Predictive Value of Voiding Efficiency After Active Void Trial in Men Undergoing BPH Surgery.

OBJECTIVES: To determine the predictive value of voiding efficiency on acute urinary retention after discharge from BPH surgery. MATERIALS AND METHODS: We performed a prospective observational cohort study of three surgeons' practices from 2019 to present. All men included underwent trial of void on post-operative day one after transurethral resection of prostate or Holmium enucleation of prostate . Active filling void trials were performed on all patients and voiding efficiency (percent of bladder volume emptied) was calculated. Multivariable logistic regression was performed to determine predictors of developing acute urinary retention. RESULTS: During the study period, 188 men met inclusion criteria. 110 (59%) men underwent Holmium enucleation of prostate , and 78 (41%) underwent transurethral resection of prostate. The median age of our cohort was 70 (IQR 65-75). The median prostate size was 100g (IQR 61-138g). Nineteen patients (10%) returned after discharge with acute urinary retention requiring catheterization. On post-operative day one, the median voiding efficiency was 75% (IQR 55%-94%). On multivariable analysis, patients with a voiding efficiency less than 50% were 3.8 times more likely (95% confidence interval 1.1-12.8) to develop subsequent retention compared to a voiding efficiency of greater than 75%. Increasing pre-operative prostate size was associated with lower risk of urinary retention after discharge (aOR 0.8, 95%CI 0.6-0.9). CONCLUSIONS: Voiding efficiency after an active void trial helps stratify risk of urinary retention in patients undergoing benign prostate surgery. High-risk patients include those with voiding efficiencies less than 50% and smaller pre-operative prostate sizes (<80g).

Complete Excision of Sacrocolpopexy Mesh With Autologous Fascia Sacrocolpopexy.

OBJECTIVE: To evaluate the safety and short-term efficacy of complete sacrocolpopexy mesh excision with concomitant autologous fascia sacrocolpopexy. METHODS: A retrospective cohort study of patients undergoing complete sacrocolpopexy mesh excision and concomitant autologous fascia sacrocolpopexy from March 2013 to September 2016 was conducted. The primary objective was assessment of perioperative outcomes including complications within 60 days of surgery. The secondary outcome measure was surgical success defined as no need for retreatment by either surgery for apical prolapse or pessary. RESULTS: Nineteen patients were identified. Median patient age was 56 years old (range 35-78). Median time from mesh placement to surgical excision was 4.5 years (0-13). Indications for mesh excision included refractory pelvic pain in 18 patients (95%), symptomatic mesh exposure in 8 patients (42%), and bilateral ureteral obstruction with ureterovaginal fistula in 1 patient (5%). Median operative time, estimated blood loss, and length of hospital stay were 228 minutes (133-362), 200 mL (50-1000), and 5 days (2-9), respectively. The rate of minor and major complications within 60 days was 36.8% and 5.3%, respectively. There were no cases of bladder or bowel injury. At a median follow-up of 9.9 months (2.4-39) no patient required secondary surgery for apical vaginal prolapse or retreatment with pessary. CONCLUSION: Complete sacrocolpopexy mesh excision with concomitant autologous fascia sacrocolpopexy can be accomplished safely with a low rate of major complications. These are short-term findings and longer follow-up of anatomic and functional outcomes is needed.

Long-term durability of the distal urethral polypropylene sling for the treatment of stress urinary incontinence: minimum 11-year followup.

PURPOSE: We report on the long-term outcomes of the distal urethral polypropylene sling for stress urinary incontinence in a patient cohort that was closely followed and whose outcomes were reported at 1 and 5 years after surgery. MATERIALS AND METHODS: We performed a prospective study of all consecutive patients who underwent a distal urethral polypropylene sling procedure between November 1999 and April 2000. The 1 and 5-year outcomes for this particular patient cohort were previously reported. At the minimum 11-year followup, outcome was determined by patient self-assessment including validated questionnaires. RESULTS: A total of 69 patients were followed prospectively and followup was obtained for 30. Of those lost to followup 10 were deceased and 5 were cognitively impaired. Mean patient age at followup was 73 years (range 40 to 97). More than 11 years after surgery 48% of patients reported no stress urinary incontinence symptoms and 63% were never bothered by stress urinary incontinence. Patients reported a mean overall symptom improvement of 64% compared to 81% at 5 years. Overall 82% of patients met the criteria for treatment success by symptom scores and 80% met the criteria by bother scores. CONCLUSIONS: The distal urethral polypropylene sling procedure has excellent long-term durability in the treatment of stress urinary incontinence, in addition to low morbidity and low cost as previously described. Eleven years after the procedure the majority of patients report symptom improvement. Nevertheless, many older patients are unable to participate in followup. When choosing an anti-incontinence procedure, durability should be considered in light of patient age given that the theoretical advantages of long-term durability are limited by cognitive decline and mortality.

BioGlue and Dermabond save time, leak less, and are not mechanically inferior to two-layer and modified one-layer vasovasostomy.

OBJECTIVE: To compare operative time, patency, and integrity of glue-assisted versus suture-only vasovasostomies. DESIGN: A Medline search revealed no vasovasostomy studies testing tissue adhesives other than fibrin. We compare glue-reinforced to suture-only vasovasostomies. SETTING: An academic medical center. PATIENT(S): None. INTERVENTION(S): Using bull vas deferens, we performed: [1] two-layer anastomoses, [2] modified one-layer anatomoses, and [3] Bioglue, Dermabond, or CoSeal-reinforced anastomoses supported by three transmural sutures. MAIN OUTCOME MEASURE(S): Operative times were recorded, patency verified, and microscopic dissection performed to rule out luminal glue intravasation. Destructive mechanical testing was then completed with statistical comparison of load to failure, displacement to failure, and linear stiffness. RESULT(S): Operative time was greatest for two-layer anastomoses and significantly reduced for all three glue-reinforced three-suture anastomoses. All techniques were patent and free of glue intravasation. BioGlue and Dermabond demonstrated greater integrity than all other techniques. Mechanically, BioGlue and Dermabond were superior to both the unreinforced three stitch and CoSeal groups and were capable of resisting higher loads before failure. CONCLUSION(S): Glue-reinforced anastomoses are significantly less time consuming than traditional techniques. BioGlue and Dermabond have greater mechanical integrity and may be superior to both CoSeal and the sutured techniques.