Adjustable continence therapy (proACT) for the treatment of male stress urinary incontinence post-prostatectomy: a systematic review and meta-analysis (2023 update).

PURPOSE: Stress urinary incontinence (SUI) is a key factor for post-prostatectomy (RP) quality of life. Current international guidelines struggle to find the adequate place for each kind of surgeries. The aim of this systematic review and meta-analysis considering updated evidence is to assess the efficacy and safety of proACT in treating male patients with post-RP SUI. METHODS: A review of the literature was performed by searching the PubMed database. We narrowed included studies with adult male patients with SUI; outcomes included pads or pad weight per day and quality of life (QOL) questionnaires, as well as safety outcomes. RESULTS: 18 studies involving 1570 patients mean age of 68.8 (EC 2.1) were included. The mean follow-up reported was 34.7 months (EC 17.7; median 38.5; range 1-128 months). An average of 60.7% (EC 27) and 40.4% of patients suffered from mild-to-moderate and severe incontinence, respectively. The overall dryness rate was 55.1% (EC 19.3) while respecting the definition of 0-1 pads per day, and the mean dryness rate was 53% (EC 0.2). The mean overall complication rate was 31.2% (EC 18.3%), including an explantation rate of 26.5% (EC 15.3) and a reoperation rate of 22.7% (EC 8.7). The methodological quality of the 18 studies was very heterogeneous. CONCLUSION: Implantation of proACT adjustable balloons is a minimally invasive technique that provides medium outcomes (53%) with a strict definition of dryness (0-1 PPD) and important complication rate (31.2%). Past of irradiation is a negative predictive factor for incontinence.

Rheo-SAXS study of shear-induced orientation and relaxation of cellulose nanocrystal and montmorillonite nanoplatelet dispersions.

The development of robust production processes is essential for the introduction of advanced materials based on renewable and Earth-abundant resources. Cellulose nanomaterials have been combined with other highly available nanoparticles, in particular clays, to generate multifunctional films and foams. Here, the structure of dispersions of rod-like cellulose nanocrystals (CNC) and montmorillonite nanoplatelets (MNT) was probed using small-angle X-ray scattering within a rheological cell (Rheo-SAXS). Shear induced a high degree of particle orientation in both the CNC-only and CNC:MNT composite dispersions. Relaxation of the shear-induced orientation in the CNC-only dispersion decayed exponentially and reached a steady-state within 20 seconds, while the relaxation of the CNC:MNT composite dispersion was found to be strongly retarded and partially inhibited. Viscoelastic measurements and Guinier analysis of dispersions at the shear rate of 0.1 s-1 showed that the addition of MNT promotes gel formation of the CNC:MNT composite dispersions. A better understanding of shear-dependent assembly and orientation of multi-component nanoparticle dispersions can be used to process materials with improved mechanical and functional properties.

Small intestinal submucosa xenograft to manage lower urinary tract prostheses perforation: a new path?

INTRODUCTION AND HYPOTHESIS: Tapes for stress urinary incontinence (SUI) and meshes for pelvic organ prolapse can result in postoperative complications, such as urethral (UP) or bladder (BP) perforations. Martius fat pad (MFP) is an historic procedure, widely used to treat lower urinary tract (LUT) fistulae. We report our experience with the insertion of the biological small intestinal submucosa (SIS) xenograft as an alternative to MFP in these prosthetic complications. METHODS: We conducted a retrospective, monocentric study which included all patients who underwent SIS insertion during surgical removal of tape/vaginal mesh for UP or BP from 2011 to 2019. Preoperative assessment was based on history, symptoms, physical examination and urethrocystoscopy. Primary outcome was successful repair defined as absence of any LUT defect. Secondary outcomes were complications, LUT symptoms, pain and additional SUI surgical procedures. RESULTS: Thirty-eight patients were included. Twenty-six had a UP and eight a BP. In four cases, perforation involved both the bladder neck and urethra. All LUT defects were cured. Six postoperative complications were reported (five of grade ≤ 2 and one of grade 3b according to the Clavien-Dindo classification). At the mean follow-up of 37.2 (range 6-98) months, 14 patients (36.8%) presenting a postoperative SUI underwent a SUI surgical procedure and 1 patient had a laparoscopic sacrocolpopexy for cystocele recurrence. CONCLUSION: Absorbable SIS xenograft is an effective and safe graft for the management of lower urinary tract tape and mesh perforations. The cost has to be balanced with the good results, short operative time and no fat pad complications as in MFP.

Effect of density, phonon scattering and nanoporosity on the thermal conductivity of anisotropic cellulose nanocrystal foams.

Anisotropic cellulose nanocrystal (CNC) foams with densities between 25 and 130 kg m-3 (CNC25 -CNC130) were prepared by directional ice-templating of aqueous dispersions. Estimates of the solid and gas conduction contributions to the thermal conductivity of the foams using a parallel resistor model showed that the relatively small increase of the radial thermal conductivity with increasing foam density can be attributed to interfacial phonon scattering. The foam wall nanoporosity and, to a lesser extent, the orientation of the CNC particles and alignment of the columnar macropores, also influence the insulation performance of the foams. The insight on the importance of phonon scattering for the thermal insulation properties of nanocellulose foams provides useful guidelines for tailoring nanofibrillar foams for super-insulating applications.

Assembly of cellulose nanocrystals and clay nanoplatelets studied by time-resolved X-ray scattering.

Time-resolved small-angle X-ray scattering (SAXS) was used to probe the assembly of cellulose nanocrystals (CNC) and montmorillonite (MNT) over a wide concentration range in aqueous levitating droplets. Analysis of the SAXS curves of the one-component and mixed dispersions shows that co-assembly of rod-like CNC and MNT nanoplatelets is dominated by the interactions between the dispersed CNC particles and that MNT promotes gelation and assembly of CNC, which occurred at lower total volume fractions in the CNC:MNT than in the CNC-only dispersions. The CNC dispersions displayed a d ∝ φ-1/2 scaling and a low-q power-law exponent of 2.0-2.2 for volume fractions up to 35%, which indicates that liquid crystal assembly co-exists and competes with gelation.

Outcomes of laparoscopic artificial urinary sphincter in women with stress urinary incontinence: mid-term evaluation.

PURPOSE: Although artificial urinary sphincter (AUS) has become an established treatment for moderate to severe stress urinary incontinence (SUI), implantation can be challenging. This study aimed to review the outcomes of laparoscopic AUS (LAUS) implantation and revision in women presenting with SUI. METHODS: We reviewed the files of female patients presenting with moderate to severe SUI treated with LAUS implantation from October 2007 to July 2017. Surgeries were performed by one surgeon experienced in open AUS implantation and starting LAUS implantation. The primary endpoint was postoperative urinary continence, which was divided into three categories: complete continence, improved continence, and unchanged incontinence. The secondary outcomes were complications, explantation-free and revision-free time. RESULTS: A total of 49 women (mean age 64 years, range 40-80) had LAUS implantation. Among the 42 patients (85.7%) with an AUS in place at the last follow-up, 25 (59.5%) were fully continent, 16 (38.1%) had improved continence, and 1 (2.4%) had unchanged incontinence. At the last follow-up, 29 (59.2%) patients had their initial AUS and 13 (26.5%) had at least one reintervention. There were 9 (18.4%) intraoperative complications and 25 (51%) postoperative complications, of which 9 (18.4%) were Clavien⩾3. After a median follow-up of 4 years, 9 (18.4%) explantations and 11 (22.5%) revisions occurred. The average period without explantation or revision was 3.7 and 3.1 years, respectively. CONCLUSION: Our study shows that the laparoscopic approach for AUS implantation is an efficient treatment option for women with moderate to severe SUI.

Thermally Insulating Nanocellulose-Based Materials.

Thermally insulating materials based on renewable nanomaterials such as nanocellulose could reduce the energy consumption and the environmental impact of the building sector. Recent reports of superinsulating cellulose nanomaterial (CNM)-based aerogels and foams with significantly better heat transport properties than the commercially dominating materials, such as expanded polystyrene, polyurethane foams, and glass wool, have resulted in a rapidly increasing research activity. Herein, the fundamental basis of thermal conductivity of porous materials is described, and the anisotropic heat transfer properties of CNMs and films with aligned CNMs and the processing and structure of novel CNM-based aerogels and foams with low thermal conductivities are presented and discussed. The extraordinarily low thermal conductivity of anisotropic porous architectures and multicomponent approaches are highlighted and related to the contributions of the Knudsen effect and phonon scattering.

Sclerotization-Inspired Aminoquinone Cross-Linking of Thermally Insulating and Moisture-Resilient Biobased Foams.

Thermally insulating foams and aerogels based on cellulose nanofibrils (CNFs) are promising alternatives to fossil-based thermal insulation materials. We demonstrate a scalable route for moisture-resilient lightweight foams that relies on sclerotization-inspired Michael-type cross-linking of amine-modified CNFs by oxidized tannic acid. The solvent-exchanged, ice-templated, and quinone-tanned cross-linked anisotropic structures were mechanically stable and could withstand evaporative drying with minimal structural change. The low-density (7.7 kg m-3) cross-linked anisotropic foams were moisture-resilient and displayed a compressive modulus of 90 kPa at 98% relative humidity (RH) and thermal conductivity values close to that of air between 20 and 80% RH at room temperature. Sclerotization-inspired cross-linking of biobased foams offers an energy-efficient and scalable route to produce sustainable and moisture-resilient lightweight materials.

Two-Stage Assembly of Mesocrystal Fibers with Tunable Diameters in Weak Magnetic Fields.

Controlling the morphology and crystallographic coherence of assemblies of magnetic nanoparticles is a promising route to functional materials. Time-resolved small-angle X-ray scattering (SAXS) was combined with microscopy and scaling analysis to probe and analyze evaporation-induced assembly in levitating drops and thin films of superparamagnetic iron oxide nanocubes in weak magnetic fields. We show that assembly of micrometer-sized mesocrystals with a cubic shape preceded the formation of fibers with a high degree of crystallographic coherence and tunable diameters. The second-stage assembly of aligned cuboidal mesocrystals into fibers was driven by the magnetic field, but the first-stage assembly of the oleate-capped nanocubes was unaffected by weak magnetic fields. The transition from 3D growth of the primary mesocrystals to the second stage 1D assembly of the elongated fibers was related to the size and field dependence of isotropic van der Waals and directional dipolar interactions between the interacting mesocrystals.

What if artificial urinary sphincter is not possible? Feasibility and effectiveness of ProACT for patients with persistent stress urinary incontinence after radical prostatectomy treated by sling.

BACKGROUND: Stress urinary incontinence (SUI) is a major component of the post radical prostatectomy (RP) trifecta. Surgical treatments are sub-urethral slings, artificial urinary sphincter (AUS) and adjustable peri-urethral balloons (PUB) ProACT. All options are imperfect at best and persistent SUI is challenging when AUS is not manageable. AIMS: This study analyzed the cumulate experience of our 2 centers with offering PUB implantation for SUI post RP in patients with insufficient improvement from slings. MATERIALS & METHODS: This retrospective study reviewed all patients implanted with second line ProACT. The primary endpoint was continence, defined as 0 pads per day (PPD). The secondary endpoints were 50% decrease in PPD and increases in the Incontinence Quality of Life score (IQOL). Refilling and complications were reported. RESULTS: Between 2007 and 2016, 26 patients were implanted. Five patients have had adjuvant radiotherapy (18%). The mean follow-up was 36 months (±20; min 14-max 128). All patient presented with persistent SUI, using 2.3 PPD (±1; min 1-max 6), and only one sling was removed due to infection. After ProACT with an average 3 mL refilling (±1.2 min 2-max 6), 18 patients (66.7%) were continent. Eight of the remaining patients (29.6%) were improved; their number of PPD decreased from 2.6 to 1. The average IQOL score of those 8 patients increased by 20 points, from 53.4 up to 74.2 (P = .005). Overall 26 patients (96.3%) were improved. The remaining patient was not implanted because of an intraoperative urethral injury and is considered a failed case (3.7%). He had instead an AUS implantation. Three patients (14.8%) needed PUB replacement. CONCLUSION: The limited population of patients from both our centers who presented with persistent SUI after RP, despite sling placement, improved with PUB ProACT implantations without significant complications.

Outcomes of open artificial urinary sphincter in women with stress urinary incontinence: long-term follow up.

BACKGROUND: The aim of this study was to report the outcomes of artificial urinary sphincter (AUS) in women with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency after a follow up of 10 years. METHODS: The charts of female patients with moderate-to-severe SUI who underwent open AUS implantation between November 1994 and April 2007 were reviewed retrospectively. All patients were operated on by a single experienced surgeon through an open retropubic approach with systematic bladder incision. Primary endpoint was postoperative continence categorized as complete continence (no pads used), improved incontinence, or unchanged incontinence. RESULTS: A total of 63 women (mean age: 58 years, range: 17-82) underwent open AUS implantation. There were seven (11.1%) intraoperative complications. At the last follow up, 26 (41.3%) initial AUSs remained in situ and 21 (33.3%) patients had at least one revision or reimplantation. Of these 47 patients (74.6%), 35 (74.5%) were fully continent, 3 (6.4%) had improved incontinence, and 9 (19.1%) had unchanged incontinence. A total of 20 patients (31.7%) experienced postoperative complications, but only 2 (3.2%) were Clavien ⩾3. After a median follow up of 14 ± 6 years, 20 (31.7%) explantations and 29 (46%) revisions occurred. The average time without explantation or revision was 11.6 and 9 years, respectively. CONCLUSIONS: In our experience, AUS is a good option for women with moderate to severe SUI, with good long-term outcomes.

The drug-resistant pudendal neuralgia management: A systematic review.

AIMS: Pudendal neuralgia (PN) due to pudendal nerve entrapment is a well-known disease in medical community but both diagnostic and treatment may be delayed for patients. The goal of this study was to achieve a systematic review of the published treatments of PN in order to help physician to take their decision to treat PN. METHODS: A Systematic review based on MEDLINE, Embase, and Cochrane databases was performed to identify articles related to PN. Studies involving ≥ 10 patients presenting PN according to Nantes's criteria who were managed with an intervention for their pain were reviewed. Data were extracted manually for qualitative analysis. RESULTS: Fifteen studies involving 672 patients (mean age 53.2 +/-5.1, SD 95%) were included. Nine different types of treatments were evaluated. Effectiveness of the treatments was heterogeneously assessed. Pain improvement was achieved in 41% to 100%, 13.4% to 100%, 60% to 100%, 12.2% to 100% in immediate, 3-month, 6-month, and 1-year post procedure, respectively. Complications reported were all grade ≤ II of Dindo-Clavien classification's. Given the heterogeneity of the outcomes measures and the lack of homogeneous prospective studies, no recommendation could be established to choose in between treatments. Methodological quality of the studies was heterogeneous. CONCLUSION: Many treatments seems available for drug-resistant PN. Given the heterogeneity of the outcomes measures and the lack of homogeneous prospective studies, no recommendation could be established to determine the best management strategy. Further studies about PN management are needed and should have common endpoint and follow-up.

Bidirectional Jejunojejunal Anastomosis Prevents Early Small Bowel Obstruction Due to the Kinking After Closure of the Mesenteric Defect in the Laparoscopic Roux-en-Y Gastric Bypass.

BACKGROUND: The closure of the mesenteric defects (CMD) in Roux-en-Y gastric bypass (RYGB) reduces the risk of small bowel obstruction (SBO) due to internal hernia but might be associated with an increased risk of early SBO triggered by the jejunojejunal anastomosis (JJS) kinking. The aim of this study was to assess how enlarging the JJS with a bidirectional linear stapling can aid in avoiding the risk of early SBO by kinking. MATERIALS AND METHODS: This retrospective cohort study concerns 1327 patients who underwent RYGB with CMD between May 2007 and August 2016. The first 626 patients (group A) had a unidirectional JJS. The following 701 patients (group B) had a bidirectional side-to-side JJS and a hand-sewn closure of the remaining defect. We compared early SBO between the two groups. RESULTS: Eleven (1.75%) early SBO due to the JJS kinking occurred in group A, whereas none occurred in group B (p = 0.0012). Thirty-nine early postoperative complications happened in group A versus 32 in group B (p = 0.17). Nine (1.2%) digestive bleedings occurred in group B versus two (0.3%) in group A (OR = 4.05 [0.87-18], p = 0.054). Average operating time was 81 min [37-330] in group A and 77 min [33-240] in group B. CONCLUSION: Enlarging the JJS with a bidirectional linear stapling is associated with a reduced risk of early SBO due to the anastomosis kinking. However, it could be related to an increased risk of digestive bleedings.

Directional Freezing of Nanocellulose Dispersions Aligns the Rod-Like Particles and Produces Low-Density and Robust Particle Networks.

We show that unidirectional freezing of nanocellulose dispersions produces cellular foams with high alignment of the rod-like nanoparticles in the freezing direction. Quantification of the alignment in the long direction of the tubular pores with X-ray diffraction shows high orientation of cellulose nanofibrils (CNF) and cellulose nanocrystals (CNC) at particle concentrations above 0.2 wt % (CNC) and 0.08 wt % (CNF). Aggregation of CNF by pH decrease or addition of salt significantly reduces the particle orientation; in contrast, exceeding the concentration where particles gel by mobility constraints had a relatively small effect on the orientation. The dense nanocellulose network formed by directional freezing was sufficiently strong to resist melting. The formed hydrogels were birefringent and displayed anisotropic laser diffraction patterns, suggesting preserved nanocellulose alignment and cellular structure. Nondirectional freezing of the hydrogels followed by sublimation generates foams with a pore structure and nanocellulose alignment resembling the structure of the initial directional freezing.

Carotid surgery in private practice: what kind of change in the last 15 years?

BACKGROUND: This retrospective study analyzes and compares the results of patients undergoing carotid endarterectomy (CE) for atherosclerotic stenosis obtained by 2 surgeons during two 5-year periods. Group 1 (G1) represents the first period (January 1994-December 1998) and group 2 (G2) represents the second period (January 2006-December 2010). Our objective was to answer the 2 following questions: (1) Has the population changed between these 2 periods with regard to age, risk factors, and symptoms? (2) Have the techniques we used in G2--local anesthesia and eversion technique--improved the results? METHODS: G1 included 682 CE procedures on 610 patients and G2 included 629 procedures on 592 patients. The following factors were analyzed in G1 and G2: distribution of age and sex, the main risk factors (diabetes and cardiovascular risk), symptomatology, the degree of stenosis, the preoperative computed tomography (CT) data, the type of anesthesia (general or local), the use of an intraoperative shunt, surgical techniques, postoperative patency, cardiac complications, central and peripheral neurologic complications, and reoperations. In conformity with the North American Symptomatic Carotid Endarterectomy Trial classifications, stenosis of >70% was included in this survey. Loops, tumors, aneurysms, and restenosis were excluded. Heparin (300 U.I./kg) was administered. Shunt placing was selective. The 3 most common techniques used were eversion, longitudinal CE with patch angioplasty, and CE with direct closure. Postoperative patency was controlled by intravenous digital angiography or duplex ultrasonography. Follow-up occurred until postoperative day 30. RESULTS: Compared with G1, the incidence of arterial hypertension, diabetes, and coronary atherosclerosis treated by angioplasty increased significantly in G2; local anesthesia replaced general anesthesia in G2, and fewer intraoperative shunts were used (P = 0.034). The technique of direct closure of the arteriotomy was no longer used. In contrast to G1, in G2 no postoperative carotid thromboses (P = 1.8) and no lethal strokes (P = 5.44) were observed. The incidence of major adverse cardiovascular events on postoperative day 30 was 1.7% in G1 compared with 0.79% in G2. The combined mortality and morbidity rate--including reoperations and peripheral neurologic deficits--was 3.95% in G1 compared with 3.81% in G2. CONCLUSION: Despite a major increase in risk factors, the combined use of local anesthesia and eversion technique, when technically feasible, improved our results in G2.