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Surgery to Improve Bladder Outlet Function
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Dayron Rodríguez, Philippe E. Zimmern
Since 1973, the artificial urinary sphincter (AUS) (Figure 32.1) has provided high rates of efficacy and patient satisfaction, but also substantial revision rates secondary to mechanical failure, infection, and erosion resulting in sphincter removal.
The urinary bladder
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Patients with GSI should be treated by means of pelvic floor exercises initially. Duloxetine can be used as medical treatment for GSI. Bulking agents, such as macroplastique, can be used and can provide good temporary solutions. Surgical treatment by means of colposuspension or TVT may be needed. Those with post-prostatectomy incontinence or neurogenic bladder dysfunction may need to be fitted with an artificial urinary sphincter (see Figure77.19), if they are well motivated and mobile, but careful assessment is required.
Complications of Stress Urinary Incontinence Surgery
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
Véronique Phé, Emmanuel Chartier-Kastler
ArtificiAl Urinary sphincter is the treAtment of femAle severe SUI with intrinsic sphincter deficiency, most often After fAilure of other surgicAl treAtments And As A "lAst treAtment." This surgery is only performed by experienced And trAined teAms [39,40] due to the technicAl difficulties relAted to the short femAle urethrA or A history of locAl surgery responsible for the morbidity of this operAtion [41]. IntrAoperAtive ComplicAtions In cAse of blAdder injury, locAlizing precisely the injuries by opening the blAdder dome Allows to repAir And does not prevent from implAnting the device if correctly repAired [40,42]. It is of trAined center expert opinion thAt Any injury At the level of the blAdder neck or posterior urethrAl portion indicAtes not to implAnt the device. Any blAdder injury fAr AwAy from the blAdder neck, either involuntAry or voluntAry done As An eye control of dissection, do not contrAindicAte implAntAtion of the cuff. vAginAl injury is rAre And leAds to stop the procedure when it is locAted posteriorly to the blAdder neck And/or urethrA, in front of cuff plAcement. Any vAginAl injury (lAterAl on cul-desAc) mAy not stop the surgery And must be cArefully repAired. The cuff mAy be inserted except in Any other intrAoperAtive complicAtion. PostoperAtive Period PostoperAtive Acute Urinary retention cAn occur And leAds to A new indwelling cAtheter insertion for At leAst 48 hours [40]. usuAlly, it is of interest to let A cAtheter until dAy 5 or 6 to
Management of stress urinary incontinence in spinal cord injured female patients with a mid-urethral tape – a single center experience
Published in The Journal of Spinal Cord Medicine, 2018
Vasileios I. Sakalis, Michael S. Floyd, Philippa Caygill, Chloe Price, Ben Hartwell, Peter J. Guy, Melissa C. Davies
Nine patients (23.7%) develop tape related complications. There were five de novo urgency episodes, three after TVT and two after TOT. It is unclear whether this was due to a stimulation of proximal urethral afferent receptors or if it was due to a change in bladder behavior as a result of SCI. All were noted to have had flat traces in their pre-operative VUDS and documented detrusor overactivity postoperatively. There was a single case of vaginal extrusion following TOT necessitating tape removal at 4 months. Another patient had frequent dysreflexia episodes postoperatively and part of the tape was excised. One patient reported worsening of incontinence and increasing leakage from her SPC site. These three patients subsequently underwent clam ileocystoplasty and insertion of an artificial urinary sphincter with the cuff placed around the bladder neck.
Gonococcal epididymo-orchitis in an octogenarian
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
This case is of an eighty-one-year-old Caucasian gentleman with a prior medical history of recurrent urinary tract infections, prostate cancer followed by prostatectomy, and urinary incontinence for which he underwent permanent placement of an artificial urinary sphincter (AUS). He presented to the emergency department with right-sided perineal pain, radiating towards his lower back, along with rigors and chills, for five days. He denied dysuria, urinary urgency, urethral discharge, scrotal erythema or swelling. He was sexually active, however denied a history of previous sexually transmitted infections. Review of his social history elicited high risk sexual behavior with five sexual partners in the preceding year.
The AdVance™ male sling: does it stand the test of time?
Published in Scandinavian Journal of Urology, 2021
Ishtiakul G. Rizvi, Pravisha Ravindra, Michelle Pipe, Ridwaan Sohawon, Thomas King, Mohammed Belal
Radical prostatectomy (RP) represents the most common cause of stress urinary incontinence (SUI) in men [1]. Current rates are cited as 21.3% after robotic RP and 20.2% after open RP at 12 months with the definition used being patients requiring at least one pad change in 24 h [2]. Other causes of SUI in men include radical cystectomy with neo-bladder, transurethral resection of prostate as well as laser enucleation of prostate. There are a number of commercially available devices to surgically treat the condition. The artificial urinary sphincter (AUS) is considered the gold standard, achieving continence rates of 82–92% (0–1 pad/24 h) but there is a growing number of male sling devices on the market [3].