False-negative finding in urodynamic study for the chief complaint. Does it interfere with the clinical outcomes for the treatment of SUI or OAB syndromes?

PURPOSE: False-negative urodynamic findings may mislead or prevent planned treatments due to unmatched findings with the clinical presentation. We hypothesized that the absence of urodynamic demonstration of SUI or OAB on urodynamics would interfere with clinical outcomes. MATERIALS AND METHODS: We prospectively studied 124 women with (94) or without (30) demonstrable SUI after sling operations. Similarly, 64 women with OAB syndrome with (38) or without (26) demonstrable DO were also compared after treatment with anticholinergic agents. Patients were assessed with the UDI-6 and IIQ-7 questionnaires 3 and 6 months after treatment. RESULTS: Only 76% of SUI patients demonstrated urine leakage during urodynamics. The UDI-6 score was higher in the demonstrable-SUI and demonstrable-DO groups, while the IIQ-7 score was comparable within the incontinence or urgency/frequency groups. Demonstrable and non-demonstrable SUI-operated patients showed similar outcomes. Patients with urgency syndromes with or without demonstrable DO had a similar rate of improvement with anticholinergic therapy. CONCLUSIONS: Women with clinical complaints of SUI objectively demonstrated on urodynamics presented the same subjective clinical outcome as those with SUI lacking objective demonstration when measured by the UDI-6 and IIQ-7 questionnaires. Similarly, patients with OAB syndrome with or without demonstrable DO had similar clinical improvement when treated with anticholinergics and measured using the same questionnaires.

Rate of spontaneous voiding recovery after acute urinary retention due to bed rest in the hospital setting in a nonurological population clinical study of the relationship between lower limbs and bladder function.

OBJECTIVES: To understand the clinical relationship between lower limbs functions and the recovery of spontaneous voiding after an acute urinary retention (AUR) in older patients admitted to hospitals for non-urological causes using clinical parameters. MATERIALS AND METHODS: 56 adult patients (32 men; mean age: 77.9 ± 8.3 and 24 women; mean age 82.1 ± 4.6) with AUR were prospectively followed with validated Physical Performance Mobility Exam (PPME) instrument to evaluate the relationship between the recovery of mobility capacity and spontaneous voiding. After a short period of permanent bladder drainage patients started CIC along evaluation by PPME during hospitalization and at 7, 15, 30 60, 90, and 180 days of discharge. Mann-Whitney U, chi-square test and ANOVA tests were used. RESULTS: All patients were hospitalized for at least 15 days (Median 26.3 ± 4.1 days). Progressive improvement on mobility scale measured by PPME was observed after leaving ICU and along the initial 7 days of hospitalization but with a deterioration if hospitalization extends beyond 15 days (p<0.03). Prolonged hospital stay impairs mobility in all domains (p<0.05) except step-up and transfer skills (p<0.02) although a recovery rate on spontaneous voiding persistented. Restoration of spontaneous voiding was accompanied by improvement on mobility scale (p<0.02). Recovery of spontaneous voiding was markedly observed after discharging the hospital. All patients recovered spontaneous voiding until 6 months of follow-up. CONCLUSIONS: Recovery to spontaneous voiding after acute urinary retention in the hospital setting may be anticipated by evaluation of lower limbs function measured by validated instruments.

Can We State Stable Bladder? How Many Repetitions Should We Do for an Appropriate Demonstration of Involuntary Detrusor Contraction?

AIMS: Involuntary Detrusor Contraction (IDC) may alter therapeutic plans; therefore, urodynamic demonstration (UD) is pivotal. We explore if same session repetitions enhance its demonstration and minimize false-negative results. METHODS: Two hundred fifty two women (mean age 47 ± 5.7) had 4 full repetitions of UD with the last round filled with 4°C fluid (Ice-water test). IDC was diagnosed if with at least 3 cm H2O after artifacts were ruled out. RESULTS: 44.4% of the cases showed IDC in the first round of the exam but it could be demonstrated in 88.5% of the women if 4 rounds are taken into account. Only 2 cases showed IDC exclusively in the first round. Nine cases (3.5%) showed IDC in the first round and only on Ice-test, while all other IDC-detected cases revealed it in scattered patterns along the repetitions. Likewise, IDC detection on the second, third and fourth rounds varied widely and unpredictably, many failing to show a consistent pattern of presentation after its detection. IDC wave amplitude did not show any correlation to the detection. CONCLUSIONS: Urodynamic repetition is a necessary procedure where IDC is important to demonstrate, as its false-negative rate is high and its unpredictable pattern of detection may be improved by repetition.

Involuntary detrusor contraction is a frequent finding in patients with recurrent urinary tract infections.

OBJECTIVE: To check whether subtle voiding dysfunction is related to recurrent urinary tract infection (rUTI). METHODS: 254 consecutive patients with at least four episodes of urinary tract infection (UTI) were studied. At least three repeat urodynamic evaluations with an additional ice water test to maximize the detection of involuntary detrusor contraction (IDC) were used. Stress urinary incontinence cases were used as controls. Nonparametric univariate and multivariate analyses were used for statistics. RESULTS: IDC was detected in 83.6% of patients in the rUTI group and in 31.7% in the control group. IDC was <15 cm H2O in 54.7% whereas high-amplitude (>50 cm H2O) IDC was observed in 6.8% in the rUTI group. Female urinary tract obstruction was diagnosed in 16.8% of patients in the rUTI group and in 7.9% in the control group. Residual volume, PdetQmax and Qmax were not predictive of UTI recurrence. Symptoms were similar in both groups. CONCLUSIONS: Patients with rUTI present with covert bladder dysfunctions represented by detrusor overactivity.

Urodynamic after-contraction waves: a large observational study in an adult female population and correlation with bladder and ureter emptying functions in women.

OBJECTIVE: To evaluate different patterns of after-contraction (A-C) waves detected during urodynamic evaluation in women. PATIENTS AND METHODS: 4,110 women were prospectively observed regarding the presence of A-C waves upon urodynamic evaluation. Intravenous pyelography and ultrasound were requested. Paired t test, χ(2) test, Wilcoxon's rank sum test and correlation analysis were performed with a 95% significance level. RESULTS: There were three distinguishing patterns of A-C: type I - detrusor contraction after the regular voiding phase, type II - detrusor contraction persisting after the flow rate had stopped, and type III - rebound of the detrusor contraction after the flow. A-C was observed in 13.9% of the women. Type I A-C wave patterns were present in 68 patients (11.8%), type II A-C wave patterns in 477 patients (83.2%), and type III A-C wave patterns in 28 patients (10.3%). Studies with intravenous pyelography and ultrasound very frequently showed bladder mucosa, muscle thickening or trabeculation. Secondary ureterectasis related to A-C waves was also observed. Additionally, watts factor, maximum flow rate, detrusor pressure and opening detrusor pressure were markedly elevated in patients with type III A-C, suggesting enhanced detrusor contraction in these A-C waves. CONCLUSION: A-C waves are a real urodynamic entity with different patterns of presentation and with clinical and morphological alterations.

One hundred cases of SUI treatment that failed: a prospective observational study on the behavior of patients after surgical failure.

OBJECTIVES: Determine what happens to patients after unsuccessful SUI operations and to explore the reasons why these patients change doctors. MATERIALS AND METHODS: One hundred consecutive failed patients treated for SUI were interviewed about the exams requested after persistence of the incontinence as well as the reasons they abandoned their primary doctors through a structured questionnaire. RESULTS: Among the patients with cases of anterior colporrhaphy, bladder suspensions or slings, 34.3%, 13.7% and 8.3%, respectively, were not offered any further type of investigative procedures to clarify the failure. Urodynamic evaluations were recommended in 75% of failed slings, and 66.6% of the patients proceeded with these tests. In contrast, only 31% of patients with bladder suspensions and 40% of patients with anterior colporrhaphy were recommended for urodynamic investigations, and only 44.4% and 28.5% of them, respectively, proceeded with the option. Patients' delusions were reinforced by the doctors' attitude toward the investigations. Vacuous justifications and the lack of intention to seek improvement were the driving forces causing the patients to change doctors. CONCLUSION: Unsuccessful patients are evaluated in a non-protocol form. Difficulty in clarifying the reasons for surgical failure and the disruption of the doctor-patient relationship are the main reasons why patients abandon them.

Female obstruction after incontinence surgery may present different urodynamic patterns.

INTRODUCTION AND HYPOTHESIS: The aim of this study is to report a novel understanding of the urodynamic parameters used to diagnose iatrogenic female obstruction. There is no consensual definition of infravesical obstruction in women. Numerous criteria were designed with arbitrary cutoff values with poor clinical correlation. In order to determine the urodynamic profile of infravesical female obstruction we restricted our analysis to women who acquired voiding disturbances after being submitted to stress urinary incontinence (SUI) surgery. METHODS: A total of 302 women developed obstructive symptoms or voiding difficulties after SUI operations: 176 cases had had Kelly-Kennedy operations (58.2 %), 50 had had Burch operations (16.5 %), 37 (12.2 %) had had anterior colporrhaphy + abdominal (Burch) operations, 33 (10.9 %) had had sling operations, and 8 (2.6 %) had had Marshall-Marchetti operations. Obstructive urinary symptoms started in 1-120 days after the operation and urodynamic evaluations were done after various periods of time (median 18.4 months). Clinical presentations varied widely with irritative symptoms predominating the picture. RESULTS: Five patterns of pressure-flow relationships could be identified: (1) elevated pressure and poor flow (7.2 %), (2) normal pressure and poor flow (41.5 %), (3) normal pressure and flow associated with prolonged flow time (24.2 %), (4) poor detrusor contraction and elevated residual volume (12.9 %), and (5) elevated pressure and high flow (14.5 %). No relationship was established amongst the group and the Urinary Distress Inventory questionnaire. CONCLUSIONS: Infravesical obstruction in women does not fit a single model. As suggested, obstruction in women must be based on broad clinical pictures and urinary complaints.

The role of a surgical learning curve in urethral obstruction following autologous fascial sling: a case-series study.

INTRODUCTION AND HYPOTHESIS: Iatrogenic female urethral obstruction resulting from sling operations may be related to surgical inexperience and must be better understood. Although there are no widely recognized parameters for this type of study, a single-surgeon consecutive series offers an opportunity to study the role of expertise in sling operations over time. METHODS: This study consecutively examined 176 women who underwent an autologous fascial sling procedure. Postoperative urethral obstruction was identified by the occurrence of voiding dysfunctions. Clinically obstructed patients were invited to undergo a postoperative urodynamic evaluation after 3 months. To enable comparison, patients were placed into 6-month groups according to the time of surgery. RESULTS: A total of 159 cases were evaluated with a mean follow-up time of 32.4 ± 13.4 months. Stress continence was cured in 97.5% of cases. Although 29 patients were identified as obstructed, only 20 underwent a postoperative urodynamic evaluation. Only five of the clinically obstructed cases showed a high P(det)Q(max). All of the other cases met one or more of the non-classic parameters linked to obstruction. Overactive bladder was present in 14 (63.6%) of the obstructed cases. Iatrogenic urethral obstruction was more common among the early cases (30.4%) than among the later ones (5%) (P < 0.001). Postoperative urodynamic evaluation showed a trend toward obstruction on pressure flow studies. CONCLUSIONS: Autologous fascial sling operations require expertise and involve a clear surgical learning curve. Iatrogenic obstruction in females does not fit a single model and may be difficult to recognize. Obstruction in females must be identified through clinical indicators and postoperative urinary complaints rather than the high detrusor pressure observed in men. Furthermore, iatrogenic female obstruction can probably be minimized but not eliminated.

Titration of dosage for the protective effect of zoledronic acid on bone loss in patients submitted to androgen deprivation therapy due to prostate cancer: a prospective open-label study.

BACKGROUND: Bisphosphonates were incorporated as agents for the long-term effect of androgen deprivation therapy (ADT) but no comparative study was established for the optimal schedule for bone preservation. METHODS: Ninety-five consecutive prostate cancer patients submitted to radical retropubic prostatectomy were recruited. At rising PSA they were prospectively enrolled in nonrandomized fashion and grouped to receive no treatment (21 - control group), and monthly (17), bi-monthly (15), tri-monthly (19) or semestral (15) 4 mg zoledronic acid infusions. The patients were followed to a minimum of 30 months after receiving ADT by LHRH agonists. Bone mineral density (BMD) was measured every 6 months in all 5 studied groups in order to compare the effect of each regimen to nontreatment. Tukey-Kramer and Scheffe's tests were used. RESULTS: The control group showed an impressive BMD loss throughout the study period. The 4 groups treated with zoledronic acid infusions showed increased BMD in the lumbar area on periodical densitometry and no statistical differences could be established among the 4 studied schedules. Different individual patterns of decreasing (control) or increasing (treated) BMD could be seen along the study as measured by bone densitometry. CONCLUSIONS: Zoledronic acid treatment promoted effective osseous protection against the natural demineralization process in patients with prostate cancer recurrence submitted to ADT.

Outline of 3,830 male patients referred to urodynamic evaluation for lower urinary tract symptoms: how common is infravesical outlet obstruction?

INTRODUCTION: The prevalence of bladder outlet obstruction in men has been overestimated leading to improper clinical results after transurethral resection of the prostate. PATIENTS AND METHODS: 3,830 consecutive male cases submitted for urodynamic evaluation were prospectively analyzed using a Schaefer nomogram. The prevalence of detrusor overactivity and the occurrence of obstruction were prospectively studied using standardized urodynamic practice. RESULTS: Infravesical obstruction was diagnosed in 44.8% of the studied population: 0.7% of the obstructed cases were obstructed at the sphincter zone and 7.9% showed obstruction as a high-pressure, high-flow-rate pattern. Detrusor overactivity was demonstrated in 73.9% of the obstructed cases and in 22% of the unobstructed. Older patients (>60 years) seemed more likely (odds ratio: 2.8) to present detrusor overactivity, but at the same time showed less frequent obstruction. The oldest subjects (>80 years) showed a lower prevalence of obstruction, although overactive bladder was a common finding. CONCLUSION: Infravesical obstruction is less frequent than previously stated. The common assumption that obstruction is the cause of lower urinary tract symptoms in older men is wrong. Older men are more likely to suffer from detrusor overactivity resulting from lower urinary tract symptoms rather than infravesical obstruction. Urodynamic studies seem to be crucial for a proper diagnosis in men considered candidates for surgical treatment.

False-negative finding in urodynamic study for the chief complaint. Does it interfere with the clinical outcomes for the treatment of SUI or OAB syndromes?

ABSTRACT Purpose: False-negative urodynamic findings may mislead or prevent planned treatments due to unmatched findings with the clinical presentation. We hypothesized that the absence of urodynamic demonstration of SUI or OAB on urodynamics would interfere with clinical outcomes. Materials and Methods: Materials and Methods: We prospectively studied 124 women with (94) or without (30) demonstrable SUI after sling operations. Similarly, 64 women with OAB syndrome with (38) or without (26) demonstrable DO were also compared after treatment with anticholinergic agents. Patients were assessed with the UDI-6 and IIQ-7 questionnaires 3 and 6 months after treatment. Results: Only 76% of SUI patients demonstrated urine leakage during urodynamics. The UDI-6 score was higher in the demonstrable-SUI and demonstrable-DO groups, while the IIQ-7 score was comparable within the incontinence or urgency/frequency groups. Demonstrable and non-demonstrable SUI-operated patients showed similar outcomes. Patients with urgency syndromes with or without demonstrable DO had a similar rate of improvement with anticholinergic therapy. Conclusions: Women with clinical complaints of SUI objectively demonstrated on urodynamics presented the same subjective clinical outcome as those with SUI lacking objective demonstration when measured by the UDI-6 and IIQ-7 questionnaires. Similarly, patients with OAB syndrome with or without demonstrable DO had similar clinical improvement when treated with anticholinergics and measured using the same questionnaires.

Safety of I.V. Nonnitrogen bisphosphonates on the occurrence of osteonecrosis of the jaw: long-term follow-up on prostate cancer patients.

INTRODUCTION: The aim of the study was to disclose information about the recently incorporated bisphosphonates therapies used to treat prostate cancer patients and their potential risks because the chemical nature and nitrogen content varies among the available drugs on the market. PATIENTS AND METHODS: Three hundred twenty-four consecutive prostate cancer patients were submitted to bisphosphonates therapy after antiandrogen treatment was started. Zoledronic acid was administered monthly (n = 45), bimonthly (n = 15), trimonthly (n = 19), and semestrally (n = 15), and monthly intravenous clodronate was administered in an additional 156 cases. Fourteen additional cases switched the drugs during the course of the treatment. RESULTS: After a median follow-up of 54 ± 24 (control), 63 ± 7 (clodronate), and 54 ± 6 months (zoledronic acid), the only 2 patients (0.6%) who developed osteonecrosis of the jaw (ONJ) occurred in those who switched the drug. CONCLUSION: This study is the longest and the largest ever reported on bisphosphonates usage in prostate cancer patients. ONJ seems to be exclusively related to nitrogen content bisphosphonates.

A randomized and prospective study on the value of antibiotic prophylaxis administration in transurethral resection of the prostate.

CONTEXT: Antibiotic prophylaxis in transurethral resection of the prostate is a regular practice in urology. However, its prophylactic effect can be questioned when the antiseptic surgical technique is used. Nonetheless, urine culture-oriented antibiotic therapy is the gold standard for avoiding improper medication usage and bacterial resistance. OBJECTIVE: To study the efficacy of antibiotic usage in patients with negative urine cultures, who were submitted to transurethral resection of the prostate. TYPE OF STUDY: Prospective open labeled study. SETTING: Tertiary care referral hospital. PARTICIPANTS: 124 consecutive patients, who were randomly divided into two groups to receive antibiotic prophylaxis or not. MAIN MEASUREMENTS: Cultures from meatus, urine, irrigation and antiseptic fluid, and prostate tissue chips, were compared and analyzed for bacterial sensitivity to the antibiotic used, according to the surgeon's personal criteria. McLennan's test was used for statistical analysis. RESULTS: No statistically significant difference regarding clinical evolution was found between the groups that received or antibiotics or not. Statistical significance was found regarding the occurrence of positive urine cultures during the postoperative period for those not receiving antibiotics, but not in relation to fever, prostate chip culture or bacteremic episodes. Sixty-eight subjects (57.1%) presented positive prostatic tissue culture. There was no specific correlation between the recovered bacteria from the meatus, prostatic tissue chip and urine and the spectrum of the administered antibiotic. Six cases showed the same bacteria in the urine and prostatic tissue chip. Only fifteen cases (25%) in the antibiotic group showed the desired sensitivity directed to the collected bacteria. CONCLUSIONS: Antibiotic prophylaxis for patients whose urine is sterile is debatable in patients who are candidates for transurethral resection of the prostate. Most of the time, the antibiotic agent used is not specific for any of the bacteria recovered from the various sources analyzed.

Incidental and symptomatic renal tumors: impact on patient survival.

CONTEXT: Renal cell carcinoma is the third most frequent genitourinary neoplasia, and there is currently an increase in the incidental diagnosis of tumors confined to the kidneys. OBJECTIVE: To study the survival of patients with incidental and symptomatic renal tumors who have undergone nephrectomy. DESIGN: Retrospective. SETTING: Hospital Sírio Libanês and Hospital Beneficência Portuguesa de São Paulo. PARTICIPANTS: 115 patients with diagnosis of renal cell carcinoma, operated on by the same group of surgeons and evaluated by a single pathologist. MAIN MEASUREMENTS: Sex, age and diagnosis method, analyzed in two groups, according to the tumor diagnosis: Group 1 with incidental diagnosis and Group 2 with symptomatic tumors. The anatomopathological characteristics and patient survival in both groups were evaluated. A statistical analysis was performed using the Student t, chi-squared, log rank and Kaplan-Meyer tests. RESULTS: Among the studied patients, 59(51%) had an incidental diagnosis, with 78% diagnosed by ultrasonography, 20% by computerized tomography scan and 2% during surgeries; 56 patients (49%) were symptomatic. Tumor locations were equally distributed between the two kidneys, and the surgery was conservative for 24% of the incidental and 9% of the symptomatic group. In the incidental group only one patient had tumor progression and there was no death, while in the symptomatic group there were 5 progressions and 10 deaths. The 5-year specific cancer-free survival was 100% in the incidental and 80% in the symptomatic group (p = 0.001) while the disease-free rate was 98% in the incidental and 62% in the symptomatic group (p < 0001). CONCLUSION: Incidental renal tumor diagnosis offers better prognosis, providing longer disease-free survival.

[Incidental and symptomatic kidney cancer: pathological features and survival]. / Carcinoma de células renais incidentais e sintomáticos: fatores patológicos e sobrevida.

BACKGROUND: Patients with early diagnosis of renal cell carcinoma (CCR) have higher chance of cure following surgical treatment. This study was set to compare the pathological characteristics between the surgical specimens and the survival of the patients with incidental and symptomatic CCR. METHODS: One hundred and fifteen patients with sporadic CCR were studied retrospectively following nephrectomy and divided into two groups. Group 1; 59 patients with incidental diagnosis and Group 2; 56 symptomatic patients. The mean age of the patients was 59 years, with 86 men and 29 women. Radical nephrectomy was performed in 96 patients and the conservative surgery was performed in the remaining 19. Comparison parameters included pathological outcome, specifically nuclear grade, pathological stage, size of the tumor and presence of microvascular invasion intratumoral and patients survival. RESULTS: Comparison between the two groups confirmed that the incidental tumors have smaller nuclear grade (p=0.003), smaller size (p=0.001), smaller incidence of microvascular invasion (p<0.001) and lower stage (p<0.001). Disease specific survival and recurrence free survival of the incidental group were statistically higher than the symptomatic group (p<0.001). CONCLUSION: Incidentally discovered CCR have more favorable pathological characteristics, the patients have disease free survival when compared to symptomatic CCR.

[Must the TNM staging of the renal cell carcinoma be modified again?]. / O estadiamento TNM do carcinoma de células renais deve ser modificado novamente ?

OBJECTIVE: The behavior of the renal cells carcinoma stage PT1 is not completely clarified. We studied the presence of factors after prognostics and tumoral size in the recurrence of survival of the sporadic kidney carcinoma after surgical treatment. METHODS: 120 patients followed after nephrectomy had been revised retrospectively 93 PT1, 9 PT2, 11 PT3, 7 PT4, It was analyzed survival and recurrence of the disease inside of three groups of tumors: Group 1: < 4cm, group 2: 4-7cm and group 3: > 7cm, and the prognostics factors above-mentioned evaluated were nuclear degree, microvascular invasion, presence of committed ganglia and sarcomatous degeneration. RESULTS: The frequency of adverse prognostics factors increase as the tumor size increase. In the group 1, we had only four tumors of high degree and only one shown microvascular invasion that does not committed ganglia or sarcomatous degeneration. In group 2 there was 16 tumors of high degree, 4 sarcomatoses, two with positive microvascular invasion and two with positive ganglia. In group 3, was found 18 tumors of high degree, 15 with microvascular invasion and 7 with positive ganglia and 5 sarcomatoses. There was statistical significance in the specific cancer survival (p=0.002) and free of illness (p=0.0002) between the three groups. CONCLUSION: The evolution of tumors PT1 is distinct for lesser tumors of 4 cm and 4-7 cm fitting the subdivision of these two groups in T1a and T1b.

Impact of Urodynamic Learning on the Management of Benign Prostatic Hyperplasia Issue on Young and Senior Urologists and Reasons to Attend a Voiding Dysfunction Course.

OBJECTIVES: The aims of this study were to compare the impact of urodynamic training on the young urologists after fellowship training as well as on senior urologists who attend regular courses on the management of benign prostatic hyperplasia (BPH) and their capacity to do and interpret urodynamic studies. METHODS: Sixty-four consecutive young urologists admitted to fellowship program on voiding dysfunctions and 110 senior urologists attending to periodical meetings were interviewed before and after the 3-day-courses regarding their ability to set, interpret and do urodynamic studies. They were also questioned on the reasons that led them to attend the courses and how they use the new concepts to manage BPH. A rank of the used parameters to indicate transurethral resection of the prostate (TURP) in BPH patients were scored before and after the course. RESULTS: Fellowship and senior urologists mainly attended the course because of lack of confidence and belief that this urological issue is too important to be disregarded. A significant portion of both groups do not trust third-party examiners. More than 90% of the urologists acquired confidence in interpreting, setting and were able to do the exam after the course. The majority of both groups believed urodynamic study was essential to manage BPH, disregarding volume as the main reason to operate on patients. Many outdated parameters became less important on the decision to operate. CONCLUSIONS: Doctors exposed to intensive or long urodynamic training dramatically changed their perceptions on the utility of this tool and became more attentive it.

Slings may not fail as frequently as believed for stress urinary incontinence: the misinterpretation of postoperative voiding dysfunction as failure based on patient report.

OBJECTIVE: : Sling operations may obstruct the urethra, promoting voiding dysfunction and secondary urine leakage that are incorrectly attributed to surgical failure. METHODS: : We prospectively evaluated the evolution of urinary symptoms in the postoperative follow-up of 108 polypropylene sling cases. Patients presented for follow-up at 1, 3, 6, 12, 18, 24, 36, and 48 months for review of individual urinary symptoms. Statistical analysis used Fisher exact test. RESULTS: : On the 30th postoperative day, 100% of the cases were cured of stress urinary incontinence, although frequency (62.9%), urgency (29.6%), urge-incontinence (23.1%), nocturia (28.6%), incomplete voiding sensation (11.1%), and poor stream (11.1%) persisted. At 3 months, 16.6% reported frequency, 38% complained of urgency, and 29.6% were troubled by nocturia. True urinary leakage under stress was resolved in 100% of cases by the first visit and did not show any further decrease when specifically questioned. Pad usage decreased after 3 months but did not completely disappear after 48 months. A total of 94.4% of the cases achieved total continence and clinical satisfaction after 4 years of follow-up, in parallel with the steady disappearance of voiding dysfunction observed in the early postoperative period. CONCLUSIONS: : Voiding dysfunction after sling procedures is frequent but transitory. As symptoms improve or disappear, patients tend to miss their follow-up. In this study, 94.4% of the cases had complete dryness and satisfaction with the operation.

Adjuvant Effect of IV Clodronate on the Delay of Bone Metastasis in High-Risk Prostate Cancer Patients: A Prospective Study.

PURPOSE: High-risk prostate cancer patients undergoing treatment often experience biochemical recurrence. The use of bisphosphonates as an adjuvant treatment delays skeletal events, yet whether or not bisphosphonates also delay metastastic development remains to be determined. MATERIALS AND METHODS: A total of 140 high-risk prostate cancer patients who were undergoing definitive treatment and who had clinically organ-confined disease and who suffered from biochemical recurrence were administered intravenous (IV) clodronate. The patients were treated with a radical retropubic prostatectomy (RP) or curative radiotherapy (RTx). Upon androgen deprivation therapy initiation, tri-monthly IV clodronate was added to the treatment to prevent bone demineralization. Twenty-six out of 60 operated cases and 45 out of 80 irradiated cases received bisphosphonate. The length of time until the first bone metastasis was recorded and analyzed. RESULTS: No statistical difference was found for the type of primary treatment (RP or RTx) on the time to the first bone metastasis (95% confidence interval [CI], 0.40 to 2.43; p=0.98). However, there was a clear advantage favoring the group that received bisphosphonate (p<0.001). The addition of bisphosphonate delayed the appearance of the first bone metastasis by seven-fold (95% CI, 3.1 to 15.4; p<0.001). CONCLUSION: Treatment with tri-monthly IV clodronate delayed the time to the first bone metastasis in high-risk prostate cancer patients who were experiencing an increase in the prostate specific antigen level after definitive treatment.