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• W4382654844 abstract "The authors are to be congratulated for investigating whether synchronous versus asynchronous (staged) management of bladder neck contracture (BNC) portends a similar clinical outcome. They studied the superiority of simultaneous BNC intervention at the time of artificial urinary sphincter placement (synchronous) or staged BNC intervention followed by artificial urinary sphincter placement (asynchronous). The importance of this investigation lies in its clinical relevance. BNC associated with urinary incontinence post prostate cancer treatment is a very common complex dilemma, not only for the surgeon but also for the patients suffering from urinary incontinence associated with BNC. Such patients are often very heterogeneous in clinical presentation. Therefore, any clinical review that is retrospective in nature, even if the data are prospectively obtained, will harbor significant bias. Therefore, such study will be extremely difficult to interpret. Similarly, study, the results and recommendations of this study should be interpreted with great caution. For instance, patients can be radiated versus nonradiated, radiation can be with external beam radiation versus brachytherapy, wide caliber BNC versus near obliterative BNC, cold knife versus hot versus, laser direct visual internal urethrotomy, resected versus non-resected BNC management, anastomotic urethroplasty post BNC versus incision, dilation of the BNC versus incision prior to management. This is just to name a few of the potential clinical scenarios which the clinician and the patient might be facing when dealing with this problem. All of this heterogeneity in clinical management will likely affect the outcome. Therefore, the reader must read this paper through the lens of its methodological limitations. The authors have admitted in the manuscript that the heterogeneity of the small group of patients with BNC managed at a single institution with incomplete data has rendered their conclusion less accurate. Multi-institutional studies with data that is prospectively obtained, more complete data, and a better study design will circumvent many of these methodological challenges. Therefore, the conclusions proposed in this investigation are guarded." @default.
• W4382654844 created "2023-07-01" @default.
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• W4382654844 date "2023-08-01" @default.
• W4382654844 modified "2023-10-01" @default.
• W4382654844 title "EDITORIAL COMMENT" @default.
• W4382654844 doi "https://doi.org/10.1016/j.urology.2023.02.052" @default.
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