Surgical outcome of a repeat midurethral sling procedure after failure of a first procedure.

INTRODUCTION AND HYPOTHESIS: Although there is no consensus on the management of persistent or recurrent stress urinary incontinence (SUI) after placement of a midurethral synthetic sling (MUS), a repeat MUS procedure is commonly performed with favorable results. The aim of this study was to evaluate the efficacy of a repeat MUS procedure compared to the primary procedure in women with SUI, and to investigate factors associated with the failure of the repeat procedure. METHODS: We retrospectively analyzed data from 53 women who underwent a repeat MUS procedure and 102 women who underwent a primary MUS procedure at a single center. Success was defined as no urine leakage during physical activity based on the Sandvik questionnaire. Outcomes were assessed using the Sandvik Severity Index and Incontinence-Quality of Life (I-QOL) questionnaire. Multivariate logistic regression analysis was used to determine the factors predicting failure of the repeat procedure. RESULTS: The success rate was 76.5 % for the primary MUS procedure (78/102 patients) and 69.8 % for the repeat MUS procedure (37/53 patients; p = 0.369). The mean follow-up duration was significantly longer for the primary procedure (83.8 months vs. 54.6 months, p < 0.001). SUI and all domain scores of the I-QOL were significantly better following the repeat MUS procedure than following the primary procedure. In the multivariate analysis, SUI grade 3 was the only independent factor predicting failure of the repeat qq (odds ratio 7.610, p = 0.023). CONCLUSIONS: A repeat MUS procedure after a failed primary MUS procedure was shown to be effective. However, a repeat procedure may be unsuccessful in patients with grade 3 SUI.

Effect of Detrusor Overactivity on Functional Outcomes After Holmium Laser Enucleation of the Prostate in Patients With Benign Prostatic Obstruction.

OBJECTIVE: To investigate the effect of detrusor overactivity (DO) on functional outcomes after holmium laser enucleation of the prostate (HoLEP). MATERIALS AND METHODS: One hundred ten men with benign prostatic obstruction were evaluated retrospectively. International Prostate Symptom Score, International Continence Society male questionnaire short form, 3-day voiding diary, and uroflowmetry with postvoid residual were evaluated preoperatively and at 3 and 6 months postoperatively. The patients underwent urodynamic study preoperatively and were divided into the DO group (58 of 110, 52.7%) and the non-DO group (52 of 100, 47.3%). RESULTS: Patients in the DO group were older than those in the non-DO group (71.4 vs 66.4 years), although prostate volume and degree of obstruction were not significantly different between the 2 groups. All International Prostate Symptom Score and uroflowmetry parameters improved significantly at the 3- and 6-month follow-ups. Storage symptoms in both groups were comparable preoperatively (9.7 vs 8.6); these improved similarly in both groups during follow-up (5.0 vs 4.0, 6-month follow-up). The number of patients taking anticholinergics increased significantly after HoLEP, from a baseline of 17 patients to 49 patients at the 3-month follow-up and 39 at the 6-month follow-up. More patients in the DO group were taking anticholinergics at the end of the follow-up period (48.3% vs 21.2%). CONCLUSION: Although the storage symptoms improved significantly in both groups, a significant number of patients with DO group took anticholinergics after HoLEP. We recommend that surgeons should counsel the possibility of taking anticholinergics in the early postoperative period to the patients with DO at baseline.

Efficacy and safety of augmentation ileocystoplasty combined with supratrigonal cystectomy for the treatment of refractory bladder pain syndrome/interstitial cystitis with Hunner's lesion.

OBJECTIVE: To evaluate the efficacy and safety of augmentation ileocystoplasty with supratrigonal cystectomy for the treatment of refractory bladder pain syndrome/interstitial cystitis patients with Hunner's lesion. METHODS: Of 45 patients who underwent augmentation ileocystoplasty with supratrigonal cystectomy between July 2006 and June 2012, 40 patients (33 women, 7 men) were included in the analysis. Primary outcome was the change in the O'Leary-Sant interstitial cystitis symptoms/problem index from baseline to 1, 3 and 6 months. Changes in pain, urgency, frequency, functional bladder capacity and maximal cystometric capacity were also assessed. Intraoperative and postoperative complications were evaluated. RESULTS: Median preoperative symptom duration was 5.0 years (range 3.0-6.0 years). Pain decreased significantly after surgery (8.3 vs. 1.3, P < 0.001). Functional bladder capacity and maximal cystometric capacity increased, whereas frequency, urgency and nocturia decreased significantly after surgery (all P < 0.001). At 6 months, significant improvements in the interstitial cystitis symptom index (17.8 vs. 9.9, P < 0.001) and interstitial cystitis problem index (14.6 vs. 6.5, P < 0.001) compared with baseline were noted. Seven patients developed vesicoureteral reflux and seven patients had acute pyelonephritis that resolved with antibiotic treatment. Five patients required clean intermittent self-catheterization. None of the preoperative factors were significant predictors of treatment failure. CONCLUSIONS: Augmentation ileocystoplasty with supratrigonal cystecomy decreased pain and frequency, and increased bladder capacity significantly. There were no severe complications related to surgery during follow up. Augmentation ileocystoplasty with supratrigonal cystectomy is therefore an appropriate final treatment strategy for refractory bladder pain syndrome/interstitial cystitis patients with Hunner's lesion.

The efficacy of extracorporeal magnetic stimulation for treatment of chronic prostatitis/chronic pelvic pain syndrome patients who do not respond to pharmacotherapy.

OBJECTIVE: To investigate the effect of extracorporeal magnetic stimulation (EMS) on symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men who did not respond to pharmacotherapy. METHODS: Patients with chronic pelvic pain and/or voiding symptoms in the absence of urinary tract infection for at least 3 months in spite of medication were included in this study. All patients underwent EMS for 6 weeks for a total of 12 sessions. The primary endpoint was the changes in total and pain scores of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) at 24 weeks after treatment. Patients were also evaluated by International Prostate Symptom Score (IPSS), voiding diary, Benefit Satisfaction and Willingness (BSW) questionnaire, and patient perception of symptom improvement (PPSI). RESULTS: A total of 46 men were included, and data from 37 patients who completed this study were analyzed. The baseline vs 24 weeks mean NIH-CPSI score was total score 25.0 ± 6.9 vs 15.6 ± 7.7, pain score 11.8 ± 3.7 vs 6.9 ± 4.7 (all P <.05). Total and subdomain sums of IPSS improved significantly after treatment, and the improvements were maintained until 24 weeks. Patient voiding diaries demonstrated a tendency toward a decrease in all subdomains after treatment. In BSW, >70% of patients reported positive answers to each domain at 24 weeks after treatment. PPSI measured by the visual analog scale was maintained from immediately after treatment until 24 weeks. CONCLUSION: EMS offers a new treatment option for patients with CP/CPPS who do not respond to pharmacotherapy.

Does the presence of hypoechoic lesions on transrectal ultrasound suggest a poor prognosis for patients with localized prostate cancer?

PURPOSE: The purpose of this study was to investigate the value of hypoechoic lesions on transrectal ultrasound (TRUS) as a prognostic factor for patients with localized prostate cancer. MATERIALS AND METHODS: The patients consisted of 71 patients with pT2N0M0 disease following radical prostatectomy between 2002 and 2008. The group with hypoechoic lesions was labeled group 1, whereas the group without hypoechoic lesions was labeled group 2. The presence of hypoechoic lesions on preoperative TRUS was analyzed as a prognostic factor along with several parameters, including preoperative factors and pathologic factors. The biochemical progression-free survival (BPFS) rate was compared between the two groups according to the presence of hypoechoic lesions on TRUS. RESULTS: A total of 35 patients had hypoechoic lesions on TRUS, whereas 36 had no hypoechoic lesions. Preoperative baseline characteristics were not significantly different between the two groups. In the univariate analysis, BPFS showed significant differences according to the presence of hypoechoic lesions on TRUS and the preoperative prostate-specific antigen level. The BPFS rates over the first 24 months were 97.0% in group 1 and 97.1% in group 2; however, the difference in the BPFS rate over 48 months significantly widened to 75.3% compared with 91.7%, respectively. Despite this finding, no significant independent prognostic factor for BPFS was found on multivariate analysis in this patient cohort. CONCLUSIONS: The presence of hypoechoic lesions on TRUS may suggest worse prognostic characteristics in pT2 prostate cancer. Further studies involving larger subject populations are needed to corroborate the significance of the presence of hypoechoic lesions as a prognostic factor.

Renal cell carcinoma in a right malrotated kidney.

The authors report a case of renal cell carcinoma in a right malrotated (horizontal axis) kidney. The patient was treated by hand-assisted laparoscopic radical nephrectomy. This is the first report of a horizontal axis malrotated kidney with renal cell carcinoma.

Spontaneous Intraperitoneal Bladder Perforation Associated with Urothelial Carcinoma with Divergent Histologic Differentiation, Diagnosed by CT Cystography.

Spontaneous bladder perforation is a very rare event. Prompt diagnosis of this injury is very important, particularly with intraperitoneal perforation, because mortality increases if surgical repair is delayed. Previous studies have reported that plain cystography is the primary modality of imaging study rather than relatively insensitive computed tomography (CT) when bladder perforation is suspected. We report here a rare case of spontaneous intraperitoneal perforation of the bladder associated with urothelial carcinoma with divergent histologic differentiation, as diagnosed with CT cystography.