Outcomes of three sling procedures at the time of abdominal sacral colpopexy.

INTRODUCTION: A sling at time of sacral colpopexy (SCP) for apical pelvic organ prolapse (POP) is valuable in the treatment of overt, urodynamic, and occult stress urinary incontinence (SUI). As there is no current agreement regarding the optimal choice of sling in these women, we compare the outcomes of three sling procedures in this population: autologous rectus fascia bladder neck sling (ARF), retropubic midurethral sling (RPM), and transobturator midurethral sling (TOM). METHODS: We performed a retrospective single institution, single-surgeon review of data identifying women with minimum follow-up of 12 months who underwent a concomitant sling and SCP following urodynamics with and without POP reduction. Preoperative and postoperative evaluation included objective and subjective assessment. Cure required absence of subjective and objective SUI. RESULTS: Out of 187 women, 152 (81%) met inclusion criteria (49 ARF, 58 RPM, and 45 TOM). There were no significant differences among sling groups regarding demographics. SUI cure rates were not significantly different between sling groups, or within each group after stratification by overt and occult SUI. QoL indices improved significantly after surgery for the entire cohort. CONCLUSIONS: All three sling types appear to produce similar cure rates of SUI when done concomitantly with SCP. There did not appear to be any significant differences when stratified by occult or overt SUI. No sling type was associated with more postoperative complications. Larger studies are necessary to confirm the findings of this single-institution, retrospective study. Neurourol. Urodynam. 36:482-485, 2017. © 2016 Wiley Periodicals, Inc.

Surgical Approaches to Pediatric Ureteropelvic Junction Obstruction.

Approximately 10-30% of infants with hydronephrosis are found to have ureteropelvic junction (UPJ) obstruction. Technological advances in imaging have allowed physicians to better identify the location of the obstruction. The classic repair is the Anderson-Hynes repair which shows a 90-100% success rate and appears superior to many less complex techniques. Is it best to approach this repair through an open incision or laparoscopically with or without a surgical robot? That question remains to be answered and largely depends on how you define "best."

Findings and Impact of Early Imaging After Partial Nephrectomy.

INTRODUCTION: American Urological Association guidelines for surveillance of renal-cell carcinoma after partial nephrectomy recommend imaging within 3-12 months of surgery. Imaging following partial nephrectomy may be difficult to interpret due to the surgical defect, the use of surgical material, and normal postoperative fluid collections. Our primary objective was to evaluate the frequency of indeterminate postoperative imaging results and how those radiographic findings altered patient management. METHODS: Retrospective chart review from 2006 to 2013 of patients who had undergone open, laparoscopic, and robotic partial nephrectomy at our institution was completed. There was a minimum of 2 years of follow-up imaging. Radiology reports were reviewed from follow-up imaging and were categorized as "normal" or "abnormal." RESULTS: We identified 180 patients with 127 (70.5%) considered to have normal findings on initial follow-up imaging, and 53 (29.5%) with abnormal findings. Median time to initial postoperative imaging for normal findings was 6.8 months compared with 4.4 months for patients with abnormal postoperative scans (p = 0.02). On subsequent imaging, 60% of abnormal studies were downgraded to normal. The median time to receive a second postoperative image from surgery in the normal and abnormal groups was 13.2 and 10.2 months, respectively. The median time interval to the second imaging study was 6.3 months for normal initial scans compared with 5.2 months for initially abnormal scans (p ≤ 0.01). CONCLUSIONS: Early postoperative imaging after partial nephrectomy frequently results in "abnormal" findings and more subsequent radiology exams even though the findings rarely represent cancer recurrences. Based on our results, and pending further validation from other centers, we believe postoperative CT or MRI surveillance after partial nephrectomy can be safely deferred until 1 year after surgery.