ObjectiveTo assess the efficacy of OnabotulinumtoxinA (BTXA) injections in men with drug-refractory non-neurogenic overactive bladder (NNOAB). Patients and MethodsA total of 43 men received BTXA injections for NNOAB from 2004 to 2012. Patient Global Impression of Improvement (PGI-I) score was obtained. For men with wet NNOAB, change in number of pads per day was also assessed. ResultsForty-three men with a mean age of 69 (range 37-85) received at least one injection. Of the 43 men, 20 (47%) had prior prostate surgery: 11 had radical prostatectomy (RP) and nine had transurethral resection of prostate (TURP). Overall, average PGI-I score was 2.7. Comparing PGI-I score in men who had prior prostate surgery with men who have not: 2.6 AE 0.5 vs 2.8 AE 0.5 respectively (average AE 95% CI), P = 0.6. Comparing PGI-I score in men who had previous TURP with men who had previous RP: PGI-I score: 3.3 AE 0.8 vs 2.0 AE 0.5 respectively, P < 0.05. Men who had RP experienced a reduction in pad use (from 3.5 AE 1.7 to 1.6 AE 0.9 pads/day, P < 0.05) while this was not the case amongst men who had TURP (from 1.7 AE 1.5 to 1.4 AE 1.5 pads/day, P = 0.4). ConclusionOverall, BTXA injection in men with drug-refractory NNOAB does provide a symptomatic benefit. Amongst men who have had prior prostate surgery, men who have had RP experience a greater benefit than men who have had TURP, both in regards to PGI-I score and pad use.

The AdVance sling provides mid-term improvement in men with PPI. However, men with radiotherapy or DO have significantly poorer outcomes with mid-term results indicating a return to baseline degree of incontinence. Caution should be taken when considering the AdVance sling in these men. Pre-op urodynamics in men with radiotherapy and/or overactive bladder may be important when considering men for AdVance sling. Neurourol. Urodynam. 36:1147-1150, 2017. © 2016 Wiley Periodicals, Inc.

ObjectiveTo prospectively trial ertapenem prophylaxis in patients with known risk factors of sepsis undergoing transrectal biopsy of the prostate. Patients and MethodsIn this prospective audit, patients were identified as having a low-or high-risk of sepsis based on a questionnaire about established risk factors: previous biopsy; recurrent urine infections; receiving ciprofloxacin in the 12 months prior; travel to South-East Asia or South America in the previous 6 months; or diabetes, immune system impairment or receipt of immunosuppressant drugs.All received ciprofloxacin and amoxicillin-clavulanate and high-risk patients additionally received ertapenem.Sepsis requiring hospital admission was recorded.Data was analysed using a two-tailed Fisher's exact test. ResultsIn all, 80 men were identified as high risk of sepsis and 90 as low risk during the audit period.Six patients in the low-risk group (6.7%, 95% confidence interval 2.1-11.3) and none in the high-risk group developed sepsis (P = 0.03).Of the six developing sepsis, two grew ciprofloxacin-resistant organisms, two had no growth and two grew a ciprofloxacinsensitive organism, although one of these grew extendedspectrum β-lactamase-producing Escherichia coli. ConclusionThe addition of ertapenem to standard prophylaxis is effective at reducing sepsis after prostate biopsy.Risk stratification is not effective at identifying those men at low risk of sepsis, as these men still have a high sepsis rate.Ertapenem prophylaxis for all patients undergoing prostate biopsy is likely to be the most effective strategy in our population group.

Objective To assess whether the penile cuff non‐invasive urodynamic test serves as an effective diagnostic tool for predicting outcomes prior to disobstructive surgery for men presenting with voiding lower urinary tract symptoms. Patients with proven urodynamic obstruction do better after surgery. The current gold standard, invasive pressure‐flow studies, imposes cost, resource demand, discomfort and inconvenience to patients. Patients and Methods Patients undergoing surgery for prostatic obstruction at Palmerston North Hospital had pre‐operative non‐invasive urodynamics and completed an International Prostate Symptom Score (IPSS). Catheterised patients were excluded. Two months post‐operatively they completed a further IPSS score. An improvement of seven or greater was defined as a clinically successful outcome. Results were compared with the outcome predicted by the nomogram supplied with the urodynamic device. Results Data was obtained for 62 patients with mean age 70 years (range 49 to 86 years; SD 9 years). Follow‐up was complete for all patients. Thirty‐eight patients underwent transurethral resection and 24 holmium laser enucleation of the prostate. Mean IPSS score was 21 (range 5 to 35; SD 6) pre‐operatively and 11 (range 1 to 31; SD 9) post‐operatively. Thirty‐five patients were predicted obstructed and 27 not obstructed. 94% of those predicted obstructed had a successful outcome (p < 0.01). 70% predicted as not obstructed did not have a successful outcome after surgery (p < 0.01). Conclusion The penile cuff test is an exciting adjunct in the decision to proceed to surgery for prostatic obstruction. Patients predicted to be obstructed have an excellent likelihood of a good surgical outcome, yet 30% of those shown not to be obstructed will still do well. Whilst numbers in our study are small, outcomes compare favourably with published results on invasive urodynamic methods.

What ' s known on the subject? and What does the study add? Flexible cystoscopy is commonly performed. Several studies show that topical anaesthetic lubricant reduces patient discomfort, particularly with long lubricant retention times (15 -25 min). No studies have specifi cally addressed whether a short, clinically manageable retention time provides any benefi t over immediate cystoscopy.Our study demonstrates that delay by a 3-min interval provides no benefi t to patients and a more expedient approach can be justifi ed without compromising patient comfort.

Study design: Retrospective review of prospectively collected data. Objectives: Stress urinary incontinence (SUI) is a cause of significant distress in women with neurogenic bladder dysfunction (NBD) due to spinal cord injury (SCI). Transobturator tape (TOT) has not previously been studied in this select group for cure of SUI. We aim to determine the long-term safety and efficacy of TOT in SCI patients with NBD and SUI. Setting: London, the United Kingdom. Methods: All patients undergoing TOT between 2005 and 2013 were identified (27 patients). All patients had pre-operative videocystometrogram (VCMG) and all had VCMG-proven SUI. Mean follow-up was 5.2 years. Patient-reported leakage, satisfaction, change in bladder management, complications and de novo overactive bladder (OAB) were recorded. Results: Mean age was 56 years (range 30-82) with complete follow-up. Twenty-two patients (81.5%) reported complete dryness from SUI post surgery. One patient (3.7%) reported SUI only when her bladder was very full but was satisfied. Twenty-three patients (85.2%) were happy. Four patients (14.8%) remained wet. Twenty-five patients (92.6%) had no change in bladder management. Two out of five patients (40%) who voided by straining prior to surgery required clean intermittent self-catheterisation (CISC) postoperatively. Two patients (7.4%) developed de novo OAB. No bladder or vaginal injuries, tape erosions or urethral obstruction were seen. Three patients (11.1%) had transient thigh pain. Conclusion: In women with NBD and SUI, TOT should be considered safe and effective with very good medium/long-term outcomes. There may be an increased risk of CISC in women who void by straining pre-operatively. INTRODUCTIONStress urinary incontinence (SUI) in women with neuropathic bladder dysfunction 1 (NBD) can be a major disabling feature. In the general population up to 25% of women are thought to be affected, 2 although among neuropaths the incidence remains unknown.In women with NBD, such as after spinal cord injury (SCI), there are specific additional problems compared with the general population that require consideration. For instance, neuropathic patients may have neurogenic detrusor overactivity (NDO) in association with weakness of the external urethral sphincter or a weak sphincter with an acontractile bladder. Particularly after childbirth, this sphincteric dysfunction may be seen in association with hypermobility or prolapse, which can further complicate management.Following Ulmsten's original description 3 in 1996 of a synthetic polypropylene tension-free vaginal tape placed at a mid-urethral level in retropubic fashion, our unit was the first to study the success of this procedure in neuropathic patients. 4,5 This showed success comparable to non-neuropaths in both short and long term with few complications. The aim of this study was to present the first series of long-term safety and efficacy outcomes of placement of mid-urethral synthetic transobturator tapes (TOT) in patients with urodynamically confirmed SUI and NBD du...

Pelvic organ prolapse (POP) and urinary tract infection (UTI) are important problems, estimated to affect around 14 and 40 % of women, respectively, at some point in their lives. Positive urine culture in the presence of symptoms is the cornerstone of diagnosis of UTI and should be performed along with ultrasound assessment of postvoid residual (PVR) in all women presenting with POP and UTI. PVR over 30 mL is an independent risk factor for UTI, although no specific association with POP and UTI has been demonstrated. The use of prophylactic antibiotics remains controversial. The major risk factors for postoperative UTI are postoperative catheterisation, prolonged catheterisation, previous recurrent UTI and an increased urethro-anal distance—suggesting that global pelvic floor dysfunction may play a role.

Outcome after TURP for urinary retention is satisfactory. Advanced age is associated with higher long-term failure requiring catheterization, although it is still recommended in the elderly where an anaesthetic is safe. A high proportion of patients report urine leakage but the majority of this is clinically insignificant. Overall, patients report good quality of life.