Factors Influencing Postoperative Overactive Bladder after Adjustable Trans-Obturator Male System Implantation for Male Stress Incontinence following Prostatectomy.

We aimed to determine the risk factors for postoperative overactive bladder (OAB) in patients treated with an adjustable trans-obturator male system (ATOMS) for stress incontinence after radical treatment of prostate cancer. A prospective study was performed on 56 patients implanted with an ATOMS for PPI. Clinical and urodynamic information was recorded before and after ATOMS implantation. We built a multivariate model to find out the clinical and urodynamic factors that independently influenced postoperative OAB and the prognostic factors that influenced the efficacy of medical treatment of OAB. We found that the clinical risk factors were the preoperative intensity of urinary incontinence (number of daily pads used and amount of urinary leakage), International Consultation on Incontinence Questionnaire (ICIQ) score, postoperative number of ATOMS adjustments, final cushion volume, and incontinence cure. The urodynamic data associated with OAB were cystometric bladder capacity, voided volume, volume at initial involuntary contraction (IC), maximum flow rate, bladder contractility index (BCI), and urethral resistance (URA). The prognostic factors for the efficacy of oral treatment of OAB were the volume at the first IC (direct relationship) and the maximum abdominal voiding pressure (inverse relationship). The multivariate model showed that the independent clinical risk factors were the daily pad count before the implantation and the ICIQ score at baseline and after treatment. The independent urodynamic data were the volume at the first IC (inverse relationship) and the URA value (direct relationship). Both predictive factors of treatment efficacy were found to be independent. Detrusor overactivity plays an important role in postoperative OAB, although other urodynamic and clinical factors such as the degree of urethral resistance and abdominal strength may influence this condition.

Robot-Assisted Radical Prostatectomy by Lateral Approach: Technique, Reproducibility and Outcomes.

BACKGROUND: Radical prostatectomy by lateral approach allows performing a prostatectomy through a buttonhole, with direct access to the seminal vesicle and fully sparing the anterior pubovesical complex. Our aim is to show the results of reproducing the technique of robotic radical prostatectomy by lateral approach, in terms of intraoperative, postoperative, oncological and functional parameters. METHODS: We analyzed 513 patients submitted to robotic radical prostatectomy by lateral approach from January 2015 to March 2021, operated on by two surgeons in our institution. The oncological and functional results of both surgeons were compared. RESULTS: When comparing both surgeons, the rate of positive surgical margins (PSM) was 32.87% and 37.9% and significant surgical margins (PSM > 2 mm) were 5.88% and 7.58% (p = 0.672) for surgeon 1 and surgeon 2, respectively. Immediate continence was 86% and 85% and sexual potency at one year 73% and 72%, with a similar rate of complications for surgeon 1 and 2. CONCLUSIONS: Radical prostatectomy by the lateral approach technique with preservation of the anterior pubovesical complex is reproducible and offers good oncological and functional results.

[Effectiveness and safety of intravesical hyaluronic acid for symptom control in chronic bladder diseases.] / Efectividad y seguridad del ácido hialurónico intravesical para el control de los síntomas en cistopatías crónicas.

INTRODUCTION: Chronic bladder disorders are a common condition. Endovesical hyaluronic acid is one of the therapeutic options for these patients. It is intended to verify the effectiveness and safety of treatment with intravesical instillations of hyaluronic acidin patients with bladder symptoms. MATERIAL AND METHODS: We present a series of 32 patients who received intravesical instillations of hyaluronic acid. Demographic characteristics, tolerance, and complications were analyzed, and symptoms before and after treatment were compared. Symptomatic relief achieved with treatment was assessed using the Patient Global Improvement Impression Scale (PGI-I). RESULTS: The median age was 74 years (IQR 60-78) and 65.6% were women. Median follow-up was 10 months (IQR 7-14). Eleven patients were diagnosed with radiotherapy-induced cystitis, 17 with bladder pain syndrome/interstitial cystitis (BPS/IC), and 4 with recurrent cystitis. After treatment, symptoms improved in 81.8% of patients with radical cystitis, 82.3% of patients with BPS/IC, and 75% of the patients with recurrent cystitis. The incidence of hematuria was reduced from 46.9% to 9.4% (p<0.001), filing symptoms from 62.5% to 12.5% (p<0.001) and pain from 40.6% to 12.5% (p= 0.004). 100% of the patients tolerated the treatment well and only 2 adverse effects were recorded (urinary tract infection and acute urine retention). During follow-up, 65.6% showed total control of symptoms and 15.6% partial control, achieving a greater response in the group of patients with hematuria (73.3%). 61.3% of the patients perceived relief of symptoms after treatment according to the PGI-I scale. 88.9% maintained symptomatic improvement at the end of the follow-up. CONCLUSION: Intravesical hyaluronic acid is a safe and effective treatment for filling symptoms, hematuria, and pain in patients with chronic cystopathies. Patients with radiotherapy-induced cystitis seem to especially benefit from treatment.

INTRODUCCIÓN: Las cistopatías crónicas son una patología frecuente. El ácido hialurónico endovesical es una de las opciones terapéuticas para estos pacientes. Se pretende verificar la efectividad y seguridad del tratamiento con instilaciones intravesicales de ácido hialurónico en pacientes con síntomas vesicales.MATERIAL Y MÉTODOS: Se presenta una serie de 32 pacientes que recibieron instilaciones intravesicales de ácido hialurónico. Se analizaron las características demográficas, tolerancia y complicaciones, y se compararon los síntomas antes y después del tratamiento. El alivio sintomático conseguido con el tratamiento se evaluó mediante la escala de impresión de mejoría global del paciente (PGI-I).RESULTADOS: La mediana de edad fue de 74 años (IQR60-78), siendo el 65,6% mujeres. La mediana de seguimiento fue 10 meses (IQR 7-14). Once pacientes fueron diagnosticados de cistitis rádica, 17 de síndrome de dolor vesical/cistitis intersticial (SDV/CI) y 4 de cistitis de repetición. Tras el tratamiento mejoraron los síntomas el 81,8% de los pacientes con cistitis rádica, el 82,3% de los pacientes con SDV/CI y el 75% de los pacientes con cistitis recurrentes. La incidencia de hematuria se redujo del 46,9% al 9,4% (p<0,001), los síntomas de llenado del 62,5% al 12,5% (p<0,001) y el dolor de un 40,6% al 12,5% (p=0,004). El 100% de los pacientes toleró bien el tratamiento y sólo se registraron 2 efectos adversos (infección del tracto urinario y retención agudade orina). Durante el seguimiento un 65,6% mostró un control total de los síntomas y un 15,6% un control parcial, consiguiendo una respuesta mayor en el grupo de pacientes con hematuria (73,3%). El 61,3% de los pacientes percibió alivio de los síntomas tras el tratamiento según la escala PGI-I. El 88,9% mantiene la mejoría de los síntomas al finalizar el seguimiento.CONCLUSIÓN: El ácido hialurónico intravesical es un tratamiento seguro y efectivo para los síntomas de llenado, hematuria y dolor en pacientes con cistopatías crónicas. Los pacientes con cistitis rádica parecen beneficiarse especialmente del tratamiento.

Efectividad y seguridad del ácido hialurónico intravesical para el control de los síntomas en cistopatías crónicas / Effectiveness and safety of intravesical hyaluronic acid for symptom control in chronic cystopathies

Introducción: Las cistopatías crónicas son una patología frecuente. El ácido hialurónicoendovesical es una de las opciones terapéuticas paraestos pacientes. Se pretende verificar la efectividad yseguridad del tratamiento con instilaciones intravesicales de ácido hialurónico en pacientes con síntomas vesicalesMaterial y métodos: Se presenta una serie de 32pacientes que recibieron instilaciones intravesicales deácido hialurónico. Se analizaron las características demográficas, tolerancia y complicaciones, y se compararon los síntomas antes y después del tratamiento. El alivio sintomático conseguido con el tratamiento se evaluómediante la escala de impresión de mejoría global delpaciente (PGI-I). Resultados: La mediana de edad fue de 74 años (IQR60-78), siendo el 65,6% mujeres. La mediana de seguimiento fue 10 meses (IQR 7-14). Once pacientes fuerondiagnosticados de cistitis rádica, 17 de síndrome dedolor vesical/cistitis intersticial (SDV/CI) y 4 de cistitisde repetición. Tras el tratamiento mejoraron los síntomasel 81,8% de los pacientes con cistitis rádica, el 82,3%de los pacientes con SDV/CI y el 75% de los pacientescon cistitis recurrentes. La incidencia de hematuria seredujo del 46,9% al 9,4% (p<0,001), los síntomas dellenado del 62,5% al 12,5% (p<0001), y el dolor de un40,6% al 12,5% (p=0,004). El 100% de los pacientestoleró bien el tratamiento y sólo se registraron 2 efectosadversos (infección del tracto urinario y retención agudade orina). Durante el seguimiento un 65,6% mostró uncontrol total de los síntomas y un 15,6% un control parcial, consiguiendo una respuesta mayor en el grupo depacientes con hematuria (73,3%). El 61,3% de los pacientes percibió alivio de los síntomas tras el tratamientosegún la escala PGI-I. El 88,9% mantiene la mejoría delos síntomas al finalizar el seguimiento.Conclusión: El ácido hialurónico intravesical es untratamiento seguro y efectivo para los síntomas de llenado, hematuria y...(AU)

Introduction: Chronic bladder disorders are a common condition. Endovesical hyaluronicacid is one of the therapeutic options for these patients.It is intended to verify the effectiveness and safety oftreatment with intravesical instillations of hyaluronic acidin patients with bladder symptoms. Material and methods: We present a series of 32patients who received intravesical instillations of hyaluronic acid. Demographic characteristics, tolerance,and complications were analyzed, and symptoms before and after treatment were compared. Symptomaticrelief achieved with treatment was assessed using thePatient Global Improvement Impression Scale (PGI-I).Results: The median age was 74 years (IQR 60-78)and 65.6% were women. Median follow-up was 10months (IQR 7-14). Eleven patients were diagnosed withradiotherapy-induced cystitis, 17 with bladder pain syndrome/interstitial cystitis (BPS/IC), and 4 with recurrentcystitis. After treatment, symptoms improved in 81.8%of patients with radical cystitis, 82.3% of patients withBPS/IC, and 75% of the patients with recurrent cystitis.The incidence of hematuria was reduced from 46.9% to9.4% (p<0.001), filling symptoms from 62.5% to 12.5%(p<0.001), and pain from 40.6% to 12.5% (p=0.004).100% of the patients tolerated the treatment well andonly 2 adverse effects were recorded (urinary tract infection and acute urine retention). During follow-up, 65.6%showed total control of symptoms and 15.6% partialcontrol, achieving a greater response in the group ofpatients with hematuria (73.3%). 61.3% of the patientsperceived relief of symptoms after treatment accordingto the PGI-I scale. 88.9% maintained symptomatic improvement at the end of the follow-up.Conclusion: Intravesical hyaluronic acid is a safeand effective treatment for filling symptoms, hematuria,and pain in patients with chronic cystopathies. Patientswith radiotherapy-induced cystitis seem to especiallybenefit from treatment.