Samer Shamout

Stress urinary incontinence in women: Current and emerging therapeutic options

Surgical management of stress urinary incontinence (SUI) is most commonly achieved by midurethral synthetic sling (MUS) insertion as a first-line surgical option. A great deal of research continues to evolve new management strategies to reach an optimal balance of high efficacy and minimal adverse events. This expert opinion review provides a brief and comprehensive discussion of recent advances and ongoing research in the management of SUI, with an emphasis on single-incision mini-slings, vaginal laser treatment, and cell-based therapy. It is based on data obtained from numerous published meta-analyses and original studies identified through literature search. Single-incision mini-slings appear equally effective initially compared with standard MUS (retropubic or transobturator) for the treatment of female SUI; however, this efficacy lacks durability evidence beyond one-year followup. There is a lack of sufficient clinical evidence to currently confirm long-term safety and effectiveness of cell-therapy and non-ablative vaginal laser therapy, besides suggestion of apparent initial safety. There are still significant challenges to overcome before widespread clinical practice of the latter two modalities. Future research should be aimed at identifying groups of patients who might benefit from these minimally invasive therapeutic options.

A cost-utility analysis of artificial urinary sphincter versus AdVance male sling in post prostatectomy stress urinary incontinence: A publicly funded health care perspective

To investigate the long‐term cost‐utility of the artificial urinary sphincter (AUS) compared with Transobturator Retroluminal Sling (AdVance) in the treatment of patients with severe post prostatectomy stress urinary incontinence (PPSUI) from a Canadian provincial health perspective.

Teaching and evaluation of basic urodynamic skills in urology residency programs: Randomized controlled study

Considering the growing role of urodynamic studies (UDS) in urology, we aimed to determine the most effective teaching method with objective evaluation for urodynamic skills, to improve training and patient care.

Short-term evaluation of the adjustable bulbourethral male sling for post-prostatectomy urinary incontinence

The Argus perineal sling is a minimally invasive surgical option to treat post‐prostatectomy stress urinary incontinence (PPSUI). This study retrospectively evaluated the short‐term clinical outcomes with the Argus sling for PPSUI management and determined the effects of potential preoperative parameters on intraoperative retrograde leak point pressure (RLPP).

MP32-14 A COST-EFFECTIVENESS ANALYSIS OF ARTIFICIAL URINARY SPHINCTER VERSUS ADVANCE MALE SLING IN POST PROSTATECTOMY STRESS URINARY INCONTINENCE: A CANADIAN PERSPECTIVE

INTRODUCTION AND OBJECTIVES: The artificial urinary sphincter (AUS) remains the 00gold standard00 for the treatment of post prostatectomy stress urinary incontinence (PPSUI). However, in recent years, minimally invasive, less expensive sling device (AdVance) are offered as potential alternative treatments. We sought to investigate the long-term cost-utility of the AUS compared with Transobturator Retroluminal Repositioning Sling (AdVance) in the treatment of severe PPSUI. METHODS: A Markov model with Monte-Carlo simulation was developed to estimate the incremental cost-effectiveness ratio (ICER) of AUS vs. AdVance sling from a provincial payer perspective over a 10-year period. Probability estimates, success rates, healthcare resources and utilities were obtained from published literature when available or by expert opinion. Cost data included in this model were obtained from provincial health care insurance system and hospital data in 2016-Canadian Dollars. RESULTS: AUS Implantation had a 10-year mean total cost of

PD41-09 TEACHING AND EVALUATION OF BASIC URODYNAMIC SKILLS: QUEBEC UROLOGY RESIDENT EXPERIENCE

12299 (SD 3509) for 8.53 quality-adjusted life years (QALYs). On the other hand, AdVance sling had a mean total cost of

MP38-17 METABOLOMIC ANALYSIS OF CANDIDATE URINARY MARKERS OF OVERACTIVE BLADDER SYNDROME IN AN AGING FEMALE POPULATION

20675 (SD 12435) for 7.98 QALYs. The cost-utility analysis over a 10-year period showed that AUS becomes cost-effective when compared to AdVance sling starting the 4th year in the treatment period. The incremental cost savings of AUS over 10-year period was

Metabolomic analysis of candidate urinary markers of overactive bladder syndrome in an aging female population: Pilot Prospective Study

8376 with an added effectiveness of 0.55 QALYs. Consequently, the AUS implementation is the dominant strategy over the AdVance sling over a 5and 10-year time-horizon. CONCLUSIONS: Although the initial cost of sling is attractive, superior long-term outcomes are demonstrated with durable high success rate of AUS in men with severe PPSUI. Hence, the AUS implementation strategy over a 10-year period time is estimated to be more economical to our health care system. More studies are needed to define utility values for health states experienced by males with PPSUI. This will enhance our ability to develop more accurate cost-utility models.

A Cost-Effectiveness Analysis of Artificial Urinary Sphincter Versus AdVance Male Sling in Post Prostatectomy Stress Urinary Incontinence: A Canadian Perspective

INTRODUCTION AND OBJECTIVES: Patient safety is fundamental to surgical practice and it is critical to ensure surgical training and competence. Little has been published on brain cognitive states during learning and retention of basic Robot-Assisted Surgical skills. We sought to evaluate the feasibility of utilizing a novel brain functional states to evaluate surgical competency. METHODS: 27 medical students were evaluated while performing four key tasks of the validated Fundamental Skills of Robot Surgery (FSRS) Curriculum and one advanced surgical module the Hands-on Surgical Training (HoST) over six sessions, utilizing the robotic Surgery Simulator (RoSS). The four FSRS tasks evaluated were Instrument Control Task, Ball Placement Task, Spatial Control II Task, Threading string through a series of hoops and 4th Arm Tissue Retraction. Tool -based metrics were assessed and recorded by RoSS. Brain states are extracted using the pairwise phase synchronization between EEG channels and are presented as functional brain networks. The functional brain networks are then quantified using network statistics, and spectral density of signals for all channels (mental workload). RESULTS: The average mental workload initially increases before significantly decreasing across sessions(Fig 1). This trend is also observed in functional brain states during the four tool-based metrics, as integration and segregation features increase at the beginning of learning and later decrease (Fig 2). We observed significant correlations between brain state and tool-based metrics (RoSS), while performing HOST task, where brain states do not correlate. CONCLUSIONS: We report to our knowledge, the first study that evaluates brain states during skill acquisition and learning after simulation-based training. Various brain areas are functionally activated and integrated while acquiring new skills but these interactions decrease after preliminary learning.