Predicting for postoperative incontinence following sling incision.

INTRODUCTION AND HYPOTHESIS: Our objective was to assess preoperative risk factors for developing recurrent stress urinary incontinence (SUI) following transvaginal sling incision (TVSI) for bladder outlet obstruction (BOO). METHODS: We identified 101 women who underwent TVSI and/or removal of a midurethral sling. Thirty-nine underwent TVSI for clinical and videourodynamic demonstrable BOO. Eighteen of 39 women demonstrated preoperative clinical SUI and urodynamic BOO. A comparative analysis was performed specifically looking at several clinical factors and the risk of the occurrence of postoperative SUI. RESULTS: Mean age, number of prior surgeries, parity, and pre- and postoperative PVRs did not predict for postoperative SUI. Nine of 18 (50%) of women with SUI and BOO preoperatively vs. only 2/21 (10%) of women with BOO alone developed postoperative SUI. This difference in the incidence of postoperative SUI was statistically significant (p<0.01). CONCLUSIONS: In patients with BOO, the presence of preoperative clinical SUI is a predictor for postoperative SUI following TVSI.

Six Weeks of Fluoroquinolone Antibiotic Therapy for Patients With Elevated Serum Prostate-specific Antigen Is Not Clinically Beneficial: A Randomized Controlled Clinical Trial.

OBJECTIVE: To evaluate asymptomatic men with elevated serum prostate-specific antigen (PSA) to determine whether a 6-week course of fluoroquinolone antibiotics lowers serum PSA and affects recommendations for prostate biopsy. MATERIALS AND METHODS: A randomized, single-center prospective trial of 150 men with an initial elevated PSA was conducted. Patients were randomized to 6 weeks of ciprofloxacin or observation. Those patients with persistently elevated PSA were recommended to proceed with transrectal ultrasound-guided 12-core biopsy. Those with reduced PSA were offered transrectal ultrasound-guided biopsy but could opt to continue serial digital rectal examination/PSA. Patients were followed an average of 4.6 years to assess trends in PSA and biopsy results. RESULTS: Of 136 men who completed the trial, 63 were in the treatment and 73 were in the observation group. The average PSA change from baseline was borderline statistically significant with a change of -0.68 ng/mL in the treatment arm and 0.01 ng/mL in the observation arm (P = .052). Of those who underwent biopsy, prostate cancer was diagnosed in the first biopsy in 24 (63%) of the treatment vs 27 (52%) of the observation group (P = .60) over follow-up. CONCLUSION: In a cohort of asymptomatic men with elevated PSA, there was only a borderline statistically significant change in serum PSA between patients randomized to a 6-week course of fluoroquinolones vs observation, and there was no difference in positive prostate biopsy results. Our clinical recommendation is one should not treat patients with elevated serum PSA with antibiotics in the absence of clinical symptoms of prostatitis.

Robot-assisted partial nephrectomy utilizing a hybrid-port technique.

Robot-assisted laparoscopic partial nephrectomy is increasingly being favored for treatment of small renal cortical neoplasms. The technique utilized varies based upon the institution and surgeon experience and several modifications have been proposed. We choose to utilize the fourth robotic arm as well as the Satinsky vascular clamp for these cases. Previously, we would utilize the fourth arm through a robotic port until the hilum was dissected, then replace the trocar with a flexible trocar for the Satinski clamp. We now utilize a hybrid-port technique where we establish placement of the flexible trocar and pass a robotic trocar through this to begin with the fourth arm in use. We then remove the fourth arm and the trocar after the hilum is dissected to place the Satinski clamp. The technique and description will be discussed.