Nationwide Analysis of Urinary Retention Following Inguinal Hernia Repair: Results from the National Prospective Hernia Registry.

BACKGROUND: Urinary retention is one of the most common early postoperative complications following inguinal hernia repair (IHR). The aim of this study was to assess the incidence of postoperative urinary retention (POUR) and to identify associated risk factors. METHOD: Data of consecutive patients undergoing IHR from 2011 to 2017 were collected from a national multicenter cohort. POUR was defined as the inability to void requiring urinary catheterization. A multivariate analysis was conducted to identify independent risk factors for POUR. RESULTS: Of 13,736 patients, 109 (0.8%) developed POUR. Patients with POUR had longer hospital length of stay (p < 0.001). IHR was performed by a laparoscopic or an open approach in 7012 (51.3%) and 6655 (48.7%) patients, respectively, and spinal anesthesia was realized in 591 (4.3%) patients. Ambulatory surgery was performed in 10,466 (76.6%) patients. Multivariate analysis identified preoperative dysuria (0R 3.73, p < 0.001), diabetes mellitus (OR 1.98, p = 0.029) and spinal anesthesia (OR 7.56, p < 0.001) as independent preoperative risk factors associated with POUR. POUR was the cause of ambulatory failure in 35 (10.2%) patients who required unanticipated admission. CONCLUSION: The incidence of POUR following IHR remains low but impacts hospitalization settings. Preoperative risk factors for POUR should be considered for the choice of the anesthetic technique.

A new sign for detection of extracapsular extension of prostatic adenocarcinoma: sum of positive sextants per lobe combining interpretation of magnetic resonance imaging and prostate biopsy results.

BACKGROUND: The objective of this study was to assess the possibility of improving the reliability of preoperative detection of extracapsular extension (ECE) in each prostate lobe by using a new sign called sum of positive sextants per lobe (SPS-L), combining interpretation of MRI and prostate biopsy results. PATIENTS AND METHODS: We reviewed the charts of 590 patients undergoing radical prostatectomy between 2002 and 2007. All patients were assessed by preoperative 1.5 Tesla MRI using an integrated endorectal and pelvic phased array coil. A sextant was defined as "positive" when tumor infiltration was observed on a biopsy sample or a pathologic image was observed on MRI (0 = absent, 1 = present). A score, called sum of positive sextants per lobe (SPS-L), was defined as the sum of positive sextants on biopsy samples and positive sextants on MRI (MRI-L) for each lobe. A second score taking into account the presence or absence of ECE visualized on MRI (T3 MRI-L + SPS-L) was also tested for the detection of ECE per lobe. RESULTS: On multivariate analysis, the SPS-L and T3 MRI-L + SPS-L scores were significantly higher in the presence of ECE and extensive ECE (P < .0001). The areas under receiver operating characteristic (ROC) curves were significantly greater for the T3 MRI-L + SPS-L score than for the positive biopsy result per lobe (PB(+)/L) rate (P < .0001). CONCLUSION: The use of indirect signs (SPS-L) associated with direct signs (T3 MRI) allows the preoperative detection of ECE per lobe by endorectal 1.5 Tesla MRI with high sensitivity.

Female urinary incontinence and artificial urinary sphincter: study of efficacy and risk factors for failure and complications.

BACKGROUND: The artificial urinary sphincter (AUS) has become a commonly used therapy for severe urinary incontinence (UI) due to intrinsic sphincter deficiency (ISD). OBJECTIVE: To evaluate retrospectively the efficacy and risk factors for failure and complications of AUS implantation in women with nonneurologic UI. DESIGN, SETTING, AND PARTICIPANTS: From May 1987 to December 2009, 215 women with ISD were treated by AUS implantation, with a mean age of 62.8 yr and a mean follow-up of 6 yr (standard deviation: 5.6 yr). Previous surgical procedures to treat incontinence had been performed in 88.8% of the patients. Urodynamic assessment was required. Patients using only 0 or 1 pad at the end of follow-up were considered continent. The patient's level of satisfaction was evaluated by a global analogue scale and clinical interview. INTERVENTION: All women had AUS implantation. MEASUREMENTS: Patients were evaluated for continence rate, risk factors for failures, and complications. RESULTS AND LIMITATIONS: At the end of follow-up, 158 patients (73.5%) were continent, and 170 (79%) were satisfied. The redo rate was 15.3% after a mean interval of 8.47 yr for the first redo procedure. Fifteen explantations (7%) were performed. The only risk factor for intraoperative complications (10.7%) was smoking (p<0.004). Six patients (2.8%) were lost to follow-up. AUS failed to treat incontinence in 51 patients (23.7%) due to defective manipulation in 27.4% of the cases. On multivariate analysis, risk factors for failure were age >70 yr (odds ratio [OR]: 2.46), a history of the Burch procedure (OR: 2.28), or pelvic radiotherapy (OR: 4.37) (p<0.05). CONCLUSIONS: The place for this safe and long-lasting effective technique in the treatment of UI due to recurrent sphincter deficiency is confirmed. Screening for these risk factors should allow better patient selection.