I-STOP TOMS transobturator male sling, a minimally invasive treatment for post-prostatectomy incontinence: continence improvement and tolerability.

OBJECTIVE: To prospectively evaluate the efficacy and tolerability of the I-STOP TOMS transobturator male sling in patients with post-prostatectomy stress urinary incontinence. Minimally invasive techniques, such as slings, are becoming the standard of care for mild to moderate post-prostatectomy incontinence. METHODS: From March 2007 to June 2009, 122 patients with post-prostatectomy stress urinary incontinence were treated with the I-STOP TOMS sling and followed up for 1 year in the Phase IV HOMme INContinence trial. The preoperative and postoperative evaluation included daily pad use, pad test, questionnaires evaluating urinary function and bother (University of California, Los Angeles, Prostate Cancer Index--urinary function short form, and International Consultation on Incontinence Modular Questionnaire--urinary incontinence short form) and uroflowmetry, including the post-void residual urine volume. Patient satisfaction and perineal pain were also assessed. RESULTS: A total of 103 patients were followed up for 12 months. The surgical procedure was considered easy to perform. The mean daily pad use decreased significantly from 2.4 to 0.6 at 12 months of follow-up; 87.0% of the patients reported improved continence (59.4% completely dry, 20.3% 1 pad/d, 7.3%>1 pad/d), and 13.0% reported no improvement. All quality-of-life scores (University of California, Los Angeles, Prostate Cancer Index--urinary function short form, and International Consultation on Incontinence Modular Questionnaire--urinary incontinence short form) improved significantly after sling implantation. Treatment satisfaction was >90%. The post-void residual urine volume did not increase substantially, and acute urinary retention did not occur. The perineal pain scores were very low at follow-up. Wound infection was seen in 2 patients at the 1-month follow-up visit. CONCLUSION: The I-STOP TOMS is a good treatment option for patients with post-prostatectomy stress urinary incontinence. With follow-up≤12 months, most patients were continent or had improved continence. The intervention was well tolerated, with few infections.

Subcutaneous pyelovesical bypass as replacement for standard percutaneous nephrostomy for palliative urinary diversion: prospective evaluation of patient's quality of life.

PURPOSE: To improve the quality of life of patients with palliative definitive percutaneous nephrostomy, we prospectively evaluated a subcutaneous ureteral bypass using a newly designed ureteral prosthesis. PATIENTS AND METHODS: A series of 19 patients receiving 27 subcutaneous tubes in replacement for percutaneous nephrostomy were evaluated. The ureteral prosthesis (Detour), a silicone tube glued inside a polyester tube, is inserted percutaneously into the renal pelvis to replace an established nephrostomy, tunneled subcutaneously, and introduced into the bladder through a small incision. All patients were followed every 3 months for 18 months or until death from tumor. Quality of life was assessed using the EORTC QLC-30 questionnaire; ultrasonography, intravenous urography, or both were used to assess the position and patency of the tubes. RESULTS: There was no failure of insertion and no operative or immediate complication. The mean follow-up was 7.8 months, 6.6 months for the 15 patients who died from their tumors and 1 year for the 4 patients still alive at the end of the study. Suprapubic parietal infection occurred in three patients with altered bladders (radiation cystitis or tumor progression). There was an improvement of the function scale as a result of the elimination of the external percutaneous tube and a parallel worsening of the symptom scale secondary to the progression of disease. Patient ratings of the global quality of life and satisfaction with the urinary diversion were improved because of the absence of the percutaneous tube. CONCLUSION: The subcutaneous pyelovesical bypass provides a better quality of life than a standard percutaneous nephrostomy tube in terminally ill patients by making them external-tube free.

[Prospective study of the quality of life after palliative urinary diversion by subcutaneous pyelovesical bypass (Detour ureteric prosthesis)]. / Etude prospective de la qualité de vie après dérivation urinaire palliative par pontage réno-vésical sous cutané (prothèse urétérale Detour).

OBJECTIVE: To prospectively evaluate the quality of life of cancer patients at the palliative stage after implantation of an extra-anatomical ureteric prosthesis as an alternative to permanent percutaneous nephrostomy (PCN). MATERIAL AND METHODS: A series of 27 prostheses in 19 patients with PCN was prospectively evaluated. The ureteric prosthesis (Detour) consists of two concentric tubes glued to each other. The inner tube is made of silicone and the outer tube is made of polyester. This prosthesis is introduced percutaneously into the renal pelvis as an alternative to nephrostomy. It is tunnelled subcutaneously and is introduced into the bladder via a short incision. Patients were reviewed every three months for 18 months or until death. The EORTC QLQ-C30 self-administered questionnaire was used to evaluate the patients' quality of life. The functioning and position of the prostheses were verified by ultrasound and/or intravenous urography (IVU). RESULTS: There were no failures of prosthesis placement and no intraoperative or early postoperative complications. Injection of the suprapubic incision was observed in 3 cases, in patients with pre-existing bladder disease (radiation cystitis or bladder tumour). The mean follow-up was 7.8 months: 6.6 months for the group of patients who died (15) and 12 months for the 4 patients still alive at the end of the study. Functional scores improved due to elimination of the external nephrostomy tube. In parallel, physical score deteriorated due to disease progression. Overall quality of life and index of satisfaction were improved by elimination of the external diversion. CONCLUSION: Subcutaneous pyelovesical diversion ensures a better quality of life than classical percutaneous nephrostomy in cancer patients at the palliative stage.