One-year outcomes after water vapor thermal therapy for symptomatic benign prostatic hyperplasia in an unselected Italian multicenter cohort.

BACKGROUND: Water vapor therapy (Rezum®; Boston Scientific, Marlborough, MA, USA) for bladder outflow obstruction (BOO) due to benign prostatic enlargement (BPE) is a minimally invasive and innovative surgical technique. The aim of this study was to evaluate its mid-term results in a large multicentric cohort of Italian patients. METHODS: Patients with BPO and moderate to severe LUTS who underwent Rezum® (Boston Scientific) treatment from May 2019 to July 2021 were included in this study. Pre- and postoperative evaluation comprised full urological evaluation with urine culture, digital rectal examination, serum PSA, transrectal prostate ultrasound, uroflowmetry, post-void residual and IPSS, OAB-q SF, ICIQ-UI SF and IIEF-5, ejaculatory anterograde rate. Minimum follow-up was 12 months. Patients' subjective satisfaction was recorded with Patient Global Impression of Improvement (PGI-I) Scale together with any early or late reported complications, classified according to Clavien-Dindo Scale. Statistical analysis was conducted as appropriate. RESULTS: Overall, 352 patients were eligible for the analysis. Procedures were routinely done on an outpatient basis. Mean operative was 12 minutes. The catheter was left in place for a median of 7 days. After treatment, Qmax, IPSS and IPSS-QoL, OAB-q SF, ICIQ-UI SF and IIEF-5 from baseline to last control follow-up (median 16, IQR 13-20 months) were improved (P<0.05). The postoperative anterograde ejaculation rate was recorded in 74.1% vs. preoperative 43.8% (P<0.001). Early (≤30 days) postoperative complications occurred in 176 patients (50%), all Clavien-Dindo Grade ≤2. One patient experienced clot retention and hematuria requiring hospitalization and blood transfusion. No late AEs were recorded. Surgical retreatment rate was 2.5% (9/352), all cases occurred within the first year. Median PGI-I was 2 (1-2). CONCLUSIONS: We confirmed the safety and efficacy of water vapor therapy for the treatment of symptomatic benign prostatic obstruction (BPO) on a large cohort of patients. Anterograde ejaculation was preserved in the majority of patients, with good subjective improvement. Further studies may rule out possible role of Rezum® (Boston Scientific) in new patients' setting.

Quality of life following urinary diversion: Orthotopic ileal neobladder versus ileal conduit. A multicentre study among long-term, female bladder cancer survivors.

INTRODUCTION: Women undergoing radical cystectomy (RC) followed by urinary diversion (UD) for bladder cancer experience a substantial reduction in health-related quality of life (HRQOL). At present, studies comparing long-term QOL outcomes for different UD methods, needed to inform evidence-based choices of bladder reconstruction for female patients, are sparse. Our objective was to compare two common UD methods in terms of their HRQOL outcomes in women. MATERIALS AND METHODS: We retrospectively analysed HRQOL in 73 consecutive female bladder cancer patients having undergone orthotopic ileal neobladder (IONB, N = 24) or ileal conduit (IC, N = 49) following RC between 2007 and 2013 in six Italian academic urological centres. Patients had no evidence of tumour recurrence and were actively followed up. Validated Italian versions of the European Organisation for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder-cancer-specific (QLQ-BLM30) questionnaires were used to evaluate HRQOL. RESULTS: Patients in the IONB group were significantly younger than those in the IC group (median age: 67 and 73 years, respectively, p = 0.02). Barring that, the two groups did not present statistically significant differences in median length of follow-up (43 vs 54 months), pathological stage, grading of the neoplasm, or adjuvant chemo - or radiotherapy. No significant differences in QOL were found between the groups, with the exception of financial difficulties, affecting IONB patients significantly more than IC patients (mean score on a scale of 0-100: 33.3 ±â€¯29.5 vs 18.4 ±â€¯19.3, respectively; p = 0.05). CONCLUSION: Financial difficulties was the only HRQOL item to differ between the two UD groups.

Quality of Life in Patients with Bladder Cancer Undergoing Ileal Conduit: A Comparison of Women Versus Men.

BACKGROUND/AIM: Studies comparing health-related quality of life (HR-QoL) between patients who underwent radical cystectomy (RC) and those who underwent a different form of urinary diversion has not reached yet univocal and reliable conclusions. The aim of our study was to evaluate bladder-specific long-term HR-QoL after radical cystectomy and ileal conduit. PATIENTS AND METHODS: A multicenter study was carried out on 145 consecutive patients (112 males and 33 females) undergoing RC and ileal conduit (IC). HR-QoL assessment was conducted using Italian versions of European Organisation for Research and Treatment of Cancer QLQ-C30 and EORTC BLM-30 questionnaires. RESULTS: Our data showed that women who underwent IC presented greater problems than men in cognitive functioning (mean score±SD: 77.3±27.9 vs. 87.8±18.6) as well in future perspective (score: 42.4±34.4 vs. 21.9±24.6). Nevertheless, men undergoing IC had more problems in sexual functioning than women (score: 23.3±24.5 vs. 7.0±20.3) (all p<0.05). CONCLUSION: In our series, female patients presented a greater burden than male patients in cognitive functioning as well in future perspective, but lower concerns with regard to sexual function.

Argus-T Sling in 182 Male Patients: Short-term Results of a Multicenter Study.

OBJECTIVE: To evaluate the short-term results with Argus-T sling in patients with post-prostatectomy incontinence (PPI). MATERIALS AND METHODS: A total of 182 patients with PPI were treated with Argus-T sling at 5 urologic centers from June 2008 to March 2013. The preoperative evaluation included medical history, pad count (1-2 pads: mild PPI; 3-5 pads: moderate PPI; >5 pads: severe PPI), visual analog scale on continence, quality of life score scale, physical examination, cystoscopy, and urodynamic evaluation. Postoperative evaluation was performed 6 weeks postoperatively, and late follow-up was achieved in April 2013. We considered a successful result when patients were cured (0-1 pads/24 hours) and or improved (1-2 pads/24 hours or a reduction in pad per day usage greater than 50%). RESULTS: Twenty-one (11.8%), 96 (52.7%), and 65 (35.7%) patients have mild, moderate, and severe incontinence, respectively. At the median follow-up of 22 months, the overall success rate was 86.2%. We obtained successful results of 95% in mild incontinence, 78% in moderate incontinence and 70% in severe incontinence. In cured and improved patients, we observed a statistically significant amelioration of quality of life (P <.0001). Sling regulation was carried out in 42.9% of cases, whereas its removal occurred in 9.3% of cases. Postoperative complications were reported in 14.3% of patients. In patients with previous radiotherapy, we observed a successful result in 61.2% of cases. CONCLUSION: This study represents the first report that shows short-term results of Argus-T positioning in a large population. Argus-T seems to offer good outcomes in patients with mild and moderate PPI.

Is Health-Related Quality of Life after Radical Cystectomy Using Validated Questionnaires Really Better in Patients with Ileal Orthotopic Neobladder Compared to Ileal Conduit: A Meta-Analysis of Retrospective Comparative Studies.

INTRODUCTION: From the most recent systematic revision of the literature, an orthotopic neobladder would seem to show marginally better health related quality of life (HR-QoL) scores compared with an ileal conduit. The aim of this study was to review all relevant published studies about the comparison between ileal orthotopic neobladder (IONB) and ileal conduit using validated HR-QoL questionnaires. MATERIALS AND METHODS: Studies were identified by searching multiple literature databases. Data were synthesized using meta-analytic methods conformed to the PRISMA statement. RESULTS: The literature search identified 10 papers; pooled effect sizes of combined quality of life outcomes for ileal conduit versus IONB showed a significantly better HR-QoL in patients with IONB (Hedges' g = 0.278; p = 0.000);. The present study has an important limitation due to the type of the analyzed comparative studies, all retrospective and not randomized. CONCLUSION: This meta-analysis of not-randomized, retrospective comparative studies on the impact of ileal conduit versus IONB on HR-QoL showed a significant advantage of IONB subgroups.

Mid- to long-term results of the Remeex system for the treatment of female incontinence due to intrinsic sphincter deficiency: A retrospective analysis of the first 50 patients.

AIMS: To retrospectively report our mid- to long-term results following suburethral tension adjustable sling (Remeex system) implantation for stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). METHODS: Fifty female patients with severe SUI due to ISD underwent Remeex system positioning between May 2002 and March 2013 (mean follow-up 83.8 months, median follow-up 85.4 months). Before surgery, patients were evaluated by physical examination, translabial ultrasonography, cystoscopy, urodynamics, 1 hr pad test and compilation of quality-of-life questionnaire. Postoperatively, based on the physical examination and pad test, patients were stratified into three groups: (i) Cured: perfectly dry patients at stress test, pad weight 0-1 g; (ii) Improved: patients with mild to moderate incontinence, pad weight 2-50 g; and (iii) Failed: unchanged or worsened patients, pad weight >50 g. RESULTS: At 7-years mean follow-up, 45 (90.0%) patients were cured, three (6.0%) were improved, and two (4.0%) had failed. Concerning the mean total score of the quality-of-life questionnaire, it increased significantly up to 87.1 ± 5.9 with an improvement of 76.9%. Sling tension readjustment was needed in three patients (6%). The incontinence-free survival curve showed that, after sling positioning and tension readjustments, all the cured patients remained continent during all the follow-up. Complications were represented by bacterial cystitis (6%), de novo urgency (10%), persistent urinary retention (6%), and seroma formation (2%). CONCLUSIONS: Our 7-year results showed the efficacy of the Remeex procedure in the treatment of SUI due to ISD. These outcomes tended to be confirmed in the mid- to long-term follow-up which would highlight the durability of this technique. Neurourol. Urodynam. 36:770-773, 2017. © 2016 Wiley Periodicals, Inc.

Quality of Life Assessment With Orthotopic Ileal Neobladder Reconstruction After Radical Cystectomy: Results From a Prospective Italian Multicenter Observational Study.

OBJECTIVE: To assess health-related quality of life (HRQoL) parameters in patients who received radical cystectomy (RC) with ileal orthotopic neobladder (IONB) reconstruction and to identify clinic-pathologic predictors of HRQoL. PATIENTS AND METHODS: From January 2010 to December 2013, a multicenter, retrospective on 174 RC-IONB patients was carried out. All patients completed the following questionnaires: the European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer-specific instruments (QLQ-BLM30) and the IONB-Patient Reported Outcome (IONB-PRO). Univariate and multivariate analyses were computed to identify clinic-pathologic predictors of HRQoL. RESULTS: Median age was 66 years (range, 31-83), and 91.4% of patients were men. Median follow-up period was 37 months (range, 3-247). The EORTC QLQ-C30 revealed that age >65 years, absence of urinary incontinence, and absence of peripheral vascular disease were independent predictors of deteriorated body image. A follow-up > 36 months and the presence of urinary incontinence were independent predictors of worsened urinary symptoms, whereas the absence of urinary incontinence was an independent predictor of a worsened body image according to EORTC QLQ-BLM30 results. A follow-up >36 months and the absence of urinary incontinence were independent predictors of better functioning in terms of relational life, emotional life, and fatigue as revealed by the IONB-PRO. CONCLUSION: Age, presence of urinary incontinence, length of follow-up, and comorbidity status may influence postoperative HRQoL and should all be taken into account when counseling RC-IONB patients.

Development of a questionnaire specifically for patients with Ileal Orthotopic Neobladder (IONB).

BACKGROUND: The ileal orthotopic neobladder (IONB) is often used in patients undergoing radical cystectomy. The IONB allows to void avoiding the disadvantages of the external urinary diversion.In IONB patients the quality of life (QoL) appears compromised by the need to urinate voluntarily. The patients need to wake up at night interrupting the sleep-wake rhythm with consequences on social and emotional life.At present the QoL in IONB patients is evaluated by generic questionnaires. These are useful when IONB patients are compared with patients with different urinary diversions but they are less effective when only IONB patients are evaluated. To address this problem a specific questionnaire-the IONB-PRO-was developed. METHODS: A) Based on a conceptual framework, narrative-based interviews were conducted on 35 IONB patients. A basic pool of 43 items was produced and organized throughout two clinical and four QoL dimensions. An additional 15 IONB patients were interviewed for face validity testing.B) Psychometric testing was conducted on 145 IONB patients. Both classic test strategy and Rasch analysis were applied. Psychometric properties of the resulting scales were comparatively tested against other QoL-validated scales. RESULTS: The IONB-PRO questionnaire includes two sections: one on the QoL and a second section on the capability of the patient to manage the IONB. For evaluation of the QoL, three versions were delivered: 1) a basic 23-item QoL version (3 domains 23-items; alpha 0.86÷ 9.69), 2) a short-form 12-item QoL scale (alpha = 0.947), and 3) a short-form 15-item Rasch QoL scale (alpha = 0.967). Correlations of the long version scales with the corresponding dimensions of the EORTC-QLQ C30 and the EORTC-BLM30 were significant. The short forms exhibited significant correlations with the global health dimension of the EORTC-QLQ and with the urinary subscales of the EORTC-BLM30. The effect size was approximately 1.00 between patients at the 1-year follow-up period and those with 3, 5, and > 5-year follow-up periods for all scales. No relevant differences were observed between the 12-item short-form and the Rasch scale. CONCLUSIONS: The IONB-PRO long and short-forms demonstrated a high level of internal consistency and reliability with an excellent discriminanting validity.

Behavioural profile and human adaptation of survivors after radical cystectomy and ileal conduit.

BACKGROUND: There is a lack of good data in the literature evaluating the Health-Related Quality of Life (HR- QoL) in patients with urinary diversions. The aim of this study was to examine the changes in expectation and needs in terms of human adaptation and behavioural profiles in patients with ileal conduit (IC) after radical cystectomy (RC) for bladder cancer (BC). MATERIALS AND METHODS: A qualitative, multicenter cross-sectional study using a "narrative based" approach was planned. We proceed with a sampling reasoned choice (purposive), selecting groups of patients with follow-up from one up to more than 7 years after surgery. Data were collected through individual interviews. RESULTS: Thirty patients participated in the study. The processing of the interviews allowed us to identify 2 major profiles: positive and negative. Patients with a positive profile resumed normal daily activities with no or limited restrictions both on the personal and the social level. This profile reflects a good HR-QoL. The negative profile reflects the patients for whom the ostomy has meant a worsening of HR-QoL. A positive profile was statistically more frequent in older patients (p = 0.023), with a longer follow-up (p = 0.042) and less complications rates (p = 0.0002). According to the length of follow-up and the occurrence of complitations, we identified further 5 intermediate profiles. CONCLUSIONS: Patients' satisfaction is related to the degree of adaptation to their new life with an urinary stoma and its correct management. Live "with urinary diversion" represents a new phase of life and not a deterioration.

Male incontinence and the transobturator approach: An analysis of current outcomes.

OBJECTIVES: To provide an analysis of the outcomes in patients who have a suburethral sling placed using the transobturator approach for the treatment of stress urinary incontinence after radical prostatectomy, because data in this specific area remain limited, and recent changes in male sling surgery might improve the efficacy in men with moderate or mild incontinence. METHODS: We evaluated the results of transobturator non-adjustable and re-adjustable sling systems after reviewing previous reports identified using the Medline and PubMed databases for original articles, from 2002 to 2012, using the terms 'postoperative male incontinence', 'transobturator' and 'male sling'. Of a total of 31 articles, we reviewed the 22 related to the outcomes of the suburethral sling with positioning by the transobturator approach. RESULTS: Currently the only results of the transobturator approach are those relating to the AdVance™ device (American Medical Systems, Minnetonka, MN, USA), for which the cure rate is ≈ 60% at 20 months. The remaining devices, although innovative, were assessed in studies for which the follow-up was too short to make a judgement. CONCLUSIONS: It would be advisable to reserve the transobturator approach for patients with mild and moderate incontinence, and refer those with severe incontinence, with or without adjuvant radiotherapy after radical prostatectomy, for treatment with an artificial urinary sphincter. More results and a long-term follow-up are needed to evaluate the effectiveness of these devices.

Porcine small intestinal submucosa implant in pubovaginal sling procedure on 48 consecutive patients: long-term results.

OBJECTIVE: The long-term efficacy of pubovaginal sling (PVS) procedure with porcine small intestinal submucosa (SIS) implant was retrospectively assessed. STUDY DESIGN: Forty-eight patients with SUI underwent a pubovaginal sling with SIS. Patient evaluation included history, physical examination with stress test and prolapse assessment by Baden-Walker classification, routine laboratory tests, 24h-pad test, and multichannel urodynamic measurement. Postoperatively the patients were classified as cured, improved and unchanged or failed. A King's Health Questionnaire (KHQ) was performed to verify post-operatively the quality of life of these patients. RESULTS: At median follow-up of 76 months 33/48 (69%) were cured, 6/48 (12%) were improved while 9/48 (19%) were failed or unchanged. No urinary retention or dyspareunia was reported and no vaginal erosion or adverse tissue reaction was detected. The descriptive statistics of KHQ scores by dimensions was done in 32/48 patients (67%). Failed or unchanged patients showed worse scores than cured and improved patients in all KHQ dimensions showing an overall overlapping between objective and subjective results although these findings are weakened due to the lack of a preoperative evaluation of QoL. CONCLUSIONS: PVS procedure using SIS cannot offer a durable option for the treatment of SUI as reported by the current mininvasive techniques.

The current role of contrast-enhanced ultrasound (CEUS) imaging in the evaluation of renal pathology.

BACKGROUND: By using a microbubble contrast agent and contrast-specific imaging software, the contrast-enhanced ultrasound (CEUS) is able to depict the micro and macrocirculation of the target organ. METHODS: A review of the peer reviewed literature was done regarding the current role of ultrasound CEUS imaging in the evaluation of renal pathology with reference to the diagnosis of renal ischaemia, in the characterization of complex cystic lesions and in those with equivocal enhancement at CT. RESULTS: CEUS provides information on tissue perfusion and may play a role in kidney mass characterization similar to the role of contrast-enhanced CT and MRI. In this context, the characterization of cystic lesions is probably the most consolidated field of application of contrast agents on kidney ultrasound imaging. Finally, CEUS provides a good alternative to CT, especially in patients with contraindications to iodinated contrast agents. CONCLUSIONS: The usefulness of CEUS in these applications is confirmed by extensive literature production and this article focuses on the potential clinical applications of recent advances in CEUS technology in urology.