ABSTRACT
OBJECTIVE: The objective of this study was to determine the safety and efficacy of sacral neuromodulation (SNM) in patients with idiopathic nonobstructive urinary retention. MATERIALS AND METHODS: We retrospectively reviewed the files of patients who underwent staged neuromodulation for idiopathic nonobstructive urinary retention from 2004 to 2016 at our hospital. Patients who had a 50% improvement in symptoms after 1 week of stage 1 procedure were qualified for permanent device implantation. Patient data were assessed on efficacy and need for intermittent self-catheterization, complications, and operative revision rates. RESULTS: Twenty-seven female patients who underwent SNM therapy were analyzed. The mean age of the patients was 32.5 ± 10.8 years. The mean duration of urinary retention was 3.2 ± 1.7 years. All patients were doing intermittent self-catheterization, but few were able to void <100 ml. Twenty-four (88.8%) of the 27 patients demonstrated a >50% improvement in symptoms and underwent permanent device placement. At a median follow-up of 5.7 ± 3.2 years, 20 (83.3%) of the 24 patients demonstrated sustained improvement rates of >50%. Seventeen (70.83%) of 24 patients could void spontaneously with a mean residual urine of 28.1 ± 24.4 ml (P < 0.001). Three (12.5%) were voiding with significant mean decreasing number of catheterizations from 5.6 ± 2.4 to 1.4 ± 2.1 (P < 0.001). Four (16.6%) had their device explanted. Ten (41.6%) of the 24 patients underwent surgical revision. Most of the adverse events were managed by device reprograming. CONCLUSION: SNM is a highly effective and safe procedure in this subset of the female population with idiopathic refractory nonobstructive urinary retention.
ABSTRACT
We determined the cause of renal deterioration after augmentation cystoplasty (AC). Twenty-nine adult patients with refractory bladder dysfunction and who underwent ileocystoplasty from 2004 to 2015 were studied. Patients with a decline in glomerular filtration rate (GFR) after augmentation were reviewed. The primary outcome was to determine the factors that might lead to deterioration of estimated GFR. Median follow-up was 7.0 ± 2.6 years. Significant bladder capacity, end filling pressure, and bladder compliance were achieved from median 114 ± 53.6 to 342.1 ± 68.3 ml (p = .0001), 68.5 ± 19.9 to 28.2 ± 6.9 cm H2O (p = .0001), and 3.0 ± 2.1 to 12.8 ± 3.9 (p = .0001), respectively. Renal function remained stable and improved in 22 (76%) patients from median eGFR 135 ± 81.98 to 142.82 ± 94.4 ml/min/1.73 m2 (p = .160). Significant deterioration was found in 7 (24%) patients from median eGFR 68.25 ± 42 to 36.57 ± 35.33 (p = .001). The causes of renal deterioration were noncompliance to self-catheterization (2 patients), posterior urethral valve/dysplastic kidneys (2 patients), and reflux/infection (2 patients). On multivariate analysis, recurrent pyelonephritis (OR 3.87, p = 0.0155) and noncompliance (OR 30.78, p = 0.0156) were significant. We concluded that AC is not the cause of progression to end-stage renal disease in patients with renal insufficiency.
ABSTRACT
AIM: To report the result of vesicovaginal fistula (VVF) repair using the transabdominal approach with flap interposition. MATERIALS AND METHODS: Between January 2004 and the end of 2011, operative reports data and medical records systems were reviewed for all VVF cases operated and followed in Urology Department. All patients had detailed history taking and physical exam followed by intravenous pyelograms or contrast CT abdomen and pelvis to rule out the presence of ureterovaginal fistulae. We utilized the infra-umbilical transabdominal approach and transpose an omental flap or peritoneal flap between the vaginal and bladder incisions in all cases. RESULTS: Twenty-six patients with an average age of 46 years were managed for VVF through transabdominal route with interposition of omental flap or peritoneal flap by a single surgeon. Twelve cases of VVF were secondary to lower segment cesarean section (LSCS) and twelve cases of VVF were secondary to lower segment cesarean section (LSCS) and 14 cases following hysterectomies. We had 16 complex VVF with 4 cases that failed the previous abdominal repair outside the hospital. More than 95% (25) of our patients were cured at the first attempt, with no recurrence at a mean follow-up of 28.6 (range 8-73) months. CONCLUSION: Successful repair of VVF depends on the experience of the surgeon and adhering to basic surgical principles. Very high success rate was seen when flap interposition had been used.
