157 THE TILOOP® MALE SLING AND PROACT® BALLONS: A NEW ADJUSTABLE TREATMENT OPTION TO IMPROVE MALE STRESS URINARY INCONTINENCE SIGNIFICANTLY

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The TiLOOP® male sling and ProAct® ballons: A new adjustable treatment option to improve male stress urinary incontinence significantly



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Post-radical cystectomy parastomal hernia repair: Long-term follow-up

Neymeyer J., Abdul-Wahab Al-Ansari W., Kassin S., Wülfing T., Behm A., Beer M.

Rodríguez Faba O., Rosales A., Palou J., Huguet J., Pardo P., Parada R., Villavicencio H.

Franziskus-Hospital-Berlin, Dept. of Urology and Urogynecology, Berlin, Germany

Fundació Puigvert, Dept. of Urology, Barcelona, Spain

Introduction & Objectives: Stress urinary incontinence (SUI) in male patients is one of the severe problems that can occur especially after radical prostatectomy (RP). Until recently the artificial sphincter prosthesis has been the most efficient treatment option for this condition. As sling techniques have proven to be highly effective in female patients and an adjustable ballon system in male patients, these techniques has been combined in male patients. After the transobturator male sling was performed and two ballons are insert in same session in case of SUI °II-III, the pre and postoperative outcome data was documented via telephone interview and evaluated.

Introduction & Objectives: Parastomal hernia is a rare complication seen in some 4.5 - 6.5% of patients with ileal conduit. Rather few studies with follow-ups longer than one year are available, as well as little information on the two main types of repair: In situ and stromal translocation. Additionally, in the published series its surgical correction presents with a 30 – 50% failure rate.To review the results of parastomal hernia surgical repair in our series of radical cystectomy with ileal conduit.

Material & Methods: From June 2007 to September 2008, 29 TiLOOP Male Slings (SUI °I) and 14 Male Slings with Ballon System ProAct (SUI °II or °III) were placed in males suffering from mild to severe SUI. The insertion of a polypropylene hammock under the bulbous-membranous urethra are according to the inside-out approach. The causes for SUI were in 22 patients RP, 1 patient Seed implantation and 5 patients Transurethral Resection of the Prostate (TURP). Pre-operatively all patients recorded their flow-rate, post-void residual urine and pad use in a micturation diary. Patients with Ballons are adjusted one month later to improve continence significantly. A postoperative evaluation was performed via telephone interview that compared preoperative vs. postoperative pad use, patient satisfaction, quality of life and postoperative complications.

Material & Methods: We carried out a retrospective review of 1,539 radical cystectomies with ileal conduit performed at our Centre between October 1982 and June 2006. Twenty-eight of them (1.81%) presented with parastomal hernia with surgical indication during the follow-up: The patients were 22 men and 6 women, and their mean age was 63 years (49 – 79). CT was performed to 20 patients (71,4%). A loop transposition technique in the ipsilateral hemi-abdomen was performed in 19 patients (68%), and local fascia repair without transposition in 9 patients (32%). The mean BMI was 28 (23 – 36), and the mean protein level was 66.46 g/L (38 – 75). The mean operative time was 180 minutes (120 – 240), and the mean hospital stay 7 days (1 – 25). Fifteen patients (53,5%) had received adjuvant chemotherapy, 9 (32%) had received radiation therapy, and 7 (25%) had received both.

Results: At a mean of 6 months follow-up (3 to 9 months), the pad usage per day decreased significantly from 6 to 1/2 respectively. 11 patients reported complete continence; Whereas 45 percent of the remaining patients used only one pad for safety reasons. None of the study patients reported decreased urinary flow or the feeling of incomplete voiding. The overall satisfaction was high and quality of life improved significantly. No major surgical complications were noted. Based on the preoperative evaluation, most patients requested the male sling due to its reduced invasiveness and minimal patient effort. Conclusions: Male sling procedures might be an efficient SUI (°I) treatment option for after radical prostatectomy and TURP. The combination of TiLOOP Male Sling with adjustable Ballon-System already provides an alternative and effective new treatment option for patients with SUI (°II and °III); The sling is performed minimally invasive, feasible and allows for an immediate improvement of incontinence after catheter removal on the second postoperative day. Minimal invasive late regulation are possible. Despite the fact that the majority of patients still use a single pad for safety reasons after the treatment, their satisfaction is high. Side effects were mild. The TiLOOP Male Sling System or the combination Sling and Ballon completes the spectrum of incontinence surgery procedures.



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Results: On a mean follow-up of 55 months (5 – 281), post-repair complications were: wound infection in 7 patients (25%), and stomal necrosis in 1 (3,57%). Seven patients (25%) experienced recidivation, and the mean time to recidivation was 43.2 months. Four individuals recidivated (21%) in the loop transposition group (19 patients), and 3 (33%) in the transposition-free group. From the total recidivating patients (7), six (86%) had undergone previous abdominal surgery; 3 (42%) radiation therapy, and 4 (57%) chemotherapy. From the total recidivating patients (7), a conservative attitude was decided for 6, and in only 1 of them the recidivation was treated surgically. Conclusions: Parastomal hernia following an ileal conduit is a rare complication, with a low rate of incidence and recidivation. Repair by means of stoma transposition in the ipsilateral hemi-abdomen shows a slightly lower recidivation rate than in situ repair (21% vs. 33%).



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Laparoscopic ureteral reimplantation: Prospective evaluation of medium term results and future developments

Male to female gender reassignment: Modified surgical technique minimizes postoperative risks and improves the final outcome

Gözen A.S.1, Cresswell J.2, Canda A.E.3, Ganta S.1, Rassweiler J.J.1, Teber D.1

Seibold J., Amend B., Kruck S., Stenzl A., Sievert K.D.

Slk Kliniken Heilbronn, University of Heidelberg, Dept. of Urology, Heilbronn, Germany, 2James Cook University Hospital, Dept. of Urology, Middlesbrough, United Kingdom, 3Atatürk Education and Research Hospital, Dept. of Urology, Ankara, Turkey

University of Tübingen, Dept. of Urology, Tübingen, Germany

1

Introduction & Objectives: Laparoscopic ureteral reimplantation is a feasible method for treating ureteral pathology with good preliminary results in the literature. In this study we review our mid-term results for laparoscopic ureteral reimplantation. Material & Methods: 22 laparoscopic ureteral reimplantations were performed between August 2003 and January 2008 for ureteral strictures or ureteral injuries. The mean age was 53.9 years (7 men, 15 women). Patient demographics, preoperative symptoms, radiological imaging, complications and postoperative outcomes were analyzed. Success was defined as relief of obstruction on postoperative imaging studies, as well as symptomatic relief. The median follow up was 31 months. Results: Laparoscopic ureteral reimplantations were successfully performed in all patients. Ten patients underwent vesicopsoas-hitch, seven patients a vesicopsoashitch combined with Boari-flap ureteral reimplantation and five Lich-Gregoir extravesical ureteral reimplantations. The mean operative time was 198 minutes (65 - 351). Mean estimated blood loss was 280 ml (50 - 550) One patient had an intraoperative bowel injury which was managed laparoscopically during the same procedure. There were 3 postoperative complications; two prolonged ileus and one deep venous thrombosis (DVT). Mean hospital stay was 7 days. Time to return to normal activity averaged 2.5 weeks. Postoperative radiological imaging studies showed good drainage, or no hydronephrosis, in 21 patients (success rate 95.4 %) at a median follow up interval of 31 months. Conclusions: Laparoscopic ureteral reimplantation is an effective procedure with good medium term results. We believe that, this procedure will become an established treatment option.

Eur Urol Suppl 2009;8(4):160

Introduction & Objectives: Various techniques for neovaginal reconstruction in gender reassignment have been published in the past. The major problems after neovaginal reconstruction are vaginal stenosis and insufficient size resulting in patient dissatisfaction. In 2000 Perovic et al. described the incorporation of an excessive penile urethra into the neovaginal circumference. Our prospective patient follow-up investigates the postoperative outcome of this technique. In addition varying the surgical positions were analyzed to reduce the risk of compartment syndrome, thrombosis and peroneal paralysis caused by prolonged lithotomy position. Material & Methods: From October 2006 to October 2008 nine patients underwent gender reassignment using the following technique: Penile disassembly and orchiectomy in the supine position. The patient is then put in the lithotomy position and supplemented with pneumatic stockings. The corpora cavernosa is resected and neovaginal reconstruction is performed using the penile skin and urethral flap. Before the neovagina is inserted into the blund-disected rectoprostatic space and fixed to the sacrospinous ligament, the size- reduced vascularized and innervated glans is used to create the neoclitoris. The medial scrotal skin is used to form the labia majora and minora and the subcutaneous fat is moved to become the mons veneris. An unique approach to move the skin resulted in reduced skin incisions. Results: In all nine patients the cosmetic results in the external genitalia were excellent with only two almost-invisible scars at the outer labia majora. In two patients a minor correction of asymmetric skin of the labia majora was necessary. In all patients a sensation in the neoclitoris was found. All patients had a satisfactory neovagina regarding depth and width and 8 patients of nine reported normal sexual intercourse. One patient was without partner. Mean operating time was 305 min (270 – 405 min), of which the mean time in the lithotomy position was 185 min. Mean hospitalization was 13 days (9 – 18 days). In one patient a small rectal lesion was closed during surgery that healed without problem. No blood transfusion was necessary. Using the two-step positioning, no postoperative complications occurred, e.g. compartment syndrome or peroneal paralysis. Conclusions: The incorporation of vascularized distal urethra for the creation of neovagina results in an optimal functional size regarding depth and width in addition to the glans use as the neoclitoris. The two-step positioning of the patients reduced operating time and postoperative complications were avoided. In most cases gender reassignment from male to female could be achieved in one operation.