Artificial urinary sphincters for treating postprostatectomy incontinence: A contemporary experience from the UK

Hosam Serag, Shirley Bang, Y Zaki Almallah Department of Urology, Queen Elizabeth Hospital Birmingham-University Hospital Birmingham, Birmingham, UK Objectives: To report a real-time contemporary practice and outcome of artificial urinary sphincter (AUS) in patients with postradical prostatectomy urinary incontinence (PPI) in the UK. Methods: A retrospective observational study of patients who underwent AUS implantation (AMS 800) from 2007 to 2013. Data were collected on patients’ demographics, infection and erosion rate, mechanical failure, reoperation, and continence rates. The study strictly included patients with postradical PPI only. Minimum follow-up was 15 months. Results: Eighty-four AUSs were implanted over a period of 6 years. Patients’ age ranged between 51 and 78 (median 69, mean 69.25) years. Median follow-up was 37 months, mean 39 months, and range 15–92 months. Among the 83 follow-up patients, 38.5% (32/83) reported that they were completely dry with no pads; 42.2% (35/83) of patients were socially continent (using 1 pad/day) and 19.3% (16/83) using ≥2 pads /day. One patient was lost to follow-up. Reoperation rate was 13.25% (11/83), including nine mechanical failures (10.8%). Two implant infections (2.4%) required explantation, out of which one had erosion (1.2%). Bladder overactivity developed in 6% of patients. Of the 83, 15 (18%) had pelvic radiotherapy. Conclusion: The implantation of AUS in patients with post-PPI has lower complications and reoperation rates than historical impression painted in the literature. This can be beneficial in counseling as well as during the education process of patients going through the decision process for prostate cancer treatment. Furthermore, these figures can add to our quest to increase the awareness of the success of anti-incontinence surgery among patients. Keywords: Post-prostatectomy urinary incontinence, artificial urinary sphincter, male incontinence, radical prostatectomy complications, outcomes of artificial urinary sphincter, incontinence surgery counselin

Inflammatory bowel diseases: principles of nutritional therapy Doenças inflamatórias intestinais: princípios da terapia nutricional

Inflammatory Bowel Diseases - ulcerative colitis and Crohn's disease- are chronic gastrointestinal inflammatory diseases of unknown etiology. Decreased oral intake, malabsorption, accelerated nutrient losses, increased requirements, and drug-nutrient interactions cause nutritional and functional deficiencies that require proper correction by nutritional therapy. The goals of the different forms of nutritional therapy are to correct nutritional disturbances and to modulate inflammatory response, thus influencing disease activity. Total parenteral nutrition has been used to correct and to prevent nutritional disturbances and to promote bowel rest during active disease, mainly in cases of digestive fistulae with high output. Its use should be reserved for patients who cannot tolerate enteral nutrition. Enteral nutrition is effective in inducing clinical remission in adults and promoting growth in children. Due to its low complication rate and lower costs, enteral nutrition should be preferred over total parenteral nutrition whenever possible. Both present equal effectiveness in primary therapy for remission of active Crohn's disease. Nutritional intervention may improve outcome in certain individuals; however, because of the costs and complications of such therapy, careful selection is warranted, especially in patients presumed to need total parenteral nutrition. Recent research has focused on the use of nutrients as primary treatment agents. Immunonutrition is an important therapeutic alternative in the management of inflammatory bowel diseases, modulating the inflammation and changing the eicosanoid synthesis profile. However, beneficial reported effects have yet to be translated into the clinical practice. The real efficacy of these and other nutrients (glutamine, short-chain fatty acids, antioxidants) still need further evaluation through prospective and randomized trials.<br>As doenças inflamatórias intestinais - retocolite ulcerativa inespecífica e doença de Crohn - são afecções inflamatórias gastrointestinais crônicas de causa ainda desconhecida. Caracterizam-se por diarréia crônica, malabsorção, síndrome do intestino curto, disfunção da barreira mucosa e processo inflamatório intestinal, fatores que determinam deficiências nutricionais e funcionais que ressaltam a importância da terapia nutricional em seu tratamento. As diversas formas de terapia nutricional visam corrigir os distúrbios nutricionais e modular à resposta inflamatória, podendo, desta forma, influir na atividade da doença. A nutrição parenteral total tem sido usada para corrigir os distúrbios nutricionais e proporcionar repouso intestinal na doença ativa. Seu uso deve ser reservado a pacientes que não podem tolerar a nutrição enteral. A nutrição enteral é efetiva em induzir remissão clínica da doença em adultos e promover crescimento em crianças. Devido à baixa incidência de complicações e menor custo, a nutrição enteral deve ser opção preferencial à nutrição parenteral total quando possível. Ambas apresentam igual efetividade na terapia primária na remissão da Doença de Crohn ativa. Embora a terapia nutricional possa melhorar a evolução de muitos pacientes, é necessária uma seleção criteriosa devido a seus custos e complicações, especialmente naqueles que requerem nutrição parenteral total. Recentes pesquisas têm se dedicado ao uso de nutrientes como agentes terapêuticos primários. A imunonutrição com ácidos graxos ômega-3 se constitui numa importante alternativa terapêutica no manuseio das doenças inflamatórias intestinais, modulando o processo inflamatório e modificando o perfil de produção de eicosanóides. Entretanto, a real eficácia deste e outros nutrientes (glutamina, ácidos graxos de cadeia curta) ainda necessitam de novas avaliações por estudos prospectivos, controlados e randomizados

Novel Nonbiologic Therapies for Ulcerative Colitis

An extensive array of compounds has been studied for the treatment of ulcerative colitis (UC). The most frequently used nonbiologic drugs for the oral and intravenous treatment of ulcerative colitis include 5-aminosalicylate (5-ASA) drugs (mesalamine and derivatives), sulfasalazine, and other azo-bonded molecules of 5-ASA, steroids, calcineurin inhibitors (cyclosporine, tacrolimus, and sirolimus), thiopurines (azathioprine, 6-mercaptopurine), and methotrexate, which are already presented in other sections of this book and are thus not considered in this chapter. The therapies presented in this section should be considered as potential alternatives, mostly for mild-to-moderate ulcerative colitis (UC). They are substances mostly used without FDA indications, such as heparin, nicotine, rosiglitazone, and N-acetylcysteine as well as “natural” compounds suggested to have anti-inflammatory or reparative properties, such as aloe vera, curcumin, short-chain fatty acids, and Bowman-Birk inhibito