Hypothesis / aims of study Bladder outlet obstruction in women can be caused by a variety of cond... more Hypothesis / aims of study Bladder outlet obstruction in women can be caused by a variety of conditions. Classically it is thought of in anatomical terms, but many functional conditions can also result in bladder outlet obstruction in women. Some studies have excluded functional causes in their analysis of female bladder outlet obstruction when trying to standardize urodynamic diagnostic criteria. 1-2 We sought to compare the clinical presentation and urodynamic characteristics of functional and anatomic obstruction in women to determine if there is a difference between the two. We also wanted to determine if there was any difference between the different causes within these broader categories of obstruction
The use of fluoroscopy during urodynamics can be helpful in the evaluation of patients with lower... more The use of fluoroscopy during urodynamics can be helpful in the evaluation of patients with lower urinary tract dysfunction. However, fluoroscopy introduces the potential hazards of ionizing radiation, including malignancy. In this study we analyzed the data for radiation exposure during videourodynamic study (VUDS) at our center; we have also tried to establish the factors associated with increased exposure to radiation during VUDS. We reviewed all VUDS from August 2010 to May 2011. Patients were included if they were ≥18 years old and had data recorded on total radiation exposure (radcm(2) ). Age, sex, body mass index, fluoroscopy time, diagnosis, and urodynamic findings were recorded. Multivariate linear regression analysis was used to identify independent risk factors that influenced increased radiation exposure. A total of 203 videourodynamic studies were assessed in 106 female and 97 male patients with a mean age of 64.3 and body mass index of 26.8. The average fluoroscopy tim...
Female Pelvic Medicine & Reconstructive Surgery, 2013
To characterize the symptoms and urodynamic findings of anatomical bladder outlet obstruction (AO... more To characterize the symptoms and urodynamic findings of anatomical bladder outlet obstruction (AO) and functional bladder outlet obstruction (FO) in women and to determine if future endeavors at defining bladder outlet obstruction in women can group these entities together. Retrospective review of all videourodynamic studies was performed on women from March 2003 to July 2009. Women with diagnosis of obstruction were categorized based on the cause of obstruction into 2 groups: AO and FO. Demographic data, symptoms, and urodynamic findings were compared between the 2 groups. One hundred fifty-seven women were identified of which 86 (54.8%) were classified as having AO and 71 (45.2%) were classified as having FO. There were no differences in symptoms between the 2 groups. There was no difference (P=0.5789) in the mean detrusor pressure at maximum flow rate Qmax between AO (38.9 cm H20) and FO (41.0 cm H20). There was a difference in the Qmax between AO and FO (10.6 [0-41.7] and 7.4 [0-35.7] mL/s, respectively; P=0.0044), but there was considerable overlap between the values in these 2 groups. Anatomical bladder outlet obstruction and FO have similar urodynamic voiding pressure findings, but Qmax was statistically significantly lower in AO. However, there is a large overlap in the Qmax values between the 2 groups. Therefore, future studies that attempt to characterize bladder outlet obstruction in women need not exclude either group.
... There have been several high-quality reviews of the literature on synthetic slings. A recent ... more ... There have been several high-quality reviews of the literature on synthetic slings. A recent Cochrane review by Ogah et al. ... In the recent Cochrane review, Ogah et al. reviewed 24 trials that compared the retropubic and transobtura-tor approaches of MUSS placement [23]. ...
To assess the accuracy of office-based ultrasound (US) to identify the fluid status of the AMS 80... more To assess the accuracy of office-based ultrasound (US) to identify the fluid status of the AMS 800 artificial urinary sphincter (AUS) pressure-regulating balloon (PRB). Patients who underwent AUS revision surgery (removal/replacement) from January 4, 2007, to January 4, 2010, were identified. US were done preoperatively to assess the system fluid status. Intraoperative findings were recorded. Sensitivity and specificity were calculated comparing US results with intra-/postoperative findings. When the PRB was underfilled, the location of the device fluid leak was determined, and the device was removed/replaced. In cases of a full PRB, patients had a cuff downsizing or total removal/replacement. A total of 27 patients were identified. Reasons for not obtaining US included: advanced device age (4), cuff erosion (2), volume determination by other modality (2), cuff site pain (1), isolated pump malfunctions (1), and other (3). Fourteen patients underwent an US before the removal/replacement. By US, PRB was full (21-23 mL) in 43% of the patients and empty/underfilled (0-6 mL) in 57%. US was 100% sensitive and specific determining fluid status. When PRB was full, management consisted of cuff downsizing (3), transcorporal cuff placement (1), and total removal/replacement (2). In all cases of device leak, an entire removal/replacement was performed. The cuff was identified as the site of leak in 50% of cases. US is an effective and accurate way of determining the fluid status of the AMS 800 AUS. Given the accuracy of this modality, the system can be filled with saline solution without losing the ability to determine fluid status.
Urinary incontinence is a major health problem that becomes more common with increasing age. A th... more Urinary incontinence is a major health problem that becomes more common with increasing age. A thorough history and examination can help determine the type of incontinence: stress, urge, mixed, or other. Initial treatments may include lifestyle and behavioral modifications, pelvic floor exercises, and anticholinergic medications. Urologic referral is appropriate when initial treatment measures fail or in complex cases, such as previous incontinence surgery or irradiation.
follow-up is available for 30 of them (15 in arm A, 15 in arm B). Questionnaire scores show bette... more follow-up is available for 30 of them (15 in arm A, 15 in arm B). Questionnaire scores show better outcomes in terms of idividual and couple erotic function re-establishment in arm B (case group) at 3, 6 and 12 months. Patients in arm B ragained sexual activity earlier after surgery when compared to men in arm A. Patient and couple’s overall satisfaction rate is significantly higher in case group. Furthermore, it is interesting to note that, during the preoperative assessment, the psychosexual counsellor observed a remarkable cultural resistance, hard to win, expecially among female partners over 55 years. CONCLUSIONS: In our study, postoperative sexual activity and erotic function are better in patients undergone psychosexual counselling after PPI when compared to patients undergone only surgery.
Abdominal wound dehiscence is a surgical catastrophe that can be attributed to patients or techni... more Abdominal wound dehiscence is a surgical catastrophe that can be attributed to patients or technical factors. The technical properties of the monofilament sutures and knots that are commonly used in abdominal closure are poorly understood. The aim of this study was to compare the tensile strength of monofilament sutures tied with conventional knots. To do this, the knot-holding capacity of four types of knots (square, surgeons', Aberdeen and loop) were tested using three types of gauge 1 monofilament suture, namely nylon, polyglyconate and polydioxanone, using a tensiometer. We found that the knot-holding capacity of the loop knot was between twofold and threefold greater than all the other knots examined. In comparing suture types, polyglyconate had the highest knot-holding capacity for all the knots that were examined and there was no difference in the tensile strength of nylon and polyglyconate tied in a square, surgeons' or Aberdeen knot (P < 0.05). In conclusion, our findings suggest that closure of an abdominal wound would be best commenced with a loop knot, using gauge 1 polyglyconate and finished with either an Aberdeen square or surgeons' knot would be appropriate.
INTRODUCTION AND OBJECTIVES: The use of male slings has emerged as a popular and efficacious trea... more INTRODUCTION AND OBJECTIVES: The use of male slings has emerged as a popular and efficacious treatment modality for men with post-prostatectomy incontinence (PPI). Traditionally, slings have been avoided in patients with impaired detrusor contractility because of concern that patients will not be able to overcome the fixed resistance of a sling during micturition. We propose that men with PPI who have impaired contractility and/or void with abdominal straining for urodynamics (UDS) can be safely treated with male slings. METHODS: A retrospective review of 123 consecutive patients with PPI who underwent a sling procedure between 1/04 and 1/10 was conducted at a single institution. Preoperative (preop) age, bladder capacity, post void residual (PVR), involuntary detrusor contractions (IDC), maximum flow rate (Qmax), detrusor pressure (Pdet), abdominal pressure (Pabd) and postoperative (postop) Patient Global Impression of Improvement (PGI-I), PVR and noninvasive uroflow were examined. Poor bladder contractility was defined as having bladder contractility index (BCI) 100. Valsalva voiding was defined as a change in Pabd at Qmax from baseline ( Pabd) 20. Exclusion criteria were lack of preop UDS and/or postop PVR or PGI-I. A total of 63 patients were analyzed. The variables were compared using Student’s t-test and chi-square test. RESULTS: No statistically significant difference was shown in postop PVR (mean 4 mos. postop) or urinary retention when comparing by BCI. Comparing by Pabd, a smaller PVR was seen with abdominal voiders, albeit likely clinically insignificant. Table 1 illustrates the preand postop outcomes compared by both BCI and Pabd. 31 patients (BCI 100, n 17 vs BCI 100, n 14) had postop uroflow available and there was no difference in postop Qmax (10.2 vs 13.1, p 0.22) or flow pattern. No patients excluded for incomplete data were treated for obstructive voiding or poor emptying. CONCLUSIONS: The results of this study indicate that men that may not have been traditionally offered a sling based on preop UDS findings can be safely treated with perineal sling. This may be a reflection of how contractility is measured in this population. Prospective studies comparing outcomes of men with impaired contractility that undergo various treatments may also be helpful. TABLE 1: Preand Postoperative Urodynamics Characterics of Male Sling Patients
Male slings have emerged as a popular and efficacious treatment for men with post-prostatectomy s... more Male slings have emerged as a popular and efficacious treatment for men with post-prostatectomy stress urinary incontinence. Traditionally slings have been used with caution or avoided in men with impaired detrusor contractility or Valsalva voiding because of concern that patients will not be able to overcome the fixed resistance of a sling during micturition. We propose that men with post-prostatectomy urinary incontinence who have impaired contractility and/or void with abdominal straining for urodynamics can be safely treated with slings. A retrospective review of patients with post-prostatectomy urinary incontinence who underwent an initial sling procedure between January 2004 and January 2010 was conducted at a single institution. Preoperative urodynamic characteristics, and postoperative Patient Global Impression of Improvement, post-void residual and noninvasive uroflow data were examined. Patients were grouped by poor bladder contractility or Valsalva voiding status. Exclusion criteria were lack of preoperative urodynamics and/or postoperative post-void residual. A total of 92 patients were analyzed. The variables were compared using the Student t test and the chi-square test. No statistically significant difference was shown in postoperative post-void residual (mean 4 months postoperatively) or urinary retention when comparing by bladder contractility or Valsalva voiding. In the subset of patients with available postoperative uroflow data, there were no differences in postoperative maximum flow rate or voided volume. Men with post-prostatectomy urinary incontinence with urodynamic findings suggesting impaired contractility or Valsalva voiding can be safely treated with sling surgery if they have normal preoperative emptying.
Hypothesis / aims of study Bladder outlet obstruction in women can be caused by a variety of cond... more Hypothesis / aims of study Bladder outlet obstruction in women can be caused by a variety of conditions. Classically it is thought of in anatomical terms, but many functional conditions can also result in bladder outlet obstruction in women. Some studies have excluded functional causes in their analysis of female bladder outlet obstruction when trying to standardize urodynamic diagnostic criteria. 1-2 We sought to compare the clinical presentation and urodynamic characteristics of functional and anatomic obstruction in women to determine if there is a difference between the two. We also wanted to determine if there was any difference between the different causes within these broader categories of obstruction
The use of fluoroscopy during urodynamics can be helpful in the evaluation of patients with lower... more The use of fluoroscopy during urodynamics can be helpful in the evaluation of patients with lower urinary tract dysfunction. However, fluoroscopy introduces the potential hazards of ionizing radiation, including malignancy. In this study we analyzed the data for radiation exposure during videourodynamic study (VUDS) at our center; we have also tried to establish the factors associated with increased exposure to radiation during VUDS. We reviewed all VUDS from August 2010 to May 2011. Patients were included if they were ≥18 years old and had data recorded on total radiation exposure (radcm(2) ). Age, sex, body mass index, fluoroscopy time, diagnosis, and urodynamic findings were recorded. Multivariate linear regression analysis was used to identify independent risk factors that influenced increased radiation exposure. A total of 203 videourodynamic studies were assessed in 106 female and 97 male patients with a mean age of 64.3 and body mass index of 26.8. The average fluoroscopy tim...
Female Pelvic Medicine & Reconstructive Surgery, 2013
To characterize the symptoms and urodynamic findings of anatomical bladder outlet obstruction (AO... more To characterize the symptoms and urodynamic findings of anatomical bladder outlet obstruction (AO) and functional bladder outlet obstruction (FO) in women and to determine if future endeavors at defining bladder outlet obstruction in women can group these entities together. Retrospective review of all videourodynamic studies was performed on women from March 2003 to July 2009. Women with diagnosis of obstruction were categorized based on the cause of obstruction into 2 groups: AO and FO. Demographic data, symptoms, and urodynamic findings were compared between the 2 groups. One hundred fifty-seven women were identified of which 86 (54.8%) were classified as having AO and 71 (45.2%) were classified as having FO. There were no differences in symptoms between the 2 groups. There was no difference (P=0.5789) in the mean detrusor pressure at maximum flow rate Qmax between AO (38.9 cm H20) and FO (41.0 cm H20). There was a difference in the Qmax between AO and FO (10.6 [0-41.7] and 7.4 [0-35.7] mL/s, respectively; P=0.0044), but there was considerable overlap between the values in these 2 groups. Anatomical bladder outlet obstruction and FO have similar urodynamic voiding pressure findings, but Qmax was statistically significantly lower in AO. However, there is a large overlap in the Qmax values between the 2 groups. Therefore, future studies that attempt to characterize bladder outlet obstruction in women need not exclude either group.
... There have been several high-quality reviews of the literature on synthetic slings. A recent ... more ... There have been several high-quality reviews of the literature on synthetic slings. A recent Cochrane review by Ogah et al. ... In the recent Cochrane review, Ogah et al. reviewed 24 trials that compared the retropubic and transobtura-tor approaches of MUSS placement [23]. ...
To assess the accuracy of office-based ultrasound (US) to identify the fluid status of the AMS 80... more To assess the accuracy of office-based ultrasound (US) to identify the fluid status of the AMS 800 artificial urinary sphincter (AUS) pressure-regulating balloon (PRB). Patients who underwent AUS revision surgery (removal/replacement) from January 4, 2007, to January 4, 2010, were identified. US were done preoperatively to assess the system fluid status. Intraoperative findings were recorded. Sensitivity and specificity were calculated comparing US results with intra-/postoperative findings. When the PRB was underfilled, the location of the device fluid leak was determined, and the device was removed/replaced. In cases of a full PRB, patients had a cuff downsizing or total removal/replacement. A total of 27 patients were identified. Reasons for not obtaining US included: advanced device age (4), cuff erosion (2), volume determination by other modality (2), cuff site pain (1), isolated pump malfunctions (1), and other (3). Fourteen patients underwent an US before the removal/replacement. By US, PRB was full (21-23 mL) in 43% of the patients and empty/underfilled (0-6 mL) in 57%. US was 100% sensitive and specific determining fluid status. When PRB was full, management consisted of cuff downsizing (3), transcorporal cuff placement (1), and total removal/replacement (2). In all cases of device leak, an entire removal/replacement was performed. The cuff was identified as the site of leak in 50% of cases. US is an effective and accurate way of determining the fluid status of the AMS 800 AUS. Given the accuracy of this modality, the system can be filled with saline solution without losing the ability to determine fluid status.
Urinary incontinence is a major health problem that becomes more common with increasing age. A th... more Urinary incontinence is a major health problem that becomes more common with increasing age. A thorough history and examination can help determine the type of incontinence: stress, urge, mixed, or other. Initial treatments may include lifestyle and behavioral modifications, pelvic floor exercises, and anticholinergic medications. Urologic referral is appropriate when initial treatment measures fail or in complex cases, such as previous incontinence surgery or irradiation.
follow-up is available for 30 of them (15 in arm A, 15 in arm B). Questionnaire scores show bette... more follow-up is available for 30 of them (15 in arm A, 15 in arm B). Questionnaire scores show better outcomes in terms of idividual and couple erotic function re-establishment in arm B (case group) at 3, 6 and 12 months. Patients in arm B ragained sexual activity earlier after surgery when compared to men in arm A. Patient and couple’s overall satisfaction rate is significantly higher in case group. Furthermore, it is interesting to note that, during the preoperative assessment, the psychosexual counsellor observed a remarkable cultural resistance, hard to win, expecially among female partners over 55 years. CONCLUSIONS: In our study, postoperative sexual activity and erotic function are better in patients undergone psychosexual counselling after PPI when compared to patients undergone only surgery.
Abdominal wound dehiscence is a surgical catastrophe that can be attributed to patients or techni... more Abdominal wound dehiscence is a surgical catastrophe that can be attributed to patients or technical factors. The technical properties of the monofilament sutures and knots that are commonly used in abdominal closure are poorly understood. The aim of this study was to compare the tensile strength of monofilament sutures tied with conventional knots. To do this, the knot-holding capacity of four types of knots (square, surgeons', Aberdeen and loop) were tested using three types of gauge 1 monofilament suture, namely nylon, polyglyconate and polydioxanone, using a tensiometer. We found that the knot-holding capacity of the loop knot was between twofold and threefold greater than all the other knots examined. In comparing suture types, polyglyconate had the highest knot-holding capacity for all the knots that were examined and there was no difference in the tensile strength of nylon and polyglyconate tied in a square, surgeons' or Aberdeen knot (P < 0.05). In conclusion, our findings suggest that closure of an abdominal wound would be best commenced with a loop knot, using gauge 1 polyglyconate and finished with either an Aberdeen square or surgeons' knot would be appropriate.
INTRODUCTION AND OBJECTIVES: The use of male slings has emerged as a popular and efficacious trea... more INTRODUCTION AND OBJECTIVES: The use of male slings has emerged as a popular and efficacious treatment modality for men with post-prostatectomy incontinence (PPI). Traditionally, slings have been avoided in patients with impaired detrusor contractility because of concern that patients will not be able to overcome the fixed resistance of a sling during micturition. We propose that men with PPI who have impaired contractility and/or void with abdominal straining for urodynamics (UDS) can be safely treated with male slings. METHODS: A retrospective review of 123 consecutive patients with PPI who underwent a sling procedure between 1/04 and 1/10 was conducted at a single institution. Preoperative (preop) age, bladder capacity, post void residual (PVR), involuntary detrusor contractions (IDC), maximum flow rate (Qmax), detrusor pressure (Pdet), abdominal pressure (Pabd) and postoperative (postop) Patient Global Impression of Improvement (PGI-I), PVR and noninvasive uroflow were examined. Poor bladder contractility was defined as having bladder contractility index (BCI) 100. Valsalva voiding was defined as a change in Pabd at Qmax from baseline ( Pabd) 20. Exclusion criteria were lack of preop UDS and/or postop PVR or PGI-I. A total of 63 patients were analyzed. The variables were compared using Student’s t-test and chi-square test. RESULTS: No statistically significant difference was shown in postop PVR (mean 4 mos. postop) or urinary retention when comparing by BCI. Comparing by Pabd, a smaller PVR was seen with abdominal voiders, albeit likely clinically insignificant. Table 1 illustrates the preand postop outcomes compared by both BCI and Pabd. 31 patients (BCI 100, n 17 vs BCI 100, n 14) had postop uroflow available and there was no difference in postop Qmax (10.2 vs 13.1, p 0.22) or flow pattern. No patients excluded for incomplete data were treated for obstructive voiding or poor emptying. CONCLUSIONS: The results of this study indicate that men that may not have been traditionally offered a sling based on preop UDS findings can be safely treated with perineal sling. This may be a reflection of how contractility is measured in this population. Prospective studies comparing outcomes of men with impaired contractility that undergo various treatments may also be helpful. TABLE 1: Preand Postoperative Urodynamics Characterics of Male Sling Patients
Male slings have emerged as a popular and efficacious treatment for men with post-prostatectomy s... more Male slings have emerged as a popular and efficacious treatment for men with post-prostatectomy stress urinary incontinence. Traditionally slings have been used with caution or avoided in men with impaired detrusor contractility or Valsalva voiding because of concern that patients will not be able to overcome the fixed resistance of a sling during micturition. We propose that men with post-prostatectomy urinary incontinence who have impaired contractility and/or void with abdominal straining for urodynamics can be safely treated with slings. A retrospective review of patients with post-prostatectomy urinary incontinence who underwent an initial sling procedure between January 2004 and January 2010 was conducted at a single institution. Preoperative urodynamic characteristics, and postoperative Patient Global Impression of Improvement, post-void residual and noninvasive uroflow data were examined. Patients were grouped by poor bladder contractility or Valsalva voiding status. Exclusion criteria were lack of preoperative urodynamics and/or postoperative post-void residual. A total of 92 patients were analyzed. The variables were compared using the Student t test and the chi-square test. No statistically significant difference was shown in postoperative post-void residual (mean 4 months postoperatively) or urinary retention when comparing by bladder contractility or Valsalva voiding. In the subset of patients with available postoperative uroflow data, there were no differences in postoperative maximum flow rate or voided volume. Men with post-prostatectomy urinary incontinence with urodynamic findings suggesting impaired contractility or Valsalva voiding can be safely treated with sling surgery if they have normal preoperative emptying.
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