Opioid-Limiting Pain Control After Transurethral Resection of the Prostate: A Randomized Controlled Trial.

Objective: To assess whether a multimodal opioid-limiting protocol and patient education intervention can reduce postoperative opioid use following transurethral resection of the prostate.

Methods: This prospective, non-blinded, single-institution, randomized controlled trial (NCT04102566) assigned 50 patients undergoing a transurethral resection of the prostate to either a standard of care control (SOC) or multimodal experimental group (MMG). The intervention included adding ibuprofen to the postoperative pain regimen, promoting appropriate opioid use while hospitalized, an educational intervention, and discharging without opioid prescription.

A "Needling" Complication.

Intracavernosal injection therapy with vasoactive agents for treatment of erectile dysfunction has been around for more than 3 decades since its advent in the early 1980s. Common complications include ecchymosis and hematoma at the site of injection, priapism, and fibrosis. We describe a rare but potentially dangerous complication of breakage of needle during administering of injections, and discuss its successful retrieval.

Long-term follow-up of polypropylene bone anchored slings.

Introduction: The transvaginal bone anchored polypropylene sling (BAS) has proven to be a successful treatment for patients with SUI. However, there is limited data on long-term outcomes following BAS with polypropylene mesh. We report our series of patients who had at least 3 years of follow-up after placement of BAS.

Bladder sensation measures and overactive bladder.

Purpose: We performed a prospective multicomponent study to determine whether subjective and objective bladder sensation instruments may provide data on sensory dysfunction in patients with overactive bladder.

Materials And Methods: We evaluated 70 prospectively enrolled patients with urodynamics and questionnaires on validated urgency (Urgency Perception Score), general overactive bladder (Urogenital Distress Inventory) and quality of life (Incontinence Impact Questionnaire). We first sought a correlation between sensory specific (Urgency Perception Score) and quality of life questionnaire scores.

Outcomes following mid-urethral sling placement in patients with intrinsic sphincteric deficiency: comparison of Sparc and Monarc slings.

Purpose: The treatment of patients with intrinsic sphincteric deficiency (ISD) remains difficult. It is theorized that differing vectors of support provided by retropubic versus transobturator mid-urethral sling routes may affect outcomes. We sought to compare outcomes of patients undergoing SPARC versus MONARC sling types in patients with Valsalva leak point pressures (VLPPs) below 60 cm H2O.

Transvaginal bone-anchored sling for the treatment of female stress urinary incontinence: effect of Valsalva leak point pressure and prior pelvic surgery on outcomes.

The effect of lower Valsalva leak point pressure (VLPP) and previous pelvic surgery on outcomes following sling surgery is controversial. We assessed outcomes following bone-anchored sling (BAS) placement in patients with intrinsic sphincteric deficiency (ISD) and previous pelvic surgery. A retrospective review of 149 patients undergoing BAS placement was performed.

Cadaveric fascial sling with bone anchors: minimum of 24 months of follow-up.

Objectives: Available published studies to define outcomes using cadaveric fascia for transvaginal urethral sling placement have revealed, in general, disappointing outcomes. However, limited data exist detailing long-term outcomes using this sling type and, more specifically, fascial grafts prepared using solvent-dehydrated techniques. We present our long-term outcomes using non-frozen solvent-dehydrated cadaveric fascia lata for transvaginal urethral sling placement with bone anchors.

Minimum 24-month followup of the sling for the treatment of stress urinary incontinence.

Purpose: The SPARC procedure is a retropubic approach for the placement of a synthetic polypropylene sling for stress urinary incontinence. Although the approach appears to be efficacious, there still exist limited long-term data. We report our experience with SPARC at a minimum followup of 24 months.

Comparison of laparoscopic and abdominal sacrocolpopexy for the treatment of vaginal vault prolapse.

Background And Purpose: Laparoscopic sacrocolpopexy (LSCP) offers a minimally invasive treatment for vaginal vault prolapse. We describe the surgical technique and offer insight into the learning curve. In addition, we performed a case series review comparing the laparoscopic procedure with its open surgical counterpart with respect to various demographic and perioperative parameters.

Vesicovaginal fistula and mesh erosion after Perigee (transobturator polypropylene mesh anterior repair).

The transobturator polypropylene mesh system is a new approach in the surgical treatment of anterior vaginal wall prolapse. We report the case of a 57-year-old woman who developed a vesicovaginal fistula with erosion of the mesh into the bladder and vagina after Perigee transobturator, polypropylene mesh anterior repair. This is a serious complication associated with this technique.

High rate of vaginal erosions associated with the mentor ObTape.

Purpose: The transobturator tape method is a newer surgical technique for the treatment of stress urinary incontinence. Limited data exist related to complications with this approach or the types of mesh products used. We report our experience with vaginal erosions associated with the Mentor ObTape and American Medical Systems Monarc transobturator slings.

Suitability of different sling materials for the treatment of female stress urinary incontinence.

Stress urinary incontinence (SUI) is defined as leakage of urine with a sudden increase in intra-abdominal pressure, such as that seen with laughing, lifting, or changing position, without a concomitant rise in detrusor (bladder-generated) pressure. The proposed mechanism of SUI is that an increase in intra-abdominal pressure resulting from various activities causes the bladder pressure to rise above the urethral pressure. The pubovaginal sling remains the standard treatment for female SUI in the US.

Incidence and management of abdominal sacrocolpopexy mesh erosions.

Objective: This study was undertaken to evaluate the occurrence and management of mesh erosions in patients undergoing abdominal sacrocolpopexy.

Study Design: A retrospective chart review of the abdominal sacrocolpopexy procedure (n = 92) between 1997 and 2003 was performed. Patients with mesh erosion were identified.

High complication rate identified in sacrocolpopexy patients attributed to silicone mesh.

Objectives: To report on our experience using a preconfigured Y-shaped silicone-coated polyester mesh and polypropylene mesh for vaginal vault suspension. A variety of materials have been used for both open and laparoscopic sacrocolpopexy in the management of vaginal vault prolapse. Recently, a preconfigured Y-shaped silicone-coated polyester mesh was introduced to facilitate the vaginal cuff suspension to the sacrum.

Perioperative complications: the first 140 polypropylene pubovaginal slings.

Purpose: Two widely used tensionless mid urethral slings currently available are the SPARC polypropylene sling (American Medical Systems, Minneapolis, Minnesota) and the TVT (tensionless vaginal tape, Ethicon, New Brunswick, New Jersey). As with the TVT system, the SPARC has been suggested as an outpatient procedure. We present the early complications of our first 140 slings, based on which we recommend that observation of all patients overnight following the SPARC sling be considered.

Management of vaginal erosion of polypropylene mesh slings.

Purpose: The SPARC (American Medical Systems, Minneapolis, Minnesota) polypropylene sling has recently been introduced as an alternative delivery system to TVT (Ethicon, New Brunswick, New Jersey) tension-free vaginal tape for placement of a tension-free mid urethral sling. Erosion must always be considered a risk of synthetic materials. We present 4 cases of vaginal erosion of polypropylene mesh placed with this system and the successful conservative management done.

Continued multicenter followup of cadaveric prolapse repair with sling.

Purpose: Since our initial description of the technique of combining a transvaginal sling with a cystocele repair using solvent dehydrated cadaveric fascia lata and bone anchors we have continued to follow our outcomes closely to determine long-term results. We present the updated, multicenter results of the cadaveric prolapse repair with sling.

Materials And Methods: A total of 172 patients 35 to 90 years old (mean age 62.

Intermediate term failure of pubovaginal slings using cadaveric fascia lata: a case series.

Purpose: The pubovaginal sling procedure using autologous fascia has become the gold standard for treating intrinsic sphincter deficiency and stress urinary incontinence in women. A recent modification has been the use of cadaveric fascia as the sling material. We recently reported similar results for cadaveric fascia lata in 121 women and autologous fascia lata in 46 at a mean followup of 12 months.