Rebecca S. Lavelle

Comparative effectiveness of perineal versus retropubic and minimally invasive radical prostatectomy.

PURPOSE While perineal radical prostatectomy has been largely supplanted by retropubic and minimally invasive radical prostatectomy, it was the predominant surgical approach for prostate cancer for many years. In our population based study we compared the use and outcomes of perineal radical prostatectomy vs retropubic and minimally invasive radical prostatectomy. MATERIALS AND METHODS We identified men diagnosed with prostate cancer from 2003 to 2005 who underwent perineal (452), minimally invasive (1,938) and retropubic (6,899) radical prostatectomy using Surveillance, Epidemiology and End Results-Medicare linked data through 2007. We compared postoperative 30-day and anastomotic stricture complications, incontinence and erectile dysfunction, and cancer therapy (hormonal therapy and/or radiotherapy). RESULTS Perineal radical prostatectomy comprised 4.9% of radical prostatectomies during our study period and use decreased with time. On propensity score adjusted analysis men who underwent perineal vs retropubic radical prostatectomy had shorter hospitalization (median 2 vs 3 days, p < 0.001), received fewer heterologous transfusions (7.2% vs 20.8%, p < 0.001) and required less additional cancer therapy (4.9% vs 6.9%, p = 0.020). When comparing perineal vs minimally invasive radical prostatectomy men who underwent the former required more heterologous transfusions (7.2% vs 2.7%, p = 0.018) but experienced fewer miscellaneous medical complications (5.3% vs 10.0%, p = 0.045) and erectile dysfunction procedures (1.4 vs 2.3/100 person-years, p = 0.008). The mean and median expenditure for perineal radical prostatectomy in the first 6 months postoperatively was

Urodynamics findings in transverse myelitis patients with lower urinary tract symptoms: Results from a tertiary referral urodynamic center

1,500 less than for retropubic or minimally invasive radical prostatectomy (p < 0.001). CONCLUSIONS Men who undergo perineal vs retropubic and minimally invasive radical prostatectomy experienced favorable outcomes associated with lower expenditure. Urologists may be abandoning an underused but cost-effective surgical approach that compares favorably with its successors.

Quality of life after suprapubic catheter placement in patients with neurogenic bladder conditions

To characterize urodynamic findings in patients referred with transverse myelitis (TM) and lower urinary tract symptoms (LUTS), as well as to identify any characteristics predictive of urodynamics findings.

Urodynamics for incontinence after midurethral sling removal

To evaluate quality of life in patients with neurogenic bladder (NGB) conditions who have elected to undergo suprapubic catheterization (SPC), as well as assess adverse events (AEs) related to the procedure.

Prolapse Recurrence after Transvaginal Mesh Removal

We reviewed the role of urodynamics (UDS) in the management of women with incontinence following mid‐urethral sling removal (MUSR).

An 84-year-old female with gross hematuria.

PURPOSE We determined the rate of pelvic organ prolapse recurrence after transvaginal mesh removal. MATERIALS AND METHODS Following institutional review board approval a longitudinally collected database of women undergoing transvaginal mesh removal for complications after transvaginal mesh placement with at least 1 year minimum followup was queried for pelvic organ prolapse recurrence. Recurrent prolapse was defined as greater than stage 1 on examination or the need for reoperation at the site of transvaginal mesh removal. Outcome measures were based on POP-Q (Pelvic Organ Prolapse Quantification System) at the last visit. Patients were grouped into 3 groups, including group 1--recurrent prolapse in the same compartment as transvaginal mesh removal, 2--persistent prolapse and 3--prolapse in a compartment different than transvaginal mesh removal. RESULTS Of 73 women 52 met study inclusion criteria from 2007 to 2013, including 73% who presented with multiple indications for transvaginal mesh removal. The mean interval between insertion and removal was 45 months (range 10 to 165). Overall mean followup after transvaginal mesh removal was 30 months (range 12 to 84). In group 1 (recurrent prolapse) the rate was 15% (6 of 40 patients). Four women underwent surgery for recurrent prolapse at a mean 7 of months (range 5 to 10). Two patients elected observation. The rate of persistent prolapse (group 2) was 23% (12 of 52 patients). Three women underwent prolapse reoperation at a mean of 10 months (range 8 to 12). In group 3 (de novo/different compartment prolapse) the rate was 6% (3 of 52 patients). One woman underwent surgical repair at 52 months. CONCLUSIONS At a mean 2.5-year followup 62% of patients (32 of 52) did not have recurrent or persistent prolapse after transvaginal mesh removal and 85% (44 of 52) did not undergo any further procedure for prolapse. Specifically for pelvic organ prolapse in the same compartment as transvaginal mesh removal 12% of patients had recurrence, of whom 8% underwent prolapse repair.

PD10-05 UTILIZING MORE RESTRICTIVE CRITERIA FOR OBTAINING URODYNAMICS IN WOMEN WITH MULTIPLE SCLEROSIS DOES NOT RESULT IN MORE WORRISOME FINDINGS

CASE An 84-year-old female presented to the emergency department with a chief complaint of painless gross hematuria for 2 days. She had a past medical history of pancreatic adenocarcinoma status post–Whipple procedure in 2004 followed by adjuvant chemoradiotherapy, diabetes mellitus, diastolic congestive heart disease, and osteoporosis. Regarding her pancreatic cancer, she developed further recurrence of her disease at her umbilicus, for which she received salvage gemcitabine and further radiotherapy. Her umbilical mass did not reduce in size and she had further progression of her disease with metastases to the liver, lungs, and spine. During urological consultation, the patient reported no prior episodes of gross hematuria but a significant history of chronic nocturia and urinary frequency. She denied any history of urinary tract infections, nephrolithiasis, or other genitourinary complaints. She had no history of tobacco use or occupational/chemical exposure. She denied dysuria, fevers, chills, nausea, vomiting, flank pain, weight loss, or changes in bowel movements. On examination, she was noted to have a well-healed chevron incision and palpable umbilical mass, and she voided wine-colored urine with small clots. The remainder of the physical examination was otherwise unremarkable. Recent routine blood tests, including hemoglobin, hematocrit, liver function tests, and coagulation studies, were within normal limits. Her urinalysis revealed microscopic hematuria and was otherwise unremarkable. A computed tomography urogram was obtained and revealed extensive blood clots within the urinary bladder and a suspicious mass along the posterior wall just medial to the left ureterovesical junction (Fig. 1). The kidneys and ureters were normal in appearance. Her umbilical mass was stable in size and there was an interval increase in her metastatic disease.

MP75-11 LONG-TERM OUTCOME OF UTERINE SPARING PROCEDURE AS PART OF ANTERIOR VAGINAL WALL SUSPENSION.

all patients spontaneously emptied their bladder with a low post-void residual volume. Conversely, detrusor overactivity was not observed in healthy subjects. H reflex size was significantly inhibited in healthy subjects at MCC (p<0.001), whereas it remained almost unchanged in MS patients (p1⁄40.71). BoNT/A intradetrusorial injections induced no significant effect on the H reflex size in MS patients. CONCLUSIONS: While H reflex significantly changed at MCC in healthy subjects, it remained unchanged in MS patients. This suggests that in MS patients, despite the prominent suprapontine lesion load, OAB symptoms mainly reflect spinal cord dysfunction. Additionally, the neurotoxin produced no significant effect on the H reflex size. The observation that BoNT/A modulates bladder filling sensation but leaves urodynamic variables testing muscle strength unchanged support the hypothesis that BoNT/A injected into the detrusor muscle modulates bladder afferent information.

Risk of Prolapse Recurrence after Native Tissue Anterior Vaginal Suspension Procedure with Intermediate to Long-Term Followup

and QoL consistently improved post-operatively, and remained stable over time (Table 1). VCUG findings also improved for urethral support and cystocele reduction. Additional therapy with sling (4) or injectable agents (8) was required in 12 (6%) women at a median of 3.8 (1.2-10.3) years. CONCLUSIONS: The AVWS procedure can durably correct SUI by restoration of anatomical support to the bladder neck and bladder base. Reference: 1. Wilson TS, Zimmern PE: Anterior Vaginal Wall Suspension, Female Urology, Urogynecology, and Voiding Dysfunction, Vasavada, Appell, Sand, and Raz, Section I, Chapter 17, 283-290, Marcel Dekker, 2005