Consequently, irrigation of the spongiosum will depend on the dorsal penile arteries and retrograde flow from the glans. However, if the penile arterial blood supply is compromised, transection may result in ischemia of the bulb and failure of the reconstruction. To decrease this risk, we modified the EPA technique avoiding urethral transection to preserve the bulbar arteries. We report our long-term results with this vesselsparing posterior EPA approach (vspEPA).METHODS: Surgical Technique. The bulbar urethra is mobilized in a non-transecting fashion by division of the triangular ligament without detachment of the bulb from the perineal body. Distal release and lateral retraction of the bulbar urethra to one side with two vessel loops provides sufficient room for scar removal and anastomosis as with the classic transecting technique. In most cases both bulbar arteries can be spared, but in front of severe local fibrosis, division of one artery may be necessary to remove the scar, preserving the contralateral artery.RESULTS: Since April 2008, 115 patients with PUS received a vspEPA at our institution. The patients had a bulbo-membranous stenosis (n[91, 79%), prostate-membranous stenosis (n[11, 10%), or bulbo-vesical stenosis (n[13, 11%). Median age was 60 years (range 15-83) and median stenosis length was 2.5 cm (range 1-6), Sixty-two patients (54%) had a complete urethral obliteration. Bulbar artery preservation was unilateral in 57 and bilateral in 58. Median operative time was 170 min (range 70-265) and median estimated blood loss was 300 cc (range 50-2,000). A bulbo-membranous anastomosis was performed in 48 patients (42%), bulbo-prostatic in 54 (47%) and bulbo-vesical in 13 (11%). With 47 months of median follow up (range 5-146), vspEPA was successful in 109 patients (95%). Complications occurred in 34 (30%) patients but only 6 (5%) of them were Clavien grade !III.CONCLUSIONS: This vspEPA technique is feasible and safe and since 2008 it is our standard approach for anastomotic urethroplasty at the posterior urethra. We believe that vascular preservation may improve the outcome of reconstruction and our results are meaningful and highly encouraging.
INTRODUCTION AND OBJECTIVE: Rates of transient postoperative urinary incontinence (UI) after holmium laser enucleation of the prostate (HoLEP) are quite variable in the existing literature. Classically, post-HoLEP UI has been found to be associated with surgeon experience and surgical technique. Patients experiencing UI are typically reassured about the expected continence recovery but the timeline of this recovery remains poorly understood. We sought to evaluate whether any patient-related factors played a role in the speed of post-HoLEP continence recovery.METHODS: We performed a prospective observational cohort study of patients undergoing HoLEP with a single surgeon from 2020 to 2021. Demographic and clinical variables were collected for analysis. Patients were followed post-operatively until they regained urinary continence. Univariate and multivariable logistic regression analyses were performed to identify predictors of early (<1 month) versus delayed (>1 month) continence recovery after HoLEP.RESULTS: A total of 171 patients were included in the analysis, 35% of whom took longer than one month to regain continence. On univariate analysis, diabetes mellitus, prostate size, length of surgery, and degree of post-operative hematuria were all associated with delayed continence recovery. On multivariable logistic regression, patients with diabetes were 3.6x more likely to experience delayed continence recovery. Patients with worse post-operative hematuria were also significantly more likely to remain incontinent for a longer period of time (OR 14, CONCLUSIONS: Surgeon experience and surgical technique may not be the only factors associated with post-operative urinary incontinence after HoLEP. Our findings indicate that patient-related factors such as diabetes mellitus can delay continence recovery as well. This understanding can inform providers' counseling practices when setting patients' expectations when undergoing HoLEP.
number of OAB patients was significantly higher in the VARD absence group than in the VARD presence group (p[0.04). The prostate volume tended to be higher in VARD absence group. The multivariate analysis revealed that OAB and prostate enlargement (BPE) were significantly related to the VARD absence group (OAB: aOR 3.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.