Retropubic TFS Minisling for Postprostatectomy Male Incontinence: First Report

<b><i>Hypothesis:</i></b> A structurally sound puboprostatic ligament (PPL), like the pubourethral ligament in the female, is the core structure for control of stress urinary incontinence (SUI) in males. <b><i>Methods:</i></b> The hypothesis was tested at several levels. Twelve transperineal ultrasound examinations were performed to confirm reflex directional closure vectors around the PPL, with digital support for the PPL rectally and cadaveric testing with a tissue fixation system (TFS) minisling, and finally, 22 cases of postprostatectomy incontinence were addressed only with retropubic insertion of a 7-mm TFS sling between the bladder neck and perineal membrane to reinforce the PPL. <b><i>Results:</i></b> On ultrasound testing, 3 urethral closure muscles were confirmed to act reflexively around the PPL to close the urethra distally and at the bladder neck. A finger was inserted rectally, pressed against the symphysis only on one side of the urethra at the origin of the PPL that controlled urine loss on coughing. The mean pre-op pad loss was 3.8 pads at 9 months; the mean post-op loss was 0.7 pads; 13/22 (59%) patients were 100% improved; 7/22 (31%) improved &#x3e;50% but &#x3c;100%; 2/22 (9.1%) improved &#x3c;50%. <b><i>Conclusions:</i></b> The 7-mm-wide TFS minisling is the first retropubic minisling for postprostatectomy urinary incontinence. It differs significantly from transobturator male operations surgically and in modus operandi. As in the female, reconstruction of the PPL alone was sufficient to cure/improve SUI, suggesting that preservation of the PPL is of critical importance during retropubic radical prostatectomy.

Urodynamic Values Role For Females With Different Types Of Urinary Incontinence

Aim — The aim of this study was to analyse how conventional urodynamic values differ between females with specific types of urinary incontinence (UI). Material and Methods — Cross-sectional study enrolled 666 females with UI. Based on patient history and questionnaires they were divided into three groups: stress (SUI), mixed (MixUI) and urgency (UUI). Physical investigation and urodynamics were performed. The continuous factors: age and urodynamic data were evaluated using Multinomial regression and ANOVA test using SUI, MixUI, UUI as outcome groups. Results — Analysing urodynamic parameters significant difference between at least two groups was shown by the cystometric capacity and maximum flow rate: both highest in the SUI group; residual urine, opening detrusor pressure, maximum urethral closure pressure at rest, functional urethral length at rest: all highest in the UUI group. Mainly all urodynamic data showed significant difference between SUI/UUI, and MixUI/UUI groups, while difference between SUI/MixUI were not significant. Conclusions — Most of urodynamic data for MixUI group patients do not differ from SUI group. UDS parameters like: maximum flow rate, residual urine, opening detrusor pressure, maximum urethral closure pressure at rest, functional urethral length at rest can help to distinguish SUI and MixUI groups from UUI group.

OUTCOME OF TUNICA VAGINALIS FLAP FOR REPAIR OF URETHROCUTANEOUS FISTULA AFTER HYPOSPADIAS REPAIR

The commonest complication following hypospadias repair is occurrence of urethro-cutaneous stula(UCF) with a reported incidence of 4-25% 1. The expected stula rate is between 10% to 15% for onestage hypospadias surgery. UCF after hypospadias repair remains a signicant challenge for paediatric surgeons despite the advances in surgical techniques. Our aim is to assess the outcome of tunica vaginalis ap repair in cases of urethro-cutaneous stula. Our study included 23 patients who underwent UCF repair using TVF. Successful repair of these UCF depends on several basic principles, which are the avoidance of procedures on inamed tissue, correction of distal obstruction, a tension-free urethral closure with absorbable suture material, and covering of the urethral repair with well-vascularized tissue. From our study we feel that many complications mainly recurrent stula can be avoided using the above principles.

Urodynamic evaluation of patients with localized prostate cancer before and 4 months after robotic radical prostatectomy

Radical prostatectomy can alter the anatomy of the urinary bladder. We aimed to evaluate bladder function before and 4 months after radical prostatectomy using the urodynamic test and overactive bladder (OAB) symptom score. Among 70 prospectively enrolled patients, 61 patients completed the study. In the urodynamic test, bladder capacity and compliance did not change, the frequency of involuntary detrusor contraction decreased, the maximum flow rate and bladder outlet obstruction index improved, and the maximum urethral closure pressure (MUCP) deteriorated. Further evaluation of urodynamic parameters according to changes in symptoms was made. Although change in bladder compliance was correlated with changes in OAB symptoms, not the relative change of bladder compliance but the relative change in the MUCP was reliable factor when OAB symptoms were deteriorated. In general, prostatectomy did not deteriorate the condition of the detrusor; rather, change in the MUCP could be responsible for postprostatectomy OAB.

Penile Entrapment Syndrome in Young Children

Introduction Entrapment syndromes can occur in extremities like the genitalia, the penis, toes and fingres and mostly due to hair shed by the mother mostly in young children but may be other materials are involved specially in adults. Penile hair Entrapment syndrome is an uncommon health problem that leads to devastating injuries to the urethra and penis including urethral fistula up to urethral complete transaction and penile injury up to penile amputation. We are going to discuss our experience with the problem. Materials and Methods All 15 patients between 2018 and 2020 had been operated upon for various degrees of Penile hair Entrapment syndrome from simple single urethral fistula, and complete urethral transection, their ages ranged between 1.5 years to 4.6 years. Follow up ranged between 6 months to 1.4 years. Each patient was invstigated and examined at the emergency room for other entrapment syndromes and the causative agent was removed and the patients were admitted for managing their urethral and penile injuries. Results All 15 patient but 1 had complete healing with fistula healing and normal voiding with no meatal stenosis or urethral divritculum. One patient had incomplete urethral Closure wit redo operation and fistula closure. Discussion There are multiple reports and literature that address the problem yet nobody took into account how to prevent it. There should be public awarence about the problem, the mother should examine her child for any entrapment syndrome and if any suspicious finding she sholud seek medical advice. Conclusion Penile entrapment syndromes are uncommon urological health problems that can face the urologist but he should be aware of the problem that can affect young children and he should put in mind the problem to manage it as early as possible to prevent further damage of the valuable urethra and penis.

Overactive Bladder Syndrome is Associated With Detrusor Overactivity and Abnormal Voiding Pattern in Nulliparous Women

Pregnancy and childbirth are frequently associated with overactive bladder syndrome (OAB). However, the role of parous effects in OAB among nulliparous (NP) women remains controversial. This study investigated abnormal voiding patterns and DO among NP woman with OAB in comparison with parous women. From August 2011 to December 2018, 906 patients met the inclusion criteria for participation and were divided into three groups: 221 patients in the NP group, 571 patients in the normal spontaneous delivery (NSD) group, and 114 patients in the cesarean section (CS) group. Urodynamic study (UDS) examinations were performed, and the presence of DO, abnormal voiding patterns, and maximum urethral closure pressure (MUCP) were recorded. Data were analyzed using analysis of variance, χ2 tests, and independent t tests. Compared with parous women in the NSD and CS groups, patients in the NP group had a significantly higher prevalence of abnormal voiding patterns, DO and MUCP. Furthermore, abnormal voiding patterns were significantly associated with DO and MUCP respectively, especially in the NP group. We hypothesized that hypertonicity or poor relaxation of the pelvic muscle in NP women may cause functional BOO, which is related to their OAB.