The role of preserving the inner sphincter mechanism and the bladder neck in the early achieving urine continence when performing radical retropubic prostatectomy

Objective: To assess the effect of preserving the internal sphincter on urine continence in patients who have gone through radical prostatectomy due to prostate cancer. Materials and methods: Open retropubic prostatectomy has been performed on 69 patients in our Urology department, of whom 44 patients were treated with careful preservation of the internal sphincter mechanism on the bladder neck, and a control group of 25 patients who didn’t have preserved internal sphincter. Retrospectively, we used the standardized international questionnaires, ICIQ-UI-SF and IIEF-5, which were translated and adapted. All of the patients were operated in the period 2014-2015. Results: Patients who had preserved inner sphincter mechanism and bladder neck during their radical prostatectomy, achieved continence much sooner, but the rate of continence in both groups after 12 months remained unchanged. The grade of incontinence till the 9-th month postoperatively was evidently lower in the examined group. The rate of anastomotic stricture and erectile dysfunction remained unchanged. Conclusion: The remains of the internal sphincter makes passive closing mechanism that helps the continence in the patients till the distal sphincter takes over the control which happens much later in the postoperative period. Key words: Incontinence, radical prostatectomy, inner sphincte

Early ultrasound surveillance of newly-created haemodialysis arteriovenous fistula

IntroductionWe assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention.MethodsConsenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling.ResultsOf 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9–77.3]; elbow, 66.7% [48.9–84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data.ConclusionEarly ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation

Early Ultrasound Surveillance of Newly-Created Hemodialysis Arteriovenous Fistula

Introduction: We assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomised controlled trial (RCT) evaluation of ultrasounddirected salvage intervention. Methods: Consenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF non-maturation identified by logistic regression modelling. Results: Of 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF non-maturation could be optimally modelled from the week four ultrasound parameters alone, but with only moderate positive predictive values (wrist, 60.6% (95% CI 43.9 – 77.3); elbow, 66.7% (48.9 - 84.4)). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modelling of the early ultrasound characteristics could also predict primary patency failure at 6 months, but that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data. Conclusions: Early ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation