Argimiro Collado Serra

Background: Stress urinary incontinence is one of the most common and debilitating complications following radical prostatectomy. Artificial urinary sphincter (AUS) implantation is the gold standard treatment for moderate to severe post-prostatectomy incontinence. Common complications include device infection, mechanical failure, component migration, urethral erosion, and urethral atrophy, which often require device removal and subsequent reimplantation. To our knowledge, erosion or migration of orthopedic osteosynthesis screws into the lower urinary tract causing new-onset urinary symptoms after AUS implantation has not previously been reported. Case Presentation: A 57-year-old man with an implanted AUS presented to the emergency department with fever, dysuria, and de novo urge incontinence. Intravenous antibiotic therapy was initiated, resulting in resolution of the fever, after which further diagnostic evaluation was performed. Cystoscopy demonstrated normal urethral coaptation and intact urethral mucosa at the cuff site. However, three orthopedic osteosynthesis screws from previous pelvic fracture fixation were identified protruding immediately below the bladder neck. The screws were removed by open surgery during ongoing empirical antimicrobial therapy. Four weeks later, the AUS was reactivated. At 8-month follow-up, the patient remained asymptomatic and maintained the same continence status as following AUS implantation. Conclusions: A detailed history of previous pelvic surgery and orthopedic fixation, together with review of available imaging, is important in candidates for AUS implantation. In patients presenting with new-onset urinary symptoms after AUS implantation, alternative etiologies should be considered, with cross-sectional imaging and cystoscopy used selectively according to the clinical presentation.

Introduction: Male sling implants are an acceptable treatment for post‐prostatectomy stress urinary incontinence, but more long‐term follow data is needed to assess clinical effectiveness. This study provides long‐term continence and quality of life outcomes using complete 10‐year follow up data from patients with AdVance™/AdVance XP™ Male Sling Systems. Methods: In an observational multicenter study, prospective data collection included preoperative patient characteristics, perioperative course, and postoperative outcomes. Continence was assessed using the 24 h pad weight test and patient‐reported outcome measures (PROMs) were measured with the International Consultation on Incontinence Questionnaire Short Form (ICIQ‐UI SF). Follow‐up over 10 years included re‐intervention. Results: Of 111 patients who underwent surgery between February 2008 and February 2012, 87 completed 10‐year follow‐up (median follow‐up was 136.6 months (range:121.9–170.5). At 3‐month follow‐up, 59 patients (67.8%) were considered cured. Of the 59 patients initially cured, 17 patients (28.81%) lost continence during follow‐up, 11 due to stress urinary incontinence recurrence (65%), four due to de novo urge incontinence (23%), and two due to salvage radiotherapy (12%). Of the 17 who lost continence, six received a second surgical treatment, with no reported intra or preoperative surgical problems due to the first surgery. In cured patients, surgery resulted in a reduction of the median ICIQ‐SF score from 16.27 (SD 3.53) to 4.03 (SD 3.36) ( p < 0.01). In the patients considered not cured, a reduction on the median ICIQ‐SF score from 16.39 (SD 3.05) to 11.29 (SD 5.34) was observed ( p < 0.01). Conclusions: Our findings suggest that long‐term continence rates after sling implant are acceptable, especially in ideal patients with mild to moderate incontinence and naïve for prior pelvic irradiation or surgical treatment for urinary incontinence or urethral stricture disease.

Background and Objectives: Patients with seminal vesicle invasion (SVI) are a highly heterogeneous group. Prognosis can be affected by many clinical and pathological characteristics. Our aim was to study whether bilateral SVI (bi-SVI) is associated with worse oncological outcomes. Materials and Methods: This is an observational retrospective study that included 146 pT3b patients treated with radical prostatectomy (RP). We compared the results between unilateral SVI (uni-SVI) and bi-SVI. The log-rank test and Kaplan–Meier curves were used to compare biochemical recurrence-free survival (BCR), metastasis-free survival (MFS), and additional treatment-free survival. Cox proportional hazard models were used to identify predictors of BCR-free survival, MFS, and additional treatment-free survival. Results: 34.93% of patients had bi-SVI. The median follow-up was 46.84 months. No significant differences were seen between the uni-SVI and bi-SVI groups. BCR-free survival at 5 years was 33.31% and 25.65% (p = 0.44) for uni-SVI and bi-SVI. MFS at 5 years was 86.03% vs. 75.63% (p = 0.1), and additional treatment-free survival was 36.85% vs. 21.93% (p = 0.09), respectively. In the multivariate analysis, PSA was related to the development of BCR [HR 1.34 (95%CI: 1.01–1.77); p = 0.03] and metastasis [HR 1.83 (95%CI: 1.13–2.98); p = 0.02]. BCR was also influenced by lymph node infiltration [HR 2.74 (95%CI: 1.41–5.32); p = 0.003]. Additional treatment was performed more frequently in patients with positive margins [HR: 3.50 (95%CI: 1.65–7.44); p = 0.001]. Conclusions: SVI invasion is an adverse pathology feature, with a widely variable prognosis. In our study, bilateral seminal vesicle invasion did not predict worse outcomes in pT3b patients despite being associated with more undifferentiated tumors.

Aims: The aim of this study was to compare magnetic resonance imaging (MRI) parameters in patients with mild incontinence after radical prostatectomy, who had undergone treatment with a suburethral sling. The objective was to compare patients who had been successfully treated with unsuccessful patients.Methods: This observational cohort study at a single institution evaluated consecutive patients treated with an AdVance XP sling. MRI was performed using a 1.5 Tesla system. Preoperative urodynamic assessment and flexible cystoscopy were performed. The qualitative analysis was based on sling indentation (complete vs incomplete). The quantitative analysis comprised the following three parameters: the sling‐pubis distance, the thickness of the proximal urethral bulb, and the sling backward distance (SBD), defined as the distance between the prolongation of a line through the major axis of the pubis (the line‐segment joining the vertices of the pubis) and the sling indentation. The primary outcome was pad count at 3 months; cure as zero pads. A logistic univariate regression model was employed to assess the potential predictors of successful outcomes. An adjusted multivariate logistic regression model using the significant univariate factors was developed.Results: Of the 83 patients enrolled, the univariate analysis revealed a relationship between failure and adverse urodynamics and between success and sling indentation, thickness of the proximal bulb and SBD. Only the association with SBD persisted in the multivariate analysis.Conclusions: MRI revealed a strong relationship between proper positioning of the sling (small SBD) and continence outcome. These data have important implications for a second surgery following initial sling failure.

OBJECTIVES: Suburethral male slings are an alternative option for mild stress urinary incontinence. Our purpose is to evaluate the long-term functional outcomes, efficacy and worsening continence of male suburethral slings. MATERIAL AND METHODS: The functional outcomes of realignment/anatomical slings were evaluated with AdVance (R), and the outcomes of compressive slings were evaluated with InVance (R). We considered 55 patients fulfilling 5 years of complete follow-up. We included patients with a 24-hour pad weight test <400 grams. Night-continent patients who also had positive "repositioning tests" were considered for AdVance (R), whereas patients without sphincter contraction or previous pelvic radiotherapy were considered for InVance (R). RESULTS: Between February 2006 and September 2010, 24 AdVance (R) and 31 InVance (R) slings were implanted. The median follow-up times from sling insertion were 75 months in the AdVance (R) group (range: 64-97) and 86 months in the InVance (R) group (range: 61-108). At three months of follow-up, 43 of 55 patients were considered to be cured (pad-free) (78.1%), 79.1% in the AdVance (R) group and 77.4% in the InVance (R) group. Postoperatively 16.6% of patients with AdVance (R) and 22.5% of patients with InVance (R) presented "de novo" urgency. At 5 years of follow-up, we observed 10 cases of some deterioration of continence, 3 patients in the AdVance (R) group and 7 in the InVance (R) group (15.8% and 29.1% of the initially cured, respectively). To date, there have been no reports of urethral sling erosion. CONCLUSIONS: Male slings are safe and effective. Although we observed an increase in "de novo" urgency, in our experience, slings seemed to maintain their efficacy during long-term follow-up, and the risks of urethral erosion are low.

To evaluate the efficacy of the Advance^® and AdvanceXP^® slings in men with stress urinary incontinence (SUI) post-radical prostatectomy and to identify predictive factors for outcome.

PCA3 has been included in a nomogram outperforming previous clinical models for the prediction of any prostate cancer (PCa) and high grade PCa (HGPCa) at the initial prostate biopsy (IBx). Our objective is to validate such IBx-specific PCA3-based nomogram. We also aim to optimize the use of this nomogram in clinical practice through the definition of risk groups. Independent external validation. Clinical and biopsy data from a contemporary cohort of 401 men with the same inclusion criteria to those used to build up the reference’s nomogram in IBx. The predictive value of the nomogram was assessed by means of calibration curves and discrimination ability through the area under the curve (AUC). Clinical utility of the nomogram was analyzed by choosing thresholds points that minimize the overlapping between probability density functions (PDF) in PCa and no PCa and HGPCa and no HGPCa groups, and net benefit was assessed by decision curves. We detect 28 % of PCa and 11 % of HGPCa in IBx, contrasting to the 46 and 20 % at the reference series. Due to this, there is an overestimation of the nomogram probabilities shown in the calibration curve for PCa. The AUC values are 0.736 for PCa (C.I.95 %:0.68–0.79) and 0.786 for HGPCa (C.I.95 %:0.71–0.87) showing an adequate discrimination ability. PDF show differences in the distributions of nomogram probabilities in PCa and not PCa patient groups. A minimization of the overlapping between these curves confirms the threshold probability of harboring PCa >30 % proposed by Hansen is useful to indicate a IBx, but a cut-off > 40 % could be better in series of opportunistic screening like ours. Similar results appear in HGPCa analysis. The decision curve also shows a net benefit of 6.31 % for the threshold probability of 40 %. PCA3 is an useful tool to select patients for IBx. Patients with a calculated probability of having PCa over 40 % should be counseled to undergo an IBx if opportunistic screening is required.