Intentionally retained pressure-regulating balloon in artificial urinary sphincter revision.

INTRODUCTION: The traditional surgical approach for revision of a malfunctioning artificial urinary sphincter (AUS) includes removal and replacement of all device components, identical to that employed in the setting of an infected or eroded AUS. AIMS: To describe outcomes of our technique in which we intentionally leave behind the original pressure-regulating balloon (PRB) at time of AUS revision in a clinically non-infected setting. METHODS: We retrospectively reviewed our combined institutional series of 35 patients who underwent 36 AUS revisions in which the original pressure-regulating balloon was left undisturbed. We removed and replaced the defective cuff and pump through a single peno-scrotal incision for most patients requiring revision of a non-infected AUS. The new PRB was then placed on the opposite side through this single incision. MAIN OUTCOME MEASURES: Assessment of outcomes, complication, and infection rate of this surgical series. RESULTS: All of the patients had the original pressure-regulating balloon placed through an inguinal counter-incision. Mean follow-up time was 14 months (2-33 months). Overall complication rate for the revision series was 11%. No infections or complications occurred secondary to the retained PRB. CONCLUSION: Follow-up of our series provides evidence that retention of the original PRB at the time of non-infected AUS revision is safe. Potential advantages include elimination of a counter incision and technically challenging exploration. By eliminating these aspects, the potentially resultant decreased operative time may help counter the theoretical yet unproven risk of infection from leaving the old PRB in place.

Image guided I125 prostate brachytherapy with Hybrid Interactive Mick technique in the community setting: How does it compare?

The aim of this study is to evaluate the target coverage, procedural techniques, and merits of Hybrid Interactive Mick (HIM) I125 transperineal permanent implantation (TPPI) of the prostate performed with 10 urologists in a community hospital. Detailed day 0 post-implant dosimetric evaluations of TPPI procedures were performed on 333 consecutive monotherapy patients treated between September 2000 and November 2003 at a single institution. All patients underwent TPPI with HIM. Pelvic and CXR films were obtained for a manual seed count at day 0 and again > day 90 on 175 patients. The HIM-prostate brachytherapy performed in a community hospital provided median D(90), V100, and V150 values of 157Gy, 94%, and 42.3%, respectively. 18% of patients had seed migration to the lungs while 2% had seed migration to the bladder. Only 7 patients (4%) had 2 or more seeds migrate to the lungs. Procedure times average 38 minutes and number of needles used averaged 18. The post-implant urinary retention rate was 2.1% Use of HIM-prostate brachytherapy in the community setting with multiple urologists reproducibly maintained excellent and consistent dosimetric coverage. Procedure times and number of needles used were minimized, and with careful attention to image-guided technique, seed migration to bladder and lung was also minimized.