Urodynamics/Incontinence/Female Urology: Evaluation And Therapy - Annual Meeting Of The American Urological Association

Main Category: Urology / Nephrology
Article Date: 02 Jul 2008 - 5:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

ORLANDO, FL (UroToday.com) - The moderated poster session covering evaluation and therapy included a broad range of presentations. Several abstracts focused on the male sling for post-prostatectomy incontinence (PPI).

Dr Walter and colleagues (Abstract 1497, data updated from publication) reported a series of 49 men undergoing AdVance sling for PPI. Post-operatively >85% of patients required 0-1 pads/day, with 24h pad weights improving from 264 to 44 grams. The authors report that urethral sphincter coaptation of pre-operative cystoscopy was suggestive of a good outcome. Technical suggestions like these are particularly important given the recent introduction of this sling type. Litt and Nitti (Abstract 1496) evaluated a cohort of 133 male patients undergoing counseling in anticipation of surgical management of PPI. In assessing factors underlying choice of sling type, the authors found that most patients will adhere to surgeon recommendation as expected. Interestingly, they also found that in the absence of specific surgeon recommendation, most patients preferred a male sling in contrast to an artificial urinary sphincter.

Other abstracts focused on the assessment of patients with incontinence. Inherent to the treatment of urinary incontinence is the use of a variety of objective and subjective instruments to assess symptom severity and outcomes. The variety of these instruments makes focus on identifying more optimal measures for common use valuable. Lazzeri and associates (Abstract 1503) evaluated the predictive value of the 1-hr pad test in the workup of women with urinary incontinence. Despite associations with a variety of other markers (pad use, closing pressure, IIQ/UDI scores), the authors found that the 1h pad test did not improve the predictive value over stress test and leakage assessment on urodynamic evaluation. Ziv and colleagues (Abstract 1507) reported the use of a novel leak score, based on the patient-reported assessment of leakage during 8 different physical activities. They found this instrument to be a reliable and valid method of assessing both baseline and post-operative urinary stress incontinence.

Additional focus was placed on novel methods of treatment for incontinence. In one related abstract, Furuta et al (Abstract 1509) examined the role of α- and glutamate receptors in external urethral sphincter activity in a rat model, building upon previous investigation. It was demonstrated that α 2-AR agonist activation suppressed sphincteric activity, and is hypothesized to do so via glutamate pathways. Such data raised the possibility of α 2-AR antagonist use in the treatment of SUI.

ABST #1496: Artifical Urinary Sphincter vs. Male Perineal Sling for Treatment of Post Prostatectomy Incontinence: What do Patients Choose?, Elana Rosenbuerg Litt, MD, et al.

ABST #1497: Keys to Patient Selection Providing Early Success with the Male Advance Sling in Management of Post-Prostatectomy Incontinence, Jack R. Walter, MD, et al.

ABST #1503: 1-Hour Pad Test has Low Predictive Value in the diagnosis of Women with Urinary Incontinence, by Massimo Lazzeri, MD, et al. ABST #1507: The Leak Score - A Novel Instrument to Assess Subjective Severity of Female Stress Urinary Incontinence and Efficacy of Treatment, by Elan Ziv, MD, et al.

ABST #1509: Role of α2-Adrenoceptors and Glutamate Receptors in the Control of External Urethral Sphincter Activity During Urethral Continence Spinal Reflex in Rats, by Akira Furuta, MD, et al.

Presented at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor David Rapp, MD

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2008 - UroToday