Ajay Singla

Adjustable continence therapy (ProACT) and bone anchored male sling: Comparison of two new treatments of post prostatectomy incontinence.

Objectives:  To compare the efficacy of two surgical treatments for male urinary stress incontinence: adjustable continence therapy (ProACT) and bone anchored male sling (BAMS).

Comparison of bone-anchored male sling and collagen implant for the treatment of male incontinence

Aim: To compare the effectiveness of transurethral collagen injection and perineal bone‐anchored male sling for the treatment of male stress urinary incontinence (SUI).

Intense Inflammatory Reaction With Porcine Small Intestine Submucosa Pubovaginal Sling or Tape for Stress Urinary Incontinence

OBJECTIVES To report on the intense local inflammatory reactions in patients undergoing pubovaginal sling or tape using a small intestinal submucosa graft. A case series of such inflammatory complications is presented. METHODS We performed 16 standard pubovaginal sling or tension-free tape procedures for stress urinary incontinence, using the Cook 4-ply Stratasis or 8-ply Stratasis-TF system. The diagnosis had been confirmed by the history, physical examination, and urodynamic study findings. RESULTS Of the 16 patients, 5 (31.3%) had intense suprapubic pain after surgery. One patient had induration of the mons pubis that required surgical drainage. Another patient had vaginal inflammation, with expulsion of graft material. Other patients had intense rectus sheath inflammation, as confirmed on computed tomography, that resolved with conservative care. CONCLUSIONS Previous case reports of inflammatory complications of small intestinal submucosa were confirmed in 31% of our patients. We have ceased using this product pending additional investigations or reformulation of the graft material.

A Comparative Study Evaluating the In Vivo Incorporation of Biological Sling Materials

OBJECTIVES To comparatively investigate biological tissues that are clinical products currently used for implantation in urological reconstruction. Specifically, we examined biological materials in vivo and evidence regarding the tissue response observed. Biological tissues are widely used in urological surgeries to treat conditions such as pelvic organ prolapse and stress urinary incontinence. METHODS Histologic data from 4 biological sling materials, that is, small intestinal submucosa (SIS), cadaveric fascia lata, cadaveric dermis, and porcine dermis, implanted within mice (n = 64) were evaluated at 2, 4, 8, and 12 weeks. Recovered tissue was assessed by several biocompatibility parameters such as capsule formation (collagen deposition), cellular number, cell morphology, and angiogenesis. RESULTS Data provide a scientific depiction of the cellular response to these biomaterials through a 12-week evaluation. SIS had a significantly higher level of angiogenesis and cell infiltrate as compared with all other material tested. Collectively, the data suggest that SIS has improved biocompatibility over other tested materials. CONCLUSIONS This study compared SIS with other biological tissues in an animal model and was found to have superior biocompatibility as seen in humans. This may be helpful for clinicians while selecting a particular biological material. The study provides evidence of the varying stages of remodeling each implant, with hopes to better understand the material response in vivo.

Solvent-dehydrated cadaveric dermis: a new allograft for pubovaginal sling surgery

Abstract

Evaluation and surgery for stress urinary incontinence: A FIGO working group report

To review available evidence regarding evaluation and treatment of stress urinary incontinence (SUI) and provide recommendations for management of urinary incontinence under specific conditions determined by the International Federation of Gynecology and Obstetrics (FIGO) Working Group.

Male incontinence: Pathophysiology and management

Post-prostatectomy incontinence in men is a devastating condition. It impacts the quality of life profoundly. Various types of male sling procedures have been introduced over the years. Bone anchored male sling appears to be effective and safe in intermediate term follow up. It certainly more effective than collagen implant and may provide alternative treatment option in patient with mild to moderate incontinence. In short term, other novel procedures seem to be promising. In spite of new technology, artificial urinary sphincter continues to provide high patient satisfaction and cure rates.

Artificial urinary sphincters for male stress urinary incontinence: current perspectives

The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe and reliable treatment for stress urinary incontinence and is currently the gold standard. After 4 decades of existence, there is substantial experience with the AUS. Today AUS is most commonly placed for postprostatectomy stress urinary incontinence. Only a small proportion of urologists routinely place AUS. In a survey in 2005, only 4% of urologists were considered high-volume AUS implanters, performing >20 per year. Globally, ~11,500 AUSs are placed annually. Over 400 articles have been published regarding the outcomes of AUS, with a wide variance in success rates ranging from 61% to 100%. Generally speaking, the AUS has good long-term outcomes, with social continence rates of ~79% and high patient satisfaction usually between 80% and 90%. Despite good outcomes, a substantial proportion of patients, generally ~25%, will require revision surgery, with the rate of revision increasing with time. Complications requiring revision include infection, urethral atrophy, erosion, and mechanical failure. Most infections are gram-positive skin flora. Urethral atrophy and erosion lie on a spectrum resulting from the same problem, constant urethral compression. However, these two complications are managed differently. Mechanical failure is usually a late complication occurring on average later than infection, atrophy, or erosions. Various techniques may be used during revisions, including cuff relocation, downsizing, transcorporal cuff placement, or tandem cuff placement. Patient satisfaction does not appear to be affected by the need for revision as long as continence is restored. Additionally, AUS following prior sling surgery has comparable outcomes to primary AUS placement. Several new inventions are on the horizon, although none have been approved for use in the US at this point.

Post-prostatectomy incontinence: Etiology, evaluation, and management

Urinary incontinence after prostatectomy or radiation is a devastating problem in men and remains the most feared complication following the treatment of localized prostate cancer. With an increasing number of radical prostatectomies performed globally for prostate cancer, the impact of urinary incontinence on quality of life assumes an even greater importance. With the advent of male sling procedures, more men are now seeking treatment for incontinence. Since the introduction of the artificial urinary sphincter almost four decades ago, several surgical procedures have emerged to manage post-prostatectomy incontinence, including the male sling for milder forms of incontinence. Several of the newer procedures have shown promise in the United States; many others have been developed and utilized in other parts of the world, though they have not yet gained FDA approval in the United States. The present review seeks to illuminate the etiology, evaluation, and management of post-prostatectomy incontinence. An effort has been made to provide an algorithm to clinicians for appropriate surgical management. The surgical techniques of commonly performed procedures and their outcomes are described.

Surgery: Outcomes of gastric-segment bladder reconstruction

Although early studies of gastrocystoplasty reported good long-term outcomes with few adverse effects, some more recent studies have contradicted this view—a recent report has shown high complication rates and poor outcomes. The use of the technique remains controversial and can be recommended only in a select group of patients.