Objective To compare the long-term outcome of arti®cial urinary sphincter (AUS) implantation in patients after prostatectomy, with and with no history of previous irradiation. Patients and methods The study included 98 men (mean age 68 years) with urinary incontinence after prostatectomy for prostate cancer (85 radical, 13 transurethral resection) who had an AUS implanted. Twenty-two of the patients had received adjuvant external beam irradiation before AUS implantation. Over a mean (range) follow-up of 46 (5±118) months, the complication and surgical revision rates were recorded and compared between irradiated and unirradiated patients. The two groups were also compared for the resolution of incontinence and satisfaction, assessed using a questionnaire. Results Overall, surgical revision was equally common in irradiated (36%) and unirradiated (24%) patients.After activating the AUS, urethral atrophy, infection and erosion requiring surgical revision were more common in irradiated patients (41% vs 11%; P<0.05); 70% of patients reported a signi®cant improvement in continence, regardless of previous irradiation. Patient satisfaction remained high, with >80% of patients stating that they would undergo surgery again and/or recommend it to others, despite previous irradiation and/or the need for surgical revision. Conclusions Despite higher complication and surgical revision rates in patients who have an AUS implanted and have a history of previous irradiation, the longterm continence and patient satisfaction appear not to be adversely affected.
Percutaneous resection of transitional cell tumor should be considered primarily in patients with early stage disease excluding tumors crossing caliceal infundibula, ureteropelvic junction tumor, tumor extending over multiple calices and synchronous ureteral tumors. The long-term outcome of low grade tumors is good and they should be managed by either form of minimally invasive surgery. Nephron sparing is possible in a large percentage of low grade disease but high grade tumors should be treated with nephroureterectomy.
A 60-year-old woman attended the gynaecology clinic with postmenopausal bleeding. She underwent hysteroscopy with dilatation and curettage, which were normal. She was referred to urology because there was an induration along the urethra and a small polypoid mass protruding through the external urinary meatus. Cystourethroscopy showed a papillary growth in the distal urethra; the bladder was normal. Biopsy of the urethral lesion showed moderately differentiated invasive TCC (Fig. 1), but random biopsies of the bladder were normal. CT of the abdomen and pelvis detected no lymphadenopathy and both kidneys were normal. She was managed by radical cysto-urethrectomy, pan-hysterectomy and excision of the anterior vaginal wall.
Objective To prospectively evaluate and quantify the efficacy of cadaveric fascia lata (CFL) as an allograft material in pubovaginal sling placement to treat stress urinary incontinence (SUI Overactive bladder symptoms were present in 23 (74%) patients before surgery, 21 (68%) at 4 months and two (6%) at 1 year; 80% of patients with low (< 15 cmH 2 O) voiding pressures before surgery required self-catheterization afterward, as did 36% at 4 months, but only one (3%) at 1 year. Twenty-four (77%) patients needed to adopt specific postures to facilitate voiding. After surgery there was a significant reduction in daytime frequency, leakage episodes and pad use ( P < 0.05). The severity of leak and storage symptoms was also significantly less ( P < 0.002), whilst the severity of obstructive symptoms remained unchanged. Mean subjective levels of improvement were 69% at 4 months and 85% at 1 year, with corresponding objective satisfaction levels of 61% and 69%, respectively. At 1 year, ≈ 80% of the patients said they would undergo the procedure again and/or recommend it to a friend. Conclusion Placing a pubovaginal sling of CFL allograft is a highly effective, safe surgical approach for resolving SUI, with a short operative time and rapid recovery. Storage symptoms are significantly improved, and subjective improvement and satisfaction rates are high.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.