The male sling for post-prostatectomy urinary incontinence: a review of contemporary sling designs and outcomes

What's known on the subject? and What does the study add? Long‐term cure and improved rates for the bone anchored sling range from 40–88%. Midterm cure and improved rates for the retrourethral transobturator sling rage from 76–91%. Midterm cure and improved rates for the adjustable retropubic sling rage from 72–79%. Potential complications common to all urethral slings include postoperative urinary retention, perineal pain, and urethral erosion/device infection. All male urethral slings have primarily been studied in post radical prostatectomy patients, with inconsistent success among patients with prior pelvic radiation.

OBJECTIVE

• ? To examine the outcomes and adverse events associated with novel male sling designs described in the last decade.

METHODS

• ? A literature review was carried out using Medline, EmBase, Cochrane Registered Trials Database and the Center for Reviews and Dissemination Database.

RESULTS

• ? Three principal slings are described in the literature. The bone‐anchored sling has success rates of 40–88%, with some series having a mean follow‐up of 36–48 months. It is associated with a mesh infection rate of 2–12%, which usually requires sling explantation.
• ? The retrourethral transobturator sling has a success rate of 76–91% among three large case series with follow‐ups of 12–27 months. There is a low reported explantation rate.
• ? The adjustable retropubic sling has a success rate of 72–79% with follow‐ups of 26–45 months. Erosion (3–13%) and infection (3–11%) can lead to explantation.

CONCLUSIONS

• ? Most male slings have a similar reported efficacy. Most case series define success as either dry or improved. True cure rates are lower. Mid‐ and long‐term data are now available that indicate the male sling is a viable option for PPI.
• ? The use of male slings in severe UI, radiated patients, and non‐radical prostatectomy patients is still unclear. Further study is needed to try and define criteria for the use of male slings, and to directly compare different procedures.

     

Impact of an enhanced recovery program on short-term outcomes after scheduled laparoscopic colon resection

Introduction

Both enhanced recovery programs (ERP) and laparoscopy can reduce complications and length of stay (LOS) in colon surgery. We investigated whether ERP further improved the short-term outcomes of scheduled laparoscopic colectomies.

Methods

We performed an audit of all patients undergoing scheduled laparoscopic colon resection between January 2003 and August 2010 in our institution. An ERP including accelerated introduction of oral nutrition, mobilization, pain control, and catheter management was introduced in 2005. Demographic data, intra and postoperative details and 30-day ER visit and readmission rate were collected. We compared LOS and short-term outcomes for patients on the program with those receiving traditional postoperative care using Chi-square and regression models. Data are presented as median [25th, 75th percentile]. Statistical significance was defined as p < 0.05.

Results

136 (46 %) of 297 eligible patients were enrolled in the ERP. At baseline, the two groups had similar demographic characteristics, but patients in the ERP were more likely to have their operation by a colorectal surgeon (p = 0.01). Patients in the ERP ate solids earlier (p < 0.001) and had earlier removal of their urinary catheter (p < 0.001). LOS was 4 [3, 6] days for both groups (p < 0.01), with more patients in the ERP discharged by POD 3 (p < 0.001). After adjusting for other variables, ERP enrolment remained an independent predictor of LOS (p < 0.01), along with age (p < 0.01) and in-hospital complications (p < 0.001). Complication rates were similar between the two groups. Patients in the ERP had significantly fewer ER visits (p = 0.02), but there were no differences in readmission rates.

Conclusion

In patients undergoing scheduled laparoscopic colectomy in a university-based clinical teaching unit, ERP can further reduce length of stay and postoperative ER visits without increasing readmission rates.     

Calcified ganglioneuroma of the bladder

The online version of the original article can be found at     

Inverted papilloma: An uncommon benign cause of a ureteral filling defect

A case of inverted papilloma of the ureter in a 62-year-old man is presented along with a literature review of 14 cases. This rare benign tumor should enter the differential diagnosis of a ureteral filling defect especially when it has a smooth configuration. Preoperative consideration of this diagnosis may lead to intraoperative confirmation of pathology and conservative resection.