Pelvic floor Muscle Training after Radical Prostatectomy: is there any differences when we compare retropubic radical prostatectomy with laparoscopic radical prostatectomy?

==inizio objective==

To evaluate the effectiveness of pelvic floor muscle training (PFMT) for treating urinary incontinence (UI) after radical prostatectomy (RP), both retropubic radical prostatectomy (RRP) and videolaparoscopic radical prostatectomy (VLRP).

==fine objective==

==inizio methodsresults==

Between February 2016 and May 2019, a total of 60 patients with different grades of UI have been retrospectively examined to understand if there were any differences in the effectiveness of PFMT between patients underwent RRP (30 patients) versus VLRP (30 patients) at Urological Clinic of “Madonna delle Grazie” hospital, in Matera, Italy. Median age was 66,8±6,1 years and median BMI was 27,1±3,2. Inclusion criteria were: diagnosis of localized prostate cancer (stage between T0 and T3c and Gleason 6-9), nerve sparing technique when indicated, absence of UI before surgery, BMI 5pads/die) was observed in 6,7% of RRP patients (ICIQ-SF medium score 18) vs 16,7% of VLRP patients (ICIQ-SF medium score 17,8). After three months: 83,3% of RRP patients achieved continence or had a low grade UI (0-2 pads/die, ICIQ-SF medium score 6,22) vs 86,7% of VLRP patients (ICIQ-SF medium score 6,15); medium grade of UI (3-4 pads/die) was obeserved in 16,7% of RRP patients (ICIQ-SF medium score 15,2) vs 13,3% of VLRP patients (ICIQ-SF medium score 15,25); no patients had high grade UI. After six months: 93,3% of both RRP and VLRP patients achieved continence or had low grade UI (ICIQ-SF medium score 4 vs 4,27); 3,3% (1 patient) of both group had medium grade UI (ICIQ-SF medium score 14 in both RRP and VLRP patients); high grade UI was observed in 3,3% (1 patient) of both RRP and VLRP group (ICIQ-SF medium score 21 vs 18).

==fine results==

==inizio discussions==

Open retropubic radical prostatectomy has been the “gold standard” treatment for locally confined prostate cancer (PCa) but in recent years minimal invasive techniques as laparoscopy and robot-assisted prostatectomy have become widely available. The trifecta of the surgical treatment of PCa is cancer control, the preservation of continence, and erectile potency (1). Incontinence after RP (P-RP-I) varies widely (2% to <60%) according to the definition and quantification of incontinence, timing of evaluation, and who evaluates (physician or patient) (2). Conservative treatments, including pelvic floor muscle training (PFMT), anal electrical stimulation (AES), lifestyle adjustment, or combination are usually recommended at first for P-RP-I (3). In our study we compare the benefits of PFMT on P-RP-I after retropubic radical prostatectomy and after laparoscopic radical prostatectomy. We found an earlier (after 1 month) recovery of continence in patients underwent retropubic radical prostatectomy vs laparoscopic approach but, after 6 months the results were the same. Just one patient in RRP group and one patient in VLRP group manifested a high grade UI at six months, but they both had adjuvant radiotherapy.

==fine discussions==

==inizio conclusion==

As is known, PFMT is an effective treatment for urinary incontinence in men after radical prostatectomy (4). There were no differences between RRP group patients and VLRP group patients in terms of long-term results.

==fine conclusion==

==inizio reference==

(1). Van Poppel H et al. Asian J Urol 2019 Apr;6(2):125-128. (2). O’Callaghan ME et al. Prostate Cancer Prostatic Dis. 2017 Dec;20(4):378-388. (3). EAU Guidelines 2019. (4). MacDonald R et al. BJU Int. 2007 Jul;100(1):76-81.

==fine reference==

HIFEM™ TECHNOLOGY CAN IMPROVE QUALITY OF LIFE OF INCONTINENT PATIENTS

==inizio objective==

The aim was to investigate the effect of High-Intensity Focused Electromagnetic technology (HIFEM) on QoL of incontinent patients.(1)High-intensity Focused Electromagnetic technology (HIFEM) triggers intense pelvic floor muscles contractions by targeting neuromuscular tissue and inducing electric currents. Electric currents depolarize neurons resulting in concentric contractions and lift up of all pelvic floor muscles. Key effectiveness is based on focused electromagnetic energy, in-depth penetration, and stimulation of the entire pelvic floor area. The HIFEM technology brings deep PFM stimulation and restoration of the neuromuscular control. The HIFEM passes non-invasively through pelvic floor area. Therefore, it represents a non-invasive solution for incontinent patients, who remain fully clothed during the therapy (2-10, 12, 14-19).

==fine objective==

==inizio methodsresults==

15 women (mean age 63.05 years) with stress, urge and mixed type of UI took part in the pilot study. They attended 6 therapies scheduled 2x a week. QoL was assessed through King’s Health Questionnaire (KHQ). The number of used hygienic pads and patients’ subjective feedback were recorded. Data was collected pre-, post-treatment, during 2- and 4-month follow-ups. KHQ scores were statistically evaluated through t-test (p<0.05). Number of used hygienic pads and patients’ subjective feedback were evaluated through frequency of occurence.3.3. Exclusion criteria
Women with pacemakers, metal implants, blood coagulation disorders, tumors, fever, menstruation and pregnant women were not included in this study. In this pilot study, FDA and EMA approved device for female urinary incontinence treatment BTL EMSELLA (BTL EMSELLA, BTL Industries Inc.) was used.Frequency range 20-30 Hz with trapezoid intensity modulation was used to achieve gradual motor unit recruitment. Relative intensity (in %) was gradually increased from patients’ motor up to above the motor threshold.All women absolved 6 therapies scheduled 2x a week. Therapy was performed by medical personnel, who positioned patients fully dressed into a comfortable sitting position, feet on the floor, hip, knee and ankle joints perpendicularly flexed. 30-minute duration for each treatment session.
Attachement 1

==fine methodsresults==

==inizio results==

After 6 treatments, 95 % of treated patients improved their QoL according to the scores of the KHQ. These results were maintained during the 2- and 4-month follow-ups. 67 % of the treated patients reduced or totally eliminated the use of hygienic pads in day-to-day life. 100 % of patients reported better awareness of the pelvic floor muscles.Additionally, patients answered the question ‘What is the major difference you noticed after the BTL EMSELLA therapies?’40 % of patients reported that they are able to perform proper contraction of the PFM; 28 % of patients were able to contract PFM selectively; 20 % of patients reported better muscle firmness and 12 % of patients reported that the period between micturition is longer. Additionally, all patients (n=15; 100 %) reported better awareness of pelvic floor muscles.

==fine results==

==inizio discussions==

To regain continence, regular pelvic floor muscles exercising is required. Normally, 300-500 contractions of the pelvic floor muscles should be performed to begin to develop a new motor pattern, whereas 3,000-5,000 contractions are required to erase and correct poor motor pattern. During 1 session using HIFEM technology, thousands PFM contractions are performed. This method is extremely important to PFM re-education as the patients are not able to perform this high-repetition rate pattern due to PFM weakness and an inability to consistently contract this muscle group. After 6 therapeutic sessions with HIFEM therapy, patients developed the new motor pattern needed to better control pelvic floor muscles and also regained muscle strength and continence control (3-9, 12-16).

==fine discussions==

==inizio conclusion==

UI represents a significant psycho-socio-economical healthcare problem that has a major negative impact on today’s modern lifestyles. The majority of patients are not satisfied with the current treatment methods offered, which include surgical intervention, drug therapy, pelvic floor muscles exercising (Kegel) or minimally invasive intravaginal procedures. This latest research, as well as, previous studies suggest that HIFEM technology leads to significant improvement in QoL of incontinent patients, maintains a patient’s privacy all while avoiding more invasive approaches.

==fine conclusion==

==inizio reference==

1)Abrams P, Blaivas JG, Stanton SL, Andersen JT. The Standardisation of Terminology of Lower Urinary Tract Function. The International Continence Society Committee on Standartisation of Terminology. Scand d Suppl 1998; 114:5-19
2)Abulhasan, J., Rumble, Y., Morgan, E., Slatter, W. and Grey, M. (2016). Peripheral Electrical and Magnetic Stimulation to Augment Resistance Training. Journal of Functional Morphology and Kinesiology, 1(3), pp.328-342
3)Almeida FG, Bruschini H, Srougi M.: Urodynamic and clinical evaluation of 91 female patients with urinary incontinence treated with perineal magnetic stimulation: 1-year follow-up. J Urol. 2004 Apr; 171(4), pages 1571-4
4)Bickford, R., Guidi, M., Fortesque, P. and Swenson, M. (1987). Magnetic stimulation of human peripheral nerve and brain. Neurosurgery, 20(1), pp.110-116.Bustamante, V., de Santa María, E., Gorostiza, A., Jiménez, 5)U. and 5Gáldiz, J. (2010). Muscle training with repetitive magnetic stimulation of the quadriceps in severe COPD patients. Respiratory Medicine, 104(2), pp.237-245.
6)Coletti, D., Teodori, L., Albertini, M., Rocchi, M., Pristerà, A., Fini, M., Molinaro, M. and Adamo, S. (2007). Static magnetic fields enhance skeletal muscle differentiation in vitro by improving myoblast alignment. Cytometry Part A, 71A(10), pp.846-856.
7)Feldman M., Magnetic Stimulation for the Treatment of Urinary Incontinence in Women, California Technology Assessment Forum, San Francisco, CA, October 20, 2004
8)Han T.R., Shin H.I., Kim I.S. Magnetic stimulation of the quadriceps femoris muscle: comparison of pain with electrical stimulation. Am J Phys Med Rehabil 2006; 85(7):593-599.
9)Ishikawa N., Suda S., Sasaki T. et al., Development of a non-invasive treatment system for urinary incontinence using a functional continuous magnetic stimulator (FCMS) , Medical & Biological Engineering & Computing, 1998, 36, 704-710
10)Man, W. (2004). Magnetic stimulation for the measurement of respiratory and skeletal muscle function. European Respiratory Journal, 24(5), pp.846-860.
11)National Association for Incontinence (NAFC), www.nafc.org Ostrovidov, S., Hosseini, V., Ahadian, S., Fujie, T., Parthiban, S., Ramalingam, M., Bae, H., Kaji, H. and Khademhosseini, A. (2014).
12)Skeletal Muscle Tissue Engineering: Methods to Form Skeletal Myotubes and Their Applications. Tissue Engineering Part B: Reviews, 20(5), pp.403-436.
13)Sand PK, Richardson DA, Staskin DR. Pelvic floor electrical stimulation in the treatment of genuine stress incontinence: a multicenter, placebo-controlled trial. Am. J. Obstet. Gynecol. 1995; 173, pages 72–9
14)M., Arnold, A.StÖlting,, Haralampieva, D., Handschin, C., Sulser, T. and Eberli, D. (2016). Magnetic stimulation supports muscle and nerve regeneration after trauma in mice. Muscle & Nerve, 53(4), pp.598-607. 15)Truijen G, Wyndaele 13)JJ, Weyler J.: Conservative treatment of stress urinary incontinence in women: Who will benefit? Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12(6), pages 386-90
16)Wallis, M., Davies, E., Thalib, L. and Griffiths, S. (2011). Pelvic Static Magnetic Stimulation to Control Urinary Incontinence in Older Women: A Randomized Controlled Trial. Clinical Medicine & Research, 10(1), pp.7- 14.
17)Yamanishi T, Yasuda K, Suda S et al. Effect of functional continuous magnetic stimulation for urinary incontinence. J. Urol. 2000; 163, pages 456–9
18)Yamanishi T, Yasuda K, Sakakibara R et al. Pelvic floor electrical stimulation in the treatment of stress incontinence: an investigational study and a placebo controlled double- blind trial. J. Urol. 1997; 158, pages 2127–31
19)Yang, S., Jee, S., Hwang, S. and Sohn, M. (2017). Strengthening of Quadriceps by Neuromuscular Magnetic Stimulation in Healthy Subjects. PM&R.

==fine reference==

Fractional CO2 laser for treatment of stress urinary incontinence

==inizio objective==

To evaluate the impact of trans-vaginal fractional CO2 laser treatment on symptoms of stress urinary incontinence (SUI) in women
Urinary incontinence (UI), defined as the complaint of any involuntary leakage of urine, affects nearly 40% of women; stress urinary incontinence (SUI) accounts for approximately half of all UI [1]. UI significantly impacts on quality of life, affecting the woman’s physical, mental, social and sexual well-being and leading to avoidance of intimacy, depression and social isolation [[2], [3], [4]]
Surgical options for SUI include trans-vaginal insertion of a mid-urethral sling (MUS) and the more invasive, traditional gold-standard Burch colposuspension procedure, requiring an abdominal approach (laparotomic or laparoscopic)
Fractional micro-ablative laser therapy has been shown to be a potential non-surgical treatment alternative for SUI [10,11]. The subclinical thermal tissue effect from the laser beam induces human dermal fibroblasts to initiate an inflammatory healing cascade, stimulating de novo collagen and elastin synthesis resulting in a thicker vaginal epithelium with larger diameter, glycogen-rich epithelial cells [[12], [13], [14]].

The aim of this study is to evaluate the change in SUI symptoms after trans-vaginal fractional micro-ablative CO2 laser in women at baseline, compared to follow-up at 3 months and 12–24 months post-treatment.

==fine objective==

==inizio methodsresults==

25 Women clinically diagnosed with SUI preferring non-surgical treatment were recruited to the study. Fractional CO2 laser system (MonaLisa T, DEKA) treatments were administered trans-vaginally every 4–6 weeks for a total of three treatments. Response to treatment was assessed at baseline (T1), at 3 months after treatment completion (T2) and at 12–24-month follow-up (T3) using KHQ scores . Number of used hygienic pads and patients’ subjective feedback were evaluated through frequency of occurence. The primary outcome was changes in reported symptoms of SUI. Secondary outcomes assessed included bladder function, urgency, urge urinary incontinence (UUI), pad usage, impact of urinary incontinence on quality of life (QOL) and degree of bothersome bladd
During 2016–2019, 25 women aged 35 years or more being treated by a single urogynaecology consultant
Inclusion criteria were no/unsatisfactory response to conservative treatments and a preference for non-surgical management of bothersome SUI symptoms. The women also demonstrated a positive cough test and urethral hypermobility on ultrasound. All women that participated were offered urodynamic studies and encouraged to continue with topical oestrogen therapy and pelvic floor muscle exercises. Women with ≥stage II pelvic organ prolapse quantification system (POPQ) score, acute or recurrent urinary tract infections, pregnancy, current malignancy, known cervical dysplasia or undiagnosed abnormal uterine bleeding were excluded. All participants were asked to complete the bladder function section of the at baseline (T1), 3 months after third treatment (T2), and at 12–24 months’ follow-up (T3). The KHQ a validated self-administered pelvic floor questionnaire utilised for quantification of clinical and research outcomes [15]. The primary outcome of this study is to describe the change in self-reported SUI symptoms based on question The secondary outcomes were bladder function, urgency, urge incontinence, pad usage, quality of life, degree of bothersome bladder score as assessed by KHQ. Improvement of SUI was calculated based on severity scoring 0-3. Bladder function score was calculated by adding all 15 questions in the bladder subsection of APFQ, with maximum score of 45. Scores 0–11.25 was normal bladder function, 11.26–22.5 was mild bladder dysfunction, 22.6–33.75 was moderate bladder dysfunction, and 33.76–45 was severe bladder dysfunction. Questionnaires were distributed to participants and collated by practice staff; the identity of individual respondents remained blinded to the invest
igators.
25 women were recruited to the study with an average age of 57.4 ± 11.4 years (30–85 years); 14 were postmenopausal, 12 had urodynamic studies, which confirmed SUI. There were 12 women who were followed-up at 3 months and 13 at 12–24 months .

==fine methodsresults==

==inizio results==

In relation to the primary outcome , Fig. 1 illustrates the reduction in SUI symptoms reported by women at follow-up (T2 and T3) compared to baseline (T1). At T1, all 25 participants reported frequent or daily SUI symptoms. At T2, 80% reported an improvement in SUI symptoms, which included 46% participants reporting no SUI symptoms, 16.4% participants reported frequent symptoms, 3.6% reported daily symptoms. These changes were also reflected in the median score reduction for KHQ (p < 0.01)
Similar results were demonstrated for secondary outcomes of bladder function , urge incontinence ) and bothersome bladder . Normal bladder function increased from 31% at 3 months to 72.2% at 12 months. This trend decreased to 69.4% at 24 months. There was an overall improvement in participants’ urge incontinence scores from T1 to T2, with an increase in the number of patients reporting “never” leaking urine when they rush to the toilet from this trend decreased slightly to at T3 (44.4%, p < 0.01). There was an improvement in the participants’ degree of bothersome bladder from T2 toT3 months more women reported “not at all (bothersome)” from T2 to T3 (3.4% to 50%, p < 0.01); this trend reduced at 24 months (36%, p = 0.01).

==fine results==

==inizio discussions==

This study describes the change in prevalence of SUI symptoms before and after fractionated CO2 laser to treat both pre- and post-menopausal women with SUI. The study showed that following 3 treatments at 4–6-week intervals, SUI symptoms improved in 80% of participants at 3 months (p < 0.01) and that these benefits persisted in 75% of participants at 12 months (p < 0.01).

==fine discussions==

==inizio conclusion==

In summary, micro-ablative fractional CO2 laser treatment appears to be a promising, non-surgical, non-hormonal, minimally invasive, durable, low risk treatment option for women with SUI. The safety this treatment modality and the reduced prevalence as per self-reported SUI symptom reduction from baseline suggests a possible alternative for women with SUI who are unwilling to accept the inherent risks of MUS and Burch colposuspension, or whose medical comorbidities exclude surgical treatment. Further research should compare the use of fractionated CO2 laser with placebo and/or established treatments, as well as determine whether booster treatment is required to sustain improvements in SUI symptoms longer term.

==fine conclusion==

==inizio reference==

E.S. Lukacz, Y. Santiago-Lastra, M.E. Albo, L. Brubaker
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Analysis of collagen status in premenopausal nulliparous women with genuine stress incontinence
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==fine reference==

Female pelvic prolapse: Considerations on Mesh Surgery and our experience with InGYNious(Ami tm) Mesh in 74 women with complicated pelvic Prolapses

==inizio objective==

Pelvic organ prolapse (PoP) is a common condition in women. In fact in lifetime
the pelvic support system in and around a woman’s vagina weakens or collapses.
Among all current treatment options, surgery can be augmented with implantation
of mesh or graft materials. (1, 2, 3 )Different kinds of meshes have been developed.
During the last 4 years we treated 74 women with complicated pelvic prolapses by using a
new generation prolene mesh with single incision procedure and fixing points with I stich device
Then we analysed the results.

==fine objective==

==inizio methodsresults==

Seventy-four women underwent surgery for the correction of PoP using a prolene
mesh. All patients presented a III-IV stage prolapse (PoP Q criteria) and were
studied by urodynamics and cystography. In 55 women we positioned an anterior
mesh, in 19 women an anterior vault mesh. In 44 patients with SUI a sling under the urethra
was also positioned. The follow-up took place after 24 months and
urogyneaecological evaluation was performed after 1, 3, 6, 12, 20 months of surgery

==fine methodsresults==

==inizio results==

No vascular or visceral complications occurred. In 5 (6,7%) cases a mild perineal
hematoma occurred and in 5 (6,7%) cases presacral pain needed antinflammatory
drugs.. Three erosions of the mesh were recorded in 4 (5,4%), but nothing was removed.
Three II degree cystocele (4%) occurred. 3 (4%) presented in second post operative day
renal colic with hydronephrosis of 2 degree with TAC
An ureteral double J stent for 4 weeks has solved the problem
All patients are continent.

==fine results==

==inizio discussions==

We don’t have serious complicance and the patients have good results and satisfaction
The new generation ultralight mesh presente less erosion and complications

==fine discussions==

==inizio conclusion==

A better knowledge is required regarding indications, efficay and safety of mesh
and graft usage with a validated and generally accepted measure of subjective
prolapse symptoms. However the surgical repair of the PoP by using new generation mesh
appears to be an extremely effective and safe procedure with encouraging outcomes, even in
complicated cases.

==fine conclusion==

==inizio reference==

1. PetroS P.e., UlMSten U. :
An Integral Theory of Female urinary incontinence.
acta obstetricia et gynecologica Scandinavica 1990,69:1-79.
2. PetroS P.e. :
Vault prolapse II: restoration of dynamic vaginal supports by infracoccygeal
sacrocolpopexy, an axial day-case vaginal procedure.
int Urogynecol J Pelvic Floor Dysfunct 2001;12:296-303.
3. De lancey:
The anatomy of the pelvic floor.
obstet ginecol, 1994; 6: 313-316.
Urogynaecologia international

==fine reference==

Colpo-istero-sacropessi laparoscopica: gold standard terapeutico per la correzione dei prolassi urogenitali

==inizio objective==

Abdominal sacrocohysteropexy is the gold standard treatment for pelvic organ prolapse (POP) and can be performed laparoscopically. The demand for treatment of pelvic floor disorders has been projected to increase significantly in the coming years, as Western countries are experiencing a rapid increase in the geriatric demographic. The prevalence of pelvic organ prolapse (POP), defined as stage ≥2 prolapse using the Pelvic Organ Prolapse Quantification (POP-Q) examination, was reported to be 37% in the general population and increased to 64.8% in an older population of women with a mean age of 68 yr . . To evaluate the surgical outcome, complications and benefits of laparoscopic single promonto-fixation for patients with pelvic prolapse.

==fine objective==

==inizio methodsresults==

Abdominal sacrocohysteropexy is the gold standard treatment for pelvic organ prolapse (POP) and can be performed laparoscopically. The demand for treatment of pelvic floor disorders has been projected to increase significantly in the coming years, as Western countries are experiencing a rapid increase in the geriatric demographic. The prevalence of pelvic organ prolapse (POP), defined as stage ≥2 prolapse using the Pelvic Organ Prolapse Quantification (POP-Q) examination, was reported to be 37% in the general population and increased to 64.8% in an older population of women with a mean age of 68 yr . . To evaluate the surgical outcome, complications and benefits of laparoscopic single promonto-fixation for patients with pelvic prolapse.

==fine methodsresults==

==inizio results==

A total of 243 patients were operated upon between 2005 and 2015. Their mean age was 63 (range 35–78), average follow-up was 14.6 months, the mean operating time was 102 minutes. There were 2 conversions due to anesthetic or surgical difficulties. Follow up was done by a postal questionnaire and physical examination at 6 months and then yearly. 96% were satisfied with the results of their operation and no patients complained of sexual dysfunction. There was a 2% recurrence rate of prolapse, 0 vaginal erosions. Perioperative complications were one vaginal effraction . The mean hospital stay was 3 days (2–5) . We observed no retraction of the mesh and no dyspareunia.With this type of conformation of the posterior mesh we have significantly reduced the dischezia compared to double promonto-fixation.

==fine results==

==inizio discussions==

Laparoscopic promonto-fixation is feasible and highly effective technique that offers good long-term results with complication rates similar to open surgery, with the added benefits of minimally invasive surgery We consider unnecessary remove uterus and promontory attached of the posterior mesh, reducing the risk of erosion, constipation and dischezia. De novo urgency was observed in 10 patients (10.5%) who had had previous high-grade cystocele (five with concomitant prolapse of other compartments). The symptoms were treated with short-term anticholinergic medications and always resolved in the first few weeks after surgery. Laparoscopic approach was developed to reduce surgical invasiveness and was shown to achieve similar results compared with the open approach . However, the procedure is technically challenging, particularly because of the need to perform intracorporeal sutures in a limited space, and is characterised by relatively long operative times.

==fine discussions==

==inizio conclusion==

With this technique we performed a complete treatment for severe prolapse by a minimally invasive approach with a low rate of recurrence at this point. Our technique of RASC with implant of polypropylene meshes is associated with low morbidity and good long-term results in the treatment of all types of POP. High BMI and previous abdominal or vaginal surgery, including previous treatments for POP, do not represent a contraindication for this surgical approach. Our study is limited by its retrospective and noncomparative design. Furthermore, we relied only on the Baden-Walker classification for assessment of POP without using the International Continence Society organ prolapse classification . We are also aware that the use of interviews before data analysis rather than standardised questionnaires or mandatory follow-up examinations might have led to an underestimation of symptoms or asymptomatic POP recurrences. Further prospective and comparative studies are needed to confirm these findings.

==fine conclusion==

==inizio reference==

==fine reference==

Adjustable single incision slings for female stress urinary incontinence: a single center study

==inizio objective==

Stress urinary incontinence (SUI) is a common problem worldwide. The aim of this study is to assess middle-term results of the adjustability single incision TOT sling (Altis) in patients with of stress urinary incontinence.

==fine objective==

==inizio methodsresults==

A consecutive series of female patients with SUI were enrolled from 2014 to 2016. Patients with neurogenic UI were excluded from the analysis. All patients underwent Altis Single Incision Sling System with or without O. Patient-reported cure rate, objective cure rate and complications were reported at 1 and 2 years.

==fine methodsresults==

==inizio results==

Overall 30 patients with a mean age of 55 years (Range: 36-79) were enrolled. Mean operating time of sling procedure alone was 11 minutes All patients completed the follow up period of 24 months. Overall success rate was 83%, improved rate was 4% and failure rate was 3%. Complications included 3 patients with mesh extrusion solved with estrogens while no voiding difficulties and no dysuria were recorded.

==fine results==

==inizio discussions==

.

==fine discussions==

==inizio conclusion==

SIMS-Altis is safe and effective in the treatment of female stress urinary incontinence. The results of the study suggest that the adjustability single incision sling (Altis) can be considered a minimally invasive TOT with no-needles and maintaining similar cure rates. Further randomized clinical trials should confirm our results.

==fine conclusion==

==inizio reference==

.

==fine reference==

Carbon and zeolite impregnated polyester fabric inhibits urine odour: a randomized experimental study

==inizio objective==

Bladder cancer ranks fifth as the most common cancer in the world. Many individuals with bladder cancer have undergone a surgical urostomy and often complain of being self-conscious of the unpleasant smell of their own urine. The focus of this study was to test the efficacy of a pouch cover made of a carbon and zeolite containing polyester material to inhibit the smell of urine by comparing two trained dogs’ response time in detecting volatile organic compounds (VOCs) in urine(1-2), with and without the fabric covering the samples.

==fine objective==

==inizio methodsresults==

This study used a randomized, blinded experimental design to evaluate the efficacy of a fabric to interfere with two highly trained dogs’ ability to detect specific VOCs present in the urine of prostate cancer patient. Ninety urine samples were analysed in this study.

==fine methodsresults==

==inizio results==

Prior to the experiment, both dogs accurately detected VOCs in the uncovered test urine samples of men with prostate cancer with a sensitivity and specificity of nearly 100%. Both dogs recognized the “uncovered” urine samples of men with prostate cancer within two seconds. When the test sample was covered with the study fabric, the test urine samples were detected within 30-40 seconds and in some instances the dogs were not able to identify the covered samples, whatsoever.

==fine results==

==inizio discussions==

The findings of this study demonstrate that the carbon and zeolite containing polyester fabric did significantly interfere with the ability of the dogs to detect VOCs in urine of men with prostate cancer

==fine discussions==

==inizio conclusion==

The fabric may show promise as a pouch cover in controlling offensive urine odour which many ostomates experience.

==fine conclusion==

==inizio reference==

1. Sniffing out prostate cancer: a new clinical opportunity.
Taverna G, Tidu L, Grizzi F
Cent European J Urol. 2015;68(3):308-10. doi: 10.5173/ceju.2015.593. Epub 2015 Oct 15. Review.
2. Highly-trained dogs’ olfactory system for detecting biochemical recurrence following radical prostatectomy.
Taverna G, Tidu L, Grizzi F, Stork B, Mandressi A, Seveso M, Bozzini G, Sardella P, Latorre G, Lughezzani G, Buffi N, Casale P, Fiorini G, Lazzeri M, Guazzoni G
Clin Chem Lab Med. 2016 Mar;54(3):e67-70. doi: 10.1515/cclm-2015-0717

==fine reference==