scholarly journals Improved artificial urinary sphincter outcomes using a transcorporal cuff placement in patients with a “fragile urethra”

2020 ◽  
Vol 14 (12) ◽  
Author(s):  
Elaine J. Redmond ◽  
Keith F. Rourke ◽  
Steven Tong ◽  
Logan Zemp ◽  
Nathan Hoy
Keyword(s):  
Effective Treatment ◽  
Treatment Option ◽  
Artificial Urinary Sphincter ◽  
Secondary Outcome ◽  
Effective Treatment Option ◽  
Erosion Rates ◽  
Increased Risk ◽  
Urinary Sphincter ◽  
Significant Difference ◽  
History Of

Introduction: The artificial urinary sphincter (AUS) is the most effective treatment option for incontinence after prostate cancer treatment. However, patients with a “fragile urethra” (defined as prior radiotherapy, previous failed AUS, or previous urethroplasty) are at increased risk of AUS failure. The aim of this study was to evaluate outcomes using standard and transcorporal cuff placement in this group of patients. Methods: A retrospective review was performed on patients with a fragile urethra who underwent AUS insertion between 2004 and 2017. The primary outcome was the need for AUS revision. Secondary outcome measures included change in pad use, patient satisfaction, continence (≤1 pad/day), improvement (≥50% change in pad use) and cuff erosion rates. Results: Seventy-six patients met the criteria for inclusion, with a mean age of 71.6 years and a mean followup of 37.9 months. A total of 42.1% had prior radiotherapy, 56.6% had a history of failed AUS, and 19.7% had previous urethroplasty. Transcorporal cuff placement was performed in 31.6% (n=24). These patients had lower revision (20.8% vs. 36.5%; p=0.05) and erosion rates (8.3% vs. 17.3%; p=0.09). There was no significant difference in functional outcomes such as continence (66.7% vs. 73.1%; p=0.57), improvement (100% vs. 90.4%;p=0.17), or satisfaction (82.6% vs. 69.4%; p=0.26), nor for 90-day complications (4.2% vs. 9.6%; p=0.41). Conclusions: AUS insertion is an effective treatment option for post-prostatectomy incontinence in the setting of a fragile urethra. Transcorporal cuff placement in this subset of patients may be recommended, as it is associated with lower revision and erosion rates compared to standard cuff placement.

scholarly journals The impact of prior urethral sling on artificial urinary sphincter outcomes

2016 ◽  
Vol 10 (11-12) ◽  
pp. 405 ◽  
Author(s):  
Matthew J. Ziegelmann ◽  
Brian J. Linder ◽  
Marcelino E. Rivera ◽  
Boyd R. Viers ◽  
Daniel S. Elliott
Keyword(s):  
Retrospective Chart Review ◽  
Artificial Urinary Sphincter ◽  
Device Failure ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Urinary Sphincter ◽  
Device Infection ◽  
Significant Difference ◽  
History Of ◽  
The Impact

Introduction: We sought to evaluate device outcomes in men who underwent primary artificial urinary sphincter (AUS) placement after failed male urethral sling (MUS).Methods: We performed a retrospective chart review of 990 men who underwent an AUS procedure between 2003 and 2014. Of these, 540 were primary AUS placements, including 30 (5.5%) with a history of MUS. AUS revisions and explantations were compared between men stratified by the presence of prior sling. Hazard ratios (HR) adjusting for competing risks were used to determine the association with prior sling and AUS outcomes (infection/ erosion, urethral atrophy, and mechanical malfunction), while overall device failure was estimated using Kaplan-Meier and Coxregression analysis.Results: There was no significant difference in age, body mass index, prior prostatectomy, or pelvic radiation when stratified by history of MUS. However, patients with a history of MUS were more likely to have undergone prior collagen injection (p=0.01). On univariate and multivariate analysis, prior MUS was not associated with device failure (HR 1.54; p=0.27). Three-year overall device survival did not significantly differ between those with and without prior MUS (70% vs. 85%; p=0.21). Also, there were no significant differences in the incidence of device infection/erosion, mechanical malfunction, and urethral atrophy.Conclusions: AUS remains a viable treatment option for men with persistent or recurrent stress urinary incontinence after MUS. However, while not statistically significant, we identified a trend towards lower three-year device outcomes in patients with prior urethral sling. These findings indicate the need for longer-term studies to determine if slings pose an increased hazard.

scholarly journals Omalizumab Treatment in Chronic Spontaneous Urticaria During Pregnancy: Report of A Case and Review of the Literature

2021 ◽  
Vol 19 (2) ◽  
pp. 114-117
Author(s):  
Andac Salman ◽  
Meryem Aktaş
Keyword(s):  
Pregnant Woman ◽  
Cohort Studies ◽  
Effective Treatment ◽  
Treatment Option ◽  
Congenital Abnormalities ◽  
Chronic Spontaneous Urticaria ◽  
Review Of The Literature ◽  
Effective Treatment Option ◽  
Increased Risk

ABSTRACT Omalizumab is a safe and effective treatment option for chronic spontaneous urticaria (CSU). Although cohort studies in patients with asthma show no increased risk of congenital abnormalities, very little data exist in the literature regarding the use of omalizumab for CSU during pregnancy. Herein, the safe and successful use of omalizumab updosing in a pregnant woman with CSU along with a review of the published literature is presented. Keywords: Chronic spontaneous urticaria, omalizumab, pregnancy, updosing

scholarly journals Continence and Complication Rates of Artificial Urinary Sphincter Devices (AMS 800) for Parkinson and Stroke Patients with Incontinence after Prostate Surgery: Retrospective Analysis of a Prospective Database

2021 ◽  
pp. 1-7
Author(s):  
Valentin Maurer ◽  
Justus Stahlberg ◽  
Insa Schiffmann ◽  
Phillip Marks ◽  
Clemens M. Rosenbaum ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Artificial Urinary Sphincter ◽  
Manual Dexterity ◽  
Life Questionnaire ◽  
Complication Rates ◽  
International Consultation ◽  
Urinary Sphincter ◽  
Significant Difference ◽  
Neurological Patients ◽  
History Of

<b><i>Objectives:</i></b> The artificial urinary sphincter (AUS) is the gold standard treatment for severe stress urinary incontinence (SUI). According to the literature, patients suffering from Parkinson’s disease (PD) or stroke (ST) show adverse continence outcomes after prostate surgery and, therefore, constitute a challenging cohort for continence surgery. However, little is known with respect to the results of AUS surgery in these patients. A retrospective analysis of our institutional, prospectively maintained AUS database aims to address this aspect with a focus on surgical and functional outcomes. <b><i>Methods and Patients:</i></b> All data of patients with an AUS implantation were prospectively collected in our database since 2009. The AUS was implanted according to a standardized protocol and activated at 6 weeks postoperatively at our institution. Further follow-up (FU) consisted of pad-test, uroflowmetry, residual urine, and radiography as well as a standardized questionnaire including the Incontinence Quality of Life questionnaire (I-Quol) and International Consultation on Incontinence questionnaire (ICIQ-SF) and is scheduled at 6 and 24 months and every 2 years thereafter. Patients received a preoperative urodynamic evaluation (UD). Patients with normal voiding and storage function were considered for AUS implantation. All patients performed a preoperative test for manual dexterity. Patients with a history of ST or PD were grouped and compared to nonneurological patients. Primary/secondary endpoints of the study were complications/continence. <b><i>Results:</i></b> 234 patients were available for analysis. The median FU was 24 months (interquartile range 7–36). Twenty-four patients (10%) had a neurological history (PD and ST). Neurological patients showed significantly worse outcomes regarding continence (objective/subjective/social continence; <i>p</i> = 0.04/<i>p</i> = 0.02/<i>p</i> = 0.1). Significant differences concerning explantation rates were not observed (<i>p</i> = 1). Kaplan-Meier analysis showed no significant difference regarding explantation-free survival (log-rank <i>p</i> = 0.53). <b><i>Conclusion:</i></b> AUS implantation shows significantly worse continence rates for neurological patients, despite the fact that all patients showed normal UD results and sufficient manual dexterity. Although neurological patients showed worse outcomes for continence, AUS implantation seems to be a safe and viable treatment for patients with a history of neurological disease.

scholarly journals Effects of Smoking Status on Device Survival Among Individuals Undergoing Artificial Urinary Sphincter Placement

2016 ◽  
Vol 12 (5) ◽  
pp. 1398-1402 ◽  
Author(s):  
Christina A. Godwin ◽  
Brian J. Linder ◽  
Marcelino E. Rivera ◽  
Matthew J. Ziegelmann ◽  
Daniel S. Elliott
Keyword(s):  
Transient Ischemic Attack ◽  
Smoking Status ◽  
Univariate Analysis ◽  
Artificial Urinary Sphincter ◽  
Wound Complications ◽  
Urinary Sphincter ◽  
Significant Difference ◽  
History Of ◽  
Ischemic Attack ◽  
The Impact

Smoking is an established risk factor for wound complications. There is limited data on the impact of smoking on artificial urinary sphincter (AUS) outcomes. Thus, the aim of this study was to assess AUS device survival outcomes based on smoking status. From 1985 to 2014, 1,270 patients underwent AUS placement with 728 having smoking status available for review. Smoking status was categorized as never, prior, and active smokers. Kaplan−Meier analysis was performed to evaluate differences in survival, including overall device and erosion/infection−free survival. Hazard regression analysis was utilized to determine the association between smoking and device outcomes. Of the 728 patients in the study, 401 had a history of smoking with 41 active smokers and 360 never smokers at the time of AUS implant. When compared with nonsmokers, past smokers had a higher rate of hypertension and prior transient ischemic attack. Clinical comorbidities were similar between nonsmokers and active smokers. On univariate analysis, patient age, history of transient ischemic attack, diabetes, and coronary artery disease were significantly associated with infection/erosion rate, but prior or active smoking statuses were not. Likewise, when comparing smokers (past or active) with lifelong nonsmokers, there was no significant difference in 1- and 5-year overall device survival. There was no evidence for adverse AUS outcomes in current or past smokers compared with nonsmokers. Given the established risk of perioperative complications secondary to smoking, the recommendation should still be to counsel patients to quit prior to undergoing AUS placement. External validation of these findings is needed.

scholarly journals 5-HT3 Antagonist for Pregnancy Associated Nausea and Vomiting

2021 ◽  
Vol 5 (9) ◽  
pp. RV9-RV11
Author(s):  
Sumit Ghosh ◽  
Nirankar Dev ◽  
David Matthews
Keyword(s):  
Pregnant Women ◽  
Effective Treatment ◽  
Treatment Option ◽  
First Trimester ◽  
Nausea And Vomiting ◽  
Congenital Defects ◽  
Effective Treatment Option ◽  
Health Authorities ◽  
Increased Risk

5-HT3 antagonists appear to be an effective treatment option in the treatment of nausea and vomiting associated with pregnancy. Literature suggests an increased risk of congenital defects in fetuses exposed to ondansetron during pregnancy, especially during first trimester. Health authorities now suggest that this drug should not be used during this period. However, this decision is debatable and whether ondansetron can be used in pregnant women is still controversial.

scholarly journals COVID-19 convalescent plasma clears SARS-CoV-2 refractory to remdesivir in an infant with congenital heart disease

2020 ◽  
Vol 4 (18) ◽  
pp. 4278-4281 ◽  
Author(s):  
Zahidee Rodriguez ◽  
Andi L. Shane ◽  
Hans Verkerke ◽  
Christopher Lough ◽  
Matthew G. Zimmerman ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Effective Treatment ◽  
Treatment Option ◽  
Congenital Heart ◽  
Effective Treatment Option ◽  
Immune Systems ◽  
Key Points ◽  
Donor Variability

Key Points COVID-19 convalescent plasma (CP) may be a safe and effective treatment option in SARS-CoV-2 infection refractory to remdesivir. Infants may benefit from CP despite developing immune systems and donor variability emphasizes the need for characterization prior to use.

scholarly journals Sialendoscopy With Intraductal Steroid Irrigation in Patients With Sialadenitis Without Sialoliths

2019 ◽  
Vol 98 (5) ◽  
pp. 291-294 ◽  
Author(s):  
Saudamini J. Lele ◽  
Mickie Hamiter ◽  
Torrey Louise Fourrier ◽  
Cherie-Ann Nathan
Keyword(s):  
Treatment Option ◽  
Case Series ◽  
Complete Response ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
Effective Treatment Option ◽  
Patient Reported ◽  
History Of ◽  
The Mean

Sialendoscopy has emerged as a safe, effective and minimally invasive technique for management of obstructive and inflammatory salivary gland disease. The aim of our study was to analyze outcomes of sialendoscopy and steroid irrigation in patients with sialadenitis without sialoliths. We performed a retrospective analysis of patients who underwent interventional sialendoscopy with steroid irrigation from 2013 to 2016, for the treatment of sialadenitis without sialolithiasis. Twenty-two patients underwent interventional sialendoscopy with ductal dilation and steroid irrigation for the treatment of sialadenitis without any evidence of sialolithiasis. Conservative measures had failed in all. Eleven patients had symptoms arising from the parotid gland, 4 patients had symptoms arising from the submandibular gland, while 6 patients had symptoms in both parotid and submandibular glands. One patient complained of only xerostomia without glandular symptoms. The mean age of the study group which included 1 male and 21 females was 44.6 years (range: 3-86 years). Four patients had autoimmune disease, while 7 patients had a history of radioactive iodine therapy. No identifiable cause for sialadenitis was found in the remaining 11 patients. The mean follow-up period was 378.9 days (range: 16-1143 days). All patients underwent sialendoscopy with ductal dilation and steroid irrigation. Twelve patients showed a complete response and 9 patients had a partial response, while 1 patient reported no response. Only 3 patients required repeat sialendoscopy. The combination of sialendoscopy with ductal dilation and steroid irrigation is a safe and effective treatment option for patients with sialadenitis without sialoliths refractory to conservative measures. Prospective studies with a larger case series are needed to establish its role as a definitive treatment option.

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