Validation of a Sagittal Section Technique for Measuring Clitoral Blood Flow. Volume Flow: A New Parameter in Clitoral Artery Doppler.

BACKGROUND: Clitoral artery Doppler has been used as an objective technique to measure changes in genital women response. However, the technique has not been fully validated, and arterial volume flow has never been used as an outcome measure. AIMS: To validate the technique clitoral artery Doppler measured in a sagittal section and explore arterial volume flow as a new parameter in clitoral Doppler. METHODS: We examined 90 healthy volunteers by clitoral artery Doppler using the sagittal section approach described by Battaglia et al in 2008. We calculated intraobserver, interobserver, and intraobserver intersession variability and reliability for all Doppler parameters and described and validated arterial volume flow as a new parameter in clitoral artery Doppler. OUTCOMES: We calculated peak systolic velocity (PSV), time-averaged maximum velocity, time-averaged mean velocity, end-diastolic velocity, pulsatility index, resistance index, and volume flow (v-flow) in all groups. We conducted reliability analyses using the intraclass correlation coefficient for agreement. We explored differences between and within observers and calculated agreement limits using the Bland-Altman test. RESULTS: The intraclass correlation coefficient analysis showed correlation values higher than 0.75 (good reliability) for most of the variables and higher than 0.60 (moderate reliability) for the remaining ones. There were statistically significant differences between PSV and time-averaged maximum velocity in the intraobserver intersession measurements. For the remaining groups and variables, no statistically significant differences were observed. Bland-Altman analyses showed that the limits of agreement were acceptable and the regressions were not significant. The v-flow parameter also showed good reliability and low variability between groups. CLINICAL IMPLICATIONS: We found that PSV was not a good outcome measure because of its high intraobserver and intersession variability. Moreover, it is possible to measure v-flow in the clitoral artery using the sagittal technique described by Battaglia et al, and it seems that this measure is reliable and reproducible. This could be the best parameter to assess clinical changes. STRENGTHS & LIMITATIONS: This study provided full validation of the sagittal section approach and of a new parameter, v-flow, which could beuseful for assessing clitoral blood flow. The main limitation of the study is its retrospective nature for validating v-flow. CONCLUSION: We found that clitoral artery Doppler measured using a sagittal approach is a valid and reliable technique for studying clitoral blood flow in women. The v-flow variable is a promising and reliable parameter for measuring changes in clitoral blood flow. Pérez MF, Agís IF, La Calle Marcos P, et al. Validation of a Sagittal Section Technique for Measuring Clitoral Blood Flow: Volume Flow - A New Parameter in Clitoral Artery Doppler. J Sex Med 2020;17:1109-1117.

Functional follow-up after Advance® and Advance XP® male sling surgery: assessment of predictive factors.

PURPOSE: To evaluate the efficacy of the Advance® and AdvanceXP® slings in men with stress urinary incontinence (SUI) post-radical prostatectomy and to identify predictive factors for outcome. METHODS: Included were male patients with SUI following radical prostatectomy who had a positive "repositioning test", 24 h-pad weight (PW) test < 400 g and who were continent at night and at rest. Urgency was defined as a sudden compelling desire to pass urine, which was difficult to defer. The cure rate was defined as no pad use. RESULTS: From February 2008 to October 2014, 24 AdVance® and 70 AdVance XP® were implanted. The median (range) follow-up was 49 (12-102) months. The overall cure rate was 77%. The preoperative 24 h PW was significantly related to the continence outcome (p = 0.044). A total of 12 patients (13%) presented with postoperative AUR, which was significantly related to abnormal voiding detrusor activity (p = 0.036). Twenty-two patients (23%) had postoperative urgency (16% "de novo"), which was significantly related to preoperative urgency (p = 0.003). During follow-up, a degree of deterioration of continence was observed in five patients who were classed as cured initially. To date, no reports of urethral sling erosion have been made. CONCLUSIONS: The AdVance® and AdVanceXP® slings are safe and effective in relieving SUI following post-radical prostatectomy. There were no differences between the two slings in terms of efficacy, urgency or postoperative AUR. There was a moderate rate of "de novo "urgency and low rate of loss of continence during follow-up.

Importance of previous transurethral resection of the prostate before eerpe.short-term functional outcomes in a single surgeon series.

OBJECTIVES: Laparoscopic Radical Prostatectomy (LRP) is technically a very demanding procedure and potentially even more challenging in patients with previous transurethral resection (TURP). This study evaluates the impact of previous TURP on the short-term functional outcome of patients undergoing extraperitoneal LRP. METHODS: Retrospective analysis of a prospectively collected database, comprising a single-surgeon cohort of 155 consecutive LRP cases, 19 of which had previous history of TURP. Demographics, clinical and functional outcomes were evaluated and compared among patients with and without previous TURP. Multivariate analysis was performed to identify potential variables independently associated with continence outcomes. Incontinence was defined as the need of more than 1 pad/day. Potency was defined as the ability for sexual intercourse with or without the use of phosphodiesterase inhibitors. RESULTS: Demographic and clinical variables were comparable among the two study groups. Neurovascular bundle preservation was possible in 26% and 37% of patients with and without previous TURP, respectively. No major complications were recorded and the incidence of minor complications was comparable. Overall continence rate at 3 months was 82,58%, for the entire cohort. Subset analysis demonstrated a 3-month continence rate of 73.7% vs. 83.8% (p>0.05) in patients with and without TURP, respectively. Multivariate analysis demonstrated age, BMI and ASA were variables independently associated with continence outcomes. In the cohort of patients with previous TURP, 2 out of 7 undergoing preservation recovered erections, with a mean follow up of 15.5 months, comparable to the 30% achieved in patients without TURP and nerve sparing procedure. CONCLUSIONS: Laparoscopic Radical Prostatectomy in patients with previous TURP is feasible, with complication rates and short-term functional outcomes comparable to those in patients without previous resection.

Relevancia de la resección transuretral de próstata en los resultados funcionales de la prostatectomía radical laparoscópica / Importance of previous transurethral resection of the prostate before eerpe. short-term functional outcomes in a single surgeon series

OBJETIVO: La dificultad del tratamiento quirúrgico del Cáncer de próstata (caP) se acentúa en los pacientes con antecedentes de resección transuretral de próstata (RTU). En este estudio valoraremos la influencia de la RTU en los resultados funcionales a corto plazo de la prostatectomía radical laparoscópica extraperitoneal. MÉTODO: Revisión retrospectiva de una base de datos de cumplimentación prospectiva de una serie de pacientes intervenidos por un solo cirujano de manera consecutiva. Se compararon las características demográficas, clínicas y patológicas de los pacientes con y sin RTU previa, para posteriormente realizar un estudio multivariante mediante regresión logística para comprobar qué variables se asociaban de manera independiente y significativa a la incontinencia según el criterio (>1 compresa/día). Se consideró potentes a aquellos pacientes capaces de penetrar con o sin la ayuda de inhibidores de la 5 fosfodiesterasa. Se dispuso de la evaluación funcional de 155 pacientes, 19 de los cuales tenían antecedentes de RTU previa. RESULTADOS: Los subgrupos no diferían en las variables relevantes para el estudio. La conservación de haces neurovasculares se realizó en un 37% de los pacientes sin RTU previa y en un 26% del grupo contrario. No se objetivaron complicaciones mayores, la frecuencia de complicaciones menores no difería. La tasa de continencia de la serie global, evaluada en los 3 primeros meses, era del 82,58%. En el subgrupo de pacientes sin antecedentes de RTU previa era del 83,8% mientras que en el subgrupo de pacientes con RTU previa era del 73,7%, p>0,05. En el análisis multivariante, se asociaron de manera independiente y significativa a la continencia la edad, el IMC y el ASA. Tampoco se observaron diferencias significativas en la proporción de pacientes que recuperaron la erección en uno y otro grupo (28 vs 30%). CONCLUSIONES: Los resultados funcionales a corto plazo son aceptables y comparables a los de los pacientes sin resección previa (AU)

OBJECTIVES: Laparoscopic Radical Prostatectomy (LRP) is technically a very demanding procedure and potentially even more challenging in patients with previous trans-urethral resection (TURP). This study evaluates the impact of previous TURP on the short-term functional outcome of patients undergoing extraperitoneal LRP. METHODS: Retrospective analysis of a prospectively collected database, comprising a single-surgeon cohort of 155 consecutive LRP cases, 19 of which had previous history of TURP. Demographics, clinical and functional outcomes were evaluated and compared among patients with and without previous TURP. Multivariate analysis was performed to identify potential variables independently associated with continence outcomes. Incontinence was defined as the need of more than 1 pad/day. Potency was defined as the ability for sexual intercourse with or without the use of phosphodiesterase inhibitors. RESULTS: Demographic and clinical variables were comparable among the two study groups. Neurovascular bundle preservation was possible in 26% and 37% of patients with and without previous TURP, respectively. No major complications were recorded and the incidence of minor complications was comparable. Overall continence rate at 3 months was 82,58%, for the entire cohort. Subset analysis demonstrated a 3-month continence rate of 73.7% vs. 83.8% (p>0.05) in patients with and without TURP, respectively. Multivariate analysis demonstrated age, BMI and ASA were variables independently associated with continence outcomes. In the cohort of patients with previous TURP, 2 out of 7 undergoing preservation recovered erections, with a mean follow up of 15.5 months, comparable to the 30% achieved in patients without TURP and nerve sparing procedure. CONCLUSIONS: Laparoscopic Radical Prostatectomy in patients with previous TURP is feasible, with complication rates and short-term functional outcomes comparable to those in patients without previous resection (AU)

Comparative study of the main top-down approaches for the estimation of measurement uncertainty in multiresidue analysis of pesticides in fruits and vegetables.

Practical "top-down" approaches appear to be the most suitable for the evaluation of measurement uncertainty in pesticide residue testing laboratories, where analytical procedures are routinely applied to a large number of pesticide/food combinations. The opposite approach, "bottom-up" evaluation of measurement uncertainty, leads to great difficulties in evaluating all of the pesticides in a consistent way. Among the top-down approaches, there are two main ways in which measurement uncertainty can be estimated: One is based on default values, which are based on previous extensive interlaboratory experience and the proven accuracy of the laboratory; these include the Horwitz equation or the fit-for-purpose relative standard deviation (FFP-RSD). The other is based on experimental data from the quality control work of the laboratory: within-laboratory reproducibility, interlaboratory validation, or a combination of results obtained in proficiency tests. The principal existing guidelines from various bodies (Eurachem, Nordtest, and Eurolab) all propose different approaches for calculating measurement uncertainty. In this paper, the main top-down approaches are evaluated and compared using the data from the European Proficiency Test Database for Fruits and Vegetables and the Multiresidue Method validation databases obtained from the National Reference and Official Laboratories in Europe. The main conclusion of the comparative study is that a default expanded measurement uncertainty value of 50% could satisfy all of the requirements for facilitating and harmonizing, worldwide, the intercomparability of the pesticide residue confidence results between laboratories.