Comparison of functional outcome after extended versus super-extended pelvic lymph node dissection during radical prostatectomy in high-risk localized prostate cancer

Background: Urinary continence and erectile function (EF) are best preserved whenmeticulous dissection of prostate and nerve sparing technique are used during radicalprostatectomy (RP). However, extent of lymph node dissection (LND) may also adverselyaffect functional results.Objective: To determine whether performing a super-extended LND (seLND) has asignificant effect on recovery of urinary continence and EF after RP.Design, setting, and participants: All patients who underwent RP from January 2007until December 2013 were handed questionnaires assessing continence and EF. Allpatients in whom at least an extended LND (eLND) was performed were selected. Thissearch yielded 526 patients. 172 of these patients had filed out 2 or more questionnairesand were included in our analysis.Outcome measurements and statistical analysis: All questionnaires were reviewed.We used Kaplan–Meier analyses and multivariate Cox analysis to assess the differencein recovery of continence and EF over time for eLND/seLND. Primary endpoints were fullrecovery of continence (no loss of urine) and full recovery of EF (successful intercoursepossible). Patients who did not reach the endpoint when the last questionnaire was filledout were censored at that time. Median follow-up was 12.43 months for continence, and18.97 months for EF.results and limitations: Patients undergoing seLND have a lower chance of regainingboth urinary continence [hazard ratio (HR) 0.59, 95% CI 0.39–0.90, p = 0.026] and EF(HR 0.28, 95% CI 0.13–0.57, p = 0.009). Age at surgery had a significant influence onboth continence and EF in multivariate analysis. Major limitation of the study was that noformal preoperative assessment of continence and potency was done.conclusion: Extending the LND template beyond the eLND template may cause atleast a significant delay in recovery of urinary continence and leads to less recovery of EF.</p

Single incision slings: Are they ready for real life?

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What is the Best Treatment Option for Coexisting Pelvic Floor Dysfunctions?

Although both intravesical onabotulinumtoxinA injections and sacral neuromodulation could be offered in cases of bladder pain syndrome and overactive bladder syndrome, there is still no scientific agreement on the best option after failure of standard therapies.status: accepte

The role of botulinum toxin A in treating neurogenic bladder

Neurogenic detrusor overactivity (NDO) can result in lower and upper urinary tract complications and eventually even in end-stage kidney failure. Since the driving force of this clinical cascade is high bladder pressure, controlling intravesical pressure in NDO patients improves both quality of life and life-expectancy in these patients. Botulinum toxin A (BTX-A) has proven its efficacy in reducing intravesical pressure and in reducing incontinence episodes. BTX-A also improves quality of life in patients with NDO. Both onabotulinumtoxinA (Botox(®), Allergan, Irvine, USA) and abobotulinumtoxinA (Dysport(®), Ipsen, Paris, France) have a level A recommendation for NDO-treatment. The recommended dose for intradetrusor injections in NDO patients is 200 U of onabotulinumtoxinA or 500 U of abobotulinumtoxinA. The drug is generally administered extratrigonal in the detrusor muscle, via cystoscopic guided injection at 20 sites in 1 mL injections. Intradetrusor BTX-A injections are safe, with mostly local complications such as urinary tract infection and high post-void residual or retention. The effect of the toxin lasts for approximately 9 months. Repeat injections can be performed without loss of efficacy. Different injection techniques, novel ways of BTX-A administration, eliminating the need for injection or new BTX-A types with better/longer response rates could change the field in the future.status: publishe

The reoperation ratio of the minisling

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Adherence to medium-term treatment with onabotulinumtoxina for neurogenic and idiopathic detrusor overactivity: a single centre’s experience

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Are patients willing to trade cure rate against less pain? Patients' preferences for single incision midurethral sling or transobturator standard midurethral sling

To quantify to what extent patients are willing to trade their chance of cure of stress urinary incontinence (SUI) against less postoperative groin pain. Randomized, controlled trials show less postoperative pain following single-incision mini-sling (SIMS), but slightly higher cure rates following a transobturator standard midurethral sling (SMUS). A multi-center, interview-based trade-off experiment for treatment preference among 100 women with predominant SUI and undergoing SIMS. A hypothetical cure rate of SIMS was systematically varied from 10% to 70%, while keeping the cure rate of SMUS constant at 70%. The trade-off was assessed for two hypothetical durations of substantial postoperative pain after SMUS-2 days or 2 weeks-while simultaneously assuming the absence of substantial postoperative pain after SIMS. To prevent 2 days of substantial postoperative pain with SMUS, patients were willing to accept a 4.3% mean decrease in cure rate of SIMS, while a 7.1% mean decrease was acceptable to forego 2 weeks of substantial pain. Younger women (P = 0.04) and single women (P = 0.04) were associated with the trade-off limit for 2 days, respectively, 2 weeks of substantial postoperative pain. Single women were willing to accept lower cure rates. No correlations with trade-off limits were found for patients' actual severity, duration, and frequency of SUI. Patients are willing to accept a slightly lower probability of cure to prevent substantial post-operative pain by undergoing a less invasive procedure. These results are relevant for counselling of patients indicated for SUI surger

Is the ICIQ-SF questionnaire reliable in a real-life setting? Results of a prospective single-center study

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