Predictors of Nerve Stimulator Success in Patients With Overactive Bladder

Purpose To identify factors associated with successful sacral nerve stimulator (SNS) trial after SNS implantation for the treatment of medication refractory overactive bladder (OAB). Methods Patients undergoing treatment for OAB at Lahey Hospital and Medical Center between 2004 and 2016 were identified. Patients undergoing SNS placement were identified; SNS success was defined as permanent implantation of the SNS. Demographic, clinical and treatment data were extracted from patient charts; uni- and multivariate analyses were conducted to identify factors associated with SNS treatment success. Results A total of 128 patients were included. On univariate analysis, male sex, prior diagnosis of benign prostatic hyperplasia, and lower volume at first urge on urodynamics (UDS) were associated with unsuccessful SNS trial. On multivariate analysis, male sex (odds ratio [OR], 0.145; 95% confidence interval [CI], 0.036–0.530) and lower volume at first urge on UDS (OR, 0.982; 95% CI, 0.967–0.995) were associated with unsuccessful SNS trial. A threshold value of 100 mL at first urge during preoperative UDS had a specificity of 0.86 in predicting SNS success in men. Conclusions SNS is frequently successful at relieving OAB symptoms. Male patients and those with lower volumes at first urge on UDS, particularly below 100 mL, are more likely to have an unsuccessful SNS trial. Patients in these groups should be counseled on the lower likelihood of SNS success

Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136665/1/nau23080.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136665/2/nau23080_am.pd

RE: Simple vs Complex Urethral Diverticulum: Presentation and Outcomes

Urethral diverticulum (UD) was first described by Hey in 1805. Albeit it has mostly an acquired origin, it might also be congenital. According to the literature, the prevalance ranges between 1 and 6% in female population and it is mostly located at the mid-urethra. Size also reveals a variability from a few mm to more bigger forms. In 10% of cases, multiple numbers of UD can be observed at the same patient. Romanzi in 2000 reported that the diagnosis is often overlooked and after an average of 9 doctors a proper diagnosis could be established. This paper is an excellent presentation of UD which were further sub-categorized as simple and complex. Literature is limited on the presenting symptoms and results after repair of complex UD compared with simple UD. In this series, 11 over 43 UD cases were classified as complex when an axial MRI imaging revealed more than 75% circumferential involvement of the urethra. Complete urethral division and an end to end anastomosis was done in complex UD to access the dorsally or circumferentially located diverticulum. In simple UD, transvaginal excision technique was used. When the patients complained urinary incontinance concomitantly, videourodynamics was done to differentiate postvoid dribbling from the true SUI. An autologous fascial pubovaginal sling was done in those cases with SUI besides the repair of UD. When the tissue was poor they utilized Martius flap. Mean age of both complex and simple UD did not reveal a significant difference (52.7 vs. 50.9). The striking difference when evaluating patient demographics was the high concomitant occurence of SUI in complex UD (90.9 vs. 56.3%). Postoperative symptoms were also similar except a more tendency to urinary tract infection after repairs of complex UD (27.3 vs. 3.2%). In three patients urinary retention was observed and in one of them sling was incised vaginally. Urethral stricture developed in one case belonging to complex group that was managed with serial dilations of the urethra. Retrospective design is the significant limitation of this study. Since experience of many female urologists on complex UD is considerably lacking, favorable postoperative outcome in this study can be encouraging