Robotic bladder neck plication for incontinence treatment.
Ontology highlight
ABSTRACT:
SUBMITTER: Minoli DG
PROVIDER: S-EPMC8318032 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundPatients who are symptomatic from diaphragmatic dysfunction may benefit from diaphragmatic plication. We recently modified our plication approach from open thoracotomy to robotic transthoracic. We report our short-term outcomes.MethodsWe conducted a single-institution retrospective review of all patients who underwent transthoracic plications from 2018, when we began using the robotic approach, to 2022. The primary outcome was short-term recurrence of diaphragm elevation with symptoms noted before or during the first planned postoperative visit. We also compared proportions of short-term recurrences in patients that underwent plication with extracorporeal knot-tying device alone versus those that used intracorporeal instrument tying (alone or supplemental). Secondary outcomes included subjective postoperative improvement of dyspnea at follow-up visit and by postoperative patient questionnaire, chest tube duration, length of stay (LOS), 30-day readmission, operative time, estimated blood loss (EBL), intraoperative complications, and perioperative complications.ResultsForty-one patients underwent robotic-assisted transthoracic plication. Four patients experienced recurrent diaphragm elevation with symptoms before or during their first routine postoperative visit, occurring on POD 6, 10, 37, and 38. All four recurrences occurred in patients whose plications were performed with the extracorporeal knot-tying device without supplemental intracorporeal instrument tying. Proportion of recurrences in the group that used extracorporeal knot-tying device alone was significantly greater than the recurrences in the group that used intracorporeal instrument tying (alone or supplemental) (P=0.016). The majority (36/41) reported clinical improvement postoperatively and 85% of questionnaire respondents also agreed they would recommend the surgery to others with similar condition. The median LOS and of chest tube duration were 3 days and 2 days, respectively. There were two patients with 30-day readmissions. Three patients developed postoperative pleural effusion necessitating thoracenteses and 8 patients (20%) had postoperative complications. No mortalities were observed.ConclusionsWhile our study shows the overall acceptable safety and favorable outcomes in patients undergoing robotic-assisted transthoracic diaphragmatic plications, the incidence of short-term recurrences and its association with the use of extracorporeally knot-tying device alone in diaphragm plication warrant further investigation.
| S-EPMC10183526 | biostudies-literature
Project description:PURPOSE:We sought to determine whether bladder neck size is associated with incontinence scores after robot-assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS:Consecutive eligible patients undergoing robot-assisted laparoscopic radical prostatectomy between July 19 and December 28, 2016 were enrolled in a prospective, longitudinal, observational cohort study. The primary outcome was patient reported urinary incontinence on the EPIC (Expanded Prostate Cancer Index Composite) scale 6 and 12 weeks postoperatively. The relationship between the EPIC score of urinary incontinence and bladder neck size was evaluated by multiple regression. Predicted EPIC scores for incontinence were displayed graphically after using restricted cubic splines to model bladder neck size. RESULTS:A total of 107 patients were enrolled. The response rate was 98% and 87% at 6 and 12 weeks, respectively. Bladder neck size was not significantly associated with incontinence scores at 6 and 12 weeks. Comparing the 90th percentile for bladder neck size (18 mm) with the 10th percentile (7 mm) revealed no significant difference in adjusted EPIC scores for incontinence at 6 weeks (? coefficient 0.88, 95% CI -10.92-12.68, p = 0.88) or at 12 weeks (? coefficient 5.80, 95% CI -7.36-18.97, p = 0.39). CONCLUSIONS:These findings question the merit of creating an extremely small bladder neck during robot-assisted laparoscopic radical prostatectomy. We contend that doing so increases the risk of positive margins at the bladder neck without facilitating early recovery of continence.
| S-EPMC5693618 | biostudies-literature
Project description:ObjectivesThe objective of this study was to compare the recurrence rate and de novo incontinence after endoscopic treatment of vesicourethral stenosis (VUS) after radical prostatectomy (RP) and for bladder neck stenosis (BNS) after transurethral resection of the prostate (TURP).MethodsRetrospective analysis of patients treated endoscopically for VUS after RP or for BNS after TURP at three German tertiary care centers between March 2009 and June 2016. Investigated endpoints were recurrence rate and de novo incontinence. Chi-squared tests and t-tests were used to model the differences between groups.ResultsA total of 147 patients underwent endoscopic therapy for VUS (59.2%) or BNS (40.8%). Mean age was 68.3 years (range 44-86), mean follow-up 27.1 months (1-98). Mean time to recurrence after initial therapy was 23.9 months (1-156), mean time to recurrence after prior endoscopic therapy for VUS or BNS was 12.0 months (1-159). Patients treated for VUS underwent significantly more often radiotherapy prior to endoscopic treatment (33.3 vs. 13.3%; p = 0.006) and the recurrence rate was significantly higher (59.8 vs. 41.7%; p = 0.031). The overall success rate of TUR for VUS was 40.2%, success rate of TUR for BNS was 58.3%. TUR for BNS is significantly more successful (p = 0.031). The mean number of TUR for BNS vs. TUR for VUS in successful cases was 1.5 vs. 1.8, which was not significantly different. The rate of de novo incontinence was significantly higher in patients treated for VUS (13.8 vs. 1.7%; p = 0.011). After excluding those patients with radiotherapy prior to endoscopic treatment, the recurrence rate did not differ significantly between both groups (60.3% for VUS vs. 44.2% for BNS; p = 0.091), whereas the rate of de novo incontinence (13.8 for VUS vs. 0% for BNS; p = 0.005) stayed significantly higher in patients treated for VUS.ConclusionMost patients with BNS are successfully treated endoscopically. In patients with VUS, the success rate is lower. Both stenoses differ with respect to de novo incontinence. Patients must be counseled regarding the increased risk of de novo incontinence after endoscopic treatment of VUS, independent of prior radiotherapy. Longer follow-up is warranted to address long-term outcomes.
| S-EPMC5554361 | biostudies-literature
Project description: Not available
| S-EPMC10580170 | biostudies-literature
Project description:Background and objectives: As pelvic floor disorders are often difficult to assess thoroughly based on clinical examination alone, the use of imaging as a complementary technique is helpful. This study's aim was to investigate by transperineal ultrasound (US) if there was any significant difference in the mobility of the bladder neck in women with stress urinary incontinence (SUI) without a cystocele and in those with SUI and an associated cystocele. The study also investigated whether the number of vaginal births and/or the heaviest newborn's birth weight was correlated with the bladder neck mobility. Materials and Methods: A total of 71 women suffering from SUI were included in the study and divided into two groups based on the presence of a cystocele. Their bladder neck mobility was evaluated by transperineal US, calculating the distance from the inferior margin of the symphysis pubis to the bladder neck (SPBN), and the dorsocaudal linear movement (DLM), term used to illustrate the displacement of the bladder neck by subtracting rest and Valsalva values. GraphPad Prism 8 was used for statistical analysis. Results: Within both study groups, the SPBN values were significantly higher and the DLM values were significantly lower at rest as compared to Valsalva maneuver (p < 0.05). No significant difference between the groups regarding SPBN and DLM values at rest, Valsalva, or subtraction was demonstrated. A significant positive correlation was found between the bladder neck mobility and the heaviest newborn's birth weight, regardless of the presence of a cystocele (p = 0.042). Conclusions: The presence of a cystocele had no significant impact on the bladder neck mobility measurements in patients with SUI. The heaviest newborn's birth weight positively correlated with bladder neck hypermobility, as quantified by SPBN.
| S-EPMC6780490 | biostudies-literature
Project description:Osteochondromas of the femoral neck are a rare but challenging problem because of their distal location, which is difficult to access arthroscopically. Traditional methods of osteochondroma resection used invasive open approaches to manage these lesions. More recently, advances in hip arthroscopy have allowed expanded treatment of extra-articular hip conditions with a minimally invasive approach. Reports have described the use of hip arthroscopy for osteochondroma removal; however, surgical techniques for the procedure have yet to be described. We describe a technique for arthroscopic resection of a femoral neck osteochondroma using an extended capsulotomy and osteochondroplasty with subsequent capsular plication. This technique uses contemporary hip arthroscopic techniques and constitutes a safe and effective approach to addressing this rare intra-articular pathology of the hip.
| S-EPMC6926320 | biostudies-literature
Project description:AIMS:The primary aim is to provide detailed rationale and methodology for the development and implementation of a perioperative behavioral/pelvic floor exercise research protocol for women who self-chose surgical intervention and who may or may not have been offered behavioral treatments initially. This protocol is part of the ESTEEM trial (Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence Trial) which was designed to determine the effect of a combined surgical and perioperative behavioral/pelvic floor exercise intervention versus surgery alone on improving mixed urinary incontinence (MUI) and overactive bladder (OAB) symptoms. METHODS:As part of a multi-site, prospective, randomized trial of women with MUI electing midurethral sling (MUS) surgical treatment, participants were randomized to a standardized perioperative behavioral/pelvic floor exercise intervention?+?MUS versus MUS alone. The specific behavioral intervention included: education on voiding habits, pelvic floor muscle training (PFMT), bladder training (BT), strategies to control urgency and reduce/prevent urinary symptoms, and monitoring/promoting adherence to behavioral recommendations. To ensure consistency across all eight research sites in the pelvic floor disorders network (PFDN), selective behavioral treatments sessions were audiotaped and audited for protocol adherence. RESULTS:The behavioral intervention protocol includes individualization of interventions using an algorithm based on pelvic floor muscle (PFM) assessment, participant symptoms, and findings from the study visits. We present, here, the specific perioperative behavioral/pelvic floor exercise interventions administered by study interventionists. CONCLUSIONS:This paper details a perioperative behavioral/pelvic floor exercise intervention research study protocol developed for women undergoing surgery for MUI.
| S-EPMC5907803 | biostudies-literature
Project description:The most commonly reported reasons for persistent hip pain after hip arthroscopy are residual femoroacetabular impingement, dysplasia and dysplasia variants, or extra-articular impingement. There are some cases in which the underlying osseous pathomorphology has been appropriately treated, and the cause of persistent hip pain can be soft-tissue injuries such as chondrolabral tears or capsular abnormalities. Capsular defects after hip arthroscopy may suggest an alteration of the biomechanical properties of the iliofemoral ligament and lead to iatrogenically induced hip instability. There are a growing number of biomechanical and clinical studies showing the importance of capsular management during hip arthroscopy. We describe the workup, examination under anesthesia, diagnostic arthroscopy, and technique of capsular plication for iatrogenic instability of the hip.
| S-EPMC4738291 | biostudies-literature
Project description:(1) Background: Male stress incontinence in patients with previously treated urethral or bladder neck stricture is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is unknown. (2) Methods: All patients with primary ATOMS implants in our institution between 2014 and 2021 were included. The outcomes of patients with previously treated urethral or bladder neck stricture (≥6 months before ATOMS implant) and stable 16Ch urethral caliber were compared to those without a history of stricture. The primary endpoint was the dry patient rate, defined as the pad test ≤ 20 mL/day, and complication rate, including device removal. The secondary variable was self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank sum test, Fisher's exact test and logistic regression were performed. (3) Results: One hundred and forty-nine consecutive patients were included, twenty-one (14%) previously treated for urethral or bladder neck stricture (seven urethroplasty, nine internal urethrotomy and five bladder neck incision). After ATOMS adjustment, 38% of the patients with treated stricture were continent compared to 83% of those without (p < 0.0001). After weighted matched observations using propensity score pairing, the proportion of continent patients without a previous stricture was 56% (p = 0.236). Complications occurred in 29% of the patients with stricture and in 20% of those without (p = 0.34). The severity of the complications was distributed evenly among the groups (p = 0.42). Regarding self-perceived satisfaction with the implant, 90% of the patients with stricture perceived the results satisfactorily (PGI-I 1-3) compared to 97% of the rest (p = 0.167). Stricture was associated with radiotherapy (p < 0.0001) and time from prostatectomy to implantation (p = 0.012). There was a moderate correlation between previous stricture and the severity of incontinence, both evaluated according to the 24-h pad test (Rho = 0.378; p < 0.0001) and the ICIQ-SF questionnaire (Rho = 0.351; p < 0.0001). Multivariate analysis for the factors predictive of failure after ATOMS adjustment revealed previous stricture (OR 4.66; 95% CI 1.2-18.87), baseline 24-h pad test (per 100 mL, OR 1.28; 95% CI 1.09-1.52) and final cushion volume (per mL, OR 1.34; 95% CI 1.19-1.55). This model predicted dryness with an AUC of 92%. After the PSMATCH procedure using a propensity score, the model remained unchanged, with the previous stricture (OR 8.05; 95% CI 1.08-110.83), baseline 24-h pad test (per 100 mL, OR 1.53; 95% CI 1.15-2.26) and final cushion volume (per mL, OR 1.45; 95% CI 1.17-2) being independent predictors and an AUC of 93%. (4) Conclusions: ATOMS can be used to treat male stress incontinence in patients with a history of stricture, although the effectiveness of the device is reduced. On the other hand, the security and perceived satisfaction were equivalent for both groups.
| S-EPMC9410097 | biostudies-literature
Project description:The poor contractility of the detrusor muscle in underactive bladders (UABs) fails to increase the pressure inside the UAB, leading to strenuous and incomplete urination. However, existing therapeutic strategies by modulating/repairing detrusor muscles, e.g., neurostimulation and regenerative medicine, still have low efficacy and/or adverse effects. Here, we present an implantable magnetic soft robotic bladder (MRB) that can directly apply mechanical compression to the UAB to assist urination. Composed of a biocompatible elastomer composite with optimized magnetic domains, the MRB enables on-demand contraction of the UAB when actuated by magnetic fields. A representative MRB for a UAB in a porcine model is demonstrated, and MRB-assisted urination is validated by in situ computed tomography imaging after 14-day implantation. The urodynamic tests show a series of successful urination with a high pressure increase and fast urine flow. Our work paves the way for developing MRB to assist urination for humans with UABs.
| S-EPMC9401625 | biostudies-literature