Economic evaluation of Optilume, a drug-coated balloon for recurrent anterior male urethral stricture.

Objectives: We aim to conduct an economic evaluation of the Optilume urethral drug-coated balloon (DCB) compared with endoscopic management for the treatment of recurrent anterior male urethral stricture in England. Patients and Methods: A cohort Markov model was developed to estimate the costs and savings to the NHS over a 5-year time horizon of adopting Optilume for the treatment of anterior urethral male stricture versus current endoscopic standard of care. A scenario analysis was conducted which compared Optilume to urethroplasty. Probabilistic and deterministic sensitivity analyses were performed to estimate the impact of uncertainties in model parameters. Results: When compared with current endoscopic standard of care Optilume resulted in an estimated cost saving of £2502 per patient if introduced in the NHS for the treatment of recurrent anterior male urethral stricture. In the scenario analysis, the use of Optilume compared with urethroplasty resulted in an estimated cost saving of £243. Results were robust to changes in individual input parameters as demonstrated in the deterministic sensitivity analyses, with the monthly probability of symptom recurrence associated with endoscopic management the only exception. Probabilistic sensitivity analysis results demonstrated that Optilume was cost saving in 93.4% of model iterations, when running 1000 iterations. Conclusion: Our analysis suggests that the Optilume urethral DCB treatment can be a cost-saving alternative management option for the treatment of recurrent anterior male urethral stricture within the NHS in England.

The discovery of the cavernous nerves and development of nerve sparing radical retropubic prostatectomy.

PURPOSE: This review is of the events that led up to the discovery of the cavernous nerves and the development of nerve sparing radical retropubic prostatectomy. MATERIALS AND METHODS: The correspondence between Pieter J. Donker and Patrick C. Walsh, along with the publication folders describing the anatomy of the dorsal vein complex, pelvic plexus and cavernous nerves, and pelvic fascia, are reviewed. RESULTS: Serendipity had a major role in the fateful meeting of Pieter J. Donker and Patrick C. Walsh on February 13, 1981 when they dissected out the cavernous nerves in a stillborn male infant. During the next year intraoperative observations identified the capsular arteries and veins of the prostate as the likely microscopic landmark that could be used in the adult male pelvis to identify the microscopic cavernous nerves. Twenty-five years ago, on April 26, 1982, the first purposeful nerve sparing radical prostatectomy was performed. One year following surgery patient sexual function was normal, and 25 years later he has retained his quality of life and an undetectable prostate specific antigen. CONCLUSIONS: The events that led up to the first nerve sparing radical prostatectomy illustrate the influence of serendipity on discovery.