1345 MEDIUM-TERM FOLLOWUP OF MALE ADVANCE SLING
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You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy III1 Apr 20121345 MEDIUM-TERM FOLLOWUP OF MALE ADVANCE SLING Nicole Golda and Sender Herschorn Nicole GoldaNicole Golda Toronto, Canada More articles by this author and Sender HerschornSender Herschorn Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1728AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The AdVance male sling is a novel surgical technique for management of male stress urinary incontinence. We report outcomes of our initial cohort. METHODS Between January 2007 and November 2011, sixty-eight men with stress urinary incontinence post prostate surgery were treated with the AdVance male sling. Preoperative evaluation included history, urodynamics, and cystoscopy. Postoperatively patients completed a questionnaire describing lower urinary tract symptoms, the impact of urinary incontinence and overall satisfaction (UDI-6, IIQ-7 and IPPS-QOL). RESULTS Mean age was 71.6 years (61.4-83.9 yrs). Etiology of incontinence was: 58 post radical prostatectomy, one post transurethral resection (TURP) and one post high intensity focused ultrasound + TURP. Five patients had previous radiation therapy. Mean time from prostate surgery to sling insertion was 7.9 years (2-16 yrs). Preoperative urodynamics demonstrated a mean capacity of 431 mL (230-800), and 43 patients demonstrated leakage with a mean valsalva leak point pressure of 101 (55-189). 9/54 had reduced compliance and 19/54 had detrusor overactivity (DO). Preoperative cystoscopy revealed bladder neck contraction (BNC)in 21 patients. Mean postoperative follow-up time was 30 months (3-58 months). The number of pads per day decreased from a mean of 2.6 (1-6) preoperatively to 0.7 (0-4) postoperatively (p<0.001). Postoperatively, 30/53 men (57%) no longer wear pads, 12/53 (23%) use 1 pad, 9/53 (17%) 2 pads, and 2/53 (3%) use more than 2 pads per day. 91% of patients have improved continence and 6% are unchanged. Mean IPPS QOL score was 1.6 (0-5) 78% positive, 14% mixed and 8% dissatisfied scores. More patients who failed AdVance had prior radiation therapy (p=0.0011). The urodynamic findings were similar in patients with and without previous radiation. No other preoperative parameters (including DO, BNC, or pad number) met statistical significance in predicting a successful result. Seven patients had troublesome persistent incontinence and an artificial urinary sphincter (AUS) was implanted in three patients, an Argus sling in one, and ProACT in one. One patient required sling incision for prolonged retention. No patients have had problems with tape infection or erosion. CONCLUSIONS Results from the AdVance sling indicate that it provides a reliable alternative to the AUS for management of post prostate surgery incontinence. Caution should be taken when deciding to place a sling in a patient with prior radiation therapy. Overall results indicate that a substantial number of patients are satisfied with their outcome after AdVance sling surgery. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e546 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicole Golda Toronto, Canada More articles by this author Sender Herschorn Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...Keywords:
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Stress incontinence
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Artificial urinary sphincters (AUS) are used to treat significant urinary incontinence. Flexible cystoscopy at the time of AUS placement provides relevant intraoperative feedback including confirmation that the AUS is functioning, visualization of coaptation, and evaluation for urethral injury. Current guidelines for placement of an AUS do not include flexible cystoscopy. The objective was to evaluate whether flexible cystoscopy at time of AUS placement changed cuff size at the time of surgery.A retrospective cohort study was performed to evaluate all patients undergoing AUS placement by a single surgeon between March 2013 and March 2017. The primary endpoint of the study was change in cuff size based on cystoscopy.A total of 109 AUS were placed in 96 patients. In five (4.6%) cases flexible cystoscopy identified a lack of coaptation of the urethra despite appropriate sizing which resulted in down-sizing of the cuff. Five patients were identified as having a bladder neck contracture that was previously unrecognized as clinic cystoscopy was performed by the referring urologist and was reportedly normal. Three patients developed postoperative infections, two of these patients had a history of multiple AUS placement and revisions and the third patient had a history of cystectomy and neobladder.Flexible cystoscopy at time of AUS placement changed the cuff size in nearly 5% of cases. Flexible cystoscopy at time of AUS placement provides valuable feedback and should be recommended for low volume prosthetic surgeons.
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Bladder neck sling cystourethropexy is a common procedure used to correct intrinsic sphincter deficiency in children with neurogenic bladders. Various modifications of the procedure have been made, but all involve circumferential dissection of the bladder neck and proximal urethra. The posterior dissection may be difficult and can result in injury to the rectum, urethra, and vagina. Using the principles of the posterior approach to the bladder neck as originally described by Lottman et al., one may perform a robotic-assisted laparoscopic placement of a bladder neck sling.
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You have accessJournal of UrologyPediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfnction, Enuresis1 Apr 2012607 IS A BLADDER NECK SLING SAFE AND SUFFICIENT FOR ALL MYELOMENINGOCELE PATIENTS: WHO, IF ANY, WILL REQUIRE A BLADDER AUGMENTATION? Blake Palmer, Yan Xiong, Jake Klein, Dominic Frimberger, and Bradley Kropp Blake PalmerBlake Palmer Oklahoma City, OK More articles by this author , Yan XiongYan Xiong Oklahoma City, OK More articles by this author , Jake KleinJake Klein Oklahoma City, OK More articles by this author , Dominic FrimbergerDominic Frimberger Oklahoma City, OK More articles by this author , and Bradley KroppBradley Kropp Oklahoma City, OK More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.684AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES More and more reports describe managing myelomeningocele neurogenic bladder (NGB) patients with an outlet procedure (bladder neck sling or bladder neck repair and sling) without bladder augmentation for patients with smaller than age expected bladder capacities. Historically, this was commonly unsuccessful and an unpredictable management strategy when artificial urinary sphincters were utilized as the outlet procedure. Our intent was to determine in our clinical practice if this was safe and in whom it could be predicted to be a sufficient management strategy. METHODS A retrospectively reviewed a database for all neurogenic bladder patients who underwent lower urinary tract reconstruction between 1997 and 2008 at the Children's Hospital of Oklahoma. We identified 2 cohorts of patients who underwent bladder neck sling alone and another who had a sling at the time of bladder augmentation. Preoperative urodynamic (UDS), postoperative UDS, bladder management, upper tract surveillance, surgical procedures, complications and long term continence outcomes were assessed for each group. RESULTS Group A has 6 patients who initially underwent bladder neck sling procedure only and Group B has 6 patients who had sling and concurrent bladder augmentation. In group A, 4 out of 6 patients bladder compliance deteriorated during postoperative follow-up and subsequently proceeded with bladder augmentation procedures because of decreased bladder capacity, increased detrusor leak point pressure (DLPP 40 cm H20), new and/or worsening hydronephrosis and persistent urinary incontinence. The dry rate (no leak for 4 hours with CIC) for Group A is 16.7% after initial sling procedures and 66.7% after 4 patients received bladder augmentation. CONCLUSIONS Although, the size of this study is small, numerical difference of preoperative UDS results and postoperative dry rate were clearly observed between groups. Patients with lower initial bladder capacity tended to have a higher chance to have bladder deterioration after sling procedure alone. However, after the subsequent augmentation these patients could still achieve similar dry rate as patient received concurrent augmentation. Bladder outlet management alone has the potential for deterioration of bladder dynamics and may require subsequent bladder augmentation. Close follow up is important if this management strategy is employed. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e247 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Blake Palmer Oklahoma City, OK More articles by this author Yan Xiong Oklahoma City, OK More articles by this author Jake Klein Oklahoma City, OK More articles by this author Dominic Frimberger Oklahoma City, OK More articles by this author Bradley Kropp Oklahoma City, OK More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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Recurrent stress urinary incontinence (SUI) following male sling can be managed surgically with artificial urinary sphincter (AUS) insertion. Prior small, single-center retrospective studies have not demonstrated an association between having failed a sling procedure and worse AUS outcomes. The aim of this study was to compare outcomes of primary AUS placement in men who had or had not undergone a previous sling procedure.A retrospective review of all AUS devices implanted at a single academic center during 2000-2018 was performed. After excluding secondary AUS placements, revision and explant procedures, 135 patients were included in this study, of which 19 (14.1%) patients had undergone prior sling procedures.There was no significant difference in demographic characteristics between patients undergoing AUS placement with or without a prior sling procedure. Average follow up time was 28.0 months. Prior sling was associated with shorter overall device survival, with an increased likelihood of requiring revision or replacement of the device (OR 4.2 (1.3-13.2), p = 0.015) as well as reoperation for any reason (OR 3.5 (1.2-9.9), p = 0.019). While not statistically significant, patients with a prior sling were more likely to note persistent incontinence at most recent follow up (68.8% vs. 42.7%, p = 0.10).Having undergone a prior sling procedure is associated with shorter device survival and need for revision or replacement surgery. When considering patients for sling procedures, patients should be counseled regarding the potential for worse AUS outcomes should they require additional anti-incontinence procedures following a failed sling.
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The title of this chapter reflects the need to specify anatomical placement when discussing slings. A decade ago, such a distinction was unnecessary as bladder neck positioning was standard. The birth, continued evolution, and success of the midurethral sling have altered the role of the bladder neck sling. This chapter discusses the history, applications, patient selection, technique, materials success rates, and complications of the bladder neck sling.
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No AccessJournal of UrologyReconstruction1 Oct 2005SMALL INTESTINAL SUBMUCOSA BLADDER NECK SLINGS FOR INCONTINENCE ASSOCIATED WITH NEUROPATHIC BLADDER ROSALIA MISSERI, MARK P. CAIN, ANTHONY J. CASALE, MARTIN KAEFER, KIRSTAN K. MELDRUM, and RICHARD C. RINK ROSALIA MISSERIROSALIA MISSERI , MARK P. CAINMARK P. CAIN , ANTHONY J. CASALEANTHONY J. CASALE , MARTIN KAEFERMARTIN KAEFER , KIRSTAN K. MELDRUMKIRSTAN K. MELDRUM , and RICHARD C. RINKRICHARD C. RINK View All Author Informationhttps://doi.org/10.1097/01.ju.0000176421.95997.6fAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assess the results using small intestinal submucosa (SIS) for neuropathic urinary incontinence in a large single institutional experience. Ambulatory status was considered as a possible predictor of success. Materials and Methods: We retrospectively reviewed the charts of patients treated with SIS bladder neck sling procedures for neuropathic urinary incontinence with a leak point pressure less than 25 cm H2O and a minimum of 6 months followup. Continence was defined as wet (requiring pads or diapers) or dry (requiring no pads and dry underwear). Patients were classified as ambulatory (able to ambulate without assistance or using braces, crawling at home) or nonambulatory (confined to a wheelchair). Results were analyzed with regard to patient sex, ambulatory status and simultaneous bladder neck repair. Results: A total of 21 females and 15 males 3 to 10 years old (mean age 9 years) were treated with SIS bladder neck slings (sling alone 27, bladder neck repair with SIS sling 9). Slings were performed along with reconstructive surgery in all cases (all had creation of urinary catheterizable channels and simultaneous or prior bladder augmentations). Minimum followup was 6 months (mean 15, range 6 to 42). Overall, 27 of the 36 patients (75%) are dry following bladder neck sling. In patients treated with the sling procedure alone 6 of 8 (75%) nonambulatory females and 8 of 10 (80%) ambulatory females were continent, and 3 of 4 (75%) nonambulatory males and 2 of 5 (40%) ambulatory males were dry. Conclusions: SIS has equivalent rates of continence compared to series using rectus fascia in patients with neuropathic urinary incontinence. The ambulatory status of males should be considered when determining which treatment option is best for the patient with myelodysplasia and neuropathic sphincteric incontinence, as in our series ambulatory males undergoing sling placement alone had a poor outcome. References 1 : Periurethral and puboprostatic sling repair for incontinence in patients with myelodysplasia. J Urol1990; 144: 434. Link, Google Scholar 2 : Use of the fascial sling for neurogenic incontinence: lessons learned. J Urol1993; 150: 683. Google Scholar 3 : Outcome of sling cystourethropexy in the pediatric population: a critical review. J Urol1996; 156: 642. Link, Google Scholar 4 : Advantages of rectus fascial slings for urinary incontinence in children with neuropathic bladders. J Urol2001; 165: 2369. Link, Google Scholar 5 : The use of small intestinal submucosa as an off-the-shelf urethral sling material for pediatric urinary incontinence. J Urol2002; 168: 1872. Link, Google Scholar 6 : Posterior approach to the bladder for implantation of the 800 AMS artificial sphincter in children and adolescents: technique and results in 8 patients. Ann Urol1999; 33: 357. Google Scholar 7 : Artificial urinary sphincter for incontinent children. Urology1981; 18: 370. Google Scholar 8 : Pubovaginal sling procedure for the management of urinary incontinence in a myelodysplastics girl. J Urol1982; 127: 744. Link, Google Scholar 9 : Bladder wall pedicle wraparound sling for neurogenic urinary incontinence in children. J Urol1996; 155: 305. Link, Google Scholar 10 : Expanded PTFE bladder neck slings for incontinence in children: the long-term outcome. BJU Int2004; 93: 139. Google Scholar 11 : Results of the rectus fascial sling and wrap procedures for the treatment of neurogenic sphincteric incontinence. J Urol1999; 161: 272. Link, Google Scholar 12 : Periurethral sling in males with neuropathic bladder or exstrophy: long-term follow-up. J Urol1998; 159: 26. part 2, abstract 101. Google Scholar 13 : Fascial slings and incontinent children—the gender gap. J Urol1995; 153: 279A. part 2, abstract 201. Google Scholar 14 : The use of rectus fascia to manage urinary incontinence. J Urol1989; 142: 516. Link, Google Scholar 15 : Modified pubovaginal sling in girls with myelodysplasia. J Urol1988; 139: 524. Google Scholar From the Department of Pediatric Urology,James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana© 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byDavis N, McGuire B, Callanan A, Flood H and McGloughlin T (2018) Xenogenic Extracellular Matrices as Potential Biomaterials for Interposition Grafting in Urological SurgeryJournal of Urology, VOL. 184, NO. 6, (2246-2253), Online publication date: 1-Dec-2010.Albouy B, Grise P, Sambuis C, Pfister C, Mitrofanoff P and Liard A (2018) Pediatric Urinary Incontinence: Evaluation of Bladder Wall Wraparound Sling ProcedureJournal of Urology, VOL. 177, NO. 2, (716-719), Online publication date: 1-Feb-2007. Volume 174Issue 4 Part 2October 2005Page: 1680-1682 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.Keywordsurinary incontinencemyelodysplasiaMetricsAuthor Information ROSALIA MISSERI Current address: Weill Medical College of Cornell University, Children's Hospital of New York Presbyterian, Institute for Pediatric Urology, New York, New York 10021. More articles by this author MARK P. CAIN More articles by this author ANTHONY J. CASALE More articles by this author MARTIN KAEFER More articles by this author KIRSTAN K. MELDRUM More articles by this author RICHARD C. RINK More articles by this author Expand All Advertisement PDF downloadLoading ...
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