GERIATRICS

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Geriatrics Re: Prostate Volume Correlates with Diabetes in Elderly Benign Prostatic Hyperplasia Patients X. Qu, Z. Huang, X. Meng, X. Zhang, L. Dong and X. Zhao Departments of Geriatrics and Urology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China Int Urol Nephrol 2014; 46: 499e504.

Abstract available at http://jurology.com/ Editorial Comment: Benign prostatic hyperplasia (BPH) is among the most common urological conditions seen in elderly men. BPH causes bothersome symptomatic voiding dysfunction and can lead to negative outcomes, including nocturia, urinary retention, renal insufficiency and urosepsis. It is also among the most costly urological conditions in the geriatric population. The authors examined the relationship between diabetes mellitus, another common comorbid condition in older adults, and BPH in a group of 117 elderly men treated at a single medical center in China. Men with diabetes and BPH had larger prostate volumes, increased prostate specific antigen levels and higher symptom scores compared to men with BPH without diabetes. Poorer diabetic control was also associated with worse BPH and voiding parameters, supporting the concept that increased severity of diabetes may be a contributing factor to urological problems in elderly men. Study limitations were inability to control for potential confounding variables that included smoking, alcohol use, physical activity levels and sex hormone concentrations. The study also did not seek to determine if treatment of diabetes helped to improve urological symptoms, including BPH. However, the study adds to the growing body of literature on the negative health effects of diabetes with aging. Tomas L. Griebling, MD, MPH

Suggested Reading Dahle SE, Chokkalingam AP, Gao YT et al: Body size and serum levels of insulin and leptin in relation to the risk of benign prostatic hyperplasia. J Urol 2002; 168: 599. Sarma AV, Parsons JK, McVary K et al: Diabetes and benign prostatic hyperplasia/lower urinary tract symptoms: what do we know? J Urol, suppl., 2009; 182: S32.

Trauma, and Genital and Urethral Reconstruction Re: Extended Outcomes in the Treatment of Male Stress Urinary Incontinence with a Transobturator Sling J. M. Zuckerman, B. Edwards, K. Henderson, H. A. Beydoun and K. A. McCammon Department of Urology and Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, Virginia Urology 2014; 83: 939e945.

Abstract available at http://jurology.com/ Editorial Comment: This is a long-term experience demonstrating outcomes of a large series of men undergoing transobturator sling for post-prostatectomy stress urinary incontinence. During a

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TRAUMA, AND GENITAL AND URETHRAL RECONSTRUCTION

mean followup of 36 months a slight but steady decline in efficacy was noted, whereupon a plateau was seen. These results differ from the 3-year study of Rehder et al, which indicates that initial efficacy rates are maintained through time.1 Amazingly 35% of the 102 patients in this series used more than 5 pads daily preoperatively, which likely skewed the overall success rate of 62% downward. Higher preoperative pad counts negatively predicted outcomes. Radiation was also suggested as a negative prognosticator. A durable cure rate of 40% was observed. Careful patient selection and counseling are of paramount importance in sling surgery. Patients expect to be cured from our interventions. My advice is to select only the cream of the crop for sling procedures. Nonradiated low volume leakers will be happy with your sling surgerydother cases will not end as well. Allen F. Morey, MD 1. Rehder P, Haab F, Cornu JN et al: Treatment of postprostatectomy male urinary incontinence with the transobturator retroluminal repositioning sling suspension: 3-year follow-up. Eur Urol 2012; 62: 140.

Re: Extended outcomes in the treatment of male stress urinary incontinence with a transobturator sling.

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