G. Primus

Patient Self-Reporting Questionnaire on Urological Morbidity and Bother after Radical Retropubic Prostatectomy

OBJECTIVES We assessed the incidence of morbidity and bother on quality-of-life (QL) after radical retropubic prostatectomy for prostate cancer. METHODS At least 12 months after surgery, self-reporting questionnaires were completed and returned by 368 (77.8%) of 473 eligible patients. Surgery related morbidity was evaluated by adhoc constructed questions. QL was assessed by the European Organization for Research and Treatment of Cancer QL core questionnaire (EORTC QLQ-C30). Multivariate and univariate analysis as well as regression analysis were used to assess the bother factors. RESULTS Postoperative urinary incontinence significant enough for the patient to use some kind of protection was reported by 27.2%. After surgery, 14.2% of preoperative potent men were able to get and maintain an erection sufficient enough for sexual intercourse without any aid. Overall 10.6% of respondents had undergone surgery for anastomotic stricture and 23.6% reported on adjuvant therapy. Furthermore, 43.2% reported on fear of not being cured from cancer. Postoperative urinary incontinence and fear of not being cured were associated with significant lower global QL scores and turned out as independent predictors for global QL. In contrast, postoperative erectile dysfunction, anastomotic stricture and adjuvant therapy were not independent predictors. In addition, 82.1% would vote for surgery again. CONCLUSION The majority of the patients would opt for surgical treatment again, although morbidity is common after radical prostatectomy and may impair QL. Particularly urinary incontinence and fear of not being cured are independent predictors for global QL after surgery. Therefore, surgical techniques with a low morbidity are requested as well as some kind of psychological support in order to cope with existential fear.

Early results of a European multicentre experience with a new self-anchoring adjustable transobturator system for treatment of stress urinary incontinence in men.

Surgical treatment options for male stress urinary incontinence (SUI) include collagen injection, artificial urinary sphincter, or male sling placement. In recent years, various minimally invasive sling systems have been investigated as treatment options for post‐prostatectomy SUI. One of the drawbacks of using male slings is the lack of ability to make postoperative adjustments. To overcome the challenges associated with peri‐ and postoperative adjustment of male sling systems, the adjustable transobturator male system (ATOMS®) was introduced. Our initial European multicentre experience with this device treatment shows a significant improvement in the severity of incontinence and mean pad use as well as quality‐of‐life scores. Our data suggest that the ability at any time to make adjustments in male sling systems should be considered as a prerequisite when managing men with SUI.

Restoration of micturition in patients with acontractile and hypocontractile detrusor by transurethral electrical bladder stimulation

The aim of transurethral electrical bladder stimulation (TEBS) treatment in patients with diminished detrusor contractility is to attain complete voiding, i.e., micturition without residual urine, which is under volitional control. In contrast to other types of electrical bladder stimulation, the physiological basis for this kind of treatment is sensitizing of the bladder mechanoreceptor afferents. The latency of afferent stimuli in normal conditions indicates that myelinated A‐δ‐fibers are used for neurotransmission from these mechanoreceptors.

Fournier's gangrene after tension-free vaginal tape (TVT) procedure.

A 78-year-old woman presented at the outpatient clinic of a peripheral urological department with oliguria and genital pain. Medical history showed that in 1996 she had had a vaginal hysterectomy combined with anterior and posterior colporrhaphy. In April 2002 she underwent anterior colporrhaphy, sacrospinal fixation of the vagina (Amreich–Richter procedure) and TVT insertion at a gynecology department because of urodynamic stress incontinence (USI) and prolapse of the anterior vaginal wall. Five weeks later the primary TVT was removed because of recurrent USI and a new one was inserted. Two weeks later, on admission, clinical examination showed a marked swelling and a brown livid discoloration of the mons pubis spreading to the left labium majus. Laboratory examination revealed anemia and elevated kidney and inflammatory parameters (creatinine 2.54 mg/dl (normal laboratory value 0.6–1.3), urea 55.6 mg/dl (10–45) and C-reactive protein 35.6 mg/l (0-8)). Computed tomography (CT) imaging of the pelvis showed a marked accumulation of gas in the pubic region and left labium majus, as well as a moderate hematoma in the small pelvis (Fig. 1). Under suspicion of clostridial necrosis she immediately underwent debridement and drainage of the affected area. The next day she was transferred in a poor general condition with artificial ventilation to our clinic for hyperbaric oxygen therapy (HBO). At this time clinical examination showed swelling and edema of the whole pubic region and the labia majora, with subcutaneous necrosis and demarcated gangrene around the drainage (Fig. 2a). Extensive necrectomy, removal of the tape and drainage of the paravesical space was performed (Fig. 2b). Histological examination showed an acute phlegmonous and abscess-forming inflammation. Subsequently she underwent several HBO sessions. Wound smears showed staphylococcus in masses, anaerobes and Bacteroides species, and therefore the initially administered antibiotic (penicillin) was changed to imipenem and fosfomycin, according to the antibiogram. Immediately postoperatively the patient had a central venous catheter placed, which caused perforation of the right subclavian artery with mediastinal bleeding. This lesion was successfully covered angiographically using a Wall’s stent. On the first postoperative day she twice underwent successful electrocardioversion for tachycardic fibrillation. Intermittently she suffered acute renal failure. On the fourth postoperative day she was extubated after a renewed necrectomy. Control CT and magnetic resonance (MR) imaging revealed moderate regression. Two weeks later the wound showed good granulation. The patient was transferred to the department of plastic surgery for reconstruction (Fig. 3). Her further course was uneventful. After removal of the indwelling catheter she showed grade 3 USI.

The monoclonal antibody GZS-1 detects a maturation-associated antigen of human spermatozoa that is also present on the surface of human mononuclear blood cells

A monoclonal antibody (GZS-1) has been generated by fusion of mouse myeloma cells with spleen cells from BALB/c mice immunised with human sperm cells. The antibody was determined to be an IgG1. The corresponding antigen is present on the whole surface of ejaculated human spermatozoa. It is not detectable on spermatozoa of other mammalian species (rabbit, cat, dog, sheep, boar, bull, horse). In human male genital organs, immunostaining with GZS-1 is observed on sperm cells in the epididymis and the ductus deferens together with the lining epithelium of those organs. No reactivity of sperm cells or germ cell precursors in the testis has been detected. Functional tests using the antibody show a strong inhibitory effect of human sperm in the hamster egg penetration assay. Furthermore, the GZS-1 antigen is detectable on the surface of human lymphocytes and monocytes by immunogold electron microscopy and FACS analysis. By Western blotting of human sperm and seminal plasma performed under reducing conditions immunostaining was detected at 21-25, 31, 51-54, and 62 kDa. The reaction with human lymphocytes shows one major band at 62 kDa and additional bands at 31 and 54 kDa. The results suggest that the monoclonal antibody GZS-1 may recognise an antigen which is secreted from the epithelial cells of the epididymis and binds to ejaculated spermatozoa as a sperm coating antigen. This component may be involved in the capacitation of the sperm and the acrosome reaction. Molecules that are expressed both on sperm and on immunocompetent cells may be relevant for the regulation of immunological processes or for the development of the related immunological tolerance of sperm in the female reproductive tract.

Behandlung der Belastungsinkontinenz nach radikaler Prostatektomie

BACKGROUND The adjustable transobturator male system (ATOMS®) is a new method for the treatment of male stress urinary incontinence. This article presents the results of a prospective multicenter observational study with this system. PATIENTS AND METHODS Between March 2009 and March 2011 a total of 124 patients with persistent stress urinary incontinence after radical prostatectomy received the ATOMS system. Postoperative adjustments via the implanted port chamber were performed after 6 weeks and thereafter when necessary. Postoperative evaluation consisted of medical history, mictionary protocol, 24-h pad tests, 24-h pad counts and sonography. RESULTS The mean age of the patients was 71.2 ± 5.5 years (range 58-85 years). Previous incontinence surgery had been carried out in 36.3% of patients while 34.5% of patients had a previous history of radiation treatment. The mean operation time was 48.3 ± 11.2 min (range 36-116 min) and the mean hospital stay was 3.8 ± 1.2 days (range 2-6 days). No intraoperative urethral or bladder injuries occurred. After removal of the transurethral catheter on the first postoperative day, temporary urinary retention occurred in 3 patients who were conservatively treated. Transient perineal/scrotal pain or dysesthesia was observed in 75 patients (60.5%) and resolved after 3-4 weeks of non-opioid analgesics. There were no perineal infections; however, infections at the port site occurred in 3 patients (2.4%) leading to explantation of the system in all cases. The average number of adjustments to achieve the desired result was 4.3 ± 1.8 (range 2-7). After a mean follow-up of 19.1 ± 2.2 months (range 12-36 months), there was a significant reduction in the mean number of pads/24 h from 8.8 to 1.8 (p<0.001). The overall success rate was 93.8% with 61.6% of the patients being dry and 32.2% of the patients showing improvement. CONCLUSIONS The results of the study demonstrate the safety and efficacy to date of the ATOMS system for treatment of stress urinary incontinence after radical prostatectomy.

Sexual function in women with stress urinary incontinence treated with the SPARC sling system.

Aim. To evaluate the impact of SPARC on female sexual function. Methods. 151 women with a mean age of 60 ± 11.90 and SUI had a complete urodynamic investigation and underwent SPARC operation. 98 women completed the validated female sexual function index questionnaire (FSFI) at baseline and 94 women at follow-up. A minimum follow-up of 12 months was required for study inclusion. Results. 52/98 women were sexually active at baseline. Postoperatively only 33 patients were sexually active. The FSFI score of all 33 pre- and postoperative sexually active women increased from 25.3 ± 5.7 at baseline to 27.4 ± 4.8 at follow-up (P = 0.1). Scores of women with reduced sexual function at baseline increased significantly in the domains desire, arousal, and lubrication as well as orgasm and satisfaction and total FSFI-score (P = 0.002) postoperatively. Conclusions. Our results suggest that the SPARC-sling procedure for SUI did not negatively interfere with female sexual function.

Behandlung der Belastungsinkontinenz nach radikaler Prostatektomie@@@Treatment of stress urinary incontinence after radical prostatectomy: Adjustierbares transobturatorisches System – prospektive multizentrische Anwendungsbeobachtung@@@Adjustable transobturator male system – results of a multicenter prospective observational study

BACKGROUND The adjustable transobturator male system (ATOMS®) is a new method for the treatment of male stress urinary incontinence. This article presents the results of a prospective multicenter observational study with this system. PATIENTS AND METHODS Between March 2009 and March 2011 a total of 124 patients with persistent stress urinary incontinence after radical prostatectomy received the ATOMS system. Postoperative adjustments via the implanted port chamber were performed after 6 weeks and thereafter when necessary. Postoperative evaluation consisted of medical history, mictionary protocol, 24-h pad tests, 24-h pad counts and sonography. RESULTS The mean age of the patients was 71.2 ± 5.5 years (range 58-85 years). Previous incontinence surgery had been carried out in 36.3% of patients while 34.5% of patients had a previous history of radiation treatment. The mean operation time was 48.3 ± 11.2 min (range 36-116 min) and the mean hospital stay was 3.8 ± 1.2 days (range 2-6 days). No intraoperative urethral or bladder injuries occurred. After removal of the transurethral catheter on the first postoperative day, temporary urinary retention occurred in 3 patients who were conservatively treated. Transient perineal/scrotal pain or dysesthesia was observed in 75 patients (60.5%) and resolved after 3-4 weeks of non-opioid analgesics. There were no perineal infections; however, infections at the port site occurred in 3 patients (2.4%) leading to explantation of the system in all cases. The average number of adjustments to achieve the desired result was 4.3 ± 1.8 (range 2-7). After a mean follow-up of 19.1 ± 2.2 months (range 12-36 months), there was a significant reduction in the mean number of pads/24 h from 8.8 to 1.8 (p<0.001). The overall success rate was 93.8% with 61.6% of the patients being dry and 32.2% of the patients showing improvement. CONCLUSIONS The results of the study demonstrate the safety and efficacy to date of the ATOMS system for treatment of stress urinary incontinence after radical prostatectomy.