No abstract

No abstract

Aims Post‐prostatectomy stress urinary incontinence (PPI) is a common condition with significant impact on patient quality of life. With rising numbers of prostatectomies performed, recognition of incontinence during survivorship care is growing. With increasing hesitance of the use of suburethral mesh in females, urethral bulking injections in this patient population as a minimally invasive alternative to surgery are evaluated. This review aims to evaluate the existing evidence base for urethral bulking therapy in PPI and provide a summary of its efficacy, durability, and side‐effect profile. Methods A literature search of Medline/Pubmed and Cochrane databases was conducted to identify publications reporting the clinical outcomes of urethral bulking injections in patients with PPI, up to and including October 1st, 2018. Case reports, letters and reviews were excluded. Results We identified 25 studies that fit our inclusion criteria, comprised of one RCT, two large retrospective cohort studies, and 22 case series. The success rates reported varying widely from 13%‐100% with reports of symptomatic control deterioration. Complication rates remain low. This review highlighted a poor performance using the more historic bulking agents (BA), and the lack of strong evidence with the more novel BA in PPI and discussed challenges regarding optimal patient selection and techniques. Conclusions There exists poor clinical evidence base concerning the use of urethral bulking in PPI with few high‐level studies and a significant lack of consistency between studies. Further study in this area is required to evaluate the role of BA in this patient population.

A 32-year-old woman presents to outpatients 10 days postpartum, with symptoms of an intermittent vaginal lump and urinary incontinence. Vaginal examination revealed no demonstrable prolapse or stress incontinence. A swelling in the bladder was noted during an antenatal scan suggesting a ureterocoele. She was referred for pelvic floor physiotherapy in the first instance. Forty-eight hours later, she represented to casualty with discomforting vaginal lump symptoms and continuous urinary incontinence. At this stage on vaginal inspection, there was an evident dusky lump emerging from the urethra with continuous incontinence. An extravesical subsphincteric prolapsed ureterocoele was evident, 5 cm beyond the external urethral meatus. The diagnosis was confirmed with an MRI scan which demonstrated the prolapsed obstructing ureterocoele causing significant left-sided hydroureteronephrosis. The ureterocoele was managed with a cystoscopy and transurethral incision of the ureterocoele under anaesthesia, which facilitated drainage and resolution. At 3-month postoperatively, the patient remains continent and satisfied.

This is a case of a 91-year-old woman presenting with urinary incontinence following insertion of a Gellhorn pessary 10 months previously. She had unfortunately missed her 6 months appointment for a change of pessary as she was admitted to hospital. Our patient was found to have had erosion of her Gellhorn shelf pessary into her urinary bladder. She underwent an open removal of the migrated Gellhorn pessary in the bladder and repair of the vesicovaginal fistula with omental interposition. She recovered well and has elected to keep her suprapubic catheter long-term.

Aims To determine the bleeding risk in patients taking anticoagulants (AC) and antiplatelets (AP) before onabotulinumtoxinA (BoNT‐A) injections and improve peri‐operative decision making and counseling. Methods We performed a retrospective review of patients having intravesical BoNT‐A in three teaching hospitals from January 2016 to July 2018. Demographic data, indication for intravesical BoNT‐A injection, and side‐effects of significant bleeding requiring intervention were recorded. Results Five hundred and thirty‐two patients had intravesical BoNT‐A injections during this time. Sixty‐three patients of mean age 69 years (range 19–89) had a total of 114 separate rounds of BoNT‐A injections whilst on treatment dose AC/AP therapy. Of the 63, there were 33 males, with 46 having idiopatic detrusor overactivity and 17 with neurogenic detrusor overactivity. Each patient had between 1 and 7 repeat injections during the studied period. AC/AP use across the 114 episodes included; aspirin 44, clopidogrel 37, warfarin 19, and NOAC (novel/non‐vitamin K oral anticoagulant) 14. Patients on warfarin who had point of care testing all had international normalized ratio less than 3. BoNT‐A dose varied from 100U to 300U—modal dosage was 200U.1/114(0.88%) injection episodes resulted in postinjection hematuria requiring overnight admission. This resolved spontaneously, with an overnight catheter. This patient was on rivaroxaban and had 300U of BoNT‐A injected through 20 sites, on a background of previous prostate radiotherapy and self‐catheterization. Conclusions Continuation of AP/AC therapy during intravesical BoNT‐A injection treatment appears to be safe—with a 0.88% rate of spontaneously resolving hematuria.

INTRODUCTION AND OBJECTIVES: Urinary incontinence is more common in older people, especially women. Androgen receptors are found throughout the pelvic floor and lower urinary tract. At menopause, women experience a decline in testosterone. However, the relationship between available testosterone in the blood and urinary incontinence in older women is not understood. Our objective was to determine if serum free testosterone levels were associated with urinary leakage in older women in a population-based cohort of aging.METHODS: The study population consisted of 3,075 healthy and well-functioning white and black men and women aged 70 to 79 years participating in the Health, Aging and Body Composition Study. Serum free and total testosterone were measured at the same time urinary health questionnaires were administered. Urinary incontinence was defined as self-reported daily urinary leakage. Data were first split by gender and then grouped by self-reported urinary leakage. A one-way ANOVA was performed, for each gender, between urinary leakage groups for both the free and total testosterone data. Additional testing was performed with pairwise Student's t-tests as the distribution of testosterone samples was approximately normal.RESULTS: Women, but not men, with urinary incontinence had decreased serum testosterone compared to women with urinary leakage less than once a month. There was also a trend towards higher free testosterone in serum with women with urinary leakage more than once per month or more than once per week.CONCLUSIONS: Decreased testosterone correlates with urinary incontinence in older women. This supports the hypothesis that testosterone may play an important role in supporting the health of muscles in the pelvic floor as well as those in maintaining urethral support, which contributes to preventing involuntary leakage of urine.

No abstract