Arun Sahai

Laparoscopic ureteroneocystostomy for benign lower ureteric stricture: case study and literature review

The surgical treatment of distal ureteric strictures depends on their length and aetiology. Laparoscopic procedures in this setting are uncommon. We describe a laparoscopic non‐refluxing ureteroneocystostomy for a symptomatic distal ureteric stricture performed on a 26‐year‐old man. The operation was carried out successfully without complication. Blood loss was 100u2003ml with an operating time of 250u2003min. He was discharged on the fourth day and returned to work after 11 days. Retrograde ureterography and cystography after 1 month showed no evidence of obstruction or reflux. At 3 months, an intravenous urogram showed excellent drainage and at 6 months the patient remained asymptomatic. We advocate the use of laparoscopic ureteroneocystostomy for benign distal ureteric stricture refractory to endoscopic procedures. In symptomatic patients, it is a feasible, safe, minimally invasive procedure with all the added benefits of laparoscopy compared with open repair. A non‐refluxing anastomosis is preferable. Reconstructive and intracorporeal suturing skills are needed to carry out this procedure.

OnabotulinumtoxinA injections in men with refractory idiopathic detrusor overactivity

OBJECTIVEnTo establish the effectiveness and safety profile of Onaboulinum toxin A (BTX-A) in men with idiopathic detrusor overactivity and compare with the outcomes observed in women. Several randomized trials have demonstrated the effectiveness of intradetrusor BTX-A injections in improving symptoms and quality of life in patients with overactive bladder (OAB) symptoms. Most trials however contained relatively few men or excluded men altogether.nnnMATERIALS AND METHODSnData patient undergoing BTX-A for refractory OAB with idiopathic detrusor overactivity on urodynamics were extracted from our centers prospectively maintained database. Incontinence impact questionnaire-7 and urogenital distress inventory-6 scores were collected at baseline and 4-12 weeks together with data regarding urinary retention requiring clean intermittent self-catheterization (CISC) and urinary tract infection (UTI). Urodynamic studies were assessed where available to see if voiding dysfunction and CISC were predictable.nnnRESULTSnSixty-five men received 133 BoNT-A treatments in the 15-year period representing 27.8% of those with refractory OAB. Baseline urogenital distress inventory-6 and incontinence impact questionnaire-7 fell by 4.2 (Pu202f=u202f.00) and 6.0 (Pu202f=u202f.00) points for men and by 6.0 (Pu202f=u202f.00) and 11.1 (Pu202f=u202f.00) for women, respectively. De novo CISC was required in 46 (42.6%) men and 107 (35.3%) women (Pu202f=u202f.10). UTI was reported in 36 (29.0%) men and 86 (27.0%) women (Pu202f=u202f.73). The bladder outflow obstruction index and the bladder contractility index did not reliably predict CISC requirement.nnnCONCLUSIONnMen with refractory OAB experience significant improvement in quality of life scores following BTX-A, though the benefit appears greater in women. The requirements for CISC and UTI rates were similar between sexes.