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Lau HH, Davila GW, Chen YY, Sartori MGF, Jármy-Di Bella ZIK, Tsai JM, Liu YM, Su TH. FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence. Int J Gynaecol Obstet 2023; 161:367-385. [PMID: 36786495 DOI: 10.1002/ijgo.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a global problem. It can significantly adversely impact a woman's quality of life. The use of synthetic mesh in vaginal surgery is controversial, especially when used for pelvic organ prolapse surgery. Although negative effects have been reported, the synthetic mesh midurethral sling (MUS) is considered to be safe and effective in the surgical treatment of SUI. OBJECTIVES To provide evidence-based data and recommendations for the obstetrician/gynecologist who treats women with SUI and performs or plans to perform MUS procedures. METHODS Academic searches of MEDLINE, the Cochrane Library, Embase, and Google Scholar articles published between 1987 and March 2020 were performed by a subgroup of the Urogynecology and Pelvic Floor Committee, International Federation of Gynecology and Obstetrics (FIGO). SELECTION CRITERIA The obtained scientific data were associated with a level of evidence according to the Oxford University Centre for Evidence-Based Medicine and GRADE Working Group system. In the absence of concrete scientific evidence, the recommendations were made via professional consensus. RESULTS The FIGO Urogynecology and Pelvic Floor Committee reviewed the literature and prepared this evidence-based recommendations document for the use of MUS for women with SUI. CONCLUSIONS Despite the extensive literature, there is a lack of consensus in the optimal surgical treatment of SUI. These recommendations provide a direction for surgeons to make appropriate decisions regarding management of SUI. The MUS is considered safe and effective in the treatment of SUI, based on many high-quality scientific publications and professional society recommendations. Comprehensive long-term data and systemic reviews are still needed, and these data will become increasingly important as women live longer. These recommendations will be continuously updated through future literature reviews.
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Affiliation(s)
- Hui-Hsuan Lau
- MacKay Medical College, New Taipei City, Taiwan.,Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - G Willy Davila
- Center for Urogynecology and Pelvic Health, Holy Cross Medical Group, Fort Lauderdale, Florida, USA
| | - Ying-Yu Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Marair G F Sartori
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Jung-Mei Tsai
- MacKay Medical College, New Taipei City, Taiwan.,College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan.,Department of Nursing, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Min Liu
- Department of Medical Research, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Tsung-Hsien Su
- MacKay Medical College, New Taipei City, Taiwan.,Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,Department of Nursing, MacKay Memorial Hospital, Taipei, Taiwan
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[Slings in the era of the mesh ban: now what?]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:165-170. [PMID: 36607437 DOI: 10.1007/s00120-022-02017-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Use of midurethral slings (MUS) as gold standard for stress urinary incontinence declined after the recent US Food and Drug Administration (FDA) communication. OBJECTIVES What is the current status in the surgical treatment of stress urinary incontinence? What impact do regular FDA communications and numerous restrictions around the world have? MATERIALS AND METHODS The current literature on surgical treatment of incontinence was evaluated; medical press information and literature regarding the FDA communication were assessed. The legal situation is illustrated using the example of the Montgomery case in England. RESULTS Despite positive results from literature and gynecological and urological societies, there has been a significant decline in the use of MUS. The current 2022 German interdisciplinary 2k-guideline for the treatment of female stress urinary incontinence confirms the efficacy and safety of MUS. CONCLUSION Analysis of recent literature supports the importance of continued long-term outcome data regarding the safety and efficacy of suburethral slings for treatment of female stress urinary incontinence.
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Muacevic A, Adler JR, Heitmeir B, Schütze J, Dayan D, Janni W, Deniz M. The Transobturator Tape Versus Retropubic Tension-Free Vaginal Tape in the Treatment of Comorbid and Elderly Women With Stress Urinary Incontinence: A Retrospective Analysis of Over 800 Women. Cureus 2023; 15:e34072. [PMID: 36843702 PMCID: PMC9943916 DOI: 10.7759/cureus.34072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 01/25/2023] Open
Abstract
Background and objective The first-line surgical treatment for female stress urinary incontinence (SUI) involves midurethral slings (MUS), including the transobturator tape (TOT) and the retropubic tension-free vaginal tape (TVT). However, whether offering these procedures to older and comorbid women could lead to increased complications is a question that needs to be seriously addressed. In this retrospective cohort study, we aimed to compare the two procedures and evaluate the impact of age, BMI, and comorbidities on complications. Materials and methods A total of 873 procedures (306 TVTs/567 TOTs) performed between 2007 and 2017 were compared and correlated with regard to age, BMI, and comorbidities. Intraoperative complications included bleeding >50 ml, bladder injury, and anesthesia-associated complications. Postoperative complications included post-void residual volume, pain, hematoma, lower urinary tract infection, revision for loosening tape, and bladder infections. The comorbidities were evaluated based on the American Society of Anesthesiologists (ASA) and Charlson scores. Results A total of 873 MUS were conducted during the study period: 306 TVTs and 567 TOTs. Groupwise comparison between these procedures showed that women in the TOT group were older (p<0.001) with a higher BMI (p<0.001) and a higher ASA score (p<0.001) compared to the TVT group. Nevertheless, significantly more intraoperative complications, especially bladder injuries, were recorded in the TVT group. Postoperative complications occurred in 19.4% of the entire cohort, especially increased post-void residual volume. Postoperative hematoma and tape loosening were significantly more frequent in the TOT group. Age, BMI, and comorbidities showed no significant impact on intraoperative complications; however, the TOT procedure was associated with significantly fewer intraoperative complications [p=0.001, odds ratio (OR): 0.281]. Conclusions Overall, both procedures were associated with a low number of perioperative complications. The TOT technique had a lower incidence of intraoperative complications. It must be highlighted that age and comorbidities had no influence on either the intra- or postoperative complication rates. Hence, we recommend that TOT is employed to treat SUI in older, more obese, and comorbid women.
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Yao J, Tse V. Twenty-Five Years of the Midurethral Sling: Lessons Learned. Int Neurourol J 2022; 26:102-110. [PMID: 35793988 PMCID: PMC9260325 DOI: 10.5213/inj.2142086.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 11/11/2022] Open
Abstract
Midurethral slings (MUS) are widely accepted for the surgical treatment of stress urinary incontinence (SUI) in cases where conservative treatment has failed. They have been shown to be a safe and effective surgical treatment for the management of SUI. However, there have recently been growing concerns regarding the safety profile of mesh procedures, generating international debate and leading to national inquiries into the effectiveness and safety of mesh implants. A multitude of clinical, technical, manufacturer-related, and other health jurisdictional factors are involved in the outcomes of MUS. Appropriate patient selection and informed consent to all treatment options, with proper guidance from healthcare providers, are critical for empowering women to choose an appropriate treatment option based on a personalized decision.
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Affiliation(s)
- Jinna Yao
- Department of Surgery, Macquarie University Hospital, Sydney, Australia
| | - Vincent Tse
- Department of Surgery, Macquarie University Hospital, Sydney, Australia
- Concord Repatriation General Hospital, Sydney, Australia
- School of Medicine, University of Sydney, Sydney, Australia
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Romics M, Keszthelyi V, Brodszky V, Molnár PJ, Keszthelyi A, Oláh O, Nyirády P, Majoros A. Narrow Vagina as a Predictor of Obstructive Voiding Dysfunction after Transobturator Sling Surgery. Urol Int 2021; 105:1092-1098. [PMID: 34438403 DOI: 10.1159/000517544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Voiding dysfunction (VD) is a potential complication after female midurethral sling operations. OBJECTIVES Our goal was to assess the rate of obstructive VD after -transobturator tension-free tape (TOT) procedures and to find perioperative risk factors (RFs) predicting postoperative voiding problems. METHODS We have retrospectively evaluated the perioperative data of 397 women who underwent TOT operations. Significant post-void residual (PVR) (>50 mL) was considered as the primary (objective) end point of the study, the voiding difficulty as the secondary (subjective) 1. First univariate analysis and then multivariate logistic regression were performed, with a 5% significance level. RESULTS Significant PVR was present in 51 (12.8%) women; catheterization was needed in 21 (5.3%) and reoperation in 3 (0.8%) cases. Seventy women (17.6%) experienced postoperative voiding difficulty. Narrow vagina (<2 cm), older age >70 years, and preoperative voiding difficulty were independent RFs for significant PVR (odds ratio: 5.07, 2.14, 5.38, respectively, p < 0.05). Preoperative overactive bladder syndrome and previous pelvic organ prolapse surgery were considered independent RFs for postoperative voiding difficulty. CONCLUSIONS Older age, narrow vagina, or preoperative voiding difficulty increases the chance for significant postoperative PVR. These patients should be chosen and counseled appropriately.
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Affiliation(s)
- Miklós Romics
- Department of Urology, Semmelweis University, Budapest, Hungary
| | | | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | | | | | - Orsolya Oláh
- Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary
| | - Péter Nyirády
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Attila Majoros
- Department of Urology, Semmelweis University, Budapest, Hungary
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Kuhlmann PK, Dallas K, Masterson J, Patel DN, Chen A, Castaneda P, Ackerman AL, Anger JT, Eilber KS. Risk Factors for Intraoperative Bladder Perforation at the Time of Midurethral Sling Placement. Urology 2020; 148:100-105. [PMID: 33227306 DOI: 10.1016/j.urology.2020.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate patient-specific and perioperative factors that may be predictive of bladder perforation during midurethral sling placement. METHODS A retrospective chart review of women who underwent a midurethral sling procedure at our institution between 2013 and 2017 was completed. All cases with bladder perforation were included. Patient demographics and perioperative factors were explored for associations with perforation. Bivariate analysis was used to compare baseline characteristics between those with and without perforation. Logistic regression modeling was used to identify predictors of perforation and associations between bladder perforation and postoperative sequelae. RESULTS Four hundred and ten women had a urethral sling procedure at our institution between 2013 and 2017. Of these, 35 (9%) had evidence of bladder perforation on cystoscopy. This rate was higher for retropubic slings (15%) compared to transobturator slings (2%). Those with a perforation were younger (54 vs 61 years, P= .004) and had a lower average BMI (24.1 kg/m2 vs 26.3 kg/m2, P = .022). Other risk factors included lack of pre-existing apical prolapse (11% vs 4%, P = .012) and concomitant urethrolysis (27% vs 8%, P = .024). In multivariable analysis, age, BMI, and sling type were significantly associated with perforation. In univariate analysis, perforation was associated with postoperative lower urinary tract symptoms (OR 2.3, P = .21) and urinary tract infection within 30 days of surgery (OR 2.2, P = .047). CONCLUSIONS Intraoperative bladder perforation was associated with younger patient age and lower BMI. Additionally, bladder perforation is a risk factor for postoperative urinary tract infection and lower urinary tract symptoms.
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Affiliation(s)
- Paige K Kuhlmann
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Kai Dallas
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John Masterson
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Devin N Patel
- Department of Urology, University of California San Diego, San Diego, CA
| | - Andrew Chen
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Peris Castaneda
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - A Lenore Ackerman
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer T Anger
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Karyn S Eilber
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
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Evaluation of urodynamics parameters in different age and incontinence group of women. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.739891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ahn SH, Park YJ, Kong MK, Bai SW. Impact of age on outcomes of midurethral sling procedures in women. Int Urogynecol J 2019; 31:785-789. [PMID: 31520090 DOI: 10.1007/s00192-019-04112-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Trans-obturator tape (TOT) and tension-free vaginal tape (TVT) comprise minimally invasive surgical management for stress urinary incontinence (SUI). The aim of this retrospective cohort study was to investigate outcomes of TOT and TVT among different age groups of women. METHODS Medical records of patients who underwent TOT and TVT from January 2010 to December 2015 were reviewed. Patients were stratified into three groups according to age. All patients were interviewed routinely before and after surgery. The primary outcome was cure rate after surgery. Secondary outcomes included hospital stay, operative time, blood loss in surgery, and complication rate. A total of 616 patients diagnosed with SUI and 262 patients who had not undergone any concurrent surgery were eligible for study inclusion. RESULTS A total of 616 patients diagnosed with SUI and 262 patients who had not undergone any concurrent surgery were eligible for study inclusion. There were 81 patients in group 1 (≤ 50 years), 97 patients in group 2 (51-59 years), and 84 patients in group 3 (≥ 60 years). After surgery, there were no significant differences in cure rates among the three groups (96.3% vs. 94.8% vs. 97.6%, P = 0.623). There were also no significant differences in operation time, blood loss, hospital stay, and complication rate among the three groups. When analyzing the TOT group (217 patients) and TVT group (45 patients) separately, primary and secondary outcomes did not differ significantly according to age group. CONCLUSIONS As surgical management for SUI, midurethral sling procedures, both TOT and TVT, were found to be safe and effective among different age groups.
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Affiliation(s)
- So Hyun Ahn
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Institute of Women's Life Medical Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Yun Jin Park
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Institute of Women's Life Medical Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Mi Kyung Kong
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Institute of Women's Life Medical Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Sang Wook Bai
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Institute of Women's Life Medical Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Engen M, Svenningsen R, Schiøtz HA, Kulseng-Hanssen S. Mid-urethral slings in young, middle-aged, and older women. Neurourol Urodyn 2018; 37:2578-2585. [PMID: 30178571 DOI: 10.1002/nau.23583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 03/04/2018] [Indexed: 11/10/2022]
Abstract
AIMS To compare subjective and objective outcomes of mid-urethral sling (MUS) surgery in women in different age decades and the utilization rates for MUS in Norwegian women. METHODS Data from the national Norwegian Female Incontinence Registry on 21 832 women with stress or mixed urinary incontinence who underwent MUS surgery from 1998 to 2016 were used. Primary outcomes were treatment satisfaction and absence of objective stress leakage at 6-12 months follow-up and "MUS utilization rate." Secondary outcomes were increase in urgency incontinence symptoms and surgical complications. RESULTS Women in the sixth decade and older had more objective postoperative stress urinary leakage, and women in the seventh decade and older were less satisfied. Urgency incontinence symptoms (persistent and de novo) after MUS increased with age. Intermittent catheterization occurred significantly more often in the seventh decade and bladder perforation in the seventh and eighth decades. Women younger than the fifth decade had fewer complications, except the need for tape transection in the fourth decade. The "MUS utilization rate" increased in all age groups during the study period, but declined slightly in the oldest age group after 2010. CONCLUSION All age groups had a high percentage of "very satisfied" and no objective stress leakage at 6-12 months follow-up, but declining slightly with age after the sixth decade. Urgency incontinence symptom bother increased with age, but the overall complication rates were low. Our study strengthens the argument that management of stress urinary incontinence with MUS seems suitable regardless of age.
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Affiliation(s)
- Madeleine Engen
- Department of Obstetrics and Gynecology, Baerum Hospital, Baerum, Norway
| | - Rune Svenningsen
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - Hjalmar A Schiøtz
- Department of Obstetrics and Gynecology, Vestfold Hospital Trust, Tønsberg, Norway
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Laterza RM, Halpern K, Ulrich D, Graf A, Tamussino K, Umek W. Influence of age, BMI and parity on the success rate of midurethral slings for stress urinary incontinence. PLoS One 2018; 13:e0201167. [PMID: 30114195 PMCID: PMC6095512 DOI: 10.1371/journal.pone.0201167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/09/2018] [Indexed: 11/26/2022] Open
Abstract
Aims Our aim was to evaluate, in a second data analysis of the prospective randomized controlled trial conducted by Austrian Urogynaecology Working Group, the effect of age, BMI and parity at the time of surgery on short- and long-term outcomes of women primarily treated for SUI (stress urinary incontinence) with midurethral slings. Methods In the original study 554 patients received randomly a retropubic (TVT) or a transobturator midurethral (TVT-O) sling procedure. 480 (87%) and 277 (50%) patients were available for a follow-up efficacy evaluation at 3 months and 5 years respectively. Results Higher age and BMI at surgery appear to lead to a larger probability to have a positive stress test 5 years after surgery, but not after 3 months. Older patients seem to have a worse perception of improvement 5 years after surgery as compared to younger ones, as described by the PGI-I score. Age and BMI do not affect significantly the quality of life of women surgically treated for SUI, as reflected by the results of King´s Health Questionnaire. Parity does not seem to have any effect on objective and subjective surgical outcomes. Conclusions Higher age and BMI at surgery have a detrimental influence on the objective cure rate at 5 years after midurethral sling surgery; higher age also has a negative influence on subjective long-term outcomes. However, these demographic parameters do not influence significantly the quality of life of patients after anti-incontinence surgery. Parity does not show any significant influence on success rate of midurethral sling.
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Affiliation(s)
- Rosa Maria Laterza
- Department of Obstetrics and Gynaecology, Division of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
- Karl-Landsteiner-Institut fuer Spezielle Gynaekologie und Geburtshilfe, Vienna, Austria
- * E-mail:
| | - Ksenia Halpern
- Department of Obstetrics and Gynaecology, Division of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Daniela Ulrich
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Alexandra Graf
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Karl Tamussino
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Wolfgang Umek
- Department of Obstetrics and Gynaecology, Division of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
- Karl-Landsteiner-Institut fuer Spezielle Gynaekologie und Geburtshilfe, Vienna, Austria
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Kobashi KC, Albo ME, Dmochowski RR, Ginsberg DA, Goldman HB, Gomelsky A, Kraus SR, Sandhu JS, Shepler T, Treadwell JR, Vasavada S, Lemack GE. Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline. J Urol 2017. [PMID: 28625508 DOI: 10.1016/j.juro.2017.06.061] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Stress urinary incontinence is a common problem experienced by many women that can have a significant negative impact on the quality of life of those who suffer from the condition and potentially those friends and family members whose lives and activities may also be limited. MATERIALS AND METHODS A comprehensive search of the literature was performed by ECRI Institute. This search included articles published between January 2005 and December 2015 with an updated abstract search conducted through September 2016. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS The AUA (American Urological Association) and SUFU (Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction) have formulated an evidence-based guideline focused on the surgical treatment of female stress urinary incontinence in both index and non-index patients. CONCLUSIONS The surgical options for the treatment of stress urinary incontinence continue to evolve; as such, this guideline and the associated algorithm aim to outline the currently available treatment techniques as well as the data associated with each treatment. Indeed, the Panel recognizes that this guideline will require continued literature review and updating as further knowledge regarding current and future options continues to grow.
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Affiliation(s)
- Kathleen C Kobashi
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Michael E Albo
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Roger R Dmochowski
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - David A Ginsberg
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Howard B Goldman
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Alexander Gomelsky
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Stephen R Kraus
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Jaspreet S Sandhu
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Tracy Shepler
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Jonathan R Treadwell
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Sandip Vasavada
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Gary E Lemack
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
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Surgical Treatment and Outcomes for the Management of Stress Urinary Incontinence in the Older Woman. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0204-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Two techniques for assessing postoperative voiding function, a randomized trial. Int Urogynecol J 2017; 28:1567-1572. [DOI: 10.1007/s00192-017-3310-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/26/2017] [Indexed: 10/20/2022]
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14
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YASA C, GUNGOR UGURLUCAN F, DURAL O, YUMRU H, GUNAYDIN C, YALCIN O. Transobturator Tape Operation for the Treatment of Stress Urinary Incontinence in Postmenopausal Women Aged Over 65 Years. Low Urin Tract Symptoms 2017; 10:153-157. [DOI: 10.1111/luts.12154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/07/2016] [Accepted: 07/11/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Cenk YASA
- Department of Obstetrics and Gynecology; Istanbul University School of Medicine; Istanbul Turkey
| | - Funda GUNGOR UGURLUCAN
- Department of Obstetrics and Gynecology; Istanbul University School of Medicine; Istanbul Turkey
| | - Ozlem DURAL
- Department of Obstetrics and Gynecology; Istanbul University School of Medicine; Istanbul Turkey
| | - Harika YUMRU
- Department of Obstetrics and Gynecology; Istanbul University School of Medicine; Istanbul Turkey
| | - Cansu GUNAYDIN
- Department of Obstetrics and Gynecology; Istanbul University School of Medicine; Istanbul Turkey
| | - Onay YALCIN
- Department of Obstetrics and Gynecology; Istanbul University School of Medicine; Istanbul Turkey
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Alas A, Chinthakanan O, Espaillat L, Plowright L, Aguilar V, Davila GW. Are suburethral slings less successful in the elderly? Int Urogynecol J 2016; 28:553-559. [PMID: 27629119 DOI: 10.1007/s00192-016-3132-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/18/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to evaluate the success of suburethral slings in women ≥70 years of age. METHODS This was a retrospective cohort study of women who underwent suburethral sling placement. Subjects were separated into three groups: ≤50 years of age (group 1), 51 to 69 years of age (group 2), and ≥70 years of age (group 3). The primary aim was to evaluate success as defined by ≥ improved on a validated patient improvement satisfaction score and a negative postoperative standardized stress test. RESULTS There were 1,464 subjects. Mean age was 44.51 ± 4.25 (n = 296) for group 1, 60.5 ± 5.28 (n = 680) for group 2, and 77.68 ± 5.41 (n = 488) for group 3. The median follow-up was 26 (6-498) weeks, 45 (6-498) weeks, and 42 (6-543) weeks, for groups 1, 2, and 3 respectively. Multiple logistic regression analysis demonstrated no difference in sling success according to age stratification. Lower success was associated with having had a previous sling (adjusted OR 0.25, 95 % CI 0.12-0.5), having detrusor overactivity (adjusted OR 0.44, 95 % CI 0.28-0.69), and having a history of urge urinary incontinence (UUI) for ≥ 4 years (adjusted OR 0.54, 95 % CI 0.31-0.95). CONCLUSIONS There is no difference in sling success between the elderly and younger populations. However, those with previous sling surgery or a long standing history of UUI may be at a higher risk of failure.
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Affiliation(s)
- Alexandriah Alas
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA
| | - Orawee Chinthakanan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Luis Espaillat
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA
| | - Leon Plowright
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA
| | - Vivian Aguilar
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA
| | - G Willy Davila
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA.
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Does age affect the outcome of suburethral tape surgery? The importance of national registries in answering bigger questions. Int Urogynecol J 2016; 27:1541-5. [DOI: 10.1007/s00192-016-2995-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/22/2016] [Indexed: 11/26/2022]
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17
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Evaluation and surgery for stress urinary incontinence: A FIGO working group report. Neurourol Urodyn 2016; 36:518-528. [DOI: 10.1002/nau.22960] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/20/2015] [Indexed: 02/04/2023]
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Brown J, King J. Age-stratified trends in 20 years of stress incontinence surgery in Australia. Aust N Z J Obstet Gynaecol 2016; 56:192-8. [PMID: 26869461 DOI: 10.1111/ajo.12445] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/09/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a common, debilitating condition in Australian women. Since its introduction in 1998-1999, the less invasive mid-urethral sling (MUS) procedure has become the new standard for surgical correction of SUI and overall numbers of continence procedures increased. Trends since 2009 have not been analysed. AIMS To identify patterns in the surgical treatment of women with SUI in Australia from January 1994 to December 2014 stratified by age. MATERIALS AND METHODS Gender- and age-specific data from Medicare Australia between January 1994 and December 2014 were extracted and the patterns of SUI surgery analysed for the 20-year period. Data on gynaecologists and urologists performing MUS and colposuspension were collected from Department of Human Services. RESULTS Following the introduction of MUS, total SUI operations increased with the peak in 2002, a plateau between 2006 and 2011, and a new decline from 2012 onwards. There has been a sustained 51.7% increase in total SUI operations in 75- to 84-year-old women, and a 105.2% increase in women aged over 84. However, SUI operations in 45- to 64-year-olds decreased below pre-MUS baseline in 2014. CONCLUSIONS Mid-urethral sling has become the standard SUI procedure being performed in Australia since its introduction in 1999. SUI operations have increased each year for patients aged over 65, with the greatest increase seen in patients aged over 84 - indicating expanded eligibility for SUI surgery in older women. However, since 2010, there has been a fall in SUI operations to below the pre-MUS baseline.
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Affiliation(s)
- James Brown
- Obstetrics and Gynaecology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Jennifer King
- Obstetrics and Gynaecology, Westmead Hospital, Westmead, New South Wales, Australia
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Ellington DR, Erekson EA, Richter HE. Outcomes of Surgery for Stress Urinary Incontinence in the Older Woman. Clin Geriatr Med 2015; 31:487-505. [PMID: 26476111 PMCID: PMC4609316 DOI: 10.1016/j.cger.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
As population demographics continue to evolve, specifics on age-related outcomes of stress urinary incontinence interventions will be critical to patient counseling and management planning. Understanding medical factors unique to older women and their lower urinary tract conditions will allow caregivers to optimize surgical outcomes, both physical and functional, and minimize complications within this population.
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Affiliation(s)
- David R. Ellington
- University of Alabama at Birmingham, Division of Urogynecology and Pelvic Reconstructive Surgery, 176 F Suite 10382, 619 19 Street South, Birmingham, Alabama 35249-7333, Phone: (205)-934-1704, Fax: (205)-975-8893,
| | - Elisabeth A. Erekson
- The Geisel School of Medicine at Dartmouth, Division of Female Pelvic Medicine and Reconstructive Surgery, 1 Medical Center Dr., Lebanon, NH 03756, Phone: (603) 653-9312, Fax: (603) 650-0906,
| | - Holly E. Richter
- University of Alabama at Birmingham, Division of Urogynecology and Pelvic Reconstructive Surgery, 176 F Suite 10382, 619 19 Street South, Birmingham, Alabama 35249-7333
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What is the best surgical intervention for stress urinary incontinence in the very young and very old? An International Consultation on Incontinence Research Society update. Int Urogynecol J 2015. [DOI: 10.1007/s00192-015-2783-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lee JKS, Rosamilia A, Dwyer PL, Lim YN, Muller R. Randomized trial of a single incision versus an outside-in transobturator midurethral sling in women with stress urinary incontinence: 12 month results. Am J Obstet Gynecol 2015; 213:35.e1-35.e9. [PMID: 25637849 DOI: 10.1016/j.ajog.2015.01.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 01/14/2015] [Accepted: 01/26/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate objective and subjective outcomes of MiniArc and Monarc (American Medical Systems, Minnetonka, MN) midurethral sling (MUS) in women with stress incontinence at 12 months. STUDY DESIGN A total of 225 women were randomized to receive MiniArc or Monarc. Women with intrinsic sphincter deficiency, previous MUS, or untreated detrusor overactivity were excluded. Objective cure was defined as negative cough stress test with a comfortably full bladder. Subjective cure was defined as no report of leakage with coughing or exercise on questionnaire. Validated questionnaires, together with urodynamic and clinical cough stress test, were used to evaluate the objective and subjective outcomes following surgery. Participants and clinicians were not masked to treatment allocation. Outcomes were compared with exact binomial tests (eg, Fisher exact test for dichotomous data) for categorical data and Student t tests or exact versions of Wilcoxon tests for numerical data as appropriate. RESULTS There was no statistically significant difference in the subjective (92.2% vs 94.2%; P = .78; difference, 2.0%; 95% confidence interval, -2.7% to +6.7%) or objective (94.4% vs 96.7%; P = .50; difference, 2.3%; 95% confidence interval, -1.5% to +6.1%) cure rates between MiniArc and Monarc at 12 m, respectively, with a significant improvement in overactive bladder outcomes and incontinence impact from baseline in both arms. CONCLUSION MiniArc outcomes are not inferior to Monarc MUS outcomes at 12 months' follow-up in women without intrinsic sphincter deficiency.
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Affiliation(s)
- Joseph K-S Lee
- Department of Urogynecology, Mercy Hospital for Women, Heidelberg, VIC, Australia; Pelvic Floor Clinic, Monash Medical Center, Moorabbin, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia.
| | - Anna Rosamilia
- Pelvic Floor Clinic, Monash Medical Center, Moorabbin, VIC, Australia; Faculty of Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter L Dwyer
- Department of Urogynecology, Mercy Hospital for Women, Heidelberg, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Yik N Lim
- Department of Urogynecology, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Reinhold Muller
- School of Public Health and Tropical Medicine, James Cook University, Townsville, QLD, Australia
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Shin YS, On JW, Kim MK. Effect of aging on urodynamic parameters in women with stress urinary incontinence. Korean J Urol 2015; 56:393-7. [PMID: 25964841 PMCID: PMC4426512 DOI: 10.4111/kju.2015.56.5.393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/25/2015] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yu Seob Shin
- Department of Urology, Chonbuk National University Medical School, Institute for Medical Sciences, Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Ji Won On
- Department of Urology, Chonbuk National University Medical School, Institute for Medical Sciences, Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Myung Ki Kim
- Department of Urology, Chonbuk National University Medical School, Institute for Medical Sciences, Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Gibson W, Wagg A. Are older women more likely to receive surgical treatment for stress urinary incontinence since the introduction of the mid-urethral sling? An examination of Hospital Episode Statistics data. BJOG 2015; 123:1386-92. [DOI: 10.1111/1471-0528.13338] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 11/27/2022]
Affiliation(s)
- W Gibson
- Division of Geriatric Medicine; University of Alberta; Edmonton AB Canada
| | - A Wagg
- Division of Geriatric Medicine; University of Alberta; Edmonton AB Canada
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Malek JM, Ellington DR, Jauk V, Szychowski JM, Parden AM, Richter HE. The effect of age on stress and urgency urinary incontinence outcomes in women undergoing primary midurethral sling. Int Urogynecol J 2014; 26:831-5. [PMID: 25510465 DOI: 10.1007/s00192-014-2594-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The primary aim was to characterize stress urinary incontinence (SUI) symptom distress and impact after a midurethral sling (MUS) in women ≥70 compared to women <70 years of age. METHODS A retrospective cohort study of women undergoing a primary MUS was conducted. The primary outcome was SUI symptoms defined as either "moderately" or "quite a bit" responses to ≥1 of the two SUI questions of the Pelvic Floor Distress Inventory-20 (PFDI-20). Urgency urinary incontinence (UUI) was defined as either moderately or quite a bit responses to the UUI question of the PFDI-20. The Pelvic Floor Impact Questionnaire (PFIQ-7), Patient Satisfaction Questionnaire (PSQ), and Patient Global Impression of Improvement (PGI-I) questionnaires were also administered. RESULTS The mean age of patients ≥70 years (n = 160) was 75.4 ± 4.5 and <70 years (n = 536) was 56.2 ± 9.4. Multivariable analysis revealed no difference in SUI failure rates in older compared to younger cohorts, adjusted odds ratio (OR) 1.7, 95 % confidence interval (CI) 0.9-3.1. Women <70 demonstrated greater improvement in urinary incontinence (UI) symptom impact [-20.4 (33.0) vs -12.2 (30.7), p = 0.01] and women ≥70 had greater persistent UUI symptoms (31.5 vs 23.3 %, p = 0.04); there was no difference between cohorts in resolution of UUI (29.6 vs 34.2 %, p = 0.34). Younger women reported a greater impression of improvement compared to older women (67.7 vs 56.6 %, p = 0.01, respectively). CONCLUSIONS Older and younger women have similar SUI outcomes after MUS; however, older women have more persistent UUI and a worse impression of improvement of their urinary tract condition.
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Affiliation(s)
- Joseph M Malek
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10382, Birmingham, AL, 35233, USA
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Stress Urinary Incontinence in the Elderly: Evaluation, Surgical Treatment, and Management of Postoperative Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0269-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Epidemiology, Evaluation, and Treatment of Urinary Incontinence in Octogenarian Women. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0247-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Transobturator vaginal tape for the treatment of stress urinary incontinence in elderly women without concomitant pelvic organ prolapse: is it effective and safe? Eur J Obstet Gynecol Reprod Biol 2012; 166:107-10. [PMID: 23164504 DOI: 10.1016/j.ejogrb.2012.10.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 09/16/2012] [Accepted: 10/23/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the transobturator approach (TVT-O) for the surgical management of stress urinary incontinence (SUI) in older women. STUDY DESIGN Between 2007 and 2010, all consecutive women with SUI undergoing an isolated TVT-O procedure were prospectively enrolled in this study. Patients were divided into two groups by age: older women (≥ 70 years old) were included in group 1, while younger women (< 70 years old) in group 2. Intra- and post-operative outcomes were compared between the groups. RESULTS During the study period 181 women met the inclusion criteria and were included for final analysis. Among these women, 60 (33.1%) and 121 (66.9%) were included in groups 1 and 2 respectively. After a median follow-up of 26 (IQR 15-41) months for the younger and 25 (IQR 18-40) months for older patients (p>0.99), no differences were observed between the two groups in terms of cure rate (92.5% vs. 88.3%; p=0.40). No differences were observed in terms of voiding dysfunction, vaginal erosion and persistent groin pain, or in terms of onset of de novo overactive bladder (9.0% vs. 13.3%; p=0.44). CONCLUSIONS TVT-O appears to be a safe and effective procedure for the management of stress urinary incontinence also in elderly population.
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[Transobturatoric sling procedures for stress urinary incontinence in elderly women: indication and results]. Urologe A 2012; 51:1393-8. [PMID: 23053035 DOI: 10.1007/s00120-012-2931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Urinary incontinence is one of the great challenges in geriatrics. The prevalence is high in elderly women and increases continuously with increasing age. The consequences of incontinence can be severe and are often associated with social isolation. Placement of a transobturatoric sling is a frequently used option in the surgical treatment of stress incontinence. Continence rates are high and associated with low side effects but several sub-analyses have shown poorer success rates and an increase in perioperative morbidity in women over 70 years. Recent studies, however, point to similarly good success rates and thus provide an effective and safe treatment option.
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Bibliography. Female urology. Current world literature. Curr Opin Urol 2011; 21:343-6. [PMID: 21654401 DOI: 10.1097/mou.0b013e3283486a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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LEE J, DWYER PL. Age-related trends in female stress urinary incontinence surgery in Australia - Medicare data for 1994-2009. Aust N Z J Obstet Gynaecol 2010; 50:543-9. [DOI: 10.1111/j.1479-828x.2010.01217.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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