Translational andrology and urology最新文献

{"title":"A single-institution experience with the Optilume Urethral Drug Coated Balloon for management of urethral stricture disease.","authors":"Ashorne K Mahenthiran, Ramzy T Burns, Mary E Soyster, Morgan Black, Peter J Arnold, Harrison L Love, Matthew J Mellon","doi":"10.21037/tau-24-104","DOIUrl":"https://doi.org/10.21037/tau-24-104","url":null,"abstract":"<p><strong>Background: </strong>Urethral stricture disease is detrimental to quality of life. The Optilume Urethral Drug Coated Balloon (DCB) offers a solution utilizing a paclitaxel-coated balloon to expand strictures and prevent recurrence. Following the ROBUST trials, it has been proposed that DCB is more effective than conventional endoscopic management for recurrent, small anterior urethral strictures. Our study provides insights into practical applications and outcomes using DCB for urethral stricture disease.</p><p><strong>Methods: </strong>A retrospective review was performed of patients who underwent DCB for urethral strictures at our institution from November 2022 to August 2023 with follow-up evaluated through January 2024. Demographics, stricture characteristics, operative details, and postoperative outcomes were collected. Primary endpoint was need for repeat intervention as determined by symptomatic burden and subsequently postoperative post-void residual if obtained. Secondary endpoint was complication rate. Statistical analysis was conducted using STATA/BE17.0 software to create Kaplan-Meier curves for time to repeat intervention after treatment with DCB.</p><p><strong>Results: </strong>Of 43 patients, 16 had no prior treatment. The other 27 had endoscopic treatment and of this group, 11 also had additional urethroplasty. Stricture etiologies included 20 iatrogenic, 14 idiopathic, 5 radiation-related, 2 inflammatory, and 2 traumatic. Stricture locations were 2 fossa navicularis, 7 pendulous, 17 bulbar, 7 membranous, 3 prostatic, and 7 bladder neck contractures. Mean balloon dilation lasted 8.4±2.7 minutes. All patients had a minimum follow-up of 150 days postoperatively and the mean duration of follow-up for the cohort was 290.3±87.0 days. The average postoperative post-void residual was 33.4±90.6 milliliters. Two patients had immediate complications: 1 with urinary retention after catheter removal requiring suprapubic tube placement and 1 with urinary tract infection requiring antibiotics. Four patients required repeat interventions: 1 endoscopic dilation, 1 graft urethroplasty, and 2 repeat DCB procedures. Mean time to repeat intervention was 203.5±82.6 days, and no patient required repeat intervention within 145 days of initial surgery.</p><p><strong>Conclusions: </strong>DCB offers a safe and less invasive treatment for both treatment-naïve and recurrent urethral strictures with paclitaxel coating to prevent recurrence. Repeat intervention was not required for 90.7% of our cohort within an average follow-up duration of 9 months postoperatively. As DCB grows in clinical use, investigation into its long-term efficacy is justified.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial urinary sphincter for neurogenic urinary incontinence: a narrative review.","authors":"Bridget L Findlay, Daniel S Elliott","doi":"10.21037/tau-22-794","DOIUrl":"https://doi.org/10.21037/tau-22-794","url":null,"abstract":"<p><strong>Background and objective: </strong>The artificial urinary sphincter (AUS) is most known for its use in the treatment of moderate to severe post-prostatectomy stress urinary incontinence. However, another lesser-known indication includes stress incontinence related to intrinsic sphincter deficiency (ISD) in the neurogenic bladder population. The purpose of this review is to discuss specific technical considerations related to device implantation in this population, efficacy, durability, and complications.</p><p><strong>Methods: </strong>We performed a non-systematic literature review using the PubMed Database to identify articles specifically related to treatment of neurogenic urinary incontinence using an artificial urinary sphincter.</p><p><strong>Key content and findings: </strong>More proximal placement of the cuff at the bladder neck is preferred in the neurogenic population due to higher rates of erosion and complications related to frequent clean intermittent catheterization or cystoscopic procedures when placed along the bulbar urethra. Robotic-assisted laparoscopic cuff placement has emerged as a safe and effective alternative to open surgery in select patients. Although continence rates are highly variable due the subjectivity of the term, functional continence (≤1 pad, ± nighttime incontinence) is reported to be between 75-90%. The need for secondary surgery for explanation with or without revision/replacement is higher in neurogenic patients compared to non-neurogenic patients.</p><p><strong>Conclusions: </strong>Neurogenic urinary incontinence is a complex condition due to the interplay of urethral resistance and bladder function/compliance. While there are a variety of strategies to treat neurogenic incontinence, high quality data from direct comparisons are lacking. Although AUS comes with a high revision rate, functional outcomes for continence with bladder neck placement are promising in this population.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management considerations and treatment outcomes for newly diagnosed prostate cancer in advanced age patients (≥80 years): real-world data from a single urological center over a 10-year period.","authors":"Xiong Xiao, Jun-Xin Wang, Yong Wang, Yong Xu, Ran-Lu Liu, Shan-Qi Guo, Xing-Kang Jiang","doi":"10.21037/tau-24-134","DOIUrl":"https://doi.org/10.21037/tau-24-134","url":null,"abstract":"<p><strong>Background: </strong>There is ongoing debate regarding prostate cancer (PCa) screening in advanced age males, leading to treatment decisions often based on tumor staging and life expectancy. A critical gap in clinical evidence and tailored guidelines for the advanced age with PCa persists. This study aims to compare survival outcomes of various treatment approaches in this demographic.</p><p><strong>Methods: </strong>We analyzed data from a large urological center for advanced age patients suspected of having PCa between 2012 and 2022. We collected clinical and pathological characteristics and evaluated treatment modalities, including palliative therapy and definitive therapy. Propensity score matching (PSM) analysis was implemented to reduce bias between treatment modalities. Kaplan-Meier and multivariate Cox proportional hazard regression analyses were conducted to evaluate progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS).</p><p><strong>Results: </strong>Out of 4,333 suspected patients, 376 individuals aged 80 years and older underwent prostate biopsy. The overall detection rate of PCa was 78.7%, with a high prevalence of high-grade tumors [International Society of Urological Pathology (ISUP) grade ≥2]. Most patients (86.5%) received palliative therapy, while 13.5% underwent definitive therapy. Patients in the definitive therapy group had lower prostate-specific antigen (PSA) values, lower tumor stage, and Charlson Comorbidity Index (CCI), longer life expectancy, and a higher Geriatric 8 (G8) score compared to the palliative therapy group. The median OS for the entire cohort was 72.0 months, with 70.0 months for palliative therapy and 96.0 months for definitive therapy. Multivariable analyses identified lymphatic and bone metastasis, as well as definitive therapy, as independent prognostic factors for PFS, CSS, and OS.</p><p><strong>Conclusions: </strong>Advanced age patients, although a small group, have distinct characteristics, including higher PSA levels, positive biopsy rates, and pathological grading and staging. In medically fit elderly patients, especially those with localized PCa and a life expectancy of ≥5 years, definitive therapy could improve survival outcomes.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncologic outcomes of neoadjuvant chemotherapy and lymph node dissection with partial cystectomy for muscle-invasive bladder cancer.","authors":"Ryan M Antar, Vincent E Xu, Christian M Farag, Jack Lucero, Arthur Drouaud, Vinaik Sundaresan, Olivia F Gordon, Sarah Azari, Michael Wynne, Armine K Smith, Michael J Whalen","doi":"10.21037/tau-24-165","DOIUrl":"https://doi.org/10.21037/tau-24-165","url":null,"abstract":"<p><strong>Background: </strong>Partial cystectomy (PC) offers potential benefits for select patients with muscle-invasive bladder cancer (MIBC). However, the oncologic efficacy of PC may be compromised due to the underutilization of standard-of-care modalities, such as neoadjuvant chemotherapy (NAC) and pelvic lymph node dissection (PLND). We aimed to assess factors influencing the incorporation of NAC and PLND with PC and evaluate their impact on overall survival (OS).</p><p><strong>Methods: </strong>We identified 2,832 patients with cT2-4N0M0 bladder cancer (BCa) who underwent PC between 2004 and 2019 using the National Cancer Database (NCDB). The primary endpoint was OS. Kaplan-Meier analysis compared OS in treatment modalities in PC patients. Multivariate Cox Proportional Hazards (CPH) model assessed the impact of age, sex, race, insurance, income, Charlson-Deyo Index (CDI), clinical T-stage, facility type, histology, surgical margins, NAC, PLND adequacy [≥10 lymph node (LN) yield], and adjuvant radiation treatment on OS. Multivariate logistic regressions were performed to examine predictors of NAC and PLND receipt in PC patients.</p><p><strong>Results: </strong>Two hundred and thirty-one patients received multi-agent NAC with PC. NAC treatment with PLND was associated with significantly improved OS (P<0.001). Median OS was 43.9 months in patients treated with PC alone, while median OS was not reached in PC patients treated with NAC & PLND. Furthermore, patients who received NAC without any PLND had a median OS of 50.6 months, while those treated with PLND without NAC had a median OS of 76.5 months. This persisted in the adjusted CPH model, where private insurance, NAC, and PLND significantly improved OS, especially when PLND yielded ≥10 LN. Conversely, age >80 years old, CDI >2, cT3-4, positive margins, and adjuvant radiation all increased adjusted mortality risk. After controlling for clinicopathologic variables, females were less likely to receive PLND [odds ratio (OR) 0.719, P=0.005], while NAC was more likely administered to PC patients diagnosed from 2016-2019 (OR 5.295, P<0.001). PC patients who received NAC were more likely to have PLND performed as part of their treatment regimen (OR 2.189, P<0.001). Additionally, patients treated at academic centers were more likely to have NAC administered and PLND performed (OR 1.745, P=0.003; OR 2.465, P<0.001, respectively).</p><p><strong>Conclusions: </strong>Despite guideline recommendations, the utilization of NAC and PLND with PC remains insufficient. Our analysis underscores the significant OS benefit of these recommended treatments as part of MIBC care. Importantly, we highlight a gradual increase in NAC and PLND receipt in recent years, centered largely at academic facilities. Notably, gender disparities exist in PLND receipt, emphasizing the need for further investigation.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing a model predicting Gleason grade group upgrading in prostate cancer.","authors":"Jian Chen, Qiming Chen, Ze Wang, Xuzhi Yan, Yapeng Wang, Yao Zhang, Jun Zhang, Jing Xu, Qiang Ma, Peng Zhong, Dianzheng Zhang, Qiuli Liu, Weihua Lan, Jun Jiang","doi":"10.21037/tau-24-155","DOIUrl":"https://doi.org/10.21037/tau-24-155","url":null,"abstract":"<p><strong>Background: </strong>Gleason grade group (GG) upgrading is associated with increased biochemical recurrence (BCR), local progression, and decreased cancer-specific survival (CSS) in prostate cancer (PCa). However, descriptions of the risk factors of GG upgrading are scarce. The objective of this study was to identify risk factors and establish a model to predict GG upgrading.</p><p><strong>Methods: </strong>There were 361 patients with PCa who underwent radical prostatectomy between May 2011 and February 2022 enrolled. Univariate and multivariate logistic regression analyses were identified and nomogram further narrowed down the contributing factors in GG upgrading. The correction curve and decision curve were used to assess the model.</p><p><strong>Results: </strong>In the overall cohort, 141 patients had GG upgrading. But the subgroup cohort (GG ≤2) showed that 68 patients had GG upgrading. Multivariate logistic regression analysis showed that in the overall cohort, total prostate-specific antigen (tPSA) ≥10 ng/mL, systemic immune-inflammation index (SII) >379.50, neutrophil-lymphocyte ratio (NLR) >2.13, the GG of biopsy ≥3, the number of positive cores >3 were independent risk factors in GG upgrading. In the cohort of biopsy GG ≤2, multivariate logistic regression showed that the tPSA ≥10 ng/mL, SII >379.50 and the number of positive cores >3 were independent risk factors in GG upgrading. A novel model predicting GG upgrading was established based on these three parameters. The area under the curve (AUC) of the prediction model was 0.759. The C-index of the nomogram was 0.768. The calibration curves of the model showed good predictive performance. Clinical decision curves indicated clinical benefit in the interval of 20% to 90% of threshold probability and good clinical utility.</p><p><strong>Conclusions: </strong>Combined levels of tPSA, SII and the positive biopsy cores distinguish patients with high-risk GG upgrading in the group of biopsy GG ≤2 and are helpful in the decision of treatment plans.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative study of survival outcomes between partial and radical cystectomy in octogenarians with muscle-invasive bladder cancer.","authors":"Arjun Pon Avudaiappan, Pushan Prabhakar, Ciara Lusnia, Mohmmad Arfat Ganiyani, Muni Rubens, Rohan Garje, Ahmed Eldefrawy, Murugesan Manoharan","doi":"10.21037/tau-24-139","DOIUrl":"https://doi.org/10.21037/tau-24-139","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant chemotherapy with radical cystectomy (RC) is the preferred first-line treatment for localized muscle-invasive bladder cancer (MIBC). Due to the concern about morbidity associated with RC, the elderly population considers bladder preservation alternatives. Guidelines suggest partial cystectomy (PC) can be considered a viable option in carefully selected individuals. We used the National Cancer Database (NCDB) to compare the overall survival (OS) among octogenarians treated with PC and RC.</p><p><strong>Methods: </strong>Using NCDB, we retrospectively evaluated individuals aged 80 years and above diagnosed with localized MIBC (cT2-4aN0M0) with tumor size less than 5 cm and urothelial histology between 2004 and 2018. Our primary cohort was divided into the RC cohort, which included patients who underwent RC with or without chemotherapy/radiotherapy, and the PC cohort, which included those who underwent PC. After propensity-matching, we compared the OS.</p><p><strong>Results: </strong>Of 94,104 patients with MIBC, 2,528 octogenarians met our selection criteria. Among them, 313 were treated with PC, and 2,215 were treated with RC. A total of 151 (48.2%) PC patients had pelvic lymph node dissection, while 1,967 (88.8%) RC patients had lymph node dissection (P<0.001). The OS for matched PC and RC was 33.4 and 29.9 months, respectively (P=0.68). In T2 tumors, the OS for PC and RC was 37 and 33.5 months, respectively (P=0.52); for T3 tumors, the OS was 22.3 and 24.4 months, respectively (P=0.98).</p><p><strong>Conclusions: </strong>Our study compared PC and RC in octogenarians with localized MIBC and observed that PC is safe and not inferior to RC in carefully selected octogenarians. The role of PC needs further exploration by comparing or integrating with strategies like concurrent chemoradiation to improve the oncological and survival outcomes.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new adjustable artificial urinary sphincter for male stress urinary incontinence (Victo^TM): preliminary clinical results.","authors":"Ghazal Ameli, Tanja Hüsch, Wilhelm A Hübner, Peter Weibl","doi":"10.21037/tau-22-779","DOIUrl":"https://doi.org/10.21037/tau-22-779","url":null,"abstract":"<p><strong>Background: </strong>Artificial urinary sphinkter (AUS) are still the gold standard for treatment of male stress urinary incontinence with good clinical outcomes and high patient's reported satisfaction rate. However, more than half of the patients with an AUS will require additional procedures, most likely revisions. To introduce a novel adjustable AUS for treatment of male stress urinary incontinence and perform a preliminary clinical investigation to determine the safety and efficacy of the device.</p><p><strong>Methods: </strong>Men with urodynamically proven SUI following radical prostatectomy (RP), transurethral resection of prostate (TURP) and pelvic injuries were implanted with the Victo-AUS. Patients with three or more previous incontinence surgeries were excluded from the series. Patients were monitored over a mean follow up of 29 months (range, 13.7-47.9 months). The device was tested for efficacy by using objective measurements of urinary leakage and continence. We used validated questionnaires at baseline and clinical follow-ups. The key outcomes were overall improvement, patients reported satisfaction and complication rate.</p><p><strong>Results: </strong>A total of 88 patients between December 2016 and December 2019 have been enrolled in this trial. Improvement was defined as a reduction in pad usage per day (p/d) over 50% compared to baseline. In total, 70 (88%) patients were reported to be improved. Treatment success according to the definition of 0-1 p/d was accomplished in 56 (70%) patients. Urethral erosion, infection or mechanical failure occurred in 4 (5%), 4 (5%) and 1 (1.3%) patient respectively. Explantation of the device was mandatory in 6 patients due to erosion, infection or mechanical failure.</p><p><strong>Conclusions: </strong>In this series, a continence rate of 70% was achieved with an acceptable complication-rate. These results together with a high satisfaction rate demonstrate effectiveness and safety of the Victo system in mid-term follow-up for the treatment of male SUI.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical strategies in artificial urinary sphincter revision surgery: troubleshooting the complications.","authors":"Marcio Augusto Averbeck, Silvio Henrique Maia de Almeida","doi":"10.21037/tau-22-830","DOIUrl":"https://doi.org/10.21037/tau-22-830","url":null,"abstract":"<p><p>Post-prostatectomy urinary incontinence (PPUI) is an important issue in the urological practice and imposes a negative effect on quality of life (QoL). Despite recent technological advances, PPUI remains a common complication and the artificial urinary sphincter (AUS) is regarded as the most effective long-term surgical treatment for moderate-to-severe stress urinary incontinence. Success rates for AUS as defined by a continence status of zero to one pad per day range from 59% to 90%. One potential downside of the AUS is the need for periodic revisions in a number of patients. Revision and explantation rates due to mechanical failure, urethral atrophy, infection and erosion vary considerably among studies with reports of 8-45% and 7-17%, respectively. These complications can be classified into different categories, including recurrent or refractory incontinence, erosion and/or infection, and other complications. This review article aims to describe the main AUS-related complications and their management strategies. Diagnostic work-up strategies are explored to facilitate timely identification and management of these complications. Additionally, emerging technologies and future directions in AUS development are discussed, highlighting potential advancements to mitigate complications and enhance device performance. This review consolidates current knowledge and provides insights for clinicians to manage the complexities associated with AUS therapy effectively.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The fragile urethra: what to do next?-a narrative review.","authors":"Aroh Pandit, Chrystal Chang, Jay Simhan","doi":"10.21037/tau-22-798","DOIUrl":"https://doi.org/10.21037/tau-22-798","url":null,"abstract":"<p><strong>Background and objective: </strong>Although the artificial urinary sphincter (AUS) has demonstrated successful outcomes in treating male stress urinary incontinence (SUI) for the past five decades, this procedure also carries inherent risks, including recurrent SUI, device malfunction, local tissue compromise, and infection/erosion, all of which may require revision surgery with or without device replacement. Patients that are at the highest risk for such untoward events often possess unhealthy urethral tissue (termed a \"fragile urethra\") that is compromised and unable to provide optimal cuff coaptation and continence. Accordingly, there are several techniques to address recalcitrant SUI in the setting of a fragile urethra to afford an improved chance of return to continence. Here, we review characteristics of patients that are at higher risk for an untoward outcome following AUS implantation and further define strategies to promote optimal success with device implantation. The aim of this paper is to review the available literature and describe surgical options for male SUI in patients with known or anticipated urethral tissue compromise.</p><p><strong>Methods: </strong>A thorough literature review was completed by querying PubMed for relevant articles. Search terms included artificial urinary sphincter, failure, recalcitrant, urethral atrophy, fragile urethra, revision, radiation, cystectomy, incontinence, and/or urethroplasty published between 1975 and 2022.</p><p><strong>Key content and findings: </strong>Options for management of the fragile urethra include cuff relocation, cuff downsizing, tandem cuff placement, transcorporal cuff placement, pressure regulating balloon exchange with increased or decreased pressure, bulbospongiosus preservation, sub-cuff ventral capsulotomy, urethral wrapping with graft, and in select cases, urinary diversion, or complete device removal with a return to SUI. Proper patient selection is paramount to optimize outcomes. Advantages and disadvantages of each strategy are reviewed.</p><p><strong>Conclusions: </strong>Numerous techniques are viable options for patients with recalcitrant SUI in the setting of a fragile urethra, but high-quality evidence with reproducible outcomes for many of these strategies remain limited. Proper patient selection as well as adequate counseling by experienced implant surgeons may help optimize outcomes. Further multi-institutional investigations with longer term outcomes are needed to improve patient selection and counseling with shared decision-making prior to any intervention.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cellular regenerative therapy in stress urinary incontinence: new frontiers?-a narrative review.","authors":"Karl-Erik Andersson, Koudy Williams","doi":"10.21037/tau-22-682","DOIUrl":"https://doi.org/10.21037/tau-22-682","url":null,"abstract":"<p><strong>Background and objective: </strong>Even if treatment with stem cells has been shown to be safe and effective in many patients with stress urinary incontinence (SUI), there is still room for improvement using other regenerative medicine alternatives. Since the beneficial effects of stem cells are probably mediated by secretion of factors rather than by the cells themselves there is a good rationale for further exploring the therapeutic effects of the secretome and/or its components. However, homing factors such as stromal derived growth factor 1 (SDF-1; CXCL12), stimulation of stem cell growth and stem cell mobilization <i>in vivo</i> using low intensity shock wave therapy (Li-ESWT) or regenerative electrical stimulation (RES), are also promising approaches.</p><p><strong>Methods: </strong>A literature search was performed based on PubMed, Scopus and Google Scholar. The search criteria included original basic science articles, systematic reviews and randomized control trials. All studies were published between 2000 and 2023. Selected, peer-reviewed studies were further analyzed to identify those of relevance. Keywords searched included: \"female stress incontinence\", \"homing factors\", \"CXCL12\", \"secretome\", \"low intensity shockwave therapy\" and \"regenerative electrical stimulation\". The peer-reviewed publications on the key word subjects that contained a novel addition to the existing body of literature were included.</p><p><strong>Key content and findings: </strong>There is evidence from studies on non-human primates (NHPs) with experimental urinary sphincter injury that CXCL12 can restore sphincter structure and function. Studies with homing factors in human patients with SUI are still to be performed. A large number of clinical studies on the use of secretome or secretome products from mesenchymal stem cells (MSCs) on indications other than human SUI are already available. However, controlled clinical trials on patients with SUI, have to the best of our knowledge, not yet been performed. Also, RES has not been studied in patients with SUI. In contrast, there is clinical evidence that Li-ESWT may improve female SUI.</p><p><strong>Conclusions: </strong>Treatment with homing factors, MSC secretome/secretome components, Li-ESWT and RES are promising frontiers in the treatment of human SUI caused by sphincter damage.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}