ResultsThe present recommendations, based on the most relevant data available in the literature, as well as expert opinion, address a variety of specific and at times problematic issues associated with SNM. These include the use of SNM for a variety of underlying conditions, need for pre-procedural testing, use of staged vs single-stage procedures, screening for success during the trial phase, ideal anesthesia, device implantation, post-procedural management, trouble-shooting loss of device function, and future directions for research. Conclusions:These guidelines undoubtedly constitute a reference document, which will help urologists, gynecologists, and colorectal surgeons optimize their use of SNM for refractory urinary urgency and frequency, UUI, NOR, and FI.• Eight urologists, three colorectal surgeons and two urogynecologists, covering a wide breadth of geographic and specialty interest representation, met for two days in Chicago, Illinois, USA on January 19-20, 2017 to discuss best practices for neuromodulation. Suggestions for statements were submitted in advance and specific topics were assigned to committee members. Committee members prepared each assigned topic and presented supporting data to the group at which time each topic was discussed in depth. Best practice statements were formulated based on available data and expert opinion and then each member prepared a discussion section for each particular topic which reflected the current literature and expert opinion. Another urologist was added to the group during the initial writing process. After multiple rounds of editing within the group the highlights of the statements were presented at the ICS meeting in Florence, Italy in September 2017. This document was then circulated to multiple external reviewers after which final edits were made and approved by the group.• The meeting and editing expenses were supported by the ICS. Funding to support this project was based on an unrestricted society-initiated grant made by Medtronic to the ICS.• As many of the recommendations herein are based on expert panel consensus, the recommendations in this document, while meant to aid clinical decision-making, do not preempt physician judgment in individual cases.The statements and recommendations included in this document pertain to SNM in its present form (Interstim, Medtronic) They may or may not have relevance for future SNM products or therapies which become available for clinical use.

These guidelines undoubtedly constitute a reference document, which will help urologists, gynecologists, and colorectal surgeons optimize their use of SNM for refractory urinary urgency and frequency, UUI, NOR, and FI.

Neuromodulation is an important treatment modality for a variety of pelvic floor disorders. Percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (SNM) are currently the two approved methods for delivering this therapy. Percutaneous tibial nerve stimulation is a minimally invasive office-based procedure that has shown efficacy in the treatment of overactive bladder, fecal incontinence, and pelvic pain. It has the advantage of minimal side effects but is limited by the need for patients to make weekly office visits to receive the series of treatments. Sacral neuromodulation uses an implanted device that stimulates the S3 nerve root and can improve symptoms of overactive bladder, non-obstructive urinary retention, fecal incontinence, and pelvic pain. This paper will review the most recent literature regarding this topic and discuss their advantages and limitations and recent innovations in their use.

3 0 1What ' s known on the subject? and What does the study add? Married individuals have lower morbidity and mortality rates for all major causes of death. Cancer-specifi c survival is better in married patients with testis cancer, prostate cancer, breast cancer, cervical cancer, as well as head and neck cancers.We have found the effect of marital status on outcomes after radical cystectomy to be variable, depending on gender and the outcome addressed. Being married is predictive of lower all-cause mortality for both men and women relative to their separated, divorced or widowed (SDW) or never-married counterparts. It is also predictive of lower bladder-cancer-specifi c mortality relative to SDW individuals. Marriage also exerts a protective effect on men regarding non-organ-confi ned disease, with those never having married having signifi cantly higher rates. OBJECTIVES• To examine the effect of marital status (MS) on the rate of non-organ-confi ned disease (NOCD) at radical cystectomy (RC) • To assess the effect of MS on the rate of bladder-cancer-specifi c mortality (BCSM) and all-cause mortality (ACM) after RC for urothelial carcinoma of the urinary bladder (UCUB). MATERIALS AND METHODS• A total of 14 859 patients, who underwent RC for UCUB, were captured within the Surveillance, Epidemiology, and End Results database, between 1988 and 2006.• Logistic regression analysis was used to assess the rate of NOCD (T 3-4 /N I-3 /M 0 ) at RC and Cox regression analyses were used to assess BCSM and ACM.• Analyses were stratifi ed according to gender; covariates included socio-economic status, tumour stage, age, race, tumour grade and year of surgery. RESULTS• Never-married males had a higher rate of NOCD at RC (odds ratio = 1.22, P = 0.004), an effect not found in nevermarried females.• Separated, divorced or widowed (SDW) males (hazard ratio [ HR ] = 1.18, P = 0.005) and females (HR = 1.16, P = 0.002) had higher rates of BCSM than their married counterparts.• SDW and never-married males had higher rates of ACM than their married counterparts (HR = 1.22, P < 0.001 and HR = 1.26, P < 0.001, respectively).• SDW and never-married females also had higher rates of ACM than married females (HR = 1.24, P < 0.001 and HR = 1.22, P = 0.01, respectively). CONCLUSIONS• For both men and women, being SDW conveyed an increased risk of BCSM after RC.• SDW and never marrying had a deleterious effect on ACM.• Unfavourable stage at RC was also seen more commonly in never-married males.

The Optilume ® Drug Coated Balloon (DCB) is a urethral dilation balloon with a paclitaxel coating that combines mechanical dilation for immediate symptomatic relief with local drug delivery to maintain urethral patency. The ROBUST III study is a randomized, single blind trial evaluating the safety and efficacy of the Optilume DCB against endoscopic management of recurrent anterior urethral strictures. Materials and Methods: Eligibility criteria were: adult men with anterior strictures ≤12F in diameter and ≤3cm in length, at least 2 prior endoscopic treatments, International Prostate Symptom Score ≥11, and maximum flow rate <15 mL/sec. 127 subjects were enrolled at 22 sites. The primary study endpoint was anatomic success (≥14F by cystoscopy or calibration) at 6 months. Key secondary endpoints included freedom from repeat treatment, International Prostatic Symptom Score (IPSS), and peak flow rate (Qmax). The primary safety endpoint included freedom from serious device or procedure related complications. Results: Baseline characteristics were similar between groups, with subjects having an average of 3.6 prior treatments and average length of 1.7cm. Anatomic success for Optilume DCB was significantly higher than Control at 6 months (75% vs 27%, p<0.001). Freedom from repeat intervention was significantly higher in the Optilume DCB arm. Immediate symptom and urinary flow rate improvement was significant in both groups, with the benefit being more durable in the Optilume DCB group. The most frequently adverse events included urinary tract infection, postprocedural hematuria, and dysuria. Conclusions: The results of this randomized controlled trial support that Optilume is safe and superior to standard DVIU/dilation for the treatment of recurrent anterior urethral strictures <3cm in length. The Optilume DCB may serve as an important alternative for men that have had an unsuccessful DVIU/dilation but want to avoid or delay urethroplasty.