Long-term Functional Outcomes and Patient Satisfaction After AdVance and AdVanceXP Male Sling Surgery.

BACKGROUND: Transobturator male sling has gained increasing acceptance for the treatment of male urinary incontinence. Several prospective trials have demonstrated the safety and efficacy of the AdVance and AdVanceXP slings. OBJECTIVE: To evaluate long-term functional outcomes after AdVance or AdVanceXP sling implant for non-neurogenic male stress urinary incontinence and identify factors associated with a higher risk for incontinence or decreased satisfaction. DESIGN, SETTING, AND PARTICIPANTS: Patients who underwent AdVance or AdVanceXP implant surgery between June 2007 and April 2018 were retrospectively included in this single-institution, consecutive series. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: In April 2020, patients were recontacted to evaluate long-term functional outcomes and satisfaction by standardized, validated questionnaires. RESULTS AND LIMITATIONS: A total of 216 patients were included in this study; 172 of them could be contacted for the assessment of long-term patient reported outcomes. The median follow-up period was 49 mo. Overall social continence (ie, needing no more than one pad per 24 h) at 5-yr follow-up was 66% (confidence interval [CI]: 58-73%). In an ideal population (ie, needing no more than four pads per 24 h and naïve for pelvic radiotherapy, prior incontinence surgery, or urethral stricture surgery), 5-yr social continence rates were markedly better and reached 79% (CI: 69-85%). Overall social continence rates tended to decrease at 10-yr follow-up to 42% (CI: 33-52%). Overall, totally dry rate at 5-yr follow-up was 53% (CI: 46-60%), which again was significantly better in the ideal population (62%, CI: 51-70%). According to the Patient Global Improvement Indices score, 71% (CI: 63-78%) of patients indicated to be satisfied after 5 yr, which improved to 77% (CI: 67-85%) in the ideal patient population. In a multivariate analysis, prior pelvic radiotherapy and previous incontinence or urethral stricture surgery were associated with decreased continence rates and patient satisfaction. CONCLUSIONS: In general, long-term continence rates and patient satisfaction after AdVance and AdVance XP sling surgery are acceptable but deteriorate significantly as time from surgery progresses. Especially patients with a history of pelvic radiotherapy, prior incontinence surgery, or urethral stricture surgery should be counseled properly about their higher risk for sling failure. PATIENT SUMMARY: In this report, we investigated long-term outcomes after Advance and AdvanceXP sling implant for male stress urinary incontinence. We found that, in general, continence and patient satisfaction are acceptable but deteriorate significantly as time from surgery progresses. Patients with previous pelvic radiotherapy, incontinence surgery, or urethral stricture surgery are at higher risk for sling failure.

Laparoscopic assisted mini-ECIRS for ectopic kidney lithiasis: A case report and literature review.

INTRODUCTION: Ectopic kidney is a rare anatomic variant with an incidence of about 1 in 900. Renal stones can pose a challenge when a standard approach is not possible. Laparoscopic-assisted endourologic procedure can be a feasible and safe choice. CASE REPORT AND LITERATURE REVIEW: We present a case of 32 years old man with spastic quadriplegia, megacolon and pelvic kidney undergoing intervention of laparoscopic-assisted Mini ECIRS for staghorn stone of the left pelvic kidney. To the best of our knowledge, only 59 cases are reported in the literature concerning laparoscopically assisted encdourologic treatment which seems a feasible, safe and adaptable technique in selected complex cases. CONCLUSION: Laparoscopic-assisted mini ECIRS is a viable option for the treatment of ectopic kidney stones. This technique should be considered when anatomical anomalies are encountered, to avoid puncture-related complications.

Long-term outcomes and patient satisfaction after artificial urinary sphincter implantation.

PURPOSE: To evaluate long-term functional outcomes of artificial urinary sphincter implantation in men for the treatment of stress urinary incontinence. MATERIALS AND METHODS: Patients who underwent artificial urinary sphincter implant for non-neurogenic stress urinary incontinence between June 1989 and January 2020 were included in this single-centre retrospective series. All patients with a functional artificial urinary sphincter in situ were contacted to evaluate long-term functional outcomes using validated questionnaires. RESULTS: A total of 263 patients were included in this retrospective series with a mean follow-up of 61 months. Explant-free survival after 5 years was 75% with a median time to explant of 16.2 years. Revision-free implant survival was 62% after 5 years with a median revision-free implant survival rate of 10.8 years. Previous pelvic irradiation, history of stricture disease and previous artificial urinary sphincter implant were associated with decreased implant survival. Overall social continence rate after 5 years was 60%. Prior radiation therapy, anticoagulation therapy and previous anti-incontinence surgery were associated with a higher incontinence risk. On long-term evaluation of 158 patients with their artificial urinary sphincter currently in situ, 51% were socially continent and 29% reported they were totally dry. Of these patients, 92% indicated to be satisfied with their current continence status. CONCLUSION: A significant proportion of patients undergoing artificial urinary sphincter implant incontinence needed revision or explant surgery. Long-term continence rates are acceptable but tend to decrease by time. Nonetheless, if patients can maintain a functional AUS in situ, long-term patient satisfaction rates remain high.

Functional and molecular characterisation of the bilateral pelvic nerve crush injury rat model for neurogenic detrusor underactivity.

OBJECTIVES: To create a rat model for neurogenic detrusor underactivity (DU) by bilateral pelvic nerve crush injury (BPNI) and to study temporal changes in detrusor contractility and morphology. MATERIALS AND METHODS: Male Sprague-Dawley rats were subjected to BPNI or sham surgery and evaluated at 1, 3 and 9 weeks after surgery. Bladder function was determined in vivo by awake cystometry, micturition pattern analysis, and 24-h urine collection. Bladders were harvested for in vitro pharmacological investigation by isometric tension recording. Bladders and major pelvic ganglia were investigated by quantitative reverse transcription-polymerase chain reaction and histochemistry. RESULTS: Overflow incontinence was observed at 1 week after BPNI. At 3 and 9 weeks after BPNI, rats showed a bladder phenotype characteristic for DU with increased post-void residual urine volumes, reduced voiding efficiencies, and lower maximum pressures. In isolated bladder strips, contractile responses to KCl, carbachol, and α,ß-methylene adenosine 5'-triphosphate (α,ß-mATP) were preserved. On the other hand, neural-induced contractility was reduced after BPNI, in line with reduced expression of protein gene product 9.5 and choline acetyltransferase in the major pelvic ganglion at 1 week after BPNI. The bladder-to-body weight ratio and detrusor thickness increased after BPNI, indicating detrusor hypertrophy to compensate for the reduced neural input. CONCLUSIONS: BPNI induces a rat model for neurogenic DU. In this model, the detrusor maintains its contractility but denervation of the detrusor was observed.

Intravesical Activation of the Cation Channel TRPV4 Improves Bladder Function in a Rat Model for Detrusor Underactivity.

BACKGROUND: Improvement of bladder emptying by modulating afferent nerve activity is an attractive therapeutic strategy for detrusor underactivity. Transient receptor potential vanilloid 4 (TRPV4) is a sensory ion channel in urothelial cells that contribute to the detection of bladder filling. OBJECTIVE: To investigate the potential benefit of intravesical TRPV4 agonists in a pelvic nerve injury rat model for detrusor underactivity. DESIGN, SETTING, AND PARTICIPANTS: Female wild-type and Trpv4 knockout rats underwent sham surgery or bilateral pelvic nerve injury (bPNI). Four weeks later, rats underwent cystometry with infusion of the TRPV4 agonist GSK1016790A. Bladders were harvested for in vitro pharmacological studies, quantitative reverse polymerase chain reaction and immunohistochemistry. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Data are expressed as median ± interquartile range. Statistical comparisons were made using the Mann-Witney U test and Wilcoxon signed rank test as appropriate. RESULTS AND LIMITATIONS: Rats with bPNI showed a phenotype characteristic of detrusor underactivity with lower-amplitude voiding contractions, decreased voiding frequency, and increased postvoid residual. Intravesical application of GSK1016790A increased voiding frequency and reduced postvoid residual in wild-type, but not Trpv4-/-, rats. In isolated bladder strips, GSK1016790A did not induce relevant contractions, indicating that the observed improvements in bladder function are the result of increased afferent signalling through TRPV4 activation, rather than a local effect on the detrusor. The altered urinary phenotype of Trpv4-/- mice was not apparent in the Trpv4-/- rat model, suggesting species-related functional variations. Our results are limited to the preclinical setting in rodents. CONCLUSIONS: Intravesical activation of TRPV4 improves bladder dysfunction after bPNI by increasing afferent signalling. PATIENT SUMMARY: We demonstrate that the sensory protein transient receptor potential vanilloid 4 (TRPV4) can be targeted to improve bladder function in animals that have iatrogenic injury to the nerves innervating the bladder. Further research is required to determine whether these results can be translated to patients with an underactive bladder.

The use of imaging techniques in understanding lower urinary tract (dys)function.

The ability to store urine in the bladder and to void at an appropriate time depends on several complex mechanisms in the lower urinary tract (LUT) and its neural control. Normal LUT function requires coordination of the urinary bladder, urethra, pelvic floor, efferent and afferent neurons and specific spinal cord and brain areas. These structures can be visualised using different imaging modalities, such as ultrasound, X-ray and magnetic resonance imaging. The supraspinal neural control of the LUT can be studied using functional brain imaging. During the last two decades, the many technological improvements of these imaging techniques have increased our knowledge of voiding dysfunction. Here, we review the different imaging modalities of the LUT and its neural control and discuss their importance for diagnosing and understanding voiding dysfunction.

(18F)FDG-PET brain imaging during the micturition cycle in rats detects regions involved in bladder afferent signalling.

BACKGROUND: This feasibility study established an experimental protocol to evaluate brain activation patterns using fluorodeoxyglucose positron emission tomography ((18F)FDG-PET) during volume-induced voiding and isovolumetric bladder contractions in rats. METHODS: Female Sprague-Dawley rats were anaesthetized with urethane and underwent either volume-induced voiding cystometry or isovolumetric cystometry and simultaneous functional PET brain imaging after injection of (18F)FDG in the tail vein. Brain glucose metabolism in both groups was compared to their respective control conditions (empty bladder). Relative glucose metabolism images were anatomically standardized to Paxinos space and analysed voxel-wise using Statistical Parametric Mapping 12 (SPM12). RESULTS: During volume-induced voiding, glucose hypermetabolism was observed in the insular cortex while uptake was decreased in a cerebellar cluster and the dorsal midbrain. Relative glucose metabolism during isovolumetric bladder contractions increased in the insular and cingulate cortices and decreased in the cerebellum. CONCLUSIONS: Our findings demonstrate that volume-induced voiding as well as isovolumetric bladder contractions in rats provokes changes in brain metabolism, including activation of the insular and cingulate cortices, which is consistent with their role in the mapping of bladder afferent activity. These findings are in line with human studies. Our results provide a basis for further research into the brain control of the lower urinary tract in small laboratory animals.

Essential role of transient receptor potential M8 (TRPM8) in a model of acute cold-induced urinary urgency.

BACKGROUND: Acute exposure of part of the skin to cold stimuli can evoke urinary urgency, a phenomenon termed acute cold-induced urgency (ACIU). Despite its high prevalence, particularly in patients with overactive bladder, little is known about the mechanisms that induce ACIU. OBJECTIVE: To develop an animal model of ACIU and test the involvement of cold-activated ion channels transient receptor potential (TRP) M8 and TRPA1. DESIGN, SETTING, AND PARTICIPANTS: Intravesical pressure and micturition were monitored in female mice (wild-type C57BL/6J, Trpa1(-/-), Trpm8(+/+), and Trpm8(-/-)) and Sprague Dawley rats. INTERVENTIONS: An intravesical catheter was implanted. Localized cooling of the skin was achieved using a stream of air or topical acetone. The TRPM8 antagonist (N-(3-aminopropyl)-2-{[(3-methylphenyl) methyl]oxy}-N-(2-thienylmethyl)benzamide (AMTB) or vehicle was injected intraperitoneally. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Frequencies of bladder contractions and voids in response to sensory stimuli were compared using the Mann-Whitney or Kruskal-Wallis test. RESULTS AND LIMITATIONS: Brief, innocuously cold stimuli applied to different parts of the skin evoked rapid bladder contractions and voids in anesthetized mice and rats. These responses were strongly attenuated in Trpm8(-/-) mice and in rats treated with AMTB. As rodent bladder physiology differs from that of humans, it is difficult to directly extrapolate our findings to human patients. CONCLUSIONS: Our findings indicate that ACIU is an evolutionarily conserved reflex rather than subconscious conditioning, and provide a useful in vivo model for further investigation of the underlying mechanisms. Pharmacological inhibition of TRPM8 may be useful for treating ACIU symptoms in patients. PATIENT SUMMARY: Brief cold stimuli applied to the skin can evoke a sudden desire to urinate, which can be highly bothersome in patients with overactive bladder. We developed an animal model to study this phenomenon, and found that it depends on a specific molecular cold sensor, transient receptor potential M8 (TRPM8). Pharmacological inhibition of TRPM8 may alleviate acute cold-induced urinary urgency in humans.

Transient receptor potential channel modulators as pharmacological treatments for lower urinary tract symptoms (LUTS): myth or reality?

Transient receptor potential (TRP) channels belong to the most intensely pursued drug targets of the last decade. These ion channels are considered promising targets for the treatment of pain, hypersensitivity disorders and lower urinary tract symptoms (LUTS). The aim of the present review is to discuss to what extent TRP channels have adhered to their promise as new pharmacological targets in the lower urinary tract (LUT) and to outline the challenges that lie ahead. TRP vanilloid 1 (TRPV1) agonists have proven their efficacy in the treatment of neurogenic detrusor overactivity (DO), albeit at the expense of prolonged adverse effects as pelvic 'burning' pain, sensory urgency and haematuria. TRPV1 antagonists have been very successful in preclinical studies to treat pain and DO. However, clinical trials with the first generation TRPV1 antagonists were terminated early due to hyperthermia, a serious, on-target, side-effect. TRP vanilloid 4 (TRPV4), TRP ankyrin 1 (TRPA1) and TRP melastatin 8 (TRPM8) have important sensory functions in the LUT. Antagonists of these channels have shown their potential in pre-clinical studies of LUT dysfunction and are awaiting clinical validation.