Comparison of retropubic synthetic mid-urethral slings to fascia pubovaginal slings following failed sling surgery.

AIMS: Mid-urethral slings are considered first-line surgical treatment of stress urinary incontinence. However, there is a paucity of data regarding the use of mid-urethral slings (MUS) for patients who have failed a prior sling procedure. MATERIALS AND METHODS: After receiving IRB approval, a multi-institutional retrospective review of 224 consecutive patients undergoing placement of a retropubic MUS (n = 153) or autologous rectus fascia (ARF) pubovaginal sling (n = 71) for prior failed sling surgery is conducted. Pre- and post-operative pad use is recorded for all patients in addition to completion of four validated questionnaires pre- and post-operatively: SEAPI-QMM incontinence classification system (stress-related leak, emptying ability, anatomy, protection, inhibition, quality of life, mobility, and mental status), incontinence impact questionnaire (IIQ-7), urogenital distress inventory (UDI-6), and 10-point visual analog score (VAS). RESULTS: Median follow-up is 29 months and the overall subjective cure rate was 61.4%. A statistically significant improvement in pad use and in all validated questionnaire outcomes is observed for secondary repair with a retropubic sling. In further sub-analysis between the MUS and the ARF groups, there are no significant differences in subjective cure rates or changes in post-operative questionnaire outcomes. CONCLUSIONS: Secondary repair with a retropubic sling is a durable and effective procedure for patients who have failed prior sling procedures without differences in outcomes noted between retropubic MUS and ARF slings. Neurourol. Urodynam. 35:851-854, 2016. © 2015 Wiley Periodicals, Inc.

Intralesional injection of mitomycin C at transurethral incision of bladder neck contracture may offer limited benefit: TURNS Study Group.

PURPOSE: Injection of mitomycin C may increase the success of transurethral incision of the bladder neck for the treatment of bladder neck contracture. We evaluated the efficacy of mitomycin C injection across multiple institutions. MATERIALS AND METHODS: Data on all patients who underwent transurethral incision of the bladder neck with mitomycin C from 2009 to 2014 were retrospectively reviewed from 6 centers in the TURNS. Patients with at least 3 months of cystoscopic followup were included in the analysis. RESULTS: A total of 66 patients underwent transurethral incision of the bladder neck with mitomycin C and 55 meeting the study inclusion criteria were analyzed. Mean ± SD patient age was 64 ± 7.6 years. Dilation or prior transurethral incision of the bladder neck failed in 80% (44 of 55) of patients. Overall 58% (32 of 55) of patients achieved resolution of bladder neck contracture after 1 transurethral incision of the bladder neck with mitomycin C at a median followup of 9.2 months (IQR 11.7). There were 23 patients who had recurrence at a median of 3.7 months (IQR 4.2), 15 who underwent repeat transurethral incision of the bladder neck with mitomycin C and 9 of 15 (60%) who were free of another recurrence at a median of 8.6 months (IQR 8.8), for an overall success rate of 75% (41 of 55). Incision with electrocautery (Collins knife) was predictive of success compared with cold knife incision (63% vs 50%, p=0.03). Four patients experienced serious adverse events related to mitomycin C and 3 needed or are planning cystectomy. CONCLUSIONS: The efficacy of intralesional injection of mitomycin C at transurethral incision of the bladder neck was lower than previously reported and was associated with a 7% rate of serious adverse events.

Testicular self-examination and testicular cancer: a cost-utility analysis.

The United States Preventive Services Task Force (USPSTF) has recommended against testicular self-examinations (TSE) or clinical examination for testicular cancer screening. However, in this recommendation there was no consideration of the significant fiscal cost of treating advanced disease versus evaluation of benign disease. In this study, a cost-utility validation for TSE was performed. The cost of treatment for an advanced-stage testicular tumor (both seminomatous and nonseminomatous) was compared to the cost of six other scenarios involving the clinical assessment of a testicular mass felt during self-examination (four benign and two early-stage malignant). Medicare reimbursements were used as an estimate for a national cost standard. The total treatment cost for an advanced-stage seminoma ($48,877) or nonseminoma ($51,592) equaled the cost of 313-330 benign office visits ($156); 180-190 office visits with scrotal ultrasound ($272); 79-83 office visits with serial scrotal ultrasounds and labs ($621); 6-7 office visits resulting in radical inguinal orchiectomy for benign pathology ($7,686) or 2-3 office visits resulting in treatment and surveillance of an early-stage testicular cancer ($17,283: seminoma, $26,190: nonseminoma). A large number of clinical evaluations based on the TSE for benign disease can be made compared to the cost of one missed advanced-stage tumor. An average of 2.4 to 1 cost benefit ratio was demonstrated for early detected testicular cancer versus advanced-stage disease.

Pediatric exposure to choking hazards is associated with parental knowledge of choking hazards.

OBJECTIVE: To evaluate parental knowledge regarding household food and non-food choking hazards. DESIGN: Cross Sectional Survey. SETTING: Tertiary Care Children's Hospital. PARTICIPANTS: Parents presenting to a Pediatric Otolaryngology Clinic with a child <4 years old. METHODS: Parental survey asking which choking hazard foods (CHF) they allow their child to eat, previous instruction of CHF, knowledge of non-food choking hazards, and their knowledge sources. STATISTICS: adjusted odds ratios (AOR) and logistic regressions. RESULTS: 492 respondents. Adjusted for significant covariates associations between correct knowledge of CHF and correct parents actions of disallowing CHF: fruit chunks (prior instruction=42%; correct action=25%; AOR=3.51; P<0.0001), hot dogs (59%; 28%; 1.75; 0.0178), raw vegetables (41%; 47%; 1.28; 0.198) popcorn (67%; 49% 2.64; <0.0001), whole grapes (68%; 51%; 2.2; <0.0001), nuts (73%; 66%; 2.47; <0.0001), chunks of peanut butter (45%; 79%; 2.55; 0.0003), sticky candy (79%; 80%; 2.16; <0.0033), gum (72%; 84%; 1.75; 0.028), seeds (65%; 87%; 1.4; 0.247), 76% always supervise meals, 57% always cut food, 62% know CPR. KNOWLEDGE OF NON-FOOD HAZARDS: Coins (97%), marbles (94%), small batteries (93%), small toy parts (93%), dice (92%), pen caps (92%), safety pins (85%), balloons (84%), syringes (40%). Sources of choking hazard knowledge: physicians (67%), family/friends (52%), books/magazines (40%), and the Internet (25%). CONCLUSIONS: Parental knowledge of CHF is incomplete. The consumption of CHF in children under 4 is significantly associated with decreased parental knowledge. Therefore, more parental education is needed.