R. Corey O'Connor

Comparison of outcomes after single or DOUBLE-CUFF artificial urinary sphincter insertion.

OBJECTIVES To assess the effectiveness and complications associated with single and double-cuff artificial urinary sphincter (AUS) implantation for postprostatectomy stress urinary incontinence. METHODS A retrospective study of 56 men with postprostatectomy stress urinary incontinence who underwent either single (28 patients) or double (28 patients) cuff AUS placement was performed. Patients in each cohort were matched on the basis of preoperative pad use, risk factors for complications, and age. Patient selection was blinded relative to outcome. Continence, quality of life, and complications were assessed using the Incontinence Impact Questionnaire Short Form (IIQ-7), postoperative pad use, and chart review. RESULTS The mean age was 67 years for each group. Daily pad use decreased from 7.7 to 1.1 in patients treated with a single-cuff AUS and from 7.8 to 0.7 in patients with a double-cuff AUS (P = 0.25). Complete continence (0 pads daily) was reported in 3 (11%) of 28 men with single-cuff and 12 (43%) of 28 men with double-cuff sphincters (P = 0.008). The IIQ-7 scores improved from 14.8 to 3.1 after single-cuff placement and from 16.3 to 2.5 after double-cuff placement (P = 0.03). With an average follow-up of 41.3 and 21.2 months for the single and double-cuff cohorts, respectively, five complications were reported in the single-cuff recipients and four in the double-cuff patients. CONCLUSIONS A significantly greater rate of complete continence and improvement in the IIQ-7 were seen in men with double-cuff AUS compared with single-cuff devices. Additional study is needed to confirm the relative advantages of double-cuff insertion.

Urethral erosion of transobturator male sling.

The transobturator male sling has been introduced as an alternative to other surgical methods for the treatment of mild to moderate postprostatectomy stress urinary incontinence. We report the first published case of mesh erosion into the urethra observed 5 months after placement. The patient was treated with suprapubic tube urinary diversion, suburethral sling explantation, and buccal mucosal grafting of the urethral defect.

Botulinum toxin outcomes for idiopathic overactive bladder stratified by indication: lack of anticholinergic efficacy versus intolerability.

To determine if the outcomes of intradetrusor botulinum toxin A (BTX‐A) injections for the management of refractory overactive bladder (OAB) symptoms are different if performed due to lack of anticholinergic efficacy versus medication intolerability.

Vesicostomy revisited: the best treatment for the hostile bladder in myelodysplastic children?

Vesicostomy is a well‐known management of the neuropathic bladder in children, and authors from Sacramento describe their experience with this in what they very appropriately name the “hostile bladder” of myelodysplastic children.

Neobladder‐vaginal fistula after cystectomy and orthotopic neobladder construction

To determine the potential surgical and clinical factors that contribute to the development of neobladder‐vaginal fistula (NVF) after cystectomy and orthotopic neobladder (ONB) construction in women.

Unilateral versus bilateral stage I neuromodulator lead placement for the treatment of refractory voiding dysfunction.

To determine if bilateral S3 lead placement during the stage I trial period improves the “success” rate for advancing to stage II (permanent) sacral neuromodulator placement.

Resonance® Metallic Ureteral Stents Do Not Successfully Treat Ureteroenteric Strictures

PURPOSE To report the outcomes of patients with ureteroenteric strictures after ileal conduit urinary diversion that were managed with Resonance metallic ureteral stents. PATIENTS AND METHODS Ten ureteroenteric strictures in patients with ileal conduits that were managed with metallic ureteral stenting were retrospectively identified. Charts were examined for patient age, anastomosis type, stricture cause, stricture laterality, complications, and follow-up. RESULTS Nine of 10 (90%) cases resulted in distal stent migration. Mean time to stent migration was 21 days (range 3-60 d). CONCLUSIONS Placement of Resonance metallic stents in patients with ileal conduits is ineffective for management of ureteroenteric strictures because of the high rate of distal migration.

Self-reported urinary continence outcomes for repeat midurethral synthetic sling placement

OBJECTIVE To evaluate our experience with tension-free transvaginal tape (TVT) placement for the management of stress urinary incontinence (SUI) in women who had previously undergone a failed midurethral synthetic sling (MUS) procedure. MATERIALS AND METHODS Ten women underwent retropubic TVT insertion for continued or recurrent SUI following a prior MUS procedure. No attempt was made to remove the previously placed sling at the time of surgery. A retrospective chart review was performed to obtain perioperative and follow-up patient information. Post-operatively, each patient completed a mailed incontinence questionnaire to assess self-reported urinary continence outcomes. RESULTS All 10 women were available for follow-up at a mean period of 16 months (range 6 to 33). Four of the 10 patients achieved complete continence, and another three patients reported significantly improved continence and quality of life. Three women stated that their continence did not improve. CONCLUSIONS TVT placement may be a viable option for the management of women with persistent or recurrent SUI following an initial MUS procedure.

Incontinent ileovesicostomy: Long-term outcomes and complications.

Incontinent ileovesicostomy was popularized in the mid‐1990s as a surgical option for patients with neurogenic voiding dysfunction who lack the dexterity to perform clean catheterization. There are several case series in the literature, but few studies look at the long‐term outcomes and complications associated with this procedure.

Transitioning Adolescents and Young Adults with a Chronic Health Condition to Adult HealthCare – An Exemplar Program

&NA; Pediatric specialists have successfully improved the longevity and quality of life of many children with chronic health conditions. As these children reach adolescence and young adulthood, the scope of their concomitant medical problems often include those typically seen in older patients. As a result, these individuals need continuing quality health care in focused adult healthcare facilities. This article describes the effective partnership between pediatric and adult healthcare providers to create and implement an exemplar Spina Bifida Transition Program. The processes, strategies and tools discussed are likely to be useful to other healthcare professionals interested in developing pediatric to adult transition programs for adolescents and young adults with chronic health conditions.