You have accessJournal of UrologyCME1 Apr 2023MP71-15 VIRTUE SUB-URETHRAL SLING FOR STRESS URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY: a SINGLE-CENTER EXPERIENCE Edoardo Beatrici, Simone Scarcella, Chiara Del Prete, Gianluca Giglioni, Simone Cappuccelli, Lucia Pitoni, Giuliana Gabrielloni, Vito Lacetera, and Valerio Beatrici Edoardo BeatriciEdoardo Beatrici More articles by this author , Simone ScarcellaSimone Scarcella More articles by this author , Chiara Del PreteChiara Del Prete More articles by this author , Gianluca GiglioniGianluca Giglioni More articles by this author , Simone CappuccelliSimone Cappuccelli More articles by this author , Lucia PitoniLucia Pitoni More articles by this author , Giuliana GabrielloniGiuliana Gabrielloni More articles by this author , Vito LaceteraVito Lacetera More articles by this author , and Valerio BeatriciValerio Beatrici More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stress urinary incontinence (SUI) still represents one of the most common complications after radical prostatectomy (RP). We aim to report our single-center experience with the sub-urethral Virtue male sling (Coloplast, Humlebaek, Denmark) for SUI after RP. METHODS: We prospectively enrolled patients with SUI after RP who underwent sub-urethral Virtue sling placement at our Institution between July 2017 and April 2022. Pre and post-operative (1, 3, 6, and 12 months) SUI was evaluated according to the International Consultation on Incontinence Short-Form Questionnaire (ICIQ-SF), and the number of pads/day. Clavien-Dindo was used to report complications, and Visual Analogue Scale (VAS) to report patients pain during follow-up. Wilcoxon signed-rank test was used to test the median difference between pre and post-operative SUI. Multivariable logistic regression models adjusted for age, BMI, RP approach, previous radiotherapy, and preoperative SUI severity were fitted to test the association between outcomes and patients’ baseline characteristics. RESULTS: A total of 52 patients with SUI after RP (69.2% open, 3.9% laparoscopic, and 26.9% robotic) were prospectively enrolled. Median (IQR) age at surgery was 73 (68 – 76.5) years. Median preoperative ICIQ-SF was 13 (12 - 14), with 32.7% and 67.3% of patients who reported moderate and severe SUI respectively. Median preoperative number of pads\day was 3 (2 - 4). Overall, 11.5% of patients developed a Clavien-Dindo Grade I / II complication after surgery. No major complications were reported. Median VAS score was 3 (2 – 4.5) at first postoperative day, 2 (11-3) upon discharge and 0 after 12 months. Compared to preoperative, Wilcoxon signed-rank test showed a significant median reduction of ICIQ-SF score and number of pads/day at each of the follow-up controls (all p<0.001). After 12 months, 29.4% of patients reached complete continence (0 pads\day) and 35.9% referred only 1 pad\day. Median number of pads\day was 1.5 (1 - 3). Median ICIQ-SF score was 6 (4 – 9), with 44.2% of patients reporting slight incontinence. Adjusted multivariable logistic regression models didn’t find any association between worse outcomes and patients’ baseline characteristics. CONCLUSIONS: To our knowledge, this is the largest single-center experience with sub-urethral Virtue sling after RP. According to our results, this device might safely provide impactful quality of life improvement and recovery in patients with SUI after RP. A larger case series might help to stratify patients who can benefit the most from this sling. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1020 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Edoardo Beatrici More articles by this author Simone Scarcella More articles by this author Chiara Del Prete More articles by this author Gianluca Giglioni More articles by this author Simone Cappuccelli More articles by this author Lucia Pitoni More articles by this author Giuliana Gabrielloni More articles by this author Vito Lacetera More articles by this author Valerio Beatrici More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: Improved cancer control with increasing surgical experience - the learning curve - has been demonstrated for open and laparoscopic prostatectomy. In a prior single center study, we found that this might not be the case for robot-assisted radical prostatectomy (RARP). Herein, we assessed the relationship between surgical experience and oncologic outcomes of RARP in a multi-institutional setting.Methods: We analyzed data of 8,101 patients with prostate cancer treated with RARP by 46 surgeons at 9 institutions between 2003 and 2021. Surgical experience was coded as the total number of robotic prostatectomies performed by the surgeon before the patient operation. We evaluated the relationship of prior surgeon experience to the probability of biochemical recurrence (BCR) adjusting for preoperative PSA, pathological stage, grade, lymph-node involvement and year of surgery.Findings: Overall, 1047 patients had BCR. Median follow-up for patients without BCR was 33 months (interquartile range: 14, 61). After adjusting for case mix, the relationship between surgical experience and the risk of BCR after surgery was not statistically significant (p=0.2). The 5-yr BCR-free survival for a patient treated by a surgeon with prior 10, 250 and 1000 procedure performed was 82.0%, 82.7% and 84.8% (absolute difference between 10 and 1000 prior procedures: 1.6% (95%CI: 0.4%, 3.3%). Results were robust to a number of sensitivity analyses.Interpretation: These findings suggest that, as opposed to open and laparoscopic radical prostatectomy, surgeons performing RARP achieve adequate cancer control in the early phase of their career. Further research should explore why the learning curve for robotic surgery differs from prior findings for open and laparoscopic radical prostatectomy. We hypothesize that surgical education, including simulation training and the adoption of objective performance metrics, is an important mechanism for flattening the learning curve.Funding: This work was supported in part by the National Institutes of Health/National Cancer Institute (NIH/NCI) with a Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center [P30 CA008748], a SPORE grant in Prostate Cancer to Dr. H. Scher [P50-CA92629],the Sidney Kimmel Center for Prostate and Urologic Cancers.Declaration of Interests: The authors declare no conflicts of interest in preparing this article.Ethics Approval Statement: All information was obtained with appropriate ethics committee or institutional review board waivers, and data were made anonymous before analysis.

To evaluate the outcomes of pre-stented (PS) versus non-pre-stented (NPS) patients who have undergone retrograde intrarenal surgery (RIRS) for renal calculi with subgroup analysis of Asian and non-Asian cohorts. Protocol is registered in PROSPERO, CRD42021261123. Eligible studies identified from four electronic databases. Meta-analysis was done to enumerate the outcomes of RIRS in between PS and NPS. Secondary sub-analysis was done to look for differences in outcomes in Asian and non-Asian cohorts. Fourteen studies involving 3831 patients (4 prospective, 10 retrospective studies) were included. PS patients experienced higher success rates of ureteral access sheath (UAS) insertion than NPS (RR 1.09, 95% CI 1.05–1.13, p < 0.00001). PS patients had lower risk of ureteral injuries from UAS placement (RR 0.69, 95% CI 0.50–0.96, p = 0.03). No significant differences in intra- and postoperative complications between two groups were found. Stone-free rate (SFR) outcomes for residual fragment (RF) cut-off of < 1 mm and < 4 mm favoured the PS patients (RR 1.10, 95% CI 1.04–1.17, p = 0.002 for < 4 mm, RR1.10, 95% CI 1.02–1.19, p = 0.02 for < 1 mm). In the subgroup analysis, PS Asian patients had similar SFR as NPS patients for SFR(< 4 mm) but non-Asian population showed better outcomes in the PS patients for SFR(< 4 mm) (RR 1.31, 95% CI 1.13–1.52, p = 0.0005). This meta-analysis suggests that pre-stenting results in a higher success for UAS placement, minimising intraoperative ureteric injury, with higher overall SFR for any RF cut-off in PS cohorts. In non-Asian cohort, significant differences occurred at SFR < 4 mm but not for SFR < 1 mm. No difference was seen in our Asian cohort for any SFR cut-off in both PS and NPS patients.