RESUMEN
OBJECTIVES: To present a modified technique in artificial urinary sphincter (AUS) placement that is associated with low rates of erosion and infection in a high-risk population. PATIENTS AND METHODS: After Institutional Review Board approval, we identified patients who underwent primary AUS placement using the modified technique between January 2007 and November 2015. Our modification consists of preserving the dorsolateral fibromuscular tissue surrounding the bulbar urethra and horizontally transecting the ventral bulbospongiosus muscle during urethral cuff placement. Preoperative variables such as radiotherapy (RT) and bladder neck contractures were recorded. Effectiveness and complications including infections, erosions, and re-operations were recorded at follow-up. RESULTS: The new technique was used on 208 patients: 40% had a history of RT, including 15% who had had a salvage radical prostatectomy; 26% had had previous bladder neck contractures. No patients developed infection. Overall, erosion occurred in six (2.9%) patients and spontaneous erosions occurred in two (0.9%) during the study period. In all, 21 patients underwent re-operation for device failure. The probability of re-operation for 'any' reason was 7% (95% confidence interval [CI] 4-12%) at 1 year. The 1-year social continence rate was 74% (95% CI 67-81%). CONCLUSION: Preservation of dorsolateral fibromuscular tissue during AUS placement is an effective means to achieve a low risk of erosions. Our modified technique is safe with low infection and erosion rates, whilst maintaining good functional outcomes despite a high-risk population.
Asunto(s)
Tejido Conectivo/cirugía , Disección/métodos , Músculo Esquelético/cirugía , Implantación de Prótesis/métodos , Uretra/cirugía , Esfínter Urinario Artificial/efectos adversos , Anciano , Humanos , Masculino , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/métodos , Complicaciones Posoperatorias/etiología , Implantación de Prótesis/efectos adversos , Infecciones Relacionadas con Prótesis/etiología , Reoperación , Estudios Retrospectivos , Enfermedades Uretrales/etiología , Incontinencia Urinaria de Esfuerzo/cirugíaRESUMEN
The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in particular any possible effect on the risk of prostate cancer have prompted further research in this regard. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms (LUTS) in patients treated with testosterone. The exact mechanism of this improvement is still debated but may have a close relationship to metabolic syndrome. For the clinician, the results of these studies are promising but do not constitute high levels of evidence. A thorough clinical examination (including history, examination and laboratory testing of testosterone) should be undertaken before considering the diagnosis of late-onset hypogonadism or instigating treatment for it. Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients.
Asunto(s)
Eunuquismo/tratamiento farmacológico , Terapia de Reemplazo de Hormonas/efectos adversos , Hiperplasia Prostática/epidemiología , Testosterona/deficiencia , Testosterona/uso terapéutico , Factores de Edad , Eunuquismo/metabolismo , Humanos , Síntomas del Sistema Urinario Inferior/epidemiología , Masculino , Calidad de Vida , Factores de Riesgo , Testosterona/efectos adversos , Resultado del Tratamiento , Obstrucción del Cuello de la Vejiga Urinaria/epidemiologíaRESUMEN
In the year following a radical prostatectomy, most men recover from any initial urinary incontinence. Nonetheless, incontinence greatly affects a man's quality of life during that time, as it does for those who have persistent incontinence thereafter. Urological assessment should be thorough in order to ensure that no treatable etiology exists aside from stress incontinence. Conservative measures can then be applied from the earliest stages, and offer benefit for those with mild to moderate symptoms. Failing this, a wide variety of surgical options can be considered. For effective outcomes, a clinician must ensure that surgical decision-making is based on current evidence and patient preference, and that it considers possible morbidities.
Asunto(s)
Prostatectomía , Incontinencia Urinaria/terapia , Manejo de la Enfermedad , Humanos , Masculino , Prostatectomía/efectos adversos , Prostatectomía/métodos , Incontinencia Urinaria/etiologíaRESUMEN
⢠Uroflowmetry is an essential investigation that can assist in the diagnosis of common lower urinary tract dysfunctions. ⢠This article describes key aspects on performing and interpreting the test.
Asunto(s)
Síntomas del Sistema Urinario Inferior/diagnóstico , Reología/métodos , Vejiga Urinaria/fisiopatología , Urodinámica/fisiología , Humanos , Síntomas del Sistema Urinario Inferior/fisiopatologíaRESUMEN
BACKGROUND: To review options for minimally invasive urological surgery in the management of incidental small renal masses (<4 cm in size). METHODS: The National Library of Medicine (PubMed) and MEDLINE databases were accessed to specifically search the available literature on minimally invasive urological surgery. Identified articles were then selected based on their contribution to the current evidence base. RESULTS: There has been an influx of articles pertaining to the management of small renal masses. Treatment options continue to evolve and thus, the scope of articles was reduced to the last ten years. All data are observational statistics, and as such, are subject to selection bias and other problems inherent in non-randomized retrospective designs. CONCLUSION: Selected cases of small renal masses can be observed with low risk of metastases, but this does not equate to zero risk. Nephron sparing surgery such as laparoscopic partial nephrectomy or open partial nephrectomy offers optimal oncological outcomes, nephron preservation and improved general prognosis. While there are no 'gold standards' in the management of the small renal mass, laparoscopic partial nephrectomy has demonstrated improving outcomes and minimal complications in the hands of an experienced surgeon. The challenge will be to encourage adoption of this technique, to ensure proficiency, but also be cognisant of the potential risks for lower volume surgeons. The role of ablative procedures is limited to the poor surgical candidate, and as an alternative to the technically difficult laparoscopic procedure. Until long-term data is available, this position is unlikely to change.