Study design: Retrospective review of prospectively collected data. Objectives: Stress urinary incontinence (SUI) is a cause of significant distress in women with neurogenic bladder dysfunction (NBD) due to spinal cord injury (SCI). Transobturator tape (TOT) has not previously been studied in this select group for cure of SUI. We aim to determine the long-term safety and efficacy of TOT in SCI patients with NBD and SUI. Setting: London, the United Kingdom. Methods: All patients undergoing TOT between 2005 and 2013 were identified (27 patients). All patients had pre-operative videocystometrogram (VCMG) and all had VCMG-proven SUI. Mean follow-up was 5.2 years. Patient-reported leakage, satisfaction, change in bladder management, complications and de novo overactive bladder (OAB) were recorded. Results: Mean age was 56 years (range 30-82) with complete follow-up. Twenty-two patients (81.5%) reported complete dryness from SUI post surgery. One patient (3.7%) reported SUI only when her bladder was very full but was satisfied. Twenty-three patients (85.2%) were happy. Four patients (14.8%) remained wet. Twenty-five patients (92.6%) had no change in bladder management. Two out of five patients (40%) who voided by straining prior to surgery required clean intermittent self-catheterisation (CISC) postoperatively. Two patients (7.4%) developed de novo OAB. No bladder or vaginal injuries, tape erosions or urethral obstruction were seen. Three patients (11.1%) had transient thigh pain. Conclusion: In women with NBD and SUI, TOT should be considered safe and effective with very good medium/long-term outcomes. There may be an increased risk of CISC in women who void by straining pre-operatively. INTRODUCTIONStress urinary incontinence (SUI) in women with neuropathic bladder dysfunction 1 (NBD) can be a major disabling feature. In the general population up to 25% of women are thought to be affected, 2 although among neuropaths the incidence remains unknown.In women with NBD, such as after spinal cord injury (SCI), there are specific additional problems compared with the general population that require consideration. For instance, neuropathic patients may have neurogenic detrusor overactivity (NDO) in association with weakness of the external urethral sphincter or a weak sphincter with an acontractile bladder. Particularly after childbirth, this sphincteric dysfunction may be seen in association with hypermobility or prolapse, which can further complicate management.Following Ulmsten's original description 3 in 1996 of a synthetic polypropylene tension-free vaginal tape placed at a mid-urethral level in retropubic fashion, our unit was the first to study the success of this procedure in neuropathic patients. 4,5 This showed success comparable to non-neuropaths in both short and long term with few complications. The aim of this study was to present the first series of long-term safety and efficacy outcomes of placement of mid-urethral synthetic transobturator tapes (TOT) in patients with urodynamically confirmed SUI and NBD du...

Aims: The majority of patients with spinal cord injury (SCI) will develop neurogenic lower urinary tract dysfunction (NLUTD). These patients require a long-term urological follow-up. The follow-up protocol has varied across SCI units in the United Kingdom and Eire. We reviewed the long-term management in the SCI units to identify changes in practice over a decade and compared them to current guidelines. Methods: We present results of a review of all SCI centres in the United Kingdom and Eire on their long-term urological management before and after the current guidelines and compared the results with European Association of Urology (EAU) Guidelines on NLUTD and the proposed British guidelines for the urological management of patients with SCI. Data were collected through questionnaires posted to SCI units. Results: SCI patients are followed up in outpatients annually in the SCI centres and the frequency of follow-up remains largely unchanged. More SCI units perform renal tract imaging annually as a part of SCI follow-up. Most units follow the proposed British guideline indications for urodynamics and do not perform 'routine urodynamics'. Conclusions: We conclude that the long-term management of SCI patients in SCI units in the United Kingdom and Eire has changed overtime to follow the proposed British guidelines. EAU guidelines offer a more extensive follow-up regime. Last, there is a continued lack of high-quality evidence to support an optimal long-term follow-up protocol. Importantly, there is a lack of evidence on clinical outcomes when these guidelines have been followed. Spinal Cord (2014) 52, 640-645; doi:10.1038/sc.2014.90; published online 10 June 2014 INTRODUCTIONThe annual incidence of spinal cord injury (SCI) is up to 40 cases per million. 1 Most of these patients develop neurogenic lower urinary tract dysfunction (NLUTD). 2 Mortality due to urological complications has decreased over recent years; 3 due to meticulous attention to the kidneys and bladder. Long-term urological follow-up is needed to optimise the bladder by low-pressure filling and complete bladder emptying. Restoration of continence is a goal for improved quality of life. 4 SCI patients are best managed in a SCI centre with integrated facilities for rehabilitation and a multidisciplinary approach: involving urologists, rehabilitation specialists, specialist nurses and physiotherapists etc. 5 Although it is agreed that patients with NLUTD should have regular follow-up, there is little concusses how this should be monitored over the long-term to detect urological complications. 6 We conducted a survey of SCI units in 2004 to evaluate the longterm urological management of SCI patients in the United Kingdom and Eire, which showed a considerable variation in urological practice among SCI centres in the United Kingdom and Eire. 7 Since then guidelines have been published on the management of NLUTD, and NLUTD in association with SCI. These include the European Association of Urology (EAU) guidelines for management of NLUTD, 4 proposed Britis...

Introduction The aim of this article was to investigate quality and cost benefits of managing urolithiasis by primary ureteroscopic procedures (P-URS) during index admission to hospital. With the rise in prevalence of urolithiasis, the focus has shifted to manage these patients during their first admission rather than using temporary measures like emergency stenting (ES) or nephrostomies which are followed by deferred ureteroscopic procedures (D-URS). We compared results of P-URS, D-URS and ES procedures in terms of quality and cost benefits. Material and methods Data was collected retrospectively for all P-URS, D-URS and ES procedures performed during year 2019. A total of 85 patients underwent ES while as 138 patients underwent elective URS (26 had P-URS and 112 had D-URS). The quality assessment was based in relation to patient factors including- number of procedures per patient, number of days spent at hospital, number of days off work. Cost analysis included theatre and hospital stay expenses, loss of working days. Results This study revealed that the average hospital stay of patients on index admission who had a ES was 1.35 days (Total 3.85) and who had P-URS was 1.78 days (Total 2.78). Overall, additional expenditure in patients who did not undergo primary URS was in the range of 1800–2000€ (excluding loss of work for patients, who needed to return for multiple procedures). Conclusions We conclude approach of P-URS and management of stones in index admission is very effective in both improving quality of patients as well as bringing down cost expenditure effectively.

We read with interest the article 'Intradetrusor versus suburothelial onabotulinum toxin A injections for neurogenic detrusor overactivity: a pilot study' published in Spinal Cord by Krhut et al. 1 The authors need to be commended for undertaking one of the first randomized controlled studies to compare intradetrusor versus suburothelial injections of onabotulinum toxin A. We have a few comments regarding this study. The authors describe using International Units (IU) of onabotulinum toxin. We understand that onabotulinum toxin is not dispensed in IU; rather it is marketed as Allergan Units (U) (http:// www. medicines.org.uk/ EMC /medicine/112/SPC/BOTOX þ 100 þ Units/). A review article in European Urology also uses U when discussing dosage. 2 We feel that U rather than IU should be used for the purpose of standardization. The authors also describe the injection technique very well using ultrasound measurement of bladder wall thickness. While there is evidence to suggest extravesical spread in association with botulinum toxin injections, we feel that in practice it is very difficult be certain clinically that all injections have been undertaken into the detrusor or suburothelially. Consequently, it is difficult to base the results on this variation. Indeed, due to this uncertainty, this aspect was not commented upon in the recent review by Mangera et al. 2

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