Longer is better than shorter: The added value of the seven-day pad test in the post-radical prostatectomy urinary incontinence.

AIMS: To investigate the feasibility and reliability of the seven-day pad test (7DPT), the correlation between 7DPT and 24-hour pad test (24HPT), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire, and the different categorization by the severity of each pad test. Pad weighting tests have been recommended in the evaluation of post-radical prostatectomy urinary incontinence severity, being considered the 24HPT gold standard. Some authors consider that the longer the testing, the better assessment. We propose a self-filled pad weight, the 7DPT. METHODS: A prospective study of incontinent male patients after radical prostatectomy. We carried out the study in two phases. All patients underwent urodynamic study. The first phase evaluated the feasibility and reliability of 7DPT. The second evaluated the correlation between 7DPT, 24HPT, and ICIQ-SF questionnaire in a larger sample. RESULTS: First phase: 32 patients were recruited. Test-retest reliability was excellent, with good agreement between mean 7DPT and 24HPT. The number of pads and mean 7DPT showed a good correlation. Second phase: 72 patients were screened, 51 (71%) met inclusion criteria. Mean 7DPT and 24HPT showed a strong association. Mean 7DPT and 24HPT correlated moderately with ICIQ-SF score. 7DPT and 24HPT agreement with ICIQ-SF groups was slight. As 7DPT captures better days with maximum urinary leakage, up to 12 patients would have been misclassified according to 24HPT (number need to treat for 7DPT was seven). CONCLUSIONS: 7DPT is a feasible and reliable tool to evaluate post-radical prostatectomy urinary incontinence, with a strong correlation with the 24HPT and moderate with the ICIQ-SF.

Onabotulinumtoxina Re-Injection for Refractory Detrusor Overactivity Using 3-4 Injection Sites: Results of a Pilot Study.

OBJECTIVE: To determine if repeated treatment with Onabot/A in less injections points, provides similar clinical efficacy, duration, and adverse events compared with previous treatment. METHODS: Prospective data of neurogenic detrusor overactivity (NDO) and idiopathic detrusor overactivity (IDO) patients previously treated with Onabot/A according to standard technique. When patients requested for repeating procedure, they were treated with the same Onabot/A dose but with 3-4 injection sites. Onabot/A injection was performed under local or spinal anaesthesia. Pain was evaluated with VAS pain scale. Efficacy was evaluated by the Treatment Benefit Scale (TBS) and attainment of complete continence. Duration of effect was determined by patient reported return of symptoms, and requested for repeating procedure. Adverse events were also reported. RESULTS: We report the results of 21 patients. Nineteen patients (90%) were female, 10 patients (48%) neurogenic, 9 (43%) were under clean intermittent catheterization. Procedure was performed under local anaesthesia in 20 patients (95%). Doses of Onabot/A used were 100-300 units with 3-4 injections sites. According to TBS, 86% of patients improved. Seventeen patients (81%) were continent after the procedure. Five patients (24%) presented urinary tract infection as adverse event. The mean duration of effect was 34.9 weeks compared with 35.6 weeks of previous procedure with no significant differences. CONCLUSION: We consider that treatment of Onabot/A with 3-4 injections may have similar clinical efficacy and duration of effect, compared to standard technique, with limited adverse events.

Mid-term safety and efficacy of the ALTIS® single-incision sling for female stress urinary incontinence: less mesh, same results.

OBJECTIVE: To analyse the mid-term safety and efficacy of the ALTIS® single-incision sling (Coloplast Corp., Minneapolis, MN, USA) for female stress urinary incontinence (SUI). PATIENTS AND METHODS: We conducted a prospective, single-arm, unsponsored, observational single-centre trial in a cohort of patients undergoing SUI surgery with the ALTIS procedure. All patients were diagnosed according to clinical reports, physical exploration and urodynamics. Body mass index (BMI) was categorised according to World Health Organization classification. Valsalva leak-point pressure (VLPP) was categorised in three groups: <60, 60-90 and >90 cmH2 O. Patients were evaluated postoperatively at 1, 6, 12 and 24 months with physical examination, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and satisfaction visual scale (SVS; score 0-10). Adverse events were assessed at each visit. Multivariate analysis for risk factors of surgery failure was performed. RESULTS: We recruited 110 women, with a mean (SD) follow-up of 22.34 (10.34) months. Regarding efficacy, 91 patients (82.7%) were objectively cured and 97 (88.2%) were subjectively cured. Regarding VLPP and BMI, no differences were seen between groups (P > 0.05). There was a ~20% decrease in urge UI (P = 0.04). No variable showed to be an independent risk factor for ALTIS failure (P > 0.05). Overall, nearly 96% of the women reported 9 or 10 points on the SVS. A total of 24 patients (21.8%) had some kind of complication. No mesh erosion was reported in any patient. CONCLUSIONS: The ALTIS sling demonstrated to be an effective and safe procedure for SUI in the mid-term setting. Objective and subjective cure rates are at least comparable to 'gold standard' procedures with a minimal rate of self-limiting non-surgical complications.

[Mid-term safety and efficacy of high power thulium laser vaporization.] / Vaporización con láser tulio de alta potencia:eficacia y seguridad a medio plazo.

OBJECTIVE: Thulium laser vaporization of the prostate (TL-PVP) has been performed for almost 10 years. However, there are very few studies focused on high power (150 W) applications. Published sources have short follow-up periods, few cases and small prostatic volumes. In this study, we present an analysis of the safety and efficacy of this technique in the mediumterm (42 months follow-up) perspective. METHODS: Data from 235 patients that underwent TL-PVP from March 2011 to November 2013 has been collected, including prostatic size, intraoperative variables, IPSS, Qmax, and PSA, among others. RESULTS: Mean age was 69±9 years. Mean prostatic size was 62±28 ml. The average IPSS score and Qmax were 18±16 and 7.6 ± 3.5 ml/s, respectively. Mean hospital stay was 24±17 h. Mean time with urethral catheter was 38 h. Only 26.1% of the patients had perioperative complications but none of the cases was higher than a Clavien III. From this population, no more than 1.7% required readmission. Mean postoperative Qmax after 3 and 24 months was 19±6 ml/s and 17±8 ml/s. IPSS was 5±5 points. A successful outcome was achieved in 81.3% of the patients. Obstructive symptoms persisted in 15.7% of the population and 3% resulted in filling-phase dysfunction. Reoperation rate was 5%. The only statistically significant difference (p=0.008) between successful and unsuccessful outcomes occurred in prostatic size, where mean values calculated were 59.73 ml and 71.82 ml, respectively. CONCLUSIONS: In this study, high power TL-PVP is a safe and effective alternative with subjective and objective functional results that are comparable to the "gold standard" technique. It also offers a shorter hospital stay and a lower complication rate.

Vaporización con láser tulio de alta potencia: eficacia y seguridad a medio plazo / Mid-term safety and efficacy of high power thulium laser vaporization

OBJETIVO: La vaporización prostática con láser Tulio (VP-LT) se realiza desde hace 12 años aproximadamente, durante este tiempo los diferentes sistemas láser han ido evolucionado, particularmente los reportes de su uso en alta potencia (150-180W) son aún escasos. En este trabajo presentamos nuestra experiencia en cuanto a su eficacia y seguridad a medio plazo (seguimiento 42 meses). MÉTODOS: Desde Marzo de 2011 a Noviembre de 2013 se recogieron datos de 235 pacientes intervenidos con VP-LT. Las variables incluyen, tamaño prostático, características intraoperatorias, IPSS, Qmax, PSA entre otros. RESULTADOS: La edad media fue 69±9 años. La media del tamaño prostático fue 62±28 ml. Las medias de IPSS y Qmax preoperatorios fueron 18±6 puntos y 7,6±3,5 ml/seg respectivamente. La media del tiempo quirúrgico fue 45,31±16 min. La estancia hospitalaria media fue 24±17 horas y el tiempo medio de sondaje fue 38 horas. Sólo 26,1% sufrieron complicaciones perioperatorias, ninguna mayor de grado III de Clavien. Únicamente 1,7% requirieron reingreso. En el postoperatorio la media del Qmax a los 3 y 24 meses fue 19±6 ml/seg, y 17±8 ml/seg. El IPSS 5±5 puntos. El resultado se considero éxito en 81,3%. Un 15,7% persistió con síntomas obstructivos y 3% con patología funcional de llenado. La tasa de reintervención fue 5%. La única diferencia significativa (p = 0,008) entre resultado exitoso vs. no exitoso fue el tamaño prostático, 60 ml vs. 72 ml respectivamente. La tasa de reintervenciones aumenta significativamente a partir de un tamaño prostático de 70 ml (p = 0,001). CONCLUSIONES: La VP-LT de alta potencia es una alternativa segura, eficaz y eficiente con resultados funcionales subjetivos y objetivos comparables a la técnica "gold standard", ofrece un tiempo de estancia hospitalaria más corto y una menor tasa de complicaciones. Sin embargo su efectividad a mediano plazo disminuye en próstatas mayores de 70 ml aumentando las probabilidades de reintervención

OBJECTIVE: Thulium laser vaporization of the prostate (TL-PVP) has been performed for almost 10 years. However, there are very few studies focused on high power (150 W) applications. Published sources have short follow-up periods, few cases and small prostatic volumes. In this study, we present an analysis of the safety and efficacy of this technique in the medium-term (42 months follow-up) perspective. METHODS: Data from 235 patients that underwent TL-PVP from March 2011 to November 2013 has been collected, including prostatic size, intraoperative variables, IPSS, Qmax, and PSA, among others. RESULTS: Mean age was 69±9 years. Mean prostatic size was 62±28 ml. The average IPSS score and Qmax were 18±16 and 7.6 ± 3.5 ml/s, respectively. Mean hospital stay was 24±17 h. Mean time with urethral catheter was 38 h. Only 26.1% of the patients had perioperative complications but none of the cases was higher than a Clavien III. From this population, no more than 1.7% required readmission. Mean postoperative Qmax after 3 and 24 months was 19±6 ml/s and 17±8 ml/s. IPSS was 5±5 points. A successful outcome was achieved in 81.3% of the patients. Obstructive symptoms persisted in 15.7% of the population and 3% resulted in filling-phase dysfunction. Reoperation rate was 5%.The only statistically significant difference (p = 0.008) between successful and unsuccessful outcomes occurred in prostatic size, where mean values calculated were 59.73 ml and 71.82 ml, respectively. CONCLUSIONS: In this study, high power TL-PVP is a safe and effective alternative with subjective and objective functional results that are comparable to the "gold standard" technique. It also offers a shorter hospital stay and a lower complication rate

Reconstruction of the lateral tibia plateau fracture with a third triangular support screw: A biomechanical study.

BACKGROUND: Split fractures of the lateral tibia plateau in young patients with good bone quality are commonly treated using two minimally invasive percutaneous lag screws, followed by unloading of the knee joint. Improved stability could be achieved with the use of a third screw inserted either in the jail-technique fashion or with a triangular support screw configuration. The aim of this study was to investigate under cyclic loading the compliance and endurance of the triangular support fixation in comparison with the standard two lag-screw fixation and the jail technique. METHODS: Lateral split fractures of type AO/OTA 41-B1 were created on 21 synthetic tibiae and subsequently fixed with one of the following three techniques for seven specimens: standard fixation by inserting two partially threaded 6.5 mm cannulated lag screws parallel to each other and orthogonal to the fracture plane; triangular support fixation-standard fixation with one additional support screw at the distal end of the fracture at 30° proximal inclination; and jail fixation-standard fixation with one additional orthogonal support screw inserted in the medial nonfractured part of the bone. Mechanical testing was performed under progressively increasing cyclic compression loading. Fragment displacement was registered via triggered radiographic imaging. RESULTS: Mean construct compliance was 3.847 × 10-3 mm/N [standard deviation (SD) 0.784] for standard fixation, 3.838 × 10-3 mm/N (SD 0.242) for triangular fixation, and 3.563 × 10-3 mm/N (SD 0.383) for jail fixation, with no significant differences between the groups (p = 0.525). The mean numbers of cycles to 2 mm fragment dislocation, defined as a failure criterion, were 12,384 (SD 2267) for standard fixation, 17,708 (SD 2193) for triangular fixation, and 14,629 (SD 5194) for jail fixation. Triangular fixation revealed significantly longer endurance than the standard one (p = 0.047). CONCLUSION: Triangular support fixation enhanced interfragmentary stability at the ultimate stage of dynamic loading. However, the level of improvement seems to be limited and may not legitimate the intervention with an additional third screw.