Objectives:To determine the association of vesico-urethral anastomosis location (VUAL) with early recovery of urinary continence (UC) after radical prostatectomy (RP). Methods: A retrospective analysis of 678 patients who underwent RP was carried out. Patients were divided into three groups based on the VUAL as determined by postoperative cystography: group I -VUAL above the upper margin of the symphysis pubis (SP), group II -between the upper margin and the middle of the SP, and group III -below the middle of the SP. Early recovery of UC was defined as using no pads or an occasional security pad within 3 months. Recovery rates were compared between the groups and factors predicting an early recovery of UC were investigated. Results: Among all patients, 62.2% achieved an early recovery of UC. Patients in group I were younger, with a longer membranous urethra, greater percent of nerve sparing and shorter time to continence than those in groups II or III. Early recovery rates were 89.5%, 69.8% and 40.7% in group I, II and III, respectively (P < 0.001). VUAL remained an independent predictor of early recovery of UC (OR 3.2 for group I vs II and 10.8 for group I vs III [P < 0.001]) when adjusted for age, operative time, membranous urethral length and operation by surgeon with high surgical volume. Conclusion: VUAL represents an independent predictor of recovery of UC after RP. A higher VUAL is associated with a higher rate of early recovery of UC.

Objective: Recent studies have investigated a combination of two antimuscarinics for adult neurogenic bladder managed with clean intermittent catheterization or pediatric refractory overactive bladder (OAB). We assessed the efficacy and tolerability of this strategy in adults with idiopathic OAB. Methods: We reviewed 49 patients with idiopathic OAB who received combined antimuscarinic medication. Patients had serially received different kinds of antimuscarinics as monotherapy, but wished to take combined medication due to a lack of sufficient subjective improvement in urgency, even with dosage escalation. Efficacy was measured by changes of episodes of urgency, daytime voiding, nocturia and mean voided volume before and after the addition of the second antimuscarinic. Results: The mean duration of combined medication was 9.3 months. After adding the second antimuscarinic, urgency per day decreased from 3.8 to 1.9 (p < 0.001) and daytime voiding decreased from 10.4 to 7.4 (p < 0.001). The number of nocturia episodes and the mean voided volume also improved, although there was no statistical significance. Efficacy did not differ between the 29 cases, with non-selective and non-selective drugs and 20 cases with non-selective and M3 selective drugs. Thirty-three (67.3%) patients reported to have benefited from combined medication. Maximal flow rate and post-void residual volume did not change in either of the sexes. Eleven (22.4%) patients discontinued the combination due to continued ineffectiveness and dry mouth. Conclusion: This retrospective study suggests that combined medication can help adults with refractory idiopathic OAB. Combined medication was tolerated in most of our patients.

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delay bladder sensations of urgency and prevent bladder contractions. Nevertheless, the role of estrogen replacement in the management of urinary incontinence remains controversial.The purpose of this study was to determine the effectiveness of a consistently applied dose of topical estrogen cream in post-menopausal women with Lower urinary tract symptoms including urinary incontinence.METHODS: Forty post-menopausal women with a chief complaint of urinary incontinence were included in our study. They were asked to fill out a series of four separate validated questionnaires (ICIQ-SF, I-QOL, UDI-6, and IIQ-7) regarding their urinary symptoms both before the use of topical estrogen and then again after a three month treatment period. The results were then compared.RESULTS: A total of 40 patients completed the study. The average age of our cohort was 62 (46 -84). Prior to topical estrogen use 27/40 (67.5%) patients experienced symptoms of atrophic vaginitis, 14/40 (35%) patients had had symptoms of urinary tract infections, and 35/40 (87.5%) patients suffered from stress urinary incontinence. After treatment with topical estrogen, only 13/40 (32.5%) patients had symptoms of atrophic vaginitis (pϽ.0005), 4/40 (10%) had symptoms of a UTI (pϽ.002), and just 12/40 (30%) patients complained of stress related urinary incontinence (pϽ.0001).All measured variables in each of the four different validated questionnaires demonstrated statistical significance with a reduction in events after treatment with topical estrogen, including the Incontinence Quality of Life Measure. This tool asks the patient to rate their current feelings regarding their urinary condition on a scale from 0 (terrible) to 10 (pleased). A mean response of 2.45 was recorded before treatment compared to a mean response of 8.0 after treatment (p Ͻ .00008) CONCLUSIONS: Post-menopausal women who suffer from lower urinary tract symptoms including urinary incontinence, can gain a dramatic improvement in their overall quality of life as well as a reduction in symptoms from vaginal atrophy and urinary symptoms including incontinence when using a consistently applied dose of topical estrogen cream.