Objective To compare the results of two slings, Argus T® and Advance®, for the treatment of postprostatectomy urinary incontinence (PPUI). Material and Methods: From December 2010 to December 2011, 22 patients with PPUI were randomized as follows: 11 (mean age 62.09(±5.30)) underwent treatment with Advance® and 11 (mean age 62.55(±8.54)) with Argus T®. All patients were evaluated preoperatively with urodynamic testing, quality of life questionnaire (ICIQ-SF), voiding diary and 24-hour pad test. Exclusion criteria were: neurological diseases, severe detrusor overactivity and urethral stenosis. Evaluation was performed at 6, 12 and 18 months after the surgery. After implantation of the Argus T® sling, patients who experienced urine leakage equal to or greater than the initial volume underwent adjustment of the sling tension. Results were statistically analyzed using the Fisher’s test, Kolmogorov-Smirnov test, Friedman’s non-parametric test or the Mann-Whitney test.Results Significant improvement of the 24-hour pad test was observed with the Argus T® sling (p=0.038) , With regard to the other parameters, there was no significant difference between the two groups. Removal of the Argus T® device due to perineal pain was performed in one patient (9%). Despite non uniform results, both devices were considered useful to improve quality of life (ICIQ-SF): Argus T® (p=0.018) and Advance® (p=0.017).Conclusions Better results were observed in the 24h pad test and in levels of satisfaction with the Argus T® device. Both slings contributed to improve quality of life (ICIQ-SF), with acceptable side effects.
INTRODUCTION AND OBJECTIVES: Recently, retrograde intrarenal surgery (RIRS) is widely being performed for treatment of renal stones with the development of instruments and technique, and its efficacy and safety has been proven in many studies. When we perform RIRS, we usually try to remove stone fragments actively using a stone basket but this procedure can increase the operation time and risk of ureter injury. Herein, we tried to verify the necessity of active stone removal during RIRS, based on our experiences.METHODS: From January 2010 to January 2015, 254 patients underwent RIRS at our institution. We classified these patients into 2 groups according to the performance of active stone removal. Group A included the patients who underwent active stone removal using stone basket during RIRS (n¼177), and group B included the patients who underwent dusting of stones without active stone removal during RIRS (n¼77) Overall success rate, complications and the operation time were retrospectively compared between the two groups. Single surgeon performed all operations using 8.4F flexible ureteroscopy (Olympus, URF-P5) and 200 nm Holmium laser. The success was defined as complete stone free or presence of clinically insignificant residual fragments (<3mm) without any symptoms on non-contrast computed tomography (CT) after 1 month of procedure.RESULTS: There were no significant differences in mean age (56.2 vs. 58.5), male to female ratio (118/59 vs. 47/30), body mass index (24.5 vs. 25.0 kg/m 2 ), mean stone size (11.1 vs. 11.2 mm) and bilaterality (37/177 vs. 12/77) between the two groups. There were also no significant differences in overall success rate, (76.3% vs 66.2%, p¼0.067), operation time (83.7 vs 83.1 minutes, p¼0.896), and complication rate (32.8% vs 31.2%, p¼0.461) between both groups.CONCLUSIONS: RIRS is considered to be effective and safe procedure for the management of small or intermediate-sized renal stones. Excellent success rate can be expected if we crush stone to small fragments enough to pass even without active stone removal.
Objective:To evaluate urodynamic alterations after sub-urethral sling surgery (SSU) in patients with post-prostatectomy urinary incontinence (PPUI).Materials and Methods:We evaluated data of 22 patients submitted to radical prosta- tectomy (RP) or transurethral resection of prostate (TURP) that presented post-surgical urinary incontinence and were treated with SSU implant in a pilot study previously performed in our institution.Methods:Those patients with PPUI were evaluated by urodynamic exam (UD) before and after surgery, and the parameters were compared, including uroflow, cystometry and micturition study. Exclusion criteria included patients without pre-operatory urodynamic study, those with urethral stenosis, those not healed of prostate cancer, pa- tients without clinical conditions to be submitted to urodynamic study and those with severe neurological diseases or that refused to sign the consent form. Results were analyzed statistically by Fisher, Wilcoxon or Mann-Whitney tests.Results:During free uroflow, none parameters showed any statistical significant differ- ences. During cystometry, there were also no statistical differences and the same was observed at pressure versus flow study; the exception was at maximal flow detrusor pressure (PdetQmax), that was lower at post-operatory (p=0.028). In relation to the presence of urinary dysfunctions associated to PPUI, we observed a significant reduc- tion of detrusor overactivity (p=0.035) in relation to pre-operatory period.Conclusion:SSU surgery significantly reduced detrusor overactivity and PdetQMax; however, there were no alterations of other evaluated urodynamic parameters.
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