Patient perspective of long-term outcome of augmentation cystoplasty for neurogenic bladder.

Objectives: Although the urologic outcomes of augmentation cystoplasty for neurogenic bladder dysfunction are well known, additional information about the patient perspective is needed. The aim of this study was to assess patient perspective using a standardized questionnaire.

Methods: Fifty-nine patients, who had undergone augmentation enterocystoplasty as part of reconstruction mainly to correct hyperactive bladders and incontinence, were subjected to a questionnaire after a median of 76.

Early experience with intraoperative cavernous nerve stimulation with penile tumescence monitoring to improve nerve sparing during radical prostatectomy.

Objectives: To determine if intraoperative stimulation of the cavernous nerves while monitoring changes in penile tumescence to map the course of these nerves would result in an improvement in nerve sparing and erectile function after radical prostatectomy.

Methods: Patients were eligible for this pilot study if they were undergoing a radical prostatectomy and were candidates for a nerve-sparing approach. Erectile function was assessed by patient self-reporting and questionnaire before surgery and by patient self-reporting periodically 12 months after surgery.

Collagen injections for genuine stress urinary incontinence: patient selection and durability.

The questions of patient selection parameters and durability of response in the use of collagen injections for genuine stress incontinence are addressed. A total of 181 women with a mean age of 64 years (range 26-94) underwent collagen injections for urethral incompetence. Treatment outcome was determined by a change in individual incontinence grades before and after injection.

Followup of intraurethral collagen for female stress urinary incontinence.

Purpose: We studied patient selection parameters and durability of response of collagen injections for female stress incontinence.

Materials And Methods: A total of 187 women 15 to 87 years old (mean age 63) underwent collagen injections for urethral incompetence. Treatment outcome was determined by a change in individual incontinence grades before and after injection.

The artificial urinary sphincter for post-radical prostatectomy incontinence: impact on urinary symptoms and quality of life.

Purpose: We addressed the impact of the artificial urinary sphincter on the health related quality of life and urinary symptoms in men with post-radical prostatectomy incontinence.

Materials And Methods: A total of 30 men with an AMS800 artificial urinary sphincter following radical prostatectomy responded to a questionnaire dealing with the impact of the symptoms on activities of daily living and quality of life. We compared these results to those of 31 patients who underwent radical prostatectomy but did not require an artificial urinary sphincter.

Magnetic resonance imaging after intraurethral collagen injected for stress urinary incontinence.

Purpose: Magnetic resonance imaging (MRI) was performed to evaluate the results of intraurethral collagen injected stress urinary incontinence.

Materials And Methods: A total of 32 women underwent MRI of the pelvis at a median of 12 months after the last injection. The appearance, volume and position of the intraurethral collagen were assessed by 1 radiologist blinded to the outcome, and these findings were compared to clinical data to identify predictive features of success.

Laparoscopic Burch bladder neck suspension: early results.

Purpose: The Burch suspension is an effective treatment for stress urinary incontinence due to hypermobility. To decrease the associated morbidity and hospital stay, we attempted the procedure laparoscopically in 46 women.

Materials And Methods: All patients had stress incontinence with bladder neck hypermobility.

Penile prosthesis insertion with corporeal reconstruction with synthetic vascular graft material.

Difficulty with penile prosthesis insertion may be encountered in patients with severe cavernous scarring or tunica albuginea deficiencies. Eleven patients who underwent penile prosthesis implantation required simultaneous corporeal reconstruction due to prior prosthesis infection and/or erosion in 6, priapism in 2 and Peyronie's disease in 1. One patient underwent prior neophallus construction with a tubularized abdominal wall flap for gender reassignment and 1 had congenitally deficient corporeal bodies.

Periurethral injection of collagen in the treatment of urinary stress incontinence: ultrasonographic appearance.

Objective: To describe the ultrasonographic appearance of collagen injected periurethrally to treat urinary stress incontinence.

Patients And Methods: Transvesical and transvaginal ultrasonography (US) was performed 26 times in 23 patients 3 to 36 months after periurethral injection of collagen to treat symptomatic urinary stress incontinence. The patients ranged in age from 23 to 86 (median 54) years.

Inverted papilloma of the upper urinary tract.

Inverted papillomas of the upper urinary tract are rare lesions that have a male predominance. The associated symptoms are similar to those of other urothelial neoplasms. The tumors are considered benign and local excision has been advocated by many but long-term followup is lacking.

Acute urinary retention in men: a comparison of voiding and nonvoiding patients after prostatectomy.

Multiple parameters were examined preoperatively to determine if any could predict successful voiding after prostatectomy in male patients who present in acute urinary retention due to benign prostatic hypertrophy. A total of 50 men 50 to 85 years old (mean age 69.5 years) who presented with this clinical picture was investigated with multichannel urodynamic studies, and completed the American Urological Association (AUA) symptom score for benign prostatic hypertrophy preoperatively and postoperatively.

Urodynamic comparison of ileum vs. sigmoid in augmentation cystoplasty for neurogenic bladder dysfunction.

We performed multichannel urodynamics before and after augmentation cystoplasty in 26 patients (11 females, 15 males) to determine which bowel segment is best to achieve a large volume and low pressure reservoir. All 26 patients had a neurogenic cause for their bladder dysfunction. Ileum was used in 14 patients and sigmoid was used in 12 patients.

Urinary undiversion in adults with myelodysplasia: long-term followup.

A total of 14 women and 6 men 19 to 39 years old (mean age 27 years) with myelodysplasia underwent undiversion 8 to 29 years (mean 16) after ileal conduit diversion. The main reasons for diversion were incontinence in 17 patients and failed ureteral reimplants in 3, and those for undiversion were a desire for an improved quality of life in 16, increasing hydronephrosis in 4 and stomal problems in 3. Preoperative assessment included upper and lower tract imaging, and video urodynamics.

Topical minoxidil in the treatment of male erectile dysfunction.

Topically applied 2% minoxidil solution has been reported to increase diameter, rigidity and arterial flow to the penis. As a result it has been suggested as a possible treatment for erectile dysfunction. A total of 21 patients received 2% minoxidil for treatment of erectile dysfunction with instructions to apply 1 cc of the solution slowly over the glans penis 20 minutes before intercourse.

Experience with the hemi-Kock ileocystoplasty with a continent abdominal stoma.

We describe our experience with the hemi-Kock ileocystoplasty with a continent abdominal stoma as an alternative to an indwelling catheter or supravesical diversion in 14 women and 4 men with various problems who could not perform intermittent urethral self-catheterization. The aim of management was also to provide, if possible, a competent urethra for additional access. Mean patient age was 37 years (range 22 to 75) and mean followup was 26 months (range 5 to 58).

Early experience with intraurethral collagen injections for urinary incontinence.

We report on 41 patients (10 men and 31 women) who underwent collagen injections for urethral incompetence. Mean followup was 6 months (range 3 to 11 months) in men cured or improved, 8.4 months (range 3 to 15 months) in women who were cured and 4.

The value of immediate or early catheterization of the traumatized posterior urethra.

A total of 16 patients with posterior urethral ruptures was treated with the aim of reestablishing urethral continuity immediately or early after injury. Followup ranged from 13 to 83 months (average 27). In all patients an emergency retrograde urethrogram demonstrated extravasation from the posterior urethra.

Fascial slings and bladder neck tapering in the treatment of male neurogenic incontinence.

Intractable incontinence in selected male patients with a neurogenic bladder has been treated by increasing bladder compliance with augmentation cystoplasty and increasing urethral resistance with the artificial urinary sphincter. However, there are a number of complications associated with the use of an artificial urinary sphincter. As an alternative, we performed bladder neck tapering and bladder neck slings in 13 men with a neurogenic bladder and an incompetent urethra (10 with spina bifida and 3 with spinal cord injury) undergoing bladder augmentation.

Risk factors associated with penile prosthesis infection.

We reviewed all 269 patients who underwent penile prosthetic implantation during the last 10 years. The data were analyzed to determine the rate of penile prosthesis infection and to determine the risk factors associated with these infections in this group. We also examined the effect of strict surgical technique, intraoperative scrub and perioperative antibiotics on these implant infections.

Evaluation and treatment of blunt renal trauma.

We examined retrospectively the records of 126 patients with blunt renal trauma to determine the criteria for radiological investigations and the imaging study of choice. Of the 3,993 patients admitted to our regional trauma unit during the last 13 years 126 (3.1%) had blunt renal trauma.