Long-Term Functional Outcomes and Quality of Life after Male Transobturator-Retrourethral Sling Surgery.

INTRODUCTION: Post-prostatectomy urinary incontinence (PPUI) has an enormous impact in quality of life (QoL). Transobturator-rethrourethral sling (AdVanceTMXP sling) is a well-established treatment option although there is paucity of data on long-term outcomes. Our objective was to assess the long-term functional outcomes and QoL in a cohort of men undergoing AdVanceTMXP sling surgery. METHODS: Retrospective observational study of men undergoing AdVanceTMXP sling in a tertiary referral institution from August 2013 to July 2020. 55 patients met the inclusion criteria, with a minimum follow-up of 12 months. Main outcomes were pre- and post-operative daily pad use and scoring in the ICIQ-SF questionnaire. Post-operative complications were assessed following the Clavien-Dindo classification system. QoL and satisfaction with the procedure were assessed through direct interview. RESULTS: Mean number of pads prior to surgery was 3.1, and mean ICIQ-SF score was 13.5. After surgery, mean daily pads use went to 1.2, and mean ICIQ-SF dropped to 5. With a mean follow-up of 42.36 months, 21.8% patients did not use any pads/day and 76.4% achieved social continence (0-1 pad/day). We found no statistically significant differences in outcomes of patients with follow-up of <36 months, 36-48 months, and >48 months (p = 0.067). CONCLUSIONS: AdVanceTMXP sling implantation in men with PPUI improves urinary incontinence and QoL, and their results are sustained over time.

Depressive ranges in infertile couples with male factor.

INTRODUCTION: Depression is not uncommon among infertile couples. The objective of the study is to analyze factors that predict depression in these couples, when they are in Assisted Reproduction Techniques programs. MATERIALS AND METHOD: We analyze the level of depression in couples referred from the Human Reproduction Unit to study the male factor using the Beck Depression Inventory and the clinical information contained in the SARAplus program. RESULTS: Depressive ranges appear in approximately half of the participants. The degree of depression correlates in a statistically significant way between both members of the couple. Among the analyzed clinical factors, we observed relational tendency between depression and obesity and depression and smoking. CONCLUSIONS: Depression in infertile couples is a fact. ART specialists should be on the lookout for symptoms of depression in order to provide patients psychological and psychiatric care and treatments, as part of the overall therapeutic framework for infertility.

Associations of Semen Quality with Seminal Non-essential Heavy Metals in Males from the Canary Islands.

Semen quality and levels of non-essential metals such as strontium (Sr), aluminum (Al), lead (Pb), nickel (Ni), and vanadium (V) were measured. Metals were determined by ICP-OES (inductively coupled plasma - optical emission spectrometry) in semen samples from 102 men who were recruited in a Reproduction Unit in the Canary Islands. The presence of each metal was as follows: Sr: 56.9%, Al: 73.5%, Pb: 45.1%, Ni: 15.7%, and V: 79.4% of the samples. No significant differences were found in the relationship between the spermiogram, the sperm motility, and the concentration of spermatozoa levels of non-essential metals. It is noteworthy that Ni levels tend to be lower in patients with oligozoospermia (t (46.4) = 1.84; p = 0.070). Between lifestyle and non-essential metals, there was a significant relationship between the level of occupational exposure to metals and Ni (χ2(2) = 13.91; p = 0.001). We did not find significant differences in non-essential seminal metal content and smoking status but, there were differences between drinkers and the concentration of V in semen (t (100) = -1.99; p = 0.050). The occupational exposure to metals and place of residence have effects on Al and V levels in semen. Regarding obesity, significant differences were found in Pb levels (t (18.0) = 2.34; p = 0.031). Obese patients have a lower Pb level, and the percentage of progressive sperm motility was lower in obese men (t (98) = 2.14; p = 0.035). The detection of metals in semen opens a new field in the study of male infertility with the possibility of performing treatments aimed at correcting these possible anomalies.

Long-term Outcomes of Sacral Nerve Stimulation in Pelvic Floor Dysfunctions.

PURPOSE: The aim of this study was to analyze the long-term outcomes of sacral nerve stimulation (SNS) in both idiopathic and neurogenic pelvic floor disorders in patients treated at a referral center. METHODS: This retrospective observational study analyzed the records of 106 patients tested at our department from December 1999 to January 2017. The efficacy variables evaluated were the Global Response Assessment (range, 0%-100%) and, according to the clinical indication, other specific variables such International Consultation on Incontinence QuestionnaireShort Form, number of catheterizations or pads/day, and the numerical pain scale. The safety variables analyzed were complications (pain, migration, infection), reinterventions and explants. Patients' quality of life (QoL) and satisfaction with the procedure were evaluated through telephone interviews. RESULTS: The clinical indications were overactive bladder (OAB) (n=36), urinary retention (UR) (n=37), bladder pain syndrome/interstitial cystitis (BPS/IC) (n=19), fecal incontinence (FI) (n=8), and double incontinence (DI) (n=6). The implant rates according to the clinical indication were as follows: OAB, 55.6%; UR, 56.8%; BPS/IC, 63.15%; FI, 87.5%; and DI, 66.7%. Clinical and/or statistically significant improvements in all efficacy variables were observed. Loss of therapeutic effect at 75 months of follow-up was observed in 34% of patients. Device-related pain appeared in 25 patients (39%); in 20 patients, it was resolved by reprogramming and 5 patients required device removal. An overall improvement in QoL and high levels of satisfaction with the procedure were observed. More than 90% of patients would recommend SNS to a friend or relative. CONCLUSION: SNS is a minimally invasive procedure that offers a real alternative to patients with refractory pelvic floor dysfunction. Its safety profile is very favorable and it provides a long-lasting improvement in symptoms and QoL.