Treatment of postoperative male urinary incontinence using transurethral macroplastique injections.

PURPOSE: To study the effect of Macroplastique injection on postoperative stress urinary incontinence (SUI) in male patients. PATIENTS AND METHODS: Since 1997, 50 consecutive men with a mean age of 66.0 years (range 51-75 years) suffering from mild to moderate postoperative SUI were treated as outpatients with transurethral Macroplastique injections. Under local anesthesia, 2.5 to 5 mL of Macroplastique was injected adjacent to the external sphincter at 5 or 7 o'clock or both. Forty-six patients had undergone radical prostatectomy, three transurethral prostatic resection, and one cystoprostatectomy with bladder substitution. Patients suffering from detrusor instability were excluded. A standardized 1-hour pad test and the patient's grading of the severity of the incontinence from 0 to 3, where 0 meant leaking took place all the time and 3 that the patient was completely dry, were carried out prior to injection and again at 3 months after each injection. Macroplastique injection was repeated if the initial treatment was not curative. RESULTS: The mean 1-hour pad test loss was 48.3 mL at baseline. After the first injection, 6 patients were completely dry and 28 improved; in the rest, no improvement was achieved. Forty patients underwent a second injection after which, 10 more patients became completely dry and 5 improved significantly. Twenty-three patients underwent a third injection, after which, 9 more patients were completely dry. Fourth injections were given to 8 patients, of whom 5 became dry, 1 improved, and 2 patients did not get any benefit. The total volume of Macroplastique injected ranged from 2.5 to 13.5 mL (mean 7.1 mL). A majority of the patients suffered some dysuria following the injection, but there were no significant side effects. CONCLUSIONS: The preliminary results of endoscopic treatment of mild to moderate postoperative SUI in males with outpatient Macroplastique injections are encouraging. To achieve satisfactory results, repeated injections are needed.

Side-fenestrated catheter decreases leakage at the urethrovesical anastomosis after robot-assisted laparoscopic radical prostatectomy.

OBJECTIVE: The aim of this study was to analyse whether a side-fenestrated urinary catheter can decrease the frequency of anastomotic leakage after robot-assisted laparoscopic radical prostatectomy (RALP). MATERIAL AND METHODS: Two-hundred and fifty patients with localized prostate cancer undergoing RALP were randomized into standard and side-fenestrated catheter groups in a prospective randomized study. The catheter was fenestrated at the site of the anastomosis to improve drainage. A cystogram was taken at 7 ± 2 days postoperatively to verify the watertightness of the anastomosis. The patients were monitored for 3 months. RESULTS: The study included 106 patients with the standard and 108 patients with the fenestrated catheter. Leakage at the urethrovesical anastomosis was found in 13/106 (12.3%) of the standard and 5/108 (4.6%) of the side-fenestrated catheter patients (p = 0.044). Discomfort induced by the catheter and urinary leakage beside the catheter did not differ between the groups. The clinical and pathological characteristics and complications were equal between the groups. CONCLUSIONS: The side-fenestrated catheter decreased leakage rates at the urethrovesical anastomosis after RALP.

Bicalutamide 150 mg in addition to standard care for patients with early non-metastatic prostate cancer: updated results from the Scandinavian Prostate Cancer Period Group-6 Study after a median follow-up period of 7.1 years.

OBJECTIVE: The Early Prostate Cancer (EPC) programme is evaluating the efficacy and tolerability of bicalutamide following standard care (radiotherapy, radical prostatectomy or watchful waiting) in patients with localized (T1-2, N0/Nx) or locally advanced (T3-4, any N; or any T, N + ) non-metastatic prostate cancer. Herein we report the latest findings after a median follow-up period of 7.1 years from the Scandinavian Prostate Cancer Group (SPCG)-6 study, one of three trials in the EPC programme. MATERIAL AND METHODS: A total of 1218 patients were randomized on a 1:1 basis to either bicalutamide 150 mg/day (n=607) or placebo (n=611) following standard care; 81.4% were followed conservatively (watchful waiting). The primary endpoints were objective progression-free survival (PFS) and overall survival (OS). RESULTS: In patients with localized disease there was no significant difference in PFS [hazard ratio (HR) 0.85; 95% CI 0.69-1.06; p=0.15] and a trend towards decreased OS with bicalutamide plus standard care compared with standard care alone (HR 1.23; 95% CI 0.96-1.58; p=0.11). In patients with locally advanced disease, bicalutamide significantly improved PFS, reducing the risk of progression by 53% compared with standard care alone (HR 0.47; 95% CI 0.37-0.59; p<0.001). The median time to progression was 8.8 years for bicalutamide plus standard care and 7.1 years for standard care alone. There was a significant improvement in OS with bicalutamide plus standard care, with a reduction in the risk of death of 35% versus standard care alone (HR 0.65; 95% CI 0.50-0.85; p=0.001). CONCLUSION: This analysis of the SPCG-6 study showed that bicalutamide plus standard care offers significant PFS and OS benefits for patients with locally advanced disease, but not for those with localized disease.

Management of prolonged urinary leakage at the urethro-vesical anastomosis.

Urinary leakage at the urethrovesical anastomosis is a rare but troublesome complication after radical prostatectomy. Usually, the anastomosis is almost watertight when tested during the operation and small leakages typically seal off in a few days. We describe 3 cases with postoperative urinary leakage where we have utilized a simple procedure of replacing the standard Foley catheter with another catheter with extra side fenestrations close to the anastomosis. Side fenestrations provide efficient drainage at the anastomosis area leading to a rapid resolution of the leakage. The method described represents an effective and low-risk solution to a potentially harmful complication.

Negative bacterial polymerase chain reaction (PCR) findings in prostate tissue from patients with symptoms of chronic pelvic pain syndrome (CPPS) and localized prostate cancer.

BACKGROUND: The etiology of chronic pelvic pain syndrome (CPPS) remains obscure. Although, bacterial etiology has frequently been suggested, evidence of both bacterial involvement in CPPS and the presence of normal bacterial flora in the prostate remain uncertain. MATERIALS AND METHODS: We investigated the presence of bacterial DNA using polymerase chain reaction (PCR) techniques on prostatic tissue samples obtained in radical prostatectomy from 10 patients with moderate to severe symptoms of CPPS and 10 nonsymptomatic patients with localized prostate cancer. For symptom evaluation we used the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). RESULTS: All but one sample were negative for bacterial DNA. The PCR from a symptomatic patient was reproducibly positive in 16S rDNA PCR but negative in 23S rDNA PCR. Bacterial DNA was found in only one out of two sample aliquots and cloning yielded different sequences in two PCR products. CONCLUSIONS: A bacterial etiology for CPPS symptoms could not be demonstrated in patients with prostate cancer. The results also suggest that the prostate is unlikely to harbor bacterial normal flora.