8 research outputs found
Preliminary report on the effect of urethral diverticulum magnetic resonance imaging configuration on the incidence of new onset urodynamic stress urinary incontinence following excision
Context: Excision of urethral diverticulum in females has been reported to be associated with new onset urodynamic stress urinary incontinence (USUI) in up to 49%.
Aims: We have assessed the incidence of new onset USUI in all patients having urethral diverticulum excision with Martius fat pad interposition under the care of a single surgeon between May 1, 2007, and December 1, 2011. The incidence of new onset USUI has been correlated with the preoperative magnetic resonance imaging (MRI) appearance of the urethral diverticulum.
Patients and Methods: All 33 patients (mean age 42) having urethral diverticulum with Martius fat pad interposition had prospective data tabulated on demographics, preoperative MRI appearance, and pre- and post-operative videocystometrogram.
Statistical Analysis Used: Statistical analysis was performed by Chi-squared and Fisher's exact.
Results: Of the 33 patients, 10 (30%) had preoperative USUI and have been excluded from this study. Other preoperative urodynamic findings included idiopathic detrusor overactivity in ten (30%) and bladder outflow obstruction in five (16%). Two (10%) of the patients had a simple diverticulum, 16 (73%) had a horseshoe diverticulum, and 5 (17%) had a circumferential diverticulum. The rate of new onset USUI was 0% for simple, 6% for saddle, and 20% for circumferential.
Conclusions: New onset USUI occurs in 9% of patients having excision of urethral diverticulum with Martius fat pad interposition. The incidence appears to increase with increasing complexity of urethral diverticulum on preoperative MRI â rising from 0% following simple urethral diverticulum excision to 20% following circumferential diverticulum excision
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Prostatic urethral lift for subjects in urinary retention (PULSAR): 12âMonth results of a prospective controlled trial compared with realâworld outcomes
Funder: NeoTract, Inc./TeleflexAbstractObjectiveTo examine the safety and efficacy of prostatic urethral lift (PUL) in acute urinary retention (AUR) patients within a controlled (PULSAR) and realâworld setting (RealâWorld Retrospective study).Materials and methodsPULSAR was a 12âmonth prospective study of PUL in AUR patients (nâ=â51) performed at six centres in the United Kingdom; enrolled BPH patients aged â„50âyears, with prostate volume of â€100âcc. AUR was defined as being catheter dependent with at least one prior failed trial without catheter (TWOC) while on an alphaâblocker. RWR consisted of 3226 consecutive PUL patients across 22 international sites treated between July 2017 and March 2020; 469 of whom were in urinary retention (RWRr), that is, catheterâdependent at the time of their procedure. Symptom response, uroflow and catheter independence rates were compared between PULSAR and RWRr subjects. A logistical regression model was constructed to evaluate patient baseline and dynamic factors predicting success after the procedure.ResultsSeventyâthree percent of PULSAR subjects were catheter independent and free from surgical reintervention at 12âmonths postâPUL. Success was associated with higher voiding efficiency during the perioperative period. Slightly higher catheterâindependent rates (80%) were seen in RWRr patients; variables that influenced success included age <70âyears, lower baseline prostateâspecific antigen (PSA), lower baseline postâvoid residual (PVR) and shorter preâprocedural catheter duration. Logistic regression of the combined PULSAR and RWRr retention groups revealed that procedural age <70âyears and higher bladder voiding efficiency (BVE) were associated with success.ConclusionsLower baseline PSA and PVR, younger age and shorter preâprocedure catheter durations drove successful outcomes in AUR patients undergoing PUL. PostâPUL voiding efficiencies may help ascertain longâterm response to treatment.</jats:sec
Prostatic urethral lift for subjects in urinary retention (PULSAR): 12âMonth results of a prospective controlled trial compared with realâworld outcomes
Abstract Objective To examine the safety and efficacy of prostatic urethral lift (PUL) in acute urinary retention (AUR) patients within a controlled (PULSAR) and realâworld setting (RealâWorld Retrospective study). Materials and methods PULSAR was a 12âmonth prospective study of PUL in AUR patients (nâ=â51) performed at six centres in the United Kingdom; enrolled BPH patients aged â„50âyears, with prostate volume of â€100âcc. AUR was defined as being catheter dependent with at least one prior failed trial without catheter (TWOC) while on an alphaâblocker. RWR consisted of 3226 consecutive PUL patients across 22 international sites treated between July 2017 and March 2020; 469 of whom were in urinary retention (RWRr), that is, catheterâdependent at the time of their procedure. Symptom response, uroflow and catheter independence rates were compared between PULSAR and RWRr subjects. A logistical regression model was constructed to evaluate patient baseline and dynamic factors predicting success after the procedure. Results Seventyâthree percent of PULSAR subjects were catheter independent and free from surgical reintervention at 12âmonths postâPUL. Success was associated with higher voiding efficiency during the perioperative period. Slightly higher catheterâindependent rates (80%) were seen in RWRr patients; variables that influenced success included age <70âyears, lower baseline prostateâspecific antigen (PSA), lower baseline postâvoid residual (PVR) and shorter preâprocedural catheter duration. Logistic regression of the combined PULSAR and RWRr retention groups revealed that procedural age <70âyears and higher bladder voiding efficiency (BVE) were associated with success. Conclusions Lower baseline PSA and PVR, younger age and shorter preâprocedure catheter durations drove successful outcomes in AUR patients undergoing PUL. PostâPUL voiding efficiencies may help ascertain longâterm response to treatment