The etiology of men's lower urinary tract storage and voiding symptoms involves a contribution from both detrusor and outlet. As such, treatment of benign prostatic enlargement (BPE) ± benign prostatic obstruction (BPO) with standard alpha-adrenergic blockade and 5-alpha reductase inhibitor therapy may leave a population of men with persistent and bothersome urinary storage symptoms. An abundance of adequately powered, randomized, placebo-controlled trials indicate that the use of antimuscarinics and beta-3 adrenergic agonists, either alone or in combination with standard BPE/BPO therapy, leads to improvement in storage symptoms. At the same time, metrics associated with urinary emptying, such as maximum flow rate, post-void residual urinary volume, and incidence of treatment-associated urinary retention, appear to be stable and not significantly impacted by the addition of antimuscarinics.

Obese women have similar success rates and significant improvement in QoL as non-obese women after RPM. Obesity alone does not appear to be a risk factor for additional complications during sling surgery and obese women may have earlier return to normal voiding after surgery.

INTRODUCTION AND OBJECTIVES: In the midurethral sling era, treatment of stress urinary incontinence (SUI) has increased dramatically. Concomitantly, use of the autologous rectus fascia pubovaginal sling (PVS) has decreased proportionately. However, for patients with intrinsic sphincter deficiency (ISD), recurrent SUI, or mesh complications, PVS remains an important procedure. We evaluated the outcomes of PVS in patients with ISD and/or recurrent SUI.METHODS: A retrospective review of prospectively collected data of patients undergoing PVS for SUI was performed. Patients were followed by mailed questionnaire annually. Success was defined as less than one incontinent episode per week or greater than 70% patientreported improvement from baseline. Patient-reported dry rate was assessed using the Urinary Distress Inventory (UDI-6) questionnaire. Secondary outcomes were complication rates.RESULTS: Between 1999 and 2014 we identified 82 patients who underwent PVS with a minimum follow up of 12 months. Mean age was 60 (range 34-87). 63% had recurrent SUI and 78% had ISD, defined as Valsalva leak point pressure (VLPP) <60 cmH2O (mean VLPP 37, range 0-58). At 6.1 years mean follow-up (range 1.4-11.0), the success rate was 74%, and patient-reported dry rate was 35%. Seventeen patients (23%) experienced a total of 20 peri-operative complications including 3 wound infections, 2 UTIs, 2 transfusions, 1 vaginal sling exposure, 1 small seroma that was drained, 1 abdominal wall hematoma, and 1 case of pneumonia. Rate of transient urinary retention was 9%, and 2% of patients had prolonged obstruction requiring intervention. In terms of postoperative urgency, 29% had de novo urgency but 17% had resolution of preoperative urgency.CONCLUSIONS: PVS is associated with a good success rate at long-term follow-up, even in more complicated and severe cases. Complication rate was low, but potential for retention and de novo urgency mandates careful preoperative counseling. PVS remains an important tool in the armamentarium for treatment of SUI.INTRODUCTION AND OBJECTIVES: Obesity is a risk factor for failure of surgery for stress urinary incontinence (SUI). In previous studies, obese women had higher rates of persistent/recurrent SUI after 3 types of slings, but lower rates of postoperative voiding symptoms vs. non-obese women. We evaluate the outcomes of retropubic midurethral slings (RPMUS) in obese women (BMI>¼30).METHODS: This is an IRB-approved, retrospective chart review of women undergoing top-down RPMUS with follow-up (FU) of >¼12 months. Of 622 women, 294 (47.3%) had BMI>¼30 and 328 BMI<30 (52.7%). Women with previous anti-incontinence surgery were included. Pre-and postoperative assessment included exam, SEAPI scoring (stress incontinence, emptying, anatomy, protection, inhibition), and quality of life (QoL) questionnaires. Cure was no subjective or objective SUI and no further procedures for SUI. Details on perioperative morbidity were abstracted from the hospital and clinic charts.

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Testicular yolk sac tumor (YST) is a nonseminomatous germ cell tumor that predominantly affects prepubescent boys. Pure endometrioid variant YST is rare, with only 1 report in the literature. We present the first reported case of en-dometrioid variant YST with mature teratoma in the retro-peritoneal specimen.