Objectives: To present our experience in the management of bladder neck contracture with concomitant post prostatectomy incontinence and to provide our recommendations based on the updated literature. Materials and Methods: Between Jan 2010 and June 2015, 37 patients from our cohort of 341 patients with post prostatectomy incontinence were evaluated. Patient data were retrospectively collected. Patients with bladder neck contracture confirmed on flexible cystoscopy underwent subsequent rigid cystoscopy and deep endoscopic bladder neck incision (BNI). A follow up flexible cystoscopy would be performed 3 months later. If there was no recurrence of the bladder neck contracture, an artificial urethral sphincter (AUS) or a male sling was recommended. Results: The mean age of patients was 68 years (range 59-77) and the mean BMI was 31 (range 21-41) kg/m2. Twenty-five (67.7%) patients had open prostatectomy and 12 (32.4%) patients had laparoscopic prostatectomy. Fourteen patients (37.8%) underwent adjuvant radiotherapy. Twenty-four (64.8%) patients had one BNI procedure, 8 (21.6%) patients had two procedures and 5 (13.5%) patients had more than 2 procedures. Twenty-one (91.3%) patients had AUS implantation and 2 (8.7%) patients had male sling placement. Besides, 85.7% of AUS and 50% of male sling patients managed to achieve successful outcomes with a mean follow up period of 13.1 months ( range 2-33 months). Conclusion: Initial management with aggressive BNI followed by implantation of an AUS or male sling when bladder neck is stable is essential to achieve a satisfactory urinary continence outcome.
Patch test reading at day 7 is suggested in current national (British Association of Dermatologists 2017) and international (European Society of Contact Dermatitis 2015) guidelines to identify late positive reactions. Allergens most established with late reactions are metals, antibiotics, acrylates and preservatives (Viggiano T, Yiannias JA, Yang YW. A retrospective review of late delayed positive patch testing greater than day 8 at Mayo Clinic from 2001 to 2020. Dermatitis 2022; 33:411–16). We report a case of significantly delayed contact dermatitis to four acrylates and ethyl paraben in a 49-year-old immunocompetent woman. She was referred to the cutaneous allergy clinic for patch testing following a rash affecting the torso after application of a sunscreen during a sunny holiday. She reported historical skin irritation after the use of nail lacquer and at the site of a caesarean section wound that was closed with skin glue 14 years prior. Patch test reading at day 4 (96 h) was negative; positive reactions to ethyl paraben, 2-hydroxyethylmethacrylate and ethyl cyanoacrylate appeared at day 23 (552 h). Positive reactions to hexanediol diacrylate and triethylene glycol diacrylate appeared at day 31 (744 h). These were communicated to us by the patient via email, with photographs clearly showing the development of new positive reactions. Of note, there was no reaction to the sunscreen product, although ethyl paraben was identified in the ingredients list, as well as two acrylate-containing polymers. Sensitization from diagnostic patch testing carried out to accepted international guidelines is rare but can occur with some allergens such as strong sensitizers, including paraphenylenediamine. The allergens identified in our case are found commonly in everyday cosmetics, adhesives and preservatives, including some that the patient had identified previous exposure to. Acrylates are acknowledged for causing potential delayed positive reaction by day 8 (Viggiano et al.); one case report describes true allergic acrylate reaction in a dental worker after 5 weeks (Fowler JF Jr. Late patch test reaction to acrylates in a dental worker. Am J Contact Dermat 1999; 10:224–5). There are no established reports of late positive reactions to ethyl paraben. With increasing online resources, delayed reactions beyond day 7 can be established with patient-initiated remote review of photographs taken during and subsequent to patch testing appointments. This case highlights the importance of keeping channels open for patients to contact the cutaneous allergy team after the final in-person reading to ensure (very) late allergen reactions are not missed.
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