Impact of Evidence-Based Nursing on Self-Efficacy, Quality of Life and Treatment Compliance in Patients Undergoing Urological Surgery: Retrospective Study.

BACKGROUND: Urological surgery presents unique challenges to patients, necessitating specialised aftercare nursing. Evidence-based nursing has emerged as a strategy to improve patient outcomes through tailored education, self-management strategies and psychological support. However, its specific impact on post-operative outcomes in patients undergoing urological surgery has not been extensively explored. METHODS: This study assessed postoperative self-efficacy, quality of life, treatment compliance and nursing satisfaction. Self-compiled percentage of satisfaction scale was used to assess the degree of satisfaction with nursing work in both groups. Patients' self-care ability was evaluated using the Self-Care Ability Scale, and their quality of life scores were assessed with Short Form 36 Health Survey (SF-36). Patients' anxiety and depression levels were examined using the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). Statistical analysis was conducted using SPSS 29.0 statistical software. RESULTS: This retrospective study analysed 231 patients undergoing urological surgery and categorised them into a usual care group (n = 99) and an evidence-based nursing group (n = 132). Post-operative outcomes in the evidence-based nursing group included significantly higher self-care abilities (p < 0.001), improved quality of life scores (p < 0.001), lower anxiety and depression levels (p < 0.001) and higher treatment compliance rates (p < 0.05) compared with the usual care group. Additionally, nursing satisfaction was higher in the evidence-based nursing group (p = 0.001). CONCLUSIONS: The findings provide compelling evidence regarding the favourable impact of evidence-based nursing on various post-operative outcomes in patients undergoing urological surgery. Evidence-based nursing shows promise in enhancing patients' self-efficacy, well-being, treatment compliance and satisfaction. The results underscore the potential benefits of evidence-based nursing in optimising aftercare nursing and driving positive patient-centred outcomes in urological surgery setting.

Perineorrhaphy Outcomes Related to Body Imagery: A Randomized Trial of Body Image Perception.

OBJECTIVES: The aim of this study was to determine if a perineorrhaphy at the time of apical pelvic organ prolapse surgery positively affects women's body image. METHODS: This is a randomized controlled trial of women undergoing apical suspension procedures in which women (GH ≥2 cm to ≤6 cm) received either perineorrhaphy or no perineorrhaphy. The primary aim compared body image between the groups postoperatively using the Body Image in Pelvic Organ Prolapse (BIPOP) questionnaire. Secondary outcomes included prolapse stage, pain, pelvic floor muscle strength, pelvic floor symptoms, and sexual function. Between- and within-group differences were compared using Fisher exact test for categorical variables and t tests for continuous variables. When continuous variables were not normally distributed, the Welch-Satterthwaite test was used. Within-group analyses were performed via paired t tests for select continuous variables. RESULTS: Forty-six women were enrolled; 45 (97.8%) completed the 6-week assessment and 38 (82.6%) completed the 3-month assessment. There were no differences in baseline characteristics. Although women within groups had an expected improvement in mean Body Image in Pelvic Organ Prolapse and subscale scores between baseline and 3 months (P < 0.05), there were no differences in the mean scores between groups. In addition, there were no differences between groups in any of the secondary outcomes. CONCLUSIONS: Performance of apical prolapse surgery improved women's body image, irrespective of performance of a perineorrhaphy. Other important outcomes, including pain, did not differ between women in the 2 groups. These findings demonstrate the need for further trials to investigate the utility of this procedure.

Impact of COVID-19 Pandemic on Health-Related Quality of Life in Uro-oncologic Patients: What Should We Wait For?

PURPOSE: To investigate the health-related quality of life of uro-oncologic patients whose surgery was postponed without being rescheduled during the coronavirus disease 2019 (COVID-19) pandemic. PATIENTS AND METHODS: From the March 1 to April 26, 2020, major urologic surgeries were drastically reduced at our tertiary-care referral hospital. In order to evaluate health-related quality-of-life outcomes, the SF-36 questionnaire was sent to all patients scheduled for major surgery at our department 3 weeks after the cancellation of the planned surgical procedures because of the COVID-19 emergency. RESULTS: All patients included in the analysis had been awaiting surgery for a median (interquartile range) time of 52.85 (35-72) days. The SF-36 questionnaire measured 8 domains: physical functioning (PF), role limitations due to physical health (PH), role limitations due to emotional problems (RE), energy/fatigue (EF), emotional well-being (EWB), social functioning (SF), bodily pain (BP), general health perceptions (GHP). When considering physical characteristics as measured by the SF-36 questionnaire, PF was 91.5 (50-100) and PH was 82.75 (50-100) with a BP of 79.56 (45-90). For emotional and social aspects, RE was 36.83 (0-100) with a SF of 37.98 (12.5-90). Most patients reported loss of energy (EF 35.28 [15-55]) and increased anxiety (EWB 47.18 [interquartile range, 20-75]). All patients perceived a reduction of their health conditions, with GHP of 49.47 (15-85). Generally, 86% of patients (n = 43) noted an almost intact physical function but a significant emotional alteration characterized by a prevalence of anxiety and loss of energy. CONCLUSION: The lockdown due to the novel coronavirus that has affected most operating rooms in Italy could be responsible for the increased anxiety and decrement in health status of oncologic patients. Without any effective solution, we should expect a new medical catastrophe-one caused by the increased risk of tumor progression and mortality in uro-oncologic patients.

Complications and quality of life of ileal conduit, orthotopic neobladder and ureterocutaneostomy: systematic review of reports using the Clavien-Dindo Classification.

INTRODUCTION: Radical cystectomy (RC) and urinary diversion (UD) are two steps of the same surgical procedure involving likely complications and important impact on quality of life (QoL). The literature was reviewed to identify recent studies reporting UDs complications occurred 90 days after surgery and graded by Clavien-Dindo Classification System (CCS). EVIDENCE ACQUISITION: A comprehensive systematic Medline search was performed in PubMed/Medline, Embase and Scopus databases to identify reports published in English starting from 2013 using key words related to review outcome (i.e. neobladder, ileal conduct, ureterocutaneostomy, cystectomy, QoL). Complications were defined as minor or major whether the CCS grade was ≤2 or ≥3, respectively. Then, manuscripts references were screened to identify unfounded studies. Only studies using CCS to report surgical complications were considered. EVIDENCE SYNTHESIS: Retrieved studies were reported according to two main items of complications and QoL. About UDs complications, fourteen studies were identified incorporating overall 4436 patients. Up to 50% of patients experienced at least one low-grade complications (CCS≤2) requiring pharmacological treatment to be healed. On the other hand, high-grade complications (CCS≥3) occurred in 0.7-42% of cases and required surgical interventions (CCS 3a and 3b) or life support (CCS=4). Finally, mortality (CCS=5) rated between 0.4-7%. Regarding QoL, six studies were analyzed with overall 445 patients. Most of them were retrospective and showed conflicting results whether the external UDs were better than neobladder in term of impact on QoL. CONCLUSIONS: The use of a standardized system such as CCS improves analyses of literature. However, rigorous patient selection for UD type makes unable a randomized comparison between UDs in terms of complications and QoL impact.

Performance Optimization Strategies for Complex Endourologic Procedures.

OBJECTIVE: To identify and address factors that may impact a surgeon's performance during endourologic procedures. METHODS: A literature review was performed for articles focusing on surgical ergonomics, education, sports and performance psychology. RESULTS: As urologists and trainees have become more comfortable approaching complex pathology endoscopically, there remains an opportunity to refine surgeon-related factors and optimize extrinsic factors to maximize efficiency and provide patients with the highest quality outcomes and safety. CONCLUSION: Medical centers and training programs should strive to include formal lessons on stress-coping mechanisms, communication, and dedicated ergonomic training, as these all play a role in physician well-being and may lead to improved clinical outcomes.

Anesthetic technique and oncological outcomes in urology: A clinical practice review.

INTRODUCTION: There is increasing awareness that different anesthetic and analgesic techniques may impact outcomes after oncological surgery, generally through modifying effects on the immune system but potentially via other mechanisms including mitigating the surgical stress response. This narrative review aims to summarize the mechanisms underlying the effect of perioperative factors on oncological outcomes, with an emphasis on the available urologic literature. METHODS: Literature on anesthetic technique (i.e., general vs. regional) and oncological outcomes were reviewed with a particular focus on urological studies. RESULTS: In prostate cancer surgery, the risk of mortality has been reported to be reduced with the use of regional (i.e., neuraxial) anesthesia, but there was no association between anesthetic technique and progression-free or biochemical recurrence-free survival. In nonmuscle invasive bladder cancer, regional anesthesia has been associated with lower recurrence rates and longer time to recurrence following transurethral resection of bladder tumor. CONCLUSIONS: This review highlights the role of regional anesthesia to improve oncoimmunological responses after surgery, potentially through decreased use of volatile anesthetics and opioids, decreased activation of the surgical stress response, and a direct local anesthetic-mediated anti-inflammatory effect. Available urological literature suggests an association of anesthetic type and outcomes for nonmuscle invasive bladder cancer and prostate cancer surgeries but the evidence is limited. Prospective studies are needed to further investigate the relationship between anesthetic technique and urologic oncological outcomes.

Development, validation and initial evaluation of patient-decision aid (SUI-PDA©) for women considering stress urinary incontinence surgery.

INTRODUCTION AND HYPOTHESIS: Following the design, face validation and publication of a novel PDA for women considering SUI surgery, the main objective of the study is to evaluate the usefulness of SUI-PDA© by using a validated tool to obtain patient feedback. METHODS: From July 2018 to March 2019, the PDA, already incorporated into the patient care pathway, was objectively evaluated using the Decisional Conflict Scale (DCS) to determine patients' views. Patients recorded their values and reasons for requests and declines of treatment. The total DCS score, scores from each DCS subgroup and individual patient responses were calculated and analysed. RESULTS: The mean age of the first 20 patients to complete the DCS was 54 years, the mean BMI was 30.1 and the median parity was 3. The average total DCS score was only 9.29 out of 100 (range 0-29.69) suggesting that the PDA was quite useful for patients considering SUI surgery. Overall, the PDA had largely favourable responses across all five DCS subgroups. The 'informed' subgroup had the best score (6.67) while the 'uncertainty' subgroup had the least favourable score (14.58). Despite the procedure pause, the mesh tape option remained on the PDA; however, no patient had chosen this option, with a large proportion citing 'safety' issues as the main reason. Bulking agent injections were the most popular choice (40.0%) and the most commonly performed procedures (50.0%) mainly because of quicker 'recovery'. The second most popular participant choice was colposuspension (35.0%) followed by autologous fascial sling (25.0%), with women citing 'efficacy' as the main reason behind their choice. CONCLUSION: SUI-PDA© was reported by patients and clinicians to be useful with clinical decision-making for SUI surgery. Further validation in a larger patient group is underway.

Parental Preferences for Vesicoureteral Reflux Treatment: A Crowd-sourced, Best-worst Scaling Study.

OBJECTIVE: To quantitatively evaluate parental preferences for the various treatments for vesicoureteral reflux using crowd-sourced best-worst scaling, a novel technique in urologic preference estimation. METHODS: Preference data were collected from a community sample of parents via 2 best-worst scaling survey instruments published to Amazon's Mechanical Turk online community. Attributes and attribute levels were selected following extensive review of the reflux literature. Respondents completed an object case best-worst scaling exercise to prioritize general aspects of reflux treatments and multiprofile case best-worst scaling to elicit their preferences for the specific differences in reflux treatments. Data were analyzed using multinomial logistic regression. Results from the object-case provided probability scaled values (PSV) that reflected the order of importance of attributes. RESULTS: We analyzed data for 248 and 228 respondents for object and multiprofile case BWS, respectively. When prioritizing general aspects of reflux treatment, effectiveness (PSV = 20.37), risk of future urinary tract infection (PSV = 14.85), and complication rate (PSV = 14.55) were most important to parents. Societal cost (PSV = 1.41), length of hospitalization (PSV = 1.09), and cosmesis (PSV = 0.91) were least important. Parents perceived no difference in preference for the cosmetic outcome of open vs minimally invasive surgery (P = .791). Bundling attribute preference weights, parents in our study would choose open surgery 74.9% of the time. CONCLUSION: High treatment effectiveness was the most important and preferred attribute to parents. Alternatively, cost and cosmesis were among the least important. Our findings serve to inform shared parent-physician decision-making for vesicoureteral reflux.

Concurrent midurethral sling excision or lysis at the time of repeat sling for treatment of recurrent or persistent stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: Limited evidence guides operative technique in primary midurethral sling (MUS) lysis or excision at the time of repeat sling placement for persistent or recurrent stress urinary incontinence (SUI). Our objective is to compare subjective improvement in patients undergoing repeat MUS placement with and without concurrent primary sling lysis or removal. METHODS: This was a retrospective cohort study with a prospective survey of patients who underwent two MUS placements for SUI at a single institution from January 1996 to December 2015. After patient identification, the electronic record was queried for demographic and perioperative data. Subjects then completed the Urogenital Distress Index, (UDI-6), Incontinence Severity Index (ISI), and the Incontinence Impact Questionnaire (IIQ-7). Subjects were also asked if they would choose to undergo repeat MUS surgery again. RESULTS: Sixty-one patients were included. 17 out of 61 (28%) underwent concomitant primary sling lysis or excision, and 44 out of 61 (72%) did not. Fifty-seven percent (n = 35) completed the survey. Of the respondents, the median ISI score was 4 (1-8), with no difference between groups; 14 out of 35 (40%) reported the presence of bothersome urge incontinence, 11 out of 35 (31%) reported bothersome stress urinary incontinence, and 8 out of 35 (23%) reported symptoms of voiding dysfunction, with no difference between groups. 57% of patients (20 out of 35) would undergo repeat MUS placement again. CONCLUSIONS: In a small cohort, concurrent excision of the primary sling at the time of repeat MUS did not improve subjective outcomes. Many patients reported urinary urgency and voiding symptoms, and only about half of patients would choose to undergo the surgery again if given the choice.

Prospective assessment of positioning-related pain in robotic urologic surgery.

This was a prospective study to assess positioning-related pain in 20 awake volunteers in the dorsal lithotomy (DL) and lateral decubitus (LD) positions. Each volunteer was put through the series of discrete, sequential steps used to achieve a final position; each step had two options. The Wong-Baker scale (WB) was used to rate pain for each option and the preferred option and ad lib comments were recorded. We found that awake volunteers could clearly and immediately distinguish differences in pain levels between position options. For the DL position, volunteers favored having the arms slightly flexed and pronated as opposed to being straight and supinated reflected by statistically less painful WB scores and option preference. Volunteers preferred having the neck flexed as opposed to being flat. For the LD position, volunteers reported statistically lower pain scores and preference for a foam roll for axilla support as opposed to a rolled blanket, the table flexed without the kidney rest as opposed to a raised kidney rest, and the over arm board as oppose to stacked blankets for contralateral arm support. Ad lib comments from the volunteers supported the above findings. To our knowledge, ours is the first study to demonstrate objective preferences for variations in surgical positioning using awake volunteers. This exercise with awake volunteers resulted in immediate changes in positioning for real robotic surgery patients in our practice.

Improving Teamwork: Evaluating Workload of Surgical Team During Robot-assisted Surgery.

OBJECTIVE: To investigate the cognitive and physical workload experienced by each operating room team member for different types of urologic procedures. METHODS: Surgeons, anesthesiologists, surgical fellows, bedside assistants, circulating nurses, and scrub nurses completed the National Aeronautics and Space Administration Task Load Index questionnaire for various urologic robot-assisted surgery procedures. A total of 338 questionnaires from 55 unique individuals were collected. Workload differences by role, type of procedure, and surgery duration were analyzed using analysis of variance for each of the 6 domains of the National Aeronautics and Space Administration Task Load Index. The effects of trainees' participation on their perceived workload and the workloads of the lead surgeon and bedside assistant were analyzed with correlation. RESULTS: The role of the surgical team was significant for all the scales of workload, and there was a main effect type of surgery on temporal demand and frustration. Frustration was higher for prostatectomy in comparison to cystectomy for the trainee surgeon. On the other hand, it was lower for the anesthesiologist, bedside assistant, and the circulating nurse. There was no effect of procedural complexity on workload. Regardless of surgical complexity, the trainees performed approximately 40% of the procedure without significantly impacting their perceived workload. CONCLUSION: This study provides an analysis of variations and contributors to workload parameters and serves as a platform to optimize team members' workload during robot-assisted surgery.

Changes in levels of parental distress after their child with atypical genitalia undergoes genitoplasty.

BACKGROUND: The birth of a child with a disorder of sex development (DSD) and atypical genitalia can be traumatizing and isolating for families. Parents of children with DSD are at risk for increased levels of psychological distress, including depression, anxiety, illness uncertainty (IU), post-traumatic stress symptoms (PTSS), and impairments in quality of life (QOL). Our previous report indicated that although the majority of parents of children with atypical genitalia were coping well prior to the child's genitoplasty, approximately 25% of them reported experiencing some type of psychological distress. OBJECTIVE: The current study sought to examine the trajectory of parental psychological distress prior to, and 6 months after their child underwent genitoplasty. METHODS: Parents were recruited as part of an ongoing, prospective, multi-site study involving 10 pediatric hospitals with specialized care for children with atypical genitalia. Results from 49 parents (27 mothers, 22 fathers) of 28 children (17 female sex of rearing, 11 male sex of rearing) born with atypical genitalia (Prader rating of 3-5 in 46,XX DSD or by a Quigley rating of 3-6 in 46,XY DSD or 45,XO/46,XY) were included in the study. RESULTS: There were no significant changes in level of depressive or anxious symptoms or quality of life between baseline and 6-month post-operative follow-up, although mothers continued to report significantly higher levels of depressive symptoms than fathers, and as a group, these parents reported lower QOL than published norms. The level of PTSS significantly decreased for all parents, suggesting that parents may have come through the acute stress phase associated with their child's diagnosis. Finally, while there were no significant changes in IU over the time period, the level of IU for parents of boys actually increased, while parents of girls reported no change (Figure). CONCLUSION: Six months after their child has undergone genitoplasty, the majority of parents report minimal levels of psychological distress. However, a subset of these parents continue to experience significant distress related to their child's diagnosis. Specifically, parents of boys appear to be at increased risk for difficulties, which may be related to either the lack of clinical diagnosis for almost half of these children or the necessity of two-stage surgeries for the majority of them. We will continue collecting data on these families to better understand the trajectory of these adjustment variables.

Are patients willing to trade cure rate against less pain? Patients' preferences for single incision midurethral sling or transobturator standard midurethral sling.

AIMS: To quantify to what extent patients are willing to trade their chance of cure of stress urinary incontinence (SUI) against less postoperative groin pain. Randomized, controlled trials show less postoperative pain following single-incision mini-sling (SIMS), but slightly higher cure rates following a transobturator standard midurethral sling (SMUS). METHODS: A multi-center, interview-based trade-off experiment for treatment preference among 100 women with predominant SUI and undergoing SIMS. A hypothetical cure rate of SIMS was systematically varied from 10% to 70%, while keeping the cure rate of SMUS constant at 70%. The trade-off was assessed for two hypothetical durations of substantial postoperative pain after SMUS-2 days or 2 weeks-while simultaneously assuming the absence of substantial postoperative pain after SIMS. RESULTS: To prevent 2 days of substantial postoperative pain with SMUS, patients were willing to accept a 4.3% mean decrease in cure rate of SIMS, while a 7.1% mean decrease was acceptable to forego 2 weeks of substantial pain. Younger women (P = 0.04) and single women (P = 0.04) were associated with the trade-off limit for 2 days, respectively, 2 weeks of substantial postoperative pain. Single women were willing to accept lower cure rates. No correlations with trade-off limits were found for patients' actual severity, duration, and frequency of SUI. CONCLUSIONS: Patients are willing to accept a slightly lower probability of cure to prevent substantial post-operative pain by undergoing a less invasive procedure. These results are relevant for counselling of patients indicated for SUI surgery.

The Impact of Midurethral Sling Surgery on Sexual Activity and Function in Women With Stress Urinary Incontinence.

INTRODUCTION: Stress urinary incontinence has a negative impact on sexual function. AIM: To assess the effect of midurethral sling surgery on sexual activity and function in women with stress urinary incontinence. METHODS: This is a secondary analysis of the Value of Urodynamics Prior to Stress Incontinence Surgery (VUSIS-II) study, which assessed the value of urodynamics in women with (predominantly) stress urinary incontinence. Patients who underwent retropubic or transobturator sling surgery were included in the present study if information was available on sexual activity before and 12 months after surgery. Data were collected from a self-report validated questionnaire combined with non-validated questions. The association between midurethral sling surgery and sexual function (coital incontinence, satisfaction, and dyspareunia) was compared with McNemar χ(2) tests for nominal data and paired t-tests for ordinal data. Potentially influential factors were analyzed with univariable and multivariable logistic regression analyses. MAIN OUTCOME MEASURES: Changes in sexual activity and sexual function after midurethral sling surgery. RESULTS: Information on sexual activity was available in 293 of the 578 women (51%) included in the VUSIS-II study. At baseline, 252 of 293 patients (86%) were sexually active vs 244 of 293 (83%) after 12 months. More patients with cured stress urinary incontinence were sexually active postoperatively (213 of 247 [86%] vs 31 of 46 [67%], P < .01). There was a significant decrease in coital incontinence (120 of 236 [51%] preoperatively vs 16 of 236 [7%] postoperatively, P < .01). De novo dyspareunia was present in 21 of 238 women (9%). There was a greater improvement in coital incontinence after placement of the retropubic sling compared with the transobturator sling (odds ratio = 2.04, 95% CI = 1.10-3.80, P = .02). CONCLUSION: These data show that midurethral sling surgery has an overall positive influence on sexual function in women with stress urinary incontinence. The retropubic sling is more effective than the transobturator sling for improvement of coital incontinence. De novo dyspareunia was present in 1 of 11 women.

[Relevance of preoperative anxiety for postoperative outcome in urological surgery patients: A prospective observational study]. / Bedeutung präoperativer Angst für den postoperativen Verlauf bei urologischen Patienten : Eine prospektive Beobachtungsstudie.

BACKGROUND: Preoperative anxiety is not systematically assessed during premedication appointments, although it may influence the postoperative course and outcome. OBJECTIVES: The aim of this study was to assess preoperative anxiety in a sample of patients before major urological surgery and to characterize the impact on postoperative pain. An additional aim was to analyze the agreement between patients' self-ratings and physicians' anxiety ratings. PATIENTS AND METHODS: In all, 127 male and 27 female patients participated in a prospective observational study. Preoperative anxiety was assessed with two validated instruments - the APAIS (Amsterdam Preoperative Anxiety and Information Scale) and the State Scale of the STOA questionnaire (State-Trait Operation Anxiety) - during the premedication appointment. Physicians provided their subjective ratings on patients' anxiety and need for information using the APAIS. The predictive value of preoperative anxiety for postoperative pain was evaluated. RESULTS: Nearly four out of ten patients were identified as "anxiety cases"; thereof women were more afraid than men were. Preoperative anxiety was not correctly assessed by physicians, who overestimated patients' anxiety. In female patients, preoperative anxiety was predictive of increased postoperative pain scores. CONCLUSION: Preoperative anxiety is a frequent concern and often not correctly assessed by physicians. The use of scoring systems to detect preoperative anxiety is useful in clinical routine and helps to decide on therapeutic interventions.

[Pediatric outpatient surgery]. / Ambulantes Operieren im Kindesalter.

BACKGROUND: The number of outpatient surgeries for routine surgical interventions continues to increase, especially in adults. For many patients, there is no doubt that interventions like arthroscopy will be performed on an outpatient basis. Regarding urologic surgeries in adults (e.g., vasectomy, hydrecelectomy), outpatient treatment is well established. For adults such a procedure represents a well-calculable situation in most cases, as the patient can quite accurately imagine the events that will follow. In terms of pediatric outpatient surgery, the scenario is sometimes quite different. Parents are more anxious and uncertain because they must decide for the well-being of their children and they often do not exactly know what will happen during the procedure. In addition, they do not have to decide for themselves but for their children. DISCUSSION: Unfortunately, parents often lack information prior to surgery. Therefore, all persons involved in the treatment of children (e.g., urologists, anesthesiologists, nurses) must be trained and educated in giving adequate and appropriate information especially for parents. CONCLUSION: The purpose of this article is to provide different starting points for an optimized preparation and care of children and parents concerning outpatient surgery in pediatric urology.

[M1-OPIOID RECEPTOR AND CATECHOL-O-METILTRANSFERASE GENES POLYMORPHISM EFFECTS ON PERIOPERATIVE PSYCHOLOGICAL CONDITION OF THE PATIENTS AND THE EFFECTIVENESS OF POSTOPERATIVE ANALGESIA WITH OPIOIDS].

OBJECTIVE: To evaluate the influence of µl-opioid receptor (OPRM1) 118A>G and catechol-O-methyltransferase (COMT) 1947G>A gene single nucleotide polymorphisms (SNP) combinations on postoperative opioid analgesia (POA) efficacy. MATERIAL AND METHODS: In 100 consecutive patients scheduled for major urologic surgeries the SNPs of OPRM1 118A>G and COMT 1947G>A (real-time PCR), preoperative anxiety and depression level (HADS scale), POA efficacy ("Pain Out" questionnaire) have been assessed. RESULTS: Preoperative anxiety and depression, additional analgesia requirements, severity of nausea, drowsiness and incidence of vomiting were higher in OPRM1 118G allele carriers. Maximum pain intensity and pain-related restriction of mobility on first postoperative day were lower in homozygous carriers of COMT 1947A. The best response to POA in view of preoperative anxiety, analgesia efficacy and severity of nausea has been revealed in carriers of combination COMT-OPRM1 AA-AA. CONCLUSIONS: SNPs of OPRM1 118A>G and COMT 1947G>A affect the preoperative patients psychological status and POA efficacy.

To tell or not: parental thoughts on disclosure of urologic surgery to their child.

PURPOSE: Literature pertaining to surgical disclosure to the pediatric patient is lacking. We hypothesized parents would find it difficult to disclose urologic surgery to a child. MATERIALS AND METHODS: Parents of patients <5 years old undergoing urologic surgery were contacted for telephone survey. Parents were asked about future plans of surgical disclosure, comfort with disclosure, and any support received. RESULTS: 98 parents consented to study participation. 87% of surgeries were on the genitalia with 62% being minor genitalia surgery (i.e. circumcision). 70% of parents would tell their child about minor genital surgery while 84% would tell about major genital surgery (p=0.07). 4 of 20 parents of children undergoing hypospadias repair (major genital surgery) did not plan to tell their child about surgery. All parents of children undergoing non-genital surgery would tell. Of all parents planning to tell their children about surgery, only 14% were nervous. 34% of parents would find guidance in talking to their child helpful despite the majority (90%) stating no guidance had ever been provided. CONCLUSIONS: Parents seem comfortable discussing urologic surgeries with a child but about 1/3 would appreciate further counseling. 20% of parents of children undergoing hypospadias repair hope to avoid telling their child.

Incontinence-specific quality of life measures used in trials of sling procedures for female stress urinary incontinence: a meta-analysis.

PURPOSE: We conducted this review to summarize the short-term and long-term efficacy of several midurethral sling procedures on quality of life (QoL) improvement based on incontinence-specific QoL measures in clinical trials among women with stress urinary incontinence (SUI). METHODS: We searched MEDLINE (January 1966 to March 2015), EMBASE (January 1988 to March 2015), and the Cochrane Incontinence Group Specialised Register (March 2015). Only randomized controlled trials (RCTs) were eligible in this analysis. RESULTS: We identified 13 different condition-specific instruments in the included 31 RCTs; the Urogenital Distress Inventory (UDI), the Incontinence Impact Questionnaire (IIQ), and Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire-12 (PISQ-12) were the most frequently used methods to measure QoL among women with SUI. We found that the improvement in sexual function (as assessed by PISQ-12) score was significantly higher in the single-incision slings group than in the TO-TVT group (WMD 1.06; 95 % CI 0.58-1.54); the post-operative pain visual analogue scale scores in the single-incision slings group was significantly lower than that in the TO-TVT group (WMD -1.59; 95 % CI -2.28 to -0.89). TO-TVT-treated patients had significantly greater reductions in total UDI scores (WMD 2.28; 95 % CI 1.77-2.80) and total IIQ scores (WMD 0.89; 95 % CI 0.26-1.52) than TVT-treated patients. The reduction in the total UDI score was significantly higher in the RP-TVT group than in the TO-TVT group (WMD -1.00; 95 % CI -1.65 to -0.35). Subgroup analysis of the total UDI score showed a significantly greater improvement in TO-TVT-treated patients than in TVT after long-term follow-up (>30 months), but no differences were detected after short-term follow-up (12-15 or 6 months). CONCLUSIONS: Our meta-analysis indicated that consistent use of the UDI and IIQ with or without the PISQ-12 might promote options for comparisons between trials. Single-incision slings were associated with significantly higher improvement in sexual function and lower post-operative pain compared with standard midurethral slings, and the long-term efficacy of TO-TVT was superior to the TVT procedure in terms of reducing the distress caused by incontinence symptoms.