Eskinder Solomon

Radiotherapy is associated with reduced continence outcomes following implantation of the artificial urinary sphincter in men with post-radical prostatectomy incontinence

Objectives: The objective of this study is to present the outcomes of men undergoing implantation of artificial urinary sphincter, after treatment for prostate cancer and also to determine the effect of radiotherapy on continence outcomes after artificial urinary sphincter (AUS) implantation. Material and Methods: A prospectively acquired database of all 184 patients having AUS insertion between 2002 and 2012 was reviewed, and demographic data, mode of prostate cancer treatment(s) before implantation, and outcome in terms of complete continence (pad free, leak free) were assessed. Statistical analysis was performed by Chi-squared and Fishers exact tests. Results: A total of 58 (32%) men had bulbar AUS for urodynamically proven stress urinary incontinence consequent to treatment for prostate cancer in this period. Median follow-up post-AUS activation was 19 months (1–119). Forty-eight (83%) men had primary AUS insertion. Twenty-one (36%) men had radiotherapy as part of or as their sole treatment. Success rates were significantly higher in nonirradiated men having primary sphincter (89%) than in irradiated men (56%). Success rates were worse for men having revision AUS (40%), especially in irradiated men (33%). Conclusion: Radiotherapy as a treatment for prostate cancer was associated with significantly lower complete continence rates following AUS implantation.

Urethral diverticulectomy with Martius labial fat pad interposition improves symptom resolution and reduces recurrence.

To assess the presenting features and medium‐term symptomatic outcomes in women having excision of urethral diverticulum with Martius labial fat pad (MLFP) interposition.

Does the appearance of the urethral pressure profile trace correlate with the sphincter EMG findings in women with voiding dysfunction

Women with functional voiding dysfunction often experience a “catching” sensation when catheterising and are in general investigated with both urethral pressure profilometry (UPP) and sphincter electromyography (EMG). It is unknown whether the pattern of the UPP trace correlates with this sensation of “catching” or with sphincter EMG findings.

Can filling phase urodynamic parameters predict the success of the bulbar artificial urinary sphincter in treating post‐prostatectomy incontinence?

To evaluate whether filling phase urodynamic parameters can predict the success of the artificial urinary sphincter (AUS) in treating post‐prostatectomy incontinence (PPI).

Predicting a successful outcome in sacral neuromodulation testing: Are urodynamic parameters prognostic?

To assess whether the urodynamic parameters of mean voided volume, peak detrusor overactivity (DO) pressure, bladder compliance, capacity, and volume at first detrusor overactivity during filling cystometry can predict a successful outcome at first stage tined lead placement (FSTLP).

Does videourodynamic classification depend on patient positioning in patients with stress urinary incontinence

Introduction and Aims: Videocystometrogram (VCMG) is used to assess patients with SUI. A common classification system of SUI is the Blaivas and Olsson classification. The position this grading is performed in has never been established.

MP63-15 CONCORDANCE OF URODYNAMIC DEFINITIONS OF FEMALE BLADDER OUTLET OBSTRUCTION

METHODS: Twenty patients whose most bothersome symptoms were nocturia and/or nocturnal enuresis underwent overnight ambulatory urodynamic studies. All patients had undergone prior undiagnostic standard filling cystometry. Traces were reviewed and it was documented if detrusor overactivity (DO) +/-leakage was demonstrated, as well as the maximum voided volume and nocturnal urine output. RESULTS: The mean ( SD) agewas 45.1 19.9 years, comprising 14 female and 6 male patients All patients presented with nocturia with 17 patients additionally complaining of nocturnal enuresis. Only 5 patients reported bothersome day time symptoms. The mean duration for the overnight ambulatory urodynamic studies was 14.5 hours (range 12 to 16.6 hours). DO was demonstrated in 80% (n1⁄416) of patients. 15 out of the 17 (88.3%) patients with nocturnal enuresis demonstrated DO. Small volume SUI was demonstrated in 4 out the 17 (23.5%) patients with nocturnal enuresis. The mean and median peak DO pressure was 68.3 ( 50.9) and 50 cmH2O. There appears to be no significant difference in the maximum voided volume and nocturnal urine output between the two DO groups (NB: small sample DO -ve patients). Incontinence was observed in 15 out of 16 (93%) patients with DO. CONCLUSIONS: 80.0% of patients who present with nocturia and 88% with nocturnal enuresis demonstrate detrusor overactivity on overnight ambulatory urodynamics tests. The DO pressures demonstrated were large amplitude and resulted in incontinence by overcoming in most cases an otherwise competent outlet. Nocturnal ambulatory urodynamics are a useful clinical adjunct for assessing night time urinary symptoms.

MP63-13 DOES VIDEOURODYNAMIC CLASSIFICATION DEPEND ON PATIENT POSITIONING IN PATIENTS WITH STRESS URINARY INCONTINENCE?

35 (33.3%) stage IV. Sixty three (60%) women were identified as occult stress incontinent, twenty seven (25.7%) as continent, and 15 (14.3%) as stress urinary incontinent (leaked without prolapse reduction). From the 63 OSUI subjects, 48 (76.2%) were identified in both evaluations, and 8 were identified only during physical examination, and 7 only during urodynamics. The sensitivity to detect OSUI during physical examination and urodynamics was 88.9% and 87.3% respectively (p1⁄40.783). The value of Kappa to measure the agreement between both tests was 0.648 (95% CI, 0.4410.854). Anterior (p1⁄40.006) and posterior (p<0.001) compartment stage IV prolapse showed increased risk of OSUI. Despite 86 (81.9%) patients mentioned storage symptoms, only 8 (7.6%) had urodynamic demonstrated detrusor overactivity. CONCLUSIONS: Urodynamic study and physical examination are equivalent and concordant to demonstrate OSUI, thus it’s not mandatory to perform urodynamics to identify OSUI.

MP63-14 OVERNIGHT AMBULATORY URODYNAMICS FINDINGS IN PATIENTS WITH NOCTURIA AND/OR NOCTURNAL ENURESIS

35 (33.3%) stage IV. Sixty three (60%) women were identified as occult stress incontinent, twenty seven (25.7%) as continent, and 15 (14.3%) as stress urinary incontinent (leaked without prolapse reduction). From the 63 OSUI subjects, 48 (76.2%) were identified in both evaluations, and 8 were identified only during physical examination, and 7 only during urodynamics. The sensitivity to detect OSUI during physical examination and urodynamics was 88.9% and 87.3% respectively (p1⁄40.783). The value of Kappa to measure the agreement between both tests was 0.648 (95% CI, 0.4410.854). Anterior (p1⁄40.006) and posterior (p<0.001) compartment stage IV prolapse showed increased risk of OSUI. Despite 86 (81.9%) patients mentioned storage symptoms, only 8 (7.6%) had urodynamic demonstrated detrusor overactivity. CONCLUSIONS: Urodynamic study and physical examination are equivalent and concordant to demonstrate OSUI, thus it’s not mandatory to perform urodynamics to identify OSUI.

The correlation between retrograde leak point pressure and 24-hour pad weight

To assess the correlation between retrograde leak point pressure (RLPP) and 24‐hr pad weight (24PW) in men with post‐prostatectomy incontinence.