Aims: Pad per day (PPD) usage is a frequently utilized measure of urinary incontinence. The 24-hour pad weight test (24PWT) is a reproducible test for quantifying incontinence volumes. We investigated whether PPD validly reports the magnitude of urinary incontinence. Methods: This was a retrospective review of patients undergoing stress incontinence surgery from July 2002 to 2005. Inclusion criteria were a documented 24PWT and patient-reported PPD usage. Grams of urine loss per pad (GPP) provided a third measure of incontinence. Descriptive statistics and correlations between all variables and signi¢cance were noted. Factor analysis was performed on the three measures of leakage and age for all patients over age 50. Results: One hundred forty-¢ve male and 116 female patients met inclusion criteria. Correlated against 24PWT, GPP has the strongest association with a correlation of 0.80 for males and 0.88 for females. PPD has a weaker correlation of 0.64 for males and 0.61 for females (R 2 ¼ 0.38 overall). Factor analysis identi¢ed two components associated with incontinence. A ''leakage'' component correlated best with 24PWT and GPP. Additionally, an ''age'' component implies that despite stable 24PWT values, older patients increase GPP while PPD decreases. Conclusions: Self-reported PPD is an unreliable measure of incontinence as this variable only measures 38% of the variation of urinary incontinence volume. Patients at a given PPD level present with a wide range of 24PWT values. Older patients have higher per-pad leakage. Future incontinence studies should report 24PWT to ensure the most reliable and uniform data.

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PFUDD injury and had a posterior urethroplasty from 1990 to 2004 were identified from a database. Patients were contacted by telephone, and those who were willing to participate were given the International Index of Erectile Function (IIEF) questionnaire. Using unpaired Student's t -tests, IIEF scores were compared to normal controls, and to results of other studies of men sustaining pelvic fractures. RESULTSIn all, 26 men completed the IIEF, among whom EF was compromised in 14 (54%), including eight with severe ED (31%). Orgasmic function and ejaculation was maintained. Men with a PFUDD had significantly worse EF than men in other series with pelvic fractures. CONCLUSIONSMen who sustain a PFUDD are at significantly greater risk of ED than those with no urethral distraction injury. Men with PFUDD injuries represent a target population for early penile rehabilitation programmes. KEYWORDS OBJECTIVETo determine the specific effect of pelvic fracture-urethral distraction defect (PFUDD) injuries on erectile function (EF) in men after pelvic fractures, and to compare EF to that found in other studies of men who sustained pelvic fractures, as currently the relationship between erectile dysfunction (ED) and PFUDD has not been elucidated using validated questionnaires. PATIENTS AND METHODSWith approval from the institutional review board, patients who sustained a

We report on men undergoing 4 variations of bulbar urethroplasty. Although the numbers are small, we found that such surgery had an insignificant effect on erectile function. Surgical complexity with long stricture excision and the use of a buccal graft did not influence outcome.

We believe that continence can be salvaged in the majority of men in whom the device fails or requires explantation and we present the logical analysis for device revision and relocation in this review.

Recent increase in the use of neuromodulation for the treatment of urinary urgency and frequency, urge incontinence, and nonobstructive urinary retention has coincided with improved knowledge of micturition physiology and concurrent technologic advances in nerve stimulation. Currently, the most common technology for bladder neuromodulation involves stimulation through the S3 foramen, or sacral neuromodulation, although other techniques of neuromodulation continue to be explored. Despite many advances in neuromodulation, the exact mechanism of action remains uncertain. Additionally, which patients will respond to neuromodulation remains unclear, and although there is a standard method for testing, this procedure is invasive and expensive. As we continue to improve patient selection criteria and better understand the mechanism of action, the efficacy and patient satisfaction should continue to increase. Currently, most patients considered for implantation with a neuromodulator are those unresponsive to other conservative treatments for bladder dysfunction.

Patients undergoing bilateral ectopic ureterocele repair are at increased risk for postoperative voiding dysfunction. Whether this risk is present preoperatively or is a result of trigonal surgery is unclear.

PATIENTS AND METHODSWith institutional review board approval, patients who had PFUDD repairs by one surgeon from 1990 to 2004 were identified from a database. Patients were contacted and given a questionnaire eliciting details about their ejaculatory function and history of fertility. Those interested in future paternity were asked to provide semen for analysis. RESULTSIn all, 32 men were contacted; all claimed to have antegrade ejaculation, although five reported having a lower ejaculatory volume than before their injury, and one claimed that his ejaculate was delayed. We assessed fertility in 19 men, six of whom had either infertility or abnormal semen analyses. CONCLUSIONSAll men in the present series who had PFUDD injuries repaired had antegrade ejaculation. Although six of 19 had either infertility or an abnormal semen analysis, it appears that the risk of damage to the ejaculatory ducts from either a PFUDD or the subsequent urethral reconstruction is low. However, other associated injuries at the time of the pelvic fracture might place these men at greater risk of infertility. KEYWORDSposterior urethroplasty, male urethral stricture, infertility, semen analysis, ejaculation Study Type -Therapy (outcomes research) Level of Evidence 2c OBJECTIVEIn men who sustain a pelvic fractureurethral distraction defect (PFUDD) injury, repairing the urethra involves a complicated urethral anastomosis located posteriorly at the junction of the membranous and prostatic urethra. In this study we performed a postoperative semen analysis and questionnaire study to determine the effect of PFUDD injuries and PFUDD repair on ejaculatory function and fertility in these men.