Tamsin Greenwell

THE LONG-TERM OUTCOME OF ARTIFICIAL URINARY SPHINCTERS

PURPOSE We reviewed the outcome of artificial urinary sphincters inserted more than 10 years ago. MATERIALS AND METHODS We analyzed the records of 100 patients and mailed a questionnaire to those without recent followup. RESULTS Overall 84 patients were continent, including 36 with the original artificial urinary sphincter in place who were dry at a median followup of 11 years and 27 in whom the device was successfully replaced due to mechanical failure who were previously continent for a median of 7 years. In 21 patients it was removed due to infection or erosion and reimplantation was successful 3 to 6 months later or they remained dry without another artificial urinary sphincter. Of the male patients with a bulbar and bladder neck sphincter 92% and 84%, respectively, were continent at 10 years as well as 73% of the females. Device survival was 66% at 10 years. Overall 37% of the prostheses were removed due to infection or erosion in the 10-year period with the highest risk in females (56%) and lowest in males with a bulbar sphincter (23%). CONCLUSIONS The artificial urinary sphincter is effective long-term treatment for incontinence in male patients. In female patients the risk of erosion is high, although overall long-term continence is satisfactory.

Augmentation cystoplasty: AUGMENTATION CYSTOPLASTY

Many patients with small-capacity, high-pressure, poorly compliant or unstable bladders will be managed successfully with pharmacological or other conservative measures. A small but signi®cant minority of these patients will require surgical intervention, the therapeutic goals of which are to provide urinary storage whilst preserving renal function, continence, resistance to infection and convenient voluntary and complete emptying.

The past, present and future of augmentation cystoplasty

Whats known on the subject? and What does the study add?

The outcome of renal denervation for managing loin pain haematuria syndrome.

To evaluate the outcome of renal denervation for the treatment of loin pain‐haematuria syndrome (LPHS), a rare syndrome of unknown cause associated with debilitating and intractable loin pain.

Routine surveillance cystoscopy for patients with augmentation and substitution cystoplasty for benign urological conditions: is it necessary?

To evaluate screening cystoscopy as the long‐term follow up in patients with an enterocystoplasty for ≥10 years.

Pregnancy after lower urinary tract reconstruction for congenital abnormalities

Authors from London evaluated 20 women with treated and reconstructed congenital urinary tract abnormalities, and assessed the effect this might have on renal function, pregnancy and delivery. They found that pregnancy had no long‐term effect on renal function and did not compromise reconstruction. However, there was a substantial complication rate and an increased need for Caesarean section. Nevertheless they felt pregnancy in women such as these is safe for mothers and baby.

A tertiary experience of urethral diverticulectomy: diagnosis, imaging and surgical outcomes

To review the outcomes of consecutive patients referred with urethral diverticula to a tertiary centre; to investigate the diagnostic, imaging and surgical factors relevant to success.

Standing the test of time: the long-term results of urethroplasty

The principle indication for urethral surgery is stricture disease. There are a number of factors that influence the outcome of surgery including location of the stricture, stricture length, aetiology, previous surgery and selection of procedure. Outcomes for different techniques are summarised. The gold standard remains anastomotic urethroplasty, where appropriate, with patch urethroplasty or two-stage stage procedures for more complicated strictures especially the penile urethra.

Treatment of pelvic fracture-related urethral trauma: a survey of current practice in the UK.

Authors from London carried out a survey of current practice for treating urethral trauma associated with pelvic fracture in the UK. The interesting findings are described, and it is suggested that even within specialised units such cases are uncommon, and that surgical management often differs significantly from what might be published by so‐called experts in the field.

A TERTIARY EXPERIENCE OF VESICO-VAGINAL AND URETHRO-VAGINAL FISTULA REPAIR: FACTORS PREDICTING SUCCESS

To review the outcomes of all patients referred with vesico‐vaginal (V VF) and urethro‐vaginal (UVF) fistulae to a tertiary centre, and to investigate the patient, fistula and surgical factors relevant to success.