcomes.
METHODS:
Twenty-seven male patients who were treated with Advance sling for urinary stress incontinence after prostate surgery were enrolled: 16 had clinical recovery, whereas 11 had persistent incontinence. Patients after sling were defined as continent if used 0-1 dry "security pad" or incontinent >1 pad. Magnetic Resonance examinations were performed with a 3 Tesla system and included 3-dimensional T2-weighted sequence. Three readers performed a qualitative (representation of the bulb and indentation of the sling) and a quantitative analysis (length of the bulb posterior to the sling and distance of the sling from a line bisecting the pubic symphysis).
RESULTS:
The sling was clearly recognizable in all 16 continent patients but only in 2 of 11 incontinent ones. The length of the bulb posterior to the sling was >10 mm (range, 10-28) in all continent patients and in 2 of the incontinent ones. The sling was coincident with a line drawn through the long axis of the pubic bone in 9 of 16 continent patients. A statistically significant association was found between MRI qualitative findings and continence status (P <.0001).
CONCLUSION:
On the basis of our MRI results, the position of the sling and, in particular, the length of the urethral bulb posterior to the sling seem to be correlated with continence and must be considered in case of treatment failure
Radical cystectomy and ileal orthotopic bladder substitution after radical retropubic prostatectomy: functional and oncological results
Full text linkMen with good functional results following radical retropubic prostatectomy (RRP) and requiring radical cystectomy (RC) for subsequent bladder carcinoma seldom receive orthotopic bladder substitution. Four patients aged 62-72 years (median 67 years), who had undergone RRP for prostate cancer of stage pT2bN0M0 Gleason score 6 (n = 1), pT2cN0M0 Gleason score 5 and 6 (n = 2) and pT3bN0M0 Gleason score 7 (n = 1) 27 to 104 months before, developed urothelial bladder carcinoma treated with RC and ileal orthotopic bladder substitution. After radical prostatectomy three were continent and one had grade I stress incontinence, and three achieved intercourse with intracavernous alprostadil injections. Follow-up after RC ranged between 27 and 42 months (median 29 months). At the 24-month follow-up visit after RC daily urinary continence was total (0 pad) in one patient, two used one pad for mild leakage, and one was incontinent following endoscopic incision of anastomotic stricture. One patient died of progression of bladder carcinoma, while the other three are alive without evidence of disease. The three surviving patients continued to have sexual intercourse with intracavernous alprostadil injections. Men with previous RRP have a reasonable chance of maintaining a satisfactory functional outcome following RC and ileal orthotopic bladder substitution
Pelvic floor muscle training after prostate surgery
No full textComment on
Urinary incontinence in men after formal one-to-one pelvic-floor muscle training following radical prostatectomy or transurethral resection of the prostate (MAPS): two parallel randomised controlled trial
Botulinum toxin type B for Type A resistant bladder spasticity
No full textUrinary dysfunction is one of the main problems afflicting patients with spinal cord injury. In particular, detrusor hyperreflexia causes urinary incontinence, which decreases quality of life, and high bladder storage pressures with secondary renal damage. Available therapies are intermittent self-catheterization and oral anticholinergic drugs, which are associated with a high frequency of side effects.
Botulinum toxin (BTX) selectively blocks the release of acetylcholine from nerve endings and accordingly blocks neural transmission in cholinergic synapses. The long-term experience of treatment for dystonia and blepharospasm has demonstrated that approximately 16% of patients undergoing repeated treatments become resistant to this drug. It is supposed that an immunological mechanism is responsible for drug resistance, and in many resistant subjects antibodies to the toxin can be detected. Recordings of the compound muscle action potentials (CMAPs) elicited by electrical stimulation of the peroneal nerve before and after botulinum toxin injection in the extensor digitorum brevis show a correspondence between antibody seropositivity and absence of toxin responsivity. 1
As botulinum toxin type B (BTX-B) has an antigenic specificity different from type A (BTX-A), type A resistant subjects affected by cervical dystonia have been treated successfully with BTX-B. BTX-A used in the treatment of bladder detrusor hyperreflexia causes increased bladder capacity and post-void residual urine volume, decreased mean maximum detrusor voiding pressure and resolution of autonomic dysreflexia.
No significant side effects have been detected. BTX-B injection was introduced recently, and only 1 report of its effect in neurogenic bladder dysfunction has been published previously. 3 In that instance a good therapeutic effect was noted without significant side effects in a patient without previous treatments. We report our experience with botulinum toxin type B injection for the management of bladder spasticity in a subject resistant to BTX-A
Male Bulbourethral sling after radical prostactectomy:intermediate outcames at 2 to 4 year followup
No full textAbstract
PURPOSE:
We reviewed our experience with 49 consecutive patients undergoing a male sling procedure.
MATERIALS AND METHODS:
The 7-item International Prostate Symptom Score and 22-item incontinence quality of life questionnaire (although not validated in Italian) were used to assess the clinical impact of the bulbourethral sling. Surgical outcome was also assessed by videourodynamics at 1 year. Urodynamic success was defined as no leakage during videourodynamic evaluation.
RESULTS:
Mean followup was 32 months (range 26 to 48). Preoperatively 3 patients used 2 pads daily (mild incontinence), 34 used 3 to 5 (moderate incontinence) and the remaining 12 used more than 5 (severe incontinence). Clinical success was defined as a decrease in pad use to completely dry (no pad) or to social continence (1 pad daily) at followup. Of the 49 patients 38 (77%), 33 (67%) and 63% (31) were considered socially continent at the 3-month, 1-year and 3-year followup, respectively. Only 15 of the 49 patients (30%) were considered completely dry at the 3-year followup. Significant perineal pain was reported in the early postoperative period but it resolved in all patients. Infection occurred in 3 patients, while no erosion was found.
CONCLUSIONS:
The male perineal sling is a safe surgical option for post-prostatectomy urinary incontinence, especially when strict patient selection is done. Patient satisfaction is superior to urodynamic results and the procedure allows physiological voiding. Patients should be informed of the possibility of progressive failure with time and significant perineal pain in the early postoperative period
Male Stress Urinary Incontinence
No full textThis book aims to offer a comprehensive and up-to-date overview of male stress urinary incontinence that will serve as a useful tool and reference for urologists, andrologists, physiotherapists, general practitioners, and nurses. Detailed information is provided on diagnostic workup, including clinical assessment and the role of urodynamic evaluations and other instrumental examinations, and on the full range of potential treatments, from conservative and pharmacological interventions to surgical options. In addition to careful descriptions of the surgical procedures themselves, clear advice is given on the management of iatrogenic complications of incontinence surgery. Helpful treatment algorithms and recommendations offer further practical support. Relevant background knowledge is provided in expert reviews of topics such as the functional anatomy of the male pelvis and the pathophysiology, epidemiology, and classification of male urinary incontinence
Recurrent pseudodiverticula of female urethra: five-year experience.
No full textOBJECTIVES:
To report our experience of transvaginal diverticulectomy with pubovaginal sling placement in a series of 32 women with recurrent urethral pseudodiverticula.
METHODS:
A total of 32 women underwent surgical repair from January 2000 to June 2007. Of the 32 women, 12 had undergone other concomitant previous urethral surgery, predominantly for stress urinary incontinence. Transvaginal excision of the diverticulum and concomitant pubovaginal sling placement were performed routinely. The women were evaluated postoperatively for symptom relief, anatomic result, and postoperative continence status at 1, 6, and 12 months and annually thereafter. Pelvic magnetic resonance imaging was repeated after 1 year.
RESULTS:
The mean follow-up was 4.3 years. In all cases, the voiding urethrogram after catheter removal showed a good urethral shape with an absence of urinary leaks. At the postoperative urodynamic investigation, 27 patients had an unobstructed and 5 an equivocal Blaivas-Groutz nomogram. Three patients (20%) reported a persistent degree of stress urinary incontinence, including 2 with grade 1 stress urinary incontinence and 1 with mixed incontinence. Two patients presented with clinically evident diverticulum recurrence, and in 1 patient, an intraurethral diverticulum, was found at the 1-year magnetic resonance imaging examination.
CONCLUSIONS:
A pubovaginal sling added routinely to all diverticulectomy procedures offers significant support to the urethral repair and/or prevention of urinary incontinence, including in recurrent cases, and does not increase the risk of erosion into the urethra or fistula formation.
PMID: 19375782 [PubMed - indexed for MEDLINE
- …
