Artificial urinary sphincter for neurogenic urinary incontinence: a narrative review.

Background And Objective: The artificial urinary sphincter (AUS) is most known for its use in the treatment of moderate to severe post-prostatectomy stress urinary incontinence. However, another lesser-known indication includes stress incontinence related to intrinsic sphincter deficiency (ISD) in the neurogenic bladder population. The purpose of this review is to discuss specific technical considerations related to device implantation in this population, efficacy, durability, and complications.

Automated surgical step recognition in transurethral bladder tumor resection using artificial intelligence: transfer learning across surgical modalities.

Objective: Automated surgical step recognition (SSR) using AI has been a catalyst in the "digitization" of surgery. However, progress has been limited to laparoscopy, with relatively few SSR tools in endoscopic surgery. This study aimed to create a SSR model for transurethral resection of bladder tumors (TURBT), leveraging a novel application of transfer learning to reduce video dataset requirements.

The "Minimal-Touch" Technique for Artificial Urinary Sphincter Placement: Description and Outcomes.

Objective: The study aimed to describe "minimal-touch" technique for primary artificial urinary sphincter placement and evaluate early device outcomes by comparing it with a historical cohort.

Materials And Methods: We identified patients who underwent primary artificial urinary sphincter placement at our institution from 1983 to 2020. Statistical analysis was performed to identify the rate of postoperative device infection in patients who underwent minimal touch versus those who underwent our traditional technique.

Emerging Nonpharmacologic Interventions to Treat Diabetic Peripheral Neuropathy.

Diabetic peripheral neuropathy (DPN), a complication of metabolic syndrome, type I and type II diabetes, leads to sensory changes that include slow nerve conduction, nerve degeneration, loss of sensation, pain, and gate disturbances. These complications remain largely untreatable, although tight glycemic control can prevent neuropathy progression. Nonpharmacologic approaches remain the most impactful to date, but additional advances in treatment approaches are needed.

A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery.

Objective: The artificial urinary sphincter (AUS) is the gold standard for severe male stress urinary incontinence, though evaluations of specific predictors for device outcomes are sparse. We sought to compare outcomes between primary and revision AUS surgery for non-infectious failures.

Methods: We identified 2045 consecutive AUS surgeries at Mayo Clinic (Rochester, MN, USA) from 1983 to 2013.

The Wisdom of the Crowd: Reliable Deep Reinforcement Learning Through Ensembles of Q-Functions.

Reinforcement learning (RL) agents learn by exploring the environment and then exploiting what they have learned. This frees the human trainers from having to know the preferred action or intrinsic value of each encountered state. The cost of this freedom is that RL is slower and more unstable than supervised learning.

Noninitiation of Discharge Medications After Revascularization.

Background: Timely initiation of medication therapy after a cardiovascular event is vital to achieve optimal patient outcomes, yet there is a lack of insight on the frequency and predictors of discharge medications that are delayed or never initiated.

Objectives: To (a) describe how frequently patients do not fill newly prescribed discharge medications within 30 days after revascularization and (b) identify predictors of patients who did not fill their new medications.

Methods: A single-center, retrospective analysis was conducted of patients discharged after percutaneous coronary intervention or coronary artery bypass grafting.

The impact of prior external beam radiation therapy on device outcomes following artificial urinary sphincter revision surgery.

Background: Previous reports on the effect of radiation therapy on primary artificial urinary sphincter (AUS) device survival have met with conflicting results, and data evaluating this after revision surgery is sparse. Thus, we evaluated AUS device outcomes after revision surgery, and compared them among individuals who did versus did not undergo prior radiation therapy.

Methods: A database of patients who underwent AUS revision surgery at our institution was used to perform a retrospective review.

Long-term device survival and quality of life outcomes following artificial urinary sphincter placement.

Background: Artificial urinary sphincter (AUS) placement is the standard for treatment of severe male stress urinary incontinence (SUI). While there is evidence to suggest satisfactory device survival, there is a paucity of data addressing long-term quality of life outcomes.

Methods: We identified patients who underwent primary AUS placement from 1983 to 2016.

Reoperation for Urinary Incontinence After Retropubic and Transobturator Sling Procedures.

Objective: To compare the reoperation rates for recurrent stress urinary incontinence (SUI) after retropubic and transobturator sling procedures.

Methods: We conducted a retrospective cohort study of all women who underwent midurethral sling procedures at a single institution for primary SUI between 2002 and 2012. To minimize bias, women in the two groups were matched on age, body mass index, isolated compared with combined procedure, and preoperative diagnosis.

Impact of care coordination based on insurance and zip code.

Objectives: To examine whether a care transitions program, Bridges, differentially reduced rehospitalizations among patients who underwent percutaneous coronary intervention (PCI) based on insurance status and zip code poverty level.

Study Design: Retrospective observational cohort.

Methods: We examined data from a single health system in Delaware, collected as part of a care transitions program for patients who underwent PCI from 2012 to 2015 compared with an unmatched historical control cohort from 2010 to 2011.

National Patterns of Filled Prescriptions and Third-Line Treatment Utilization for Privately Insured Women With Overactive Bladder.

Objective: The aim of this study was to evaluate national patterns of care for women with overactive bladder (OAB) in an administrative data set and identify potential areas for improvement.

Methods: We performed an analysis using the OptumLabs Data Warehouse, which contains deidentified administrative claims data from a large national US health insurance plan. The study included women, older than 18 years, with a new OAB diagnosis from January 1, 2007, to June 30, 2017.

Evaluating the impact of radiation therapy on patient quality of life following primary artificial urinary sphincter placement.

Background: The impact of prior radiation therapy on patient satisfaction following primary artificial urinary sphincter (AUS) placement is not well described, therefore our aim was to evaluate the effect of radiation on patient satisfaction among men undergoing primary AUS with and without a history of prior radiation.

Methods: From 1983-2011, 1,082 men underwent primary AUS placement at our institution. Of these, 467 were alive, with an intact primary AUS and invited to participate in a mailed survey assessing AUS status, patient satisfaction, and urinary control.

Autologous transobturator sling as an alternative therapy for stress urinary incontinence.

Objective: To evaluate efficacy and outcomes of the autologous transobturator midurethral sling for treatment of stress urinary incontinence (SUI).

Methods: In a prospective cohort study, an autologous transobturator mid-urethral sling was used to treat SUI among women attending a university hospital in Montevideo, Uruguay, from June 2017 to July 2018. In the first phase, autologous tissue of the abdominis rectus fascia was collected.

Electric-field enhanced reactivity and migration of iron nanoparticles with implications for groundwater treatment technologies: Proof of concept.

The extensive use of nanoscale zero-valent iron (nZVI) particles for groundwater treatment has been limited, in part, because of their non-selective reactivity and low mobility in aquatic environments. Herein, we describe and explore progressive changes in the reactivity and migration of aqueous dispersed nZVI particles under an applied DC electric field. Due to the applied electric field with an intensity of about 1 V cm, the solution oxidation-reduction potential (ORP) remained as low as -200 mV for at least 32 days, which was in agreement with the persistence of the reduced iron species (mainly Fe(II)), and led to substantially prolonged reactivity of the original nZVI.

Bacterial Cultures at the Time of Artificial Urinary Sphincter Revision Surgery in Clinically Uninfected Devices: A Contemporary Series.

Purpose: We evaluated the rate of bacterial colonization in artificial urinary sphincters during revision surgery for noninfectious etiologies.

Materials And Methods: We evaluated bacterial culture swab data on all explanted artificial urinary sphincter components (cuff, pump and reservoir) in patients who underwent revision surgery between February 2016 and July 2018. Those treated with revision for infection or erosion were excluded from study.

Risk factors for subsequent urethral atrophy in patients undergoing artificial urinary sphincter placement.

Objective: Artificial urinary sphincter (AUS) device failure or revision can be due to multiple etiologies including erosion, infection, mechanical malfunction, and urethral atrophy. However, few studies have evaluated factors that predispose patients to urethral atrophy. Here, we sought to identify preoperative and perioperative risk factors associated with urethral atrophy in men undergoing primary artificial urinary sphincter (AUS) placement for stress urinary incontinence.

Artificial urinary sphincter revision with Quick Connects versus suture-tie connectors: does technique make a difference?

Objective: To evaluate characteristics of artificial urinary sphincter (AUS) mechanical failures and compare outcomes based on the use of either suture-tied connections or Quick-Connects (QC) for single-component revisions.

Material And Methods: A total of 46 patients underwent single-component AUS revisions following primary AUS placement from January 1983 to January 2011 at our institute. Prior to 1996 all revision cases were performed with suture-tie connections and after that time we used QC for revisions.