Study Type – Therapy (RCT) Level of Evidence 1b What's known on the subject? and What does the study add? HoLEP has been widely adopted worldwide as an alternative to TURP but long term results have been lacking despite the strong scientific basis for the technique. This study provides long‐term results from the original RCT comparing the two techniques. OBJECTIVE To assess the durability of holmium laser enucleation of prostate in comparison to transurethral resection of the prostate (TURP). PATIENTS AND METHODS Patients were enrolled in the present study between June 1997 and December 2000 and followed per protocol. All patients were urodynamically obstructed with a prostate volume of between 40 and 200 mL. At long‐term follow‐up, variables assessed included Benign Prostatic Hyperplasia Impact Index (BPHII), International Continence Society Short Form Male questionnaire (ICSmale‐SF) and the International Index of Erectile Function (IIEF). Adverse events, including the need for retreatment, were specifically assessed. RESULTS Thirty‐one (14 holmium laser enucleation of the prostate [HoLEP] and 17 TURP) of the initial 61 patients were available, with 12 deceased and 18 lost to follow‐up. The mean (range) follow‐up was 7.6 (5.9–10.0) years and the mean (±sd) age at follow‐up was 79.8 (±6.2) years. The mean (±sd) values (HoLEP vs TURP) were as follows: maximum urinary flow rate (Qmax), 22.09 ± 15.47 vs 17.83 ± 8.61 mL/s; American Urological Association (AUA) symptom score, 8.0 ± 5.2 vs 10.3 ± 7.42; quality of life (QOL) score 1.47 ± 1.31 vs 1.31 ± 0.85; BPHII, 1.53 ± 2.9 vs 0.58 ± 0.79; IIEF‐EF (erectile function), 11.6 ± 7.46 vs 9.21 ± 7.17; ICSmale Voiding Score (VS), 4.2 ± 3.76 vs 3.0 ± 2.41; ICSmale Incontinence Score (IS), 3.07 ± 3.3 vs 1.17 ± 1.4. There were no significant differences in any variable between the two groups beyond the first year. Of the assessable patients, none required re‐operation for recurrent BPH in the HoLEP arm and three (of 17) required re‐operation in the TURP arm . CONCLUSION The results of this randomized trial confirm that HoLEP is at least equivalent to TURP in the long term with fewer re‐operations being necessary.

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OBJECTIVE To compare the efficacy of extracorporeal electromagnetic stimulation (ES) of the pelvic floor for treating stress urinary incontinence (SUI) vs sham ES. PATIENTS AND METHODS In all, 70 women with urodynamically confirmed SUI were randomized to receive active (35) or sham (35) ES. The NeoControl chair (NeoTonus, Marietta, GA, USA) was used, and treatment consisted of three sessions per week for 6 weeks. data were collected before and after treatment on all women, including a 20‐min provocative pad‐test with a predetermined bladder volume (primary outcome measure), a 3‐day bladder diary and 24 h pad‐test. Circumvaginal muscle (CVM) rating score, perineometry using two separate instruments and video‐urodynamics were also used, and the Urinary Incontinence Quality of Life Scale (I‐QOL) and King’s Health Questionnaires. Patients were fully re‐evaluated 8 weeks after treatment, and the bladder diary, pad‐test and questionnaires were repeated at 6 months. The urotherapist and physician were unaware to which treatment group the patient was assigned. RESULTS In the overall group of 70 patients there were significant improvements in each of the primary and secondary outcome measures at 8 weeks. There were also significant improvements in primary and secondary outcome measures in the active treatment group when compared with baseline measures. At 8 weeks, there were improvements in the mean (sd) values for the 20‐min pad‐test, of 39.5 (5.1) vs 19.4 (4.6) g (P < 0.001); the 24‐h pad‐test, of 24.0 (4.7) vs 10.1 (3.1) g (P < 0.01); the number of pads/day, of 0.9 (0.1) vs 0.6 (0.1) (P < 0.01), the I‐QOL score, of 63.7 (2.8) vs 71.2 (3.3) (P < 0.001); and King’s Health Questionnaire score, of 9.6 (0.8) vs 6.9 (0.7) (P < 0.001). However, these improvements were not statistically significant when compared with the sham‐treatment group. In those patients on active treatment who had a poor pelvic floor contraction at the initial assessment (defined by the CVM score and perineometry), there was a significant reduction (P < 0.05) in the 20‐min pad‐test leakage when compared with the sham‐treatment group. CONCLUSIONS ES was no more effective overall than sham treatment in this patient group. However, in those women who were unable to generate adequate pelvic floor muscle contractions, there was an objective improvement in provocative pad testing when compared to sham treatment.

OBJECTIVE To evaluate the efficacy and safety of the ProACTTM (Uromedica, Inc., MN, USA) balloon device, an alternative for the surgical management of incontinence after prostatectomy. PATIENTS AND METHODS The initial patients who received this device at our institution were evaluated, using urodynamics at baseline and at 6 months. Perioperative variables were recorded and pad usage, volume adjustments, an estimate of Incontinence Quality of Life (I‐QoL) and adverse events were recorded at baseline, and 1, 3, 6, 12 and 24 months after surgery. RESULTS In all, 37 patients were treated on this protocol between November 2001 and March 2005. Of these, 30 had had radical prostatectomy and seven holmium laser enucleation of the prostate. The mean (range) pad usage decreased from 2.81  (1–12) at baseline to 0.7 (0–4) pads at 24 months, and the I‐QOL increased from 49.7 (4.5–77) to 81.3 (13.6–100) over the same period. At 24 months, 62% of 34 men were pad‐free and 81% required one pad or less. Bilateral explantation was required in three patients (11%) for infection (one) and balloon migration (two). All other adverse events were mild and transient. CONCLUSIONS The ProACT balloon device is an acceptable therapy for the surgical management of incontinence after prostatectomy.

This article is being published concurrently in Annals of Surgery and Diseases of the Colon & Rectum. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Citation from any of the 2 journals can be used when citing this article.

OBJECTIVES To review the urological literature regarding the management of Post‐Prostatectomy Incontinence (PPUI) METHODS A Pubmed literature search was performed RESULTS The definition of Post‐Prostatectomy Incontinence varied widely The artificial urinary sphincter has proven efficacy and durability Newer devices, in particular the AdVance sling, lack quality studies despite its apparent popularity CONCLUSION Currently there is insufficient evidence to determine whether newer devices approach the efficacy and durability of the artificial urinary sphincter

This brief discusses the definition of nominal group technique; how to prepare for it; the four-step process to conduct it; when to use it; and the disadvantages and advantages of its use.