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UP-03.186 A Tertiary Experience of Male Bulbar Urethral Closure in Neuropathic and Non-Neuropathic Patients
UNMODERATED POSTER SESSIONS
answered yes while those who received some form of treatment was only 2.6%. Conclusion: The incidences of female incontinence and urgency symptoms are extremely high and have negative effect on the quality of life of many women. However, the medical assistance is inadequate for the community. The incidence of incontinence increases considerably after 25 years of age in the female population. This may be attributed to the higher birth rates.
UP-03.185 Laparoscopic Artificial Urinary Sphincter for Female Stress Urinary Incontinence: Single Center Experience With 39 Cases Leitão T, Papatsoris A, Bryckaert P, Mandron E Dept. of Urology, Clinique Chirurgicale Du Pré, Le Mans, France Introduction and Objective: Laparoscopic implantation of an artificial urinary sphincter (AUS) in women is an efficient treatment for refractory severe stress urinary incontinence (SUI) and intrinsic urinary sphincter deficiency. Materials and Methods: In the period of April 2005 to April 2010, 39 women with SUI underwent a laparoscopic implantation of an AUS (AMS 800TM, American Medical Systems, Minnetonka, MN, USA). All patients had a negative Marshall-Bonney test and a history of urogynaecological surgery. Eighteen patients had a previous failed vaginal tape insertion. Transperitoneal laparoscopic access was created with two midline 10mm and two lateral 5mm trocars. One of the lateral port incisions was later extended to facilitate urethrovaginal dissection with scissors and dissector, and the insertion and assembly of the AUS. In 8 cases with concomitant genito-urinary prolapse, laparoscopic sacropromontofixation with anterior and posterior meshes was also performed. Results: Patients had a mean age of 67.9 years, a mean body mass index of 26,5 and the urodynamic study revealed a mean urethral closure pressure of 16,1cmH20. The AUS implantation was successful in all 39 cases, with a mean operative duration of 89 min (65 min without and 120 min with simultaneous sacropromontofixation). There were no conversions to open surgery. There was one intra-operative complication, a vaginal perforation which was repaired during surgery. Mean hospital stay was 6 days. Five patients (12.8%) developed urinary
S406
retention when the urethral catheter was removed, which was managed with reinsertion of the urethral catheter for 2 days in four and with insertion of a suprapubic catheter for 4 weeks in a patient with spina bifida. During the mean follow-up of 21.4 months, 3 treatment failures (7.7%) were diagnosed, 2 due to vaginal erosion and one due to infection. They were all managed by removal of the AUS. All the remaining 36 patients (92.3%) reported continence, complete in 32 patients (82.0%) and social in 4. Conclusion: Laparoscopic implantation of the AUS in women with SIU is possible, with good functional results.
UP-03.186 A Tertiary Experience of Male Bulbar Urethral Closure in Neuropathic and Non-Neuropathic Patients Noon A, Reid S, Tophill P Princess Royal Spinal Injuries Centre, Sheffield, UK Introduction and Objective: Bulbar urethral closure is an established treatment for intractable urinary incontinence in patients unfit or unwilling to undergo urinary diversion. It renders future surgical bladder access difficult and is viewed as a last resort, making it an infrequently performed procedure. Therefore little has been published to date of the outcome of this procedure in male patients and particularly in those with a failed or eroded artificial urinary sphincter (AUS). Materials and Methods: 14 male patients that underwent urethral closure between 2006 and 2011 were identified by searching the theatre database. A retrospective case note analysis was undertaken to evaluate this procedure. Results: Eleven patients had an underlying neurological disorder as cause for their incontinence (Spinal Injury ⫽ 5, Spina Bifida ⫽ 6,) 3 patients had an iatrogenic cause for their incontinence (radical prostatectomy (RP) ⫽ 2 and abdominoperineal resection ⫽ 1). An AUS had been previously inserted into 7 patients. After a median follow up of 38 months (range 6 – 55), two patients underwent a repeat urethral closure for urethral leakage (both patients had a prior eroded AUS following RP). Both of these patients were found to have extremely high pressure uninhibited detrusor contractions on urodynamic testing. These two patients are also maintained on anticholinergic therapy and one patient has annual intravesical botulinum toxin injection. All 14 patients are now dry urethrally.
Conclusions: Urethral closure is a low morbidity and effective procedure. The outcome however may be jeopardised by patients with high detrusor pressures as a result of detrusor overactivity / decreased bladder compliance. We recommend urodynamics prior to urethral closure to identify and appropriately manage patients with uninhibited high pressure detrusor contractions.
UP-03.187 Effect of Complete Bladder Neck Preservation (cBNP) on Oncological Outcome, Continence and QOL: A Randomised Controlled Trial Nyarangi-Dix J, Prado L, Pahernik S, Teber D, Hadaschik B, Hohenfellner M Dept. of Urology, Heidelberg University Hospital, Heidelberg, Germany Introduction and Objective: To investigate the effect of strict and complete bladder neck preservation (cBNP) on oncological outcome, continence and quality on life (QOL) after radical prostatectomy (RP) for cancer of the prostate. Materials and Methods: A randomised controlled prospective study between 2009 and August 2011 was initiated to verify the effect of cBNP on the oncological outcome, continence and the QOL. 192 patients were recruited, randomised to cBNP or non- cBNP and followed up for 12 months. The cBNP-Group comprised of only patients who had a strict preservation such that the proximal urethra could later be anatomised to the distal urethra. Data was collected on patient age at operation, period of catheterisation, prostate volume, preoperative PSA-Value, Gleason score, resection margin, tumour pathology and lymph node status. At 3, 6 and 12 months 24h-pad test, pad use, IQOL-score and oncological outcome were evaluated. Only patients with no pad usage were deemed continent. Results: Final results of the complete collective will be available at the beginning of August 2011 and can be presented in the congress. Preliminary results of this study show significantly higher early continence rates in the cBNP-Group. At 6 weeks,12 weeks and 3 months 17.6 vs. 56.3% (p⫽0.033), 55.9 vs. 81% (p⫽0.12) and 72.2% vs. 88% (p⫽0.04). There is no significant difference in continence at 6 months. No significant difference was found as far as QOL and cancer control was concerned. Conclusion: Preliminary results show that cBNP as performed in our institution does not comprise oncological outcome.
UROLOGY 78 (Supplement 3A), September 2011
answered yes while those who received some form of treatment was only 2.6%. Conclusion: The incidences of female incontinence and urgency symptoms are extremely high and have negative effect on the quality of life of many women. However, the medical assistance is inadequate for the community. The incidence of incontinence increases considerably after 25 years of age in the female population. This may be attributed to the higher birth rates.
UP-03.185 Laparoscopic Artificial Urinary Sphincter for Female Stress Urinary Incontinence: Single Center Experience With 39 Cases Leitão T, Papatsoris A, Bryckaert P, Mandron E Dept. of Urology, Clinique Chirurgicale Du Pré, Le Mans, France Introduction and Objective: Laparoscopic implantation of an artificial urinary sphincter (AUS) in women is an efficient treatment for refractory severe stress urinary incontinence (SUI) and intrinsic urinary sphincter deficiency. Materials and Methods: In the period of April 2005 to April 2010, 39 women with SUI underwent a laparoscopic implantation of an AUS (AMS 800TM, American Medical Systems, Minnetonka, MN, USA). All patients had a negative Marshall-Bonney test and a history of urogynaecological surgery. Eighteen patients had a previous failed vaginal tape insertion. Transperitoneal laparoscopic access was created with two midline 10mm and two lateral 5mm trocars. One of the lateral port incisions was later extended to facilitate urethrovaginal dissection with scissors and dissector, and the insertion and assembly of the AUS. In 8 cases with concomitant genito-urinary prolapse, laparoscopic sacropromontofixation with anterior and posterior meshes was also performed. Results: Patients had a mean age of 67.9 years, a mean body mass index of 26,5 and the urodynamic study revealed a mean urethral closure pressure of 16,1cmH20. The AUS implantation was successful in all 39 cases, with a mean operative duration of 89 min (65 min without and 120 min with simultaneous sacropromontofixation). There were no conversions to open surgery. There was one intra-operative complication, a vaginal perforation which was repaired during surgery. Mean hospital stay was 6 days. Five patients (12.8%) developed urinary
S406
retention when the urethral catheter was removed, which was managed with reinsertion of the urethral catheter for 2 days in four and with insertion of a suprapubic catheter for 4 weeks in a patient with spina bifida. During the mean follow-up of 21.4 months, 3 treatment failures (7.7%) were diagnosed, 2 due to vaginal erosion and one due to infection. They were all managed by removal of the AUS. All the remaining 36 patients (92.3%) reported continence, complete in 32 patients (82.0%) and social in 4. Conclusion: Laparoscopic implantation of the AUS in women with SIU is possible, with good functional results.
UP-03.186 A Tertiary Experience of Male Bulbar Urethral Closure in Neuropathic and Non-Neuropathic Patients Noon A, Reid S, Tophill P Princess Royal Spinal Injuries Centre, Sheffield, UK Introduction and Objective: Bulbar urethral closure is an established treatment for intractable urinary incontinence in patients unfit or unwilling to undergo urinary diversion. It renders future surgical bladder access difficult and is viewed as a last resort, making it an infrequently performed procedure. Therefore little has been published to date of the outcome of this procedure in male patients and particularly in those with a failed or eroded artificial urinary sphincter (AUS). Materials and Methods: 14 male patients that underwent urethral closure between 2006 and 2011 were identified by searching the theatre database. A retrospective case note analysis was undertaken to evaluate this procedure. Results: Eleven patients had an underlying neurological disorder as cause for their incontinence (Spinal Injury ⫽ 5, Spina Bifida ⫽ 6,) 3 patients had an iatrogenic cause for their incontinence (radical prostatectomy (RP) ⫽ 2 and abdominoperineal resection ⫽ 1). An AUS had been previously inserted into 7 patients. After a median follow up of 38 months (range 6 – 55), two patients underwent a repeat urethral closure for urethral leakage (both patients had a prior eroded AUS following RP). Both of these patients were found to have extremely high pressure uninhibited detrusor contractions on urodynamic testing. These two patients are also maintained on anticholinergic therapy and one patient has annual intravesical botulinum toxin injection. All 14 patients are now dry urethrally.
Conclusions: Urethral closure is a low morbidity and effective procedure. The outcome however may be jeopardised by patients with high detrusor pressures as a result of detrusor overactivity / decreased bladder compliance. We recommend urodynamics prior to urethral closure to identify and appropriately manage patients with uninhibited high pressure detrusor contractions.
UP-03.187 Effect of Complete Bladder Neck Preservation (cBNP) on Oncological Outcome, Continence and QOL: A Randomised Controlled Trial Nyarangi-Dix J, Prado L, Pahernik S, Teber D, Hadaschik B, Hohenfellner M Dept. of Urology, Heidelberg University Hospital, Heidelberg, Germany Introduction and Objective: To investigate the effect of strict and complete bladder neck preservation (cBNP) on oncological outcome, continence and quality on life (QOL) after radical prostatectomy (RP) for cancer of the prostate. Materials and Methods: A randomised controlled prospective study between 2009 and August 2011 was initiated to verify the effect of cBNP on the oncological outcome, continence and the QOL. 192 patients were recruited, randomised to cBNP or non- cBNP and followed up for 12 months. The cBNP-Group comprised of only patients who had a strict preservation such that the proximal urethra could later be anatomised to the distal urethra. Data was collected on patient age at operation, period of catheterisation, prostate volume, preoperative PSA-Value, Gleason score, resection margin, tumour pathology and lymph node status. At 3, 6 and 12 months 24h-pad test, pad use, IQOL-score and oncological outcome were evaluated. Only patients with no pad usage were deemed continent. Results: Final results of the complete collective will be available at the beginning of August 2011 and can be presented in the congress. Preliminary results of this study show significantly higher early continence rates in the cBNP-Group. At 6 weeks,12 weeks and 3 months 17.6 vs. 56.3% (p⫽0.033), 55.9 vs. 81% (p⫽0.12) and 72.2% vs. 88% (p⫽0.04). There is no significant difference in continence at 6 months. No significant difference was found as far as QOL and cancer control was concerned. Conclusion: Preliminary results show that cBNP as performed in our institution does not comprise oncological outcome.
UROLOGY 78 (Supplement 3A), September 2011