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Re: A Systematic Review of Surgical Techniques Used in the Treatment of Female Urethral Stricture
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Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology Re: The Role of Phosphodiesterases in Bladder Pathophysiology € M. S. Rahnama’i, S. Uckert, R. Hohnen and G. A. van Koeveringe Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands Nat Rev Urol 2013; 10: 414e424.
Abstract available at http://jurology.com/ Editorial Comment: This is an excellent review article which is well referenced and well illustrated on the importance of cyclic guanosine monophosphate and cyclic adenosine monophosphate pathways in control of bladder function, and the effects of inhibition of the various phosphodiesterases found in bladder, bladder neck and prostate smooth muscle. This, along with the article by Osman et al (see next comment), gives considerable insight into the potential use of these compounds for the treatment of lower urinary tract symptoms, as yet explored with only phosphodiesterase type 1 and phosphodiesterase type 5 inhibitors.1 Alan J. Wein, MD, PhD (hon) 1. Andersson KE, de Groat WC, McVary K et al: Tadalafil for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: pathophysiology and mechanism(s) of action. Neurourol Urodyn 2011; 30: 292.
Re: A Systematic Review of Surgical Techniques Used in the Treatment of Female Urethral Stricture N. I. Osman, A. Mangera and C. R. Chapple Department of Urology, Royal Hallamshire Hospital, Sheffield, United Kingdom Eur Urol 2013; 64: 965e973.
Abstract available at http://jurology.com/ Editorial Comment: The incidence of true female urethral stricture (as opposed to calculations based on the number of urethral dilations carried out in women with lower urinary tract symptoms or recurrent urinary tract infections) is low. The literature cites this cause as responsible for 4% to 13% of cases of bladder outlet obstruction in women. The authors have collected 221 cases that satisfy their criteria of what they consider to be proper diagnosis and outcome assessment. The 2 main techniques reported on were urethral dilation and augmentation urethroplasty. Urethral dilation had a success rate of 47% and a mean followup of 43 months. The success rate was 58% in patients with no history of dilation and 27% in those who had undergone previous dilatation. It appears that the urethra was most commonly dilated to 41Fr. There were no reports of de novo incontinence with dilation. The techniques for formal urethroplasty utilized vaginal or labial flaps, free grafts from the labia or vagina and free oral mucosal grafts. Flaps were primarily vaginal and showed a 91% success rate at a
0022-5347/14/1922-0001/0 THE JOURNAL OF UROLOGY® © 2014 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2014.05.079 Vol. 192, 1-2, August 2014 Printed in U.S.A.
www.jurology.com Dochead: Urological Survey
LIT 5.2.0 DTD JURO11504_proof 13 May 2014 11:52 pm EO:
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VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
mean of 32 months, although 12 of the 50 patients were on intermittent catheterization. No sphincteric incontinence were reported. Success was reported in 80% of patients utilizing free vaginal or labial grafts at a mean followup of 22 months, with no instances of de novo incontinence and no use of intermittent catheterization. With the use of oral mucosal grafts the success rate was 94% at a followup of 15 months, with no usage of intermittent catheterization afterward and no reports of de novo incontinence. This represents a nice review of the subject. Surgical techniques are not described in detail. Alan J. Wein, MD, PhD (hon)
Suggested Reading Santucci RA, Payne CK, Anger JT et al: Office dilation of the female urethra: a quality of care problem in the field of urology. J Urol 2008; 180: 2068. Simonato A, Varca V, Esposito M et al: Vaginal flap urethroplasty for wide female stricture disease. J Urol 2010; 184: 1381. Blaivas JG, Santos JA, Tsui JF et al: Management of urethral stricture in women. J Urol 2012; 188: 1778. Migliari R, Leone P, Berdondini E et al: Dorsal buccal mucosa graft urethroplasty for female urethral strictures. J Urol 2006; 176: 1473.
Re: TVT-O for the Treatment of Pure Urodynamic Stress Incontinence: Efficacy, Adverse Effects, and Prognostic Factors at 5-Year Follow-up e, F. Haab, M. Serati, R. Bauer, J. N. Cornu, E. Cattoni, A. Braga, G. Siesto, D. Lize M. Torella and S. Salvatore Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy Eur Urol 2013; 63: 872e878.
Abstract available at http://jurology.com/ Editorial Comment: The patient population included only patients with “pure” urodynamically proved stress incontinence and symptomatology, and without higher than stage 1 vaginal prolapse or post-void residual greater than 100 ml. Of the patients 11% had undergone a prior failed antiincontinence surgical procedure. A total of 191 women were originally included and 6 were lost to followup. There was only 1 bladder perforation and no other intraoperative complications, and only 11 patients reported early postoperative voiding dysfunction, requiring only 1 revision. A total of 19 patients complained of groin pain a day after surgery, and this persisted 1 month after surgery in 6. Two women complained of persistent such pain 1 year postoperatively, and none after 5 years. Objective cure with a negative stress test at 12 months for the patients able to be evaluated was 90.9%, and 91.4% considered themselves to be subjectively satisfied. Of those available for followup at 5 years 90.8% exhibited a negative stress test, and 90.3% considered themselves subjectively satisfied. Certainly one would have to agree with the authors in this population of patients that this represents a “highly effective and safe procedure, with a long lasting effectiveness.” However, the onset of de novo overactive bladder symptoms was reported by 24% of the evaluable population at 1 year and by 19.5% at 5 years. There were no predictors for the risk of developing de novo overactive bladder symptoms. The editorial comment calls for the procedure to be labeled “a new gold standard surgical treatment of female [stress urinary incontinence].” It is not clear whether this is meant to be along with traditional tension-free vaginal tape or in preference to it. If the latter, this needs to be tempered by the fact that the editorial author is a consultant for the manufacturer and an employee of the university which holds the patent for inside-out tension-free vaginal transobturator tape. Alan J. Wein, MD, PhD (hon)
Dochead: Urological Survey
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Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology Re: The Role of Phosphodiesterases in Bladder Pathophysiology € M. S. Rahnama’i, S. Uckert, R. Hohnen and G. A. van Koeveringe Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands Nat Rev Urol 2013; 10: 414e424.
Abstract available at http://jurology.com/ Editorial Comment: This is an excellent review article which is well referenced and well illustrated on the importance of cyclic guanosine monophosphate and cyclic adenosine monophosphate pathways in control of bladder function, and the effects of inhibition of the various phosphodiesterases found in bladder, bladder neck and prostate smooth muscle. This, along with the article by Osman et al (see next comment), gives considerable insight into the potential use of these compounds for the treatment of lower urinary tract symptoms, as yet explored with only phosphodiesterase type 1 and phosphodiesterase type 5 inhibitors.1 Alan J. Wein, MD, PhD (hon) 1. Andersson KE, de Groat WC, McVary K et al: Tadalafil for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: pathophysiology and mechanism(s) of action. Neurourol Urodyn 2011; 30: 292.
Re: A Systematic Review of Surgical Techniques Used in the Treatment of Female Urethral Stricture N. I. Osman, A. Mangera and C. R. Chapple Department of Urology, Royal Hallamshire Hospital, Sheffield, United Kingdom Eur Urol 2013; 64: 965e973.
Abstract available at http://jurology.com/ Editorial Comment: The incidence of true female urethral stricture (as opposed to calculations based on the number of urethral dilations carried out in women with lower urinary tract symptoms or recurrent urinary tract infections) is low. The literature cites this cause as responsible for 4% to 13% of cases of bladder outlet obstruction in women. The authors have collected 221 cases that satisfy their criteria of what they consider to be proper diagnosis and outcome assessment. The 2 main techniques reported on were urethral dilation and augmentation urethroplasty. Urethral dilation had a success rate of 47% and a mean followup of 43 months. The success rate was 58% in patients with no history of dilation and 27% in those who had undergone previous dilatation. It appears that the urethra was most commonly dilated to 41Fr. There were no reports of de novo incontinence with dilation. The techniques for formal urethroplasty utilized vaginal or labial flaps, free grafts from the labia or vagina and free oral mucosal grafts. Flaps were primarily vaginal and showed a 91% success rate at a
0022-5347/14/1922-0001/0 THE JOURNAL OF UROLOGY® © 2014 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2014.05.079 Vol. 192, 1-2, August 2014 Printed in U.S.A.
www.jurology.com Dochead: Urological Survey
LIT 5.2.0 DTD JURO11504_proof 13 May 2014 11:52 pm EO:
j
58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 1 113 114
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115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176
VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
mean of 32 months, although 12 of the 50 patients were on intermittent catheterization. No sphincteric incontinence were reported. Success was reported in 80% of patients utilizing free vaginal or labial grafts at a mean followup of 22 months, with no instances of de novo incontinence and no use of intermittent catheterization. With the use of oral mucosal grafts the success rate was 94% at a followup of 15 months, with no usage of intermittent catheterization afterward and no reports of de novo incontinence. This represents a nice review of the subject. Surgical techniques are not described in detail. Alan J. Wein, MD, PhD (hon)
Suggested Reading Santucci RA, Payne CK, Anger JT et al: Office dilation of the female urethra: a quality of care problem in the field of urology. J Urol 2008; 180: 2068. Simonato A, Varca V, Esposito M et al: Vaginal flap urethroplasty for wide female stricture disease. J Urol 2010; 184: 1381. Blaivas JG, Santos JA, Tsui JF et al: Management of urethral stricture in women. J Urol 2012; 188: 1778. Migliari R, Leone P, Berdondini E et al: Dorsal buccal mucosa graft urethroplasty for female urethral strictures. J Urol 2006; 176: 1473.
Re: TVT-O for the Treatment of Pure Urodynamic Stress Incontinence: Efficacy, Adverse Effects, and Prognostic Factors at 5-Year Follow-up e, F. Haab, M. Serati, R. Bauer, J. N. Cornu, E. Cattoni, A. Braga, G. Siesto, D. Lize M. Torella and S. Salvatore Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy Eur Urol 2013; 63: 872e878.
Abstract available at http://jurology.com/ Editorial Comment: The patient population included only patients with “pure” urodynamically proved stress incontinence and symptomatology, and without higher than stage 1 vaginal prolapse or post-void residual greater than 100 ml. Of the patients 11% had undergone a prior failed antiincontinence surgical procedure. A total of 191 women were originally included and 6 were lost to followup. There was only 1 bladder perforation and no other intraoperative complications, and only 11 patients reported early postoperative voiding dysfunction, requiring only 1 revision. A total of 19 patients complained of groin pain a day after surgery, and this persisted 1 month after surgery in 6. Two women complained of persistent such pain 1 year postoperatively, and none after 5 years. Objective cure with a negative stress test at 12 months for the patients able to be evaluated was 90.9%, and 91.4% considered themselves to be subjectively satisfied. Of those available for followup at 5 years 90.8% exhibited a negative stress test, and 90.3% considered themselves subjectively satisfied. Certainly one would have to agree with the authors in this population of patients that this represents a “highly effective and safe procedure, with a long lasting effectiveness.” However, the onset of de novo overactive bladder symptoms was reported by 24% of the evaluable population at 1 year and by 19.5% at 5 years. There were no predictors for the risk of developing de novo overactive bladder symptoms. The editorial comment calls for the procedure to be labeled “a new gold standard surgical treatment of female [stress urinary incontinence].” It is not clear whether this is meant to be along with traditional tension-free vaginal tape or in preference to it. If the latter, this needs to be tempered by the fact that the editorial author is a consultant for the manufacturer and an employee of the university which holds the patent for inside-out tension-free vaginal transobturator tape. Alan J. Wein, MD, PhD (hon)
Dochead: Urological Survey
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