Bladder neck preservation during radical retropubic prostatectomy and postoperative urinary continence

Bladder neck-sparing modification of radical retropubic prostatectomy has been reported to lower the risk of urinary incontinence after prostatectomy. We reviewed the outcomes in men with prostate cancer who had undergone prostatectomy with either bladder neck preservation or bladder neck reconstruction. In this retrospective study, a total of 103 patients who had undergone radical retropubic prostatectomy were assessed. The patients were divided into two groups of bladder neck preservation [51 patients] and bladder neck reconstruction [52 patients]. WE compared frequency of biochemical failure, bladder neck stricture, and urinary incontinence between these two groups. Biochemical failure was defined as a serum prostate-specific antigen level higher than 0.2 ng/mL and its rising trend in at least 2 postoperative subsequent measurements. Continence was defined as no need to use sanitary pads or diapers. The two groups were comparable in terms of age, serum prostate-specific antigen level, Gleason score, and prostate volume. After a mean follow-up period of 32.5 months, all patients with bladder neck preservation and 46 [88.5%] with bladder neck reconstruction were continent [P=.03]. There were no significant differences in the frequency of biochemical failure and bladder neck stricture that required dilation between the two groups of the patients. Bladder neck preservation during radical retropubic prostatectomy may improve long-term results of urinary continence and be effective in eradicating prostate cancer without increasing the recurrence rate

Tacrolimus rescue therapy for corticosteroid-resistant and polyclonal antibody-resistant kidney allograft rejections

The conventional treatment of acute kidney allograft injection consists of high-dose corticosteroids and polyclonal antibodies. We report our experience of tacrolimus rescue therapy in patients with acute rejections refractory to corticosteroids and polyclonal antibodies. A total of 34 patients with a mean age of 42.3 years and clinical diagnosis of acute kidney allograft rejection underwent tacrolimus rescue therapy when treatment with corticosteroids and polyclonal antibodies failed. Kidney allograft biopsy results were available in 21 patients. All of the patients received tacrolimus, 0.1 mg twice daily, and in those who responded to the therapy after 4 to 6 months, tacrolimus was replaced with cyclosporine. Pathologic examination of 21 biopsy specimens of the kidney allografts showed acute vascular rejection in 7 patients [33.3%, acute humoral rejection in 6 [28.6%], acute cellular rejection in 3 [14.3%], and accelerated acute rejection in 3 [14.3]. Twenty-six patients [76.5%] responded to rescue therapy with tacrolimus and discharged with a mean serum creatinine level of 1.4 mg/dL [range, 1.1 mg/dL to 1.7 mg/dL]. Allograft nephrectomy was done in 8 patients [23.5%] because of no response to treatment of rejection, the pathology reports of which consisted of acute vascular rejection in 5 patients and extensive necrosis in 3. Tacrolimus therapy is able to salvage kidney allograft with acute refractory injection. We recommend that tacrolimus be used as an alternative to the conventional drugs used for antirejection therapy. However, severe infectious complications as a result of overt immunosuppression must be considered

Sexual dysfunction in aging men with lower urinary tract symptoms

Our aim was to evaluate the relationship between lower urinary tract symptoms [LUTS], age, and sexual dysfunction in the Iranian men aged 50 to 80 years. A total of 357 men aged 50 to 80 years presenting at the urological clinic were enrolled in this study. The International Prostatic Symptom Score [IPSS] and the International Index of Erectile Function [IIEF] questionnaires were used to assess the LUTS and sexual function, respectively. The questionnaires were completed by face-to-face interview. Logistic regression model was used for multivariate analysis of the risk factors of sexual dysfunction and its domains assessed by the IIEF. Of the patients, 332 [93%] were sexually active with a median sexual attempts of 4.6 times per month. Frequency of sexual attempts was inversely related to LUTS severity [P < .001]. Advanced age was positively associated with LUTS severity [r = 0.534, P < .001]. Sexual dysfunction, defined as IIEF score of 20 and less, was present in 68.2% of the patients. All IIEF domain scores and the overall score were correlated with age [P < .001] and the IPSS [P < .001]. In a multivariate analysis, age, diabetes mellitus, and the IPSS were strong independent predictors of the overall IIEF score. Sexual activity as an important component of the quality of life continues in the majority of men over 50 years. However, their sexual function can be severely affected by LUTS and its severity

Transanal repair of rectourethral and rectovaginal fistulas

We evaluated the efficacy and safety of repair of the rectourethral and rectovaginal fistulas with transanal approach using the Latzko technique. We repaired 8 fistulas with transanal approach. Fistulas were rectourethreal in 5 patients, and in the only woman of the series, they were rectovaginal and vesicovaginal, In 3 patients, the fistulas has been diagnosed following prostatectomy, urethral stricture repair, and colonic resection and radiotherapy due to rectosigmoid cancer in 3, 2 and 1 patients, respectively. Complying with Latzko technique, the fistula orifice was exposed and a fusiform incision was made with the orifice in its center. The mucosa lying between the incision and the orifice was excised in the direction of the incision to the orifice, leaving the fistula edges to meet. Then, the edges were closed, followed by closure of the muscular layers above it. Finally, the edges of the rectal mucosa were closed. Two patients had 2 fistulas and 4 had 1 fistula who were all managed by transanal approach. During a median follow-up period of 44 months, no serious complication was noted, except for recurrence of deep vein thrombosis in 1 patient with a positive history for this complication. Hospitalization period was 1 to 7 days. It seems that transanal repair is a simple and effective technique with minimal complication rate in the treatment of rectourethral fistulas. Regardless of the etiology, this method can be used as the preferred therapeutic technique. Further studies are necessary to confirm our findings