==inizio objective==
Few data are available on the efficacy and safety of Mirabegron in the
treatment of neurogenic detrusor overactivity incontinence due to Parkinsons’
disease (PD). We investigated persistence rates and adherence to this kind of
treatment in a medium-term follow up in PD patients refractory to
antimuscarinics.
==fine objective==
==inizio methodsresults==
A prospective study was conducted in urological department. 49 PD patients
with refractory overactive bladder (OAB) were prospectively included in the
study. At baseline assessment of motor symptoms, disease severity and
cognitive status with the Hoehn–Yahr Scale (H&Y), the Unified Parkinson’s
disease Rating Scale (UPDRS), the Mini Mental State examination (MMSE) and
the Montreal Cognitive Assessment (MCA) was performed. Urinary symptoms,
treatment satisfaction and the impact of urinary incontinence on quality of life
were assessed with the 3-day voiding diary, the Visual Analogue Scale (VAS) and
the Incontinence–QoL questionnaire (I-QoL). Patients were treated with
mirabegron 50 mg tablets once daily. Evaluation of urinary symptoms and
related questionnaires, motor symptoms, severity of PD and uroflowmetry with
postvoid residual volume measurement were then repeated at different time
points follow up. Adverse effect were recorded and presence of comorbidities
was also noted. Here, the results observed at 18 months follow up are
described.
==fine methodsresults==
==inizio results==
At baseline urge urinary incontinence was present in 40/49 cases (81.6%). All
patients presented with comorbidities, with osteoarticular disease and
affective disorders being the most frequently reported. At 18 months follow
up, data were available in 27 cases (55.1%): 9/27 (33.3%) achieved a complete
urinary continence; in the remaining patients an improvement in symptoms
was noted. Overall, nocturia was the only symptom not achieving a significant
reduction. In these patients a significant amelioration was detected in VAS and
I-QoL scores. 13 patients discontinued treatment due to a poor clinical
improvement and 9 due to the cost of the drug. No serious adverse effects were
reported and no patient stopped taking the drug due to these. Duration of the
disease and H&Y scores were significantly higher in nonresponder patients
==fine results==
==inizio discussions==
==fine discussions==
==inizio conclusion==
Mirabegron is an effective drug to control urinary symptoms in about 55% of
patients affected by PD and refractory OAB in the medium-term follow up. The
lack of intolerable side effects appears to be the most relevant issue in
refractory PD patients to anticholinergics.
==fine conclusion==
==inizio reference==
==fine reference==
==inizio abstract==
Stress urinary incontinence is a feared complication after radical prostatectomybecause it impacts on the quality of life and determines a high rate of emotional distress.
When the first-line pharmacological and physical conservative treatments fail compression devices may be recommended.
The ProACT prosthesis is a postoperatively adjustable device that aims to achieve optimal outlet resistance by progressively increasing the volume of the periurethral balloons.
Furthemore, in case of mechanical rupture it may be easily substituted (removed and reimplanted) in expert centres.
In this video we present the clinical case of a male patient who had undergone PRO-ACT implantation about 10 years ago. Due to the rupture of the right balloon, its substitution was indicated and performed under ultrasound guidance.
Our aim is to provide a description of the surgical technique.
A set of simple steps, that makes the surgical procedure safe and easy to perform even in inexperienced hands.
==fine abstract==
==inizio abstract==
Abstract
Study Objective
Technical video demonstrating a combined cystoscopic, laparoscopic, and vaginal approach to repair of a vesicovaginal fistula (VVF).
Case presentation
We present the case of a 72-year-old woman affected by urinary incontinence (UI) and pelvic prolapse organ prolapse (POP) for about 2 years. Therefore, she underwent a colpohysterectomy surgery and cistopexy and colpoperineoplasty.
After 10 days, the patient returned our attention for recurrent episodes of UI (4-5 pad/die).
A hysterography revealed a fistula of 8 mm diameter at the posterior wall of the bladder, supratrigonal in position. We chose the laparoscopic approach to treat the VVF.
During cystoscopy, ureters and the fistula tract were catheterized previously.
In this way, the time of laparoscopy was beneficial to localize the fistula tract and allowed meticulous dissection in the retrovesical space between the bladder and the vagina.
The sutures of the bladder and vagina were performed in a perpendicular direction, without overlap and tension of the vaginal mucosa. [1]
Bladder closure was confirmed by the hydrostatic leak test at 250 cc.
The attempt to place the epiploic appendagitis was unsuccessful, it caused tension and angle of the rectum. Alternatively, we used an omental flap to repair the VVF. [2]
Results
Operating time was approximately 150 min. Estimated blood loss was 50 mL. No intraoperative or postoperative complications occurred. The bladder catheter was removed after 15 days, after which the control cystography showed no leakage. The woman had no signs of recurrence after 12 months of follow-up.
Conclusion
Laparoscopic repair of VVF is a feasible, effective, and mini-invasive management option of treatment with successful outcome. [3]
1. Prognostic factors of recurrence after vesicovaginal fistula repair. Mohsen Ayed, Rabii El Atat, Lotfi Ben Hassine, Mohamed Sfaxi, Mohamed Chebil, Saadoun Zmerli. Comparative Study Int J Urol 2006 Apr;13(4):345-9. doi: 10.1111/j.1442-2042.2006.01308.x.
2. Kiricuta I, Goldstein AMB. The repair of extensive vesicovaginal with pedicled omentum: a review of 27 cases. J Urol. 1972;108:724–7
3. Miklos JR. Laparoscopic treatment of vesicouterine fistula. J Am Assoc Gynecol Laparosc. 1999;6(3):339-341.
==fine abstract==
