Publications by authors named "Ockrim J"
Aims: Insights into the role of the urethra in maintaining continence and in normal voiding have been provided with advances in imaging techniques. Also, functional urethral testing is used to understand which treatments are optimal for women with functional bladder outlet obstruction (BOO), but which testing is better for which treatment? This review aims to describe our current understanding of female urethral function and dysfunction and to provide future research directions for treating functional female urethral disorders.
Materials And Methods: This is a consensus report of the proceedings of a research proposal discussed at the annual International Consultation on Incontinence-Research Society (ICI-RS), 6th-8th June 2024 (Bristol, UK): "Do we need to re-focus on functional female urethral disorders in lower urinary tract dysfunction? ICI-RS 2024".
Objectives: Implantation of an artificial urinary sphincter (AUS) to treat post-prostatectomy incontinence (PPI) has been traditionally offered with an overnight hospital stay. The aim of this prospective, comparative pilot study was to assess the feasibility and outcomes of the AUS procedure in a day-case setting.
Patients And Methods: We included consecutive patients having primary or redo AUS surgery over an 18-month period.
Objective: To present the contemporary evidence on transvaginal urogenital fistulae (UGF) repair with Martius fat pad (MFP), compared to direct graftless fistula repair.
Methods: We reviewed all available studies reporting lower UGF repair via the transvaginal approach in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). The primary outcome of interest was the fistula closure rates.
Introduction: The evidence basis for therapy selection in women who have failed primary stress urinary incontinence (SUI) surgery is limited. The ICI-RS group discussed the available data at its meeting in June 2023, particularly the anatomical characteristics as assessed using magnetic resonance imaging (MRI) and ultrasound (US) modalities, functional characteristics associated with storage and voiding urodynamic assessment, as well as the patient characteristics that might influence outcomes. This paper summarizes the evidence base that supported these discussions and offers the basis for research proposals for future groups.
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- - The study aimed to assess the effectiveness of ona-botulinum toxin A (BTX-A) injections into the external urethral sphincter for women suffering from voicing dysfunction due to nonneurogenic nonrelaxing sphincter issues.
- - A group of 35 female patients (average age 37.5) was examined after receiving BTX-A; results showed significant improvements, with 60% able to void normally and increased flow rates after treatment.
- - Predictors of successful outcomes included high preoperative postvoid residuals and prior surgeries, with about 46% of patients opting for repeat injections after experiencing an average symptom relief duration of 4.7 months.
Article Synopsis
- PTNS is a neuromodulation technique for treating overactive bladder, and the study investigates whether its response can predict outcomes for subsequent sacral nerve stimulation (SNS) trials.
- A retrospective review of patients who underwent both PTNS and SNS from 2014 to 2020 showed that most who responded poorly to PTNS still had varied outcomes with SNS, with a statistically significant difference in response rates.
- The findings suggest that a lack of response to PTNS does not indicate that a patient will not benefit from SNS, highlighting the need for further research to understand predictive factors.
Article Synopsis
- The study aimed to assess the bleeding risks for patients on anticoagulants (AC) and antiplatelets (AP) receiving BoNT-A injections, in order to enhance decision-making and patient counseling prior to procedures.
- A retrospective review was conducted on 532 patients over two years, revealing that out of 63 patients on AC/AP therapy, only one episode (0.88%) resulted in significant bleeding that required intervention, which resolved on its own.
- The findings suggest that continuing AC/AP therapy during intravesical BoNT-A injections is generally safe, with minimal risk of complications.
Article Synopsis
- The study investigates the impact of vaginal surgical excision on women with urethral extrusion of mid-urethral tape (MUT) and aims to assess both immediate and long-term outcomes.
- A retrospective analysis of 34 patients was conducted, revealing that a significant percentage (85%) experienced urinary incontinence before the surgery, and after excision, many reported relief from vaginal/urethral pain and improved urinary flow.
- Despite the high rate (82%) of persistent urinary incontinence following excision, a majority of those who sought additional surgery experienced positive results, with 83% achieving improvement or resolution of their symptoms.
Article Synopsis
- The study aimed to assess postoperative pain and complications in men who underwent AdVance™/AdVance™ XP male sling implantation due to post-prostatectomy incontinence.
- The review included 127 men, averaging 70 years old, with a significant portion reporting successful outcomes and mild pain, particularly within the first month after surgery.
- Although 23% experienced some level of postoperative pain, chronic pain was rare (2.3%) and typically resolved within a year, with younger men being more likely to report pain and acute urinary retention significantly related to the level of pain post-surgery.
Purpose Of Review: The aim of the present report was to review the recent evidences regarding the use of artificial urinary sphincter (AUS) in adult females.
Recent Findings: While the excellent functional outcomes of AUS in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) have been reported for decades, its use has remained confidential in most countries likely due to its challenging implantation and inherent morbidity. Over the past few years, laparoscopic and, more recently, robotic techniques of AUS implantation in female patients have been described with promising perioperative outcomes.
Article Synopsis
- The study aimed to measure typical pad weight gain (PWG) in healthy women without urinary incontinence symptoms.
- The observational research involved 35 women, who wore sanitary pads for a median of 6 hours, showing a median PWG of 0.111 grams.
- Findings indicate that PWG remains below 0.7 grams in asymptomatic women, suggesting that higher weights in symptomatic women could indicate urinary incontinence.
Aims: This article reviews the clinical outcomes and basic science related to negative effects of radiotherapy (RT) on the lower urinary tract (LUT) when used to treat pelvic malignancies.
Methods: The topic was discussed at the 2019 meeting of the International Consultation on Incontinence-Research Society during a "think tank" session and is summarized in the present article.
Results: RT is associated with adverse effects on the LUT, which may occur during treatment or which can develop over decades posttreatment.
Article Synopsis
- The study aims to link the shape of flow rate curves with video-urodynamic findings in women experiencing lower urinary tract symptoms (LUTS).
- Researchers analyzed flow rate curves from 250 women over a 28-month period, categorizing them into five shapes and correlating these with urodynamic diagnoses.
- Results indicated that specific flow patterns, such as bell-shaped and plateau curves, can help identify urodynamic issues like obstruction and underactivity, suggesting that many women do not require invasive tests based on their flow patterns.
Article Synopsis
- The study investigates the effectiveness of onabotulinumtoxinA (BTX-A) injections in patients who experienced unsuccessful augmentation cystoplasty due to neuropathic or idiopathic detrusor overactivity.
- A retrospective analysis of 30 patients revealed that 43% experienced significant improvements in their overactive bladder symptoms, allowing them to avoid more invasive procedures.
- The results suggest that higher peak detrusor overactivity pressure may increase the likelihood of a positive response to the injections, highlighting their potential benefit for patients' quality of life.
Purpose: To investigate pre-operative urodynamic parameters in male sling patients to ascertain whether this might better predict surgical outcomes and facilitate patient selection.
Methods: We performed a retrospective, case notes and video-urodynamics, review of men who underwent AdVanceXP male sling in three London hospitals between 2012 and 2019. Urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was performed in one centre.
Impact of anaemia at discharge following colorectal cancer surgery.
Int J Colorectal Dis
September 2020
Objectives: Preoperative anaemia is common in patients with colorectal cancer and increasingly optimised prior to surgery. Comparably little attention is given to the prevalence and consequences of postoperative anaemia. We aimed to investigate the frequency and short- or long-term impact of anaemia at discharge following colorectal cancer resection.
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- The study aimed to evaluate the Solomon-Greenwell bladder outlet obstruction (SG BOO) nomogram as a tool for measuring the resolution of bladder outlet obstruction (BOO) in women following surgical treatment.
- The research involved 21 women diagnosed with BOO due to various conditions, such as pelvic organ prolapse and previous surgeries, with significant pre- and post-treatment changes observed in urodynamic parameters like flow rate and pressure.
- Overall, findings support the effectiveness of the SG BOO nomogram in diagnosing and monitoring BOO, highlighting that surgical treatment leads to significant improvement in symptoms and urodynamic measures.
Article Synopsis
- The study examines the challenges and success rates of repairing vesicovaginal fistulae (VVF) in patients who have undergone radiotherapy, noting that while simple surgical repairs are usually successful, cases within a radiotherapy field are more complex.
- Data from 20 women indicated that most had cervical cancer, and surgical repairs had a closure success rate of only 20%, with variations based on the type of fistula, where spontaneous ones had lower success compared to those post-surgery.
- The findings suggest that VVF repair is difficult, highlighting a need for personalized surgical approaches, as 70% of women required urinary diversion and the overall success rate was only 25%.
Background: Laparoscopic total mesorectal excision is a challenging procedure requiring high-quality surgery for optimal outcomes. Patient, tumor, and pelvic factors are believed to determine difficulty, but previous studies were limited to postoperative data.
Objective: This study aimed to report factors predicting laparoscopic total mesorectal excision performance by using objective intraoperative assessment.
Vesicovaginal fistulae (VVF) and ureteric reimplantation are two rare complications of obstetric surgery. VVF can be repaired via a vaginal approach utilizing Martius fat pad interposition to minimize urethral complications and improve surgical outcomes, while ureteric reimplantation into the bladder classically necessitates an abdominal or laparoscopic approach. We present a new technique of ureteric reimplantation via vaginal approach with concomitant repair of a 5-cm VVF in a 25-year-old woman after an emergency caesarean section with bladder injury and ureteric transection.
View Article and Find Full Text PDFContext: While much has been published on vesicovaginal fistula (VVF), little is known about the urinary, bowel, and sexual functional outcomes following successful anatomical closure.
Aims: We assessed the medium- to long-term urological, sexual, and bowel function outcomes following the successful anatomical closure of VVF.
Patients And Methods: We conducted interviews with 36 women (median age - 47.
Aims: An updated literature review on outcomes in men treated with currently commercially available bulking agents was performed to determine whether this is a reasonable option in selected patients.
Methods: The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework of systematic reviews. A comprehensive search of PubMed, Medline, and Embase was undertaken.
Introduction And Hypothesis: The objective was to assess the comparative provider costs of vaginal and open abdominal repair of vesicovaginal fistula (VVF) and to determine the most cost-effective means of managing VVF.
Methods: A prospectively acquired database of all women undergoing VVF repair by a single surgeon between 2007 and 2015 was retrospectively reviewed to determine operating time, perioperative complications, inpatient stay and 30-day readmissions. The success and cost of the VVF repair were identified.
Aims: Functional obstruction secondary to a high-tone nonrelaxing sphincter (HTNRS) may lead to the formation of a proximal-to-mid-urethral diverticulum (pmUD) in patients without a history of anatomical obstruction, vaginal delivery, vaginal and/or urethral surgery, or periurethral gland infection, that is, a functional pmUD (fpmUD). We used measurements of the urethra-sphincter complex volume (USCv) as a proxy for the maximal urethral closure pressure to evaluate this potential etiological factor.
Methods: We compared 17 consecutive women with fpmUD (mean age ± SD of 49.