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Wadensten T, Nyström E, Sjöström M, Lindam A, Samuelsson E. APP-based treatment of urgency and mixed urinary incontinence in women: factors associated with long-term satisfaction. Arch Gynecol Obstet 2024; 309:2193-2202. [PMID: 38141064 PMCID: PMC11018664 DOI: 10.1007/s00404-023-07303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE App-based treatment of urgency (UUI) and mixed (MUI) urinary incontinence has proved to be effective. To further improve treatment, it will be beneficial to analyze baseline and treatment-related factors that are associated with satisfaction. METHODS A secondary analysis was conducted of data from a randomized controlled trial (RCT) assessing an app for UUI or MUI treatment, encompassing 98 women for whom there was long-term treatment satisfaction data. All participants completed a short-term (15 weeks) and a long-term (15 months) follow-up questionnaire after being given access to treatment. The outcome was a 3-item question on current treatment satisfaction at the long-term follow-up. Factors potentially associated with the outcome were analyzed using the chi-square test, Student's t test or logistic regression. RESULTS At the long-term follow-up, 58% of the women were satisfied with the treatment. The most important baseline variable associated with satisfaction was incontinence-related quality of life (International Consultation on Incontinence Questionnaire (ICIQ) - Lower Urinary Tract Symptoms Quality of Life Module) (OR 0.91, 95% CI 0.58-0.97). Short-term follow-up variables associated with long-term treatment satisfaction were improvement in the ability to endure urgency (OR 4.33, 95% CI 1.43-13.12), and confidence in pelvic floor contraction ability (OR 2.67, 95% CI 1.04-6.82). CONCLUSION App-based treatment for UUI and MUI may be an alternative first-line treatment that is satisfactory to many women over the long-term. Furthermore, short-term treatment that focuses on improving the ability to endure urgency, and confidence in pelvic floor contraction ability, can also be recommended for long-term satisfaction.
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Affiliation(s)
- Towe Wadensten
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Emma Nyström
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
- Unit of Research, Education, and Development, Östersund Hospital, Östersund, Sweden
| | - Malin Sjöström
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Anna Lindam
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
- Unit of Research, Education, and Development, Östersund Hospital, Östersund, Sweden
| | - Eva Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
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Rogers RG. Everything About Urogynecologic Surgery That I Thought Was True But Is Not. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:1-2. [PMID: 38133935 DOI: 10.1097/spv.0000000000001463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Affiliation(s)
- Rebecca G Rogers
- From the Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY
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Treat or Wait? Natural Perioperative Course of Overactive Bladder Symptoms at the Time of Midurethral Sling Placement. Female Pelvic Med Reconstr Surg 2021; 27:e348-e351. [PMID: 32947550 DOI: 10.1097/spv.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to describe the perioperative course of untreated overactive bladder (OAB) (urinary frequency [UF] and urgency urinary incontinence [UUI]) before and after isolated retropubic midurethral sling (MUS) and to identify the time point for spontaneous OAB symptom improvement in the most patients. METHODS This is a prospective cohort study of women undergoing an isolated MUS. Women completed the Urogenital Distress Inventory 6 and Incontinence Impact Questionnaire 7 preoperatively and weekly for 13 weeks postoperatively. Bothersome UF and UUI were defined as a response of "moderately" or "greatly" bothered on questions 1 and 2 of the Urogenital Distress Inventory. The treatment for OAB was deferred until 13 weeks after surgery. RESULTS Fifty-four women were included with a mean ± SD age of 48 ± 9 years. Preoperatively, 41% of women reported both bothersome UF and UUI. Six weeks after surgery, only 15% and 6% reported bothersome UF and UUI (P < 0.001 and P < 0.001, respectively). Between 6 and 13 weeks, percentages of bothersome symptoms remained low (11.7% UF and 5.8% UUI). In addition, the impact of these urinary symptoms on activities, relationships, and feelings became consistently negligible (Incontinence Impact Questionnaire 7 median score <1) at 5 weeks postoperatively. Only 3 women desired treatment for UUI after the study period. CONCLUSIONS Overactive bladder is common before and immediately after MUS. However, the majority of patients have spontaneous symptom resolution by 6 weeks after surgery; it may be reasonable to discontinue preoperatively initiated overactive bladder treatment or defer starting treatment until this time point.
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Worthington J, Lane JA, Taylor H, Young G, Noble SM, Abrams P, Ahern A, Brookes ST, Cotterill N, Johnson L, Khan R, Fernandez AM, Page T, Swami S, Hashim H. Thulium laser transurethral vaporesection versus transurethral resection of the prostate for benign prostatic obstruction: the UNBLOCS RCT. Health Technol Assess 2020; 24:1-96. [PMID: 32901611 PMCID: PMC7520718 DOI: 10.3310/hta24410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) is the standard operation for benign prostatic obstruction (BPO). Thulium laser transurethral vaporesection of the prostate (ThuVARP) vaporises and resects the prostate using a technique similar to TURP. The small amount of existing literature suggests that there may be potential advantages of ThuVARP over TURP. OBJECTIVE To determine whether or not the outcomes from ThuVARP are equivalent to the outcomes from TURP in men with BPO treated in the NHS. DESIGN A multicentre, pragmatic, randomised controlled parallel-group trial, with an embedded qualitative study and economic evaluation. SETTING Seven UK centres - four university teaching hospitals and three district general hospitals. PARTICIPANTS Men aged ≥ 18 years who were suitable to undergo TURP, presenting with bothersome lower urinary tract symptoms (LUTS) or urinary retention secondary to BPO. INTERVENTIONS Patients were randomised 1 : 1 to receive TURP or ThuVARP and remained blinded. MAIN OUTCOME MEASURES Two co-primary outcomes - patient-reported International Prostate Symptom Score (IPSS) and clinical measure of maximum urine flow rate (Qmax) at 12 months post surgery. RESULTS In total, 410 men were randomised, 205 to each arm. The two procedures were equivalent in terms of IPSS [adjusted mean difference 0.28 points higher for ThuVARP (favouring TURP), 95% confidence interval (CI) -0.92 to 1.49 points]. The two procedures were not equivalent in terms of Qmax (adjusted mean difference 3.12 ml/second in favour of TURP, 95% CI 0.45 to 5.79 ml/second), with TURP deemed superior. Surgical outcomes, such as complications and blood transfusion rates, and hospital stay were similar for both procedures. Patient-reported urinary and sexual symptoms were also similar between the arms. Qualitative interviews indicated similar patient experiences with both procedures. However, 25% of participants in the ThuVARP arm did not undergo their randomised allocation, compared with 2% of participants in the TURP arm. Prostate cancer was also detected less frequently from routine histology after ThuVARP (65% lower odds of detection) in an exploratory analysis. The adjusted mean differences between the arms were similar for secondary care NHS costs (£9 higher for ThuVARP, 95% CI -£359 to £376) and quality-adjusted life-years (0.01 favouring TURP, 95% CI -0.04 to 0.01). LIMITATIONS Complications were recorded in prespecified categories; those not prespecified were excluded owing to variable reporting. Preoperative Qmax and IPSS data could not be collected for participants with indwelling catheters, making adjustment for baseline status difficult. CONCLUSIONS TURP was superior to ThuVARP in terms of Qmax, although both operations resulted in a Qmax considered clinically successful. ThuVARP also potentially resulted in lower detection rates of prostate cancer as a result of the smaller volume of tissue available for histology. Length of hospital stay after ThuVARP, anticipated to be a key benefit, was equal to that after TURP in this trial. Overall, both ThuVARP and TURP were effective procedures for BPO, with minor benefits in favour of TURP. Therefore, the results suggest that it may be appropriate that new treatment alternatives continue to be compared with TURP. FUTURE WORK Longer-term follow-up to assess reoperation rates over time, and research into the comparative effectiveness of ThuVARP and TURP in large prostates. TRIAL REGISTRATION Current Controlled Trials ISRCTN00788389. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 41. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jo Worthington
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J Athene Lane
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hilary Taylor
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Grace Young
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian M Noble
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Aideen Ahern
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sara T Brookes
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nikki Cotterill
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Lyndsey Johnson
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rafiyah Khan
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Aida Moure Fernandez
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tobias Page
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Satchi Swami
- Urology Department, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Saraswat L, Rehman H, Omar MI, Cody JD, Aluko P, Glazener CMA. Traditional suburethral sling operations for urinary incontinence in women. Cochrane Database Syst Rev 2020; 1:CD001754. [PMID: 31990055 PMCID: PMC7027385 DOI: 10.1002/14651858.cd001754.pub5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Stress urinary incontinence constitutes a significant health and economic burden to society. Traditional suburethral slings are surgical operations used to treat women with symptoms of stress urinary incontinence. OBJECTIVES To assess the effectiveness of traditional suburethral sling procedures for treating stress urinary incontinence in women; and summarise the principal findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), as well as MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP); we handsearched journals and conference proceedings (searched 27 February 2017) and the reference lists of relevant articles. On 23 January 2019, we updated this search; as a result, several additional reports of studies are awaiting classification. SELECTION CRITERIA Randomised or quasi-randomised trials that assessed traditional suburethral slings for treating stress or mixed urinary incontinence. DATA COLLECTION AND ANALYSIS At least two review authors independently extracted data from included trials and assessed risk of bias. When appropriate, a summary statistic was calculated: risk ratio (RR) for dichotomous data, odds ratio (OR) for continence and cure rates that were expected to be high, and mean difference (MD) for continuous data. We adopted the GRADE approach to assess the quality of evidence. MAIN RESULTS A total of 34 trials involving 3244 women were included. Traditional slings were compared with 10 other treatments and with each other. We did not identify any trials comparing suburethral slings with no treatment or sham treatment, conservative management, anterior repair, or laparoscopic retropubic colposuspension. Most trials did not distinguish between women having surgery for primary or recurrent incontinence. One trial compared traditional slings with bladder neck needle suspension, and another trial compared traditional slings with single-incision slings. Both trials were too small to be informative. Traditional suburethral sling operation versus drugs One small trial compared traditional suburethral sling operations with oxybutynin to treat women with mixed urinary incontinence. This trial did not report any of our GRADE-specific outcomes. It is uncertain whether surgery compared with oxybutynin leads to more women being dry (83% vs 0%; OR 195.89, 95% confidence interval (CI) 9.91 to 3871.03) or having less urgency urinary incontinence (13% vs 43%; RR 0.29, 95% CI 0.09 to 0.94) because the quality of this evidence is very low. Traditional suburethral sling versus injectables One small trial compared traditional slings with suburethral injectable treatment. The impact of surgery versus injectables is uncertain in terms of the number of continent women (100% were dry with a traditional sling versus 71% with the injectable after the first year; OR 11.57, 95% CI 0.56 to 239.74), the need for repeat surgery for urinary incontinence (RR 0.52, 95% CI 0.05 to 5.36) or the occurrence of perioperative complications (RR 1.57, 95% CI 0.29 to 8.49), as the quality of evidence is very low. Traditional suburethral sling versus open abdominal retropubic colposuspension Eight trials compared slings with open abdominal retropubic colposuspension. Moderate-quality evidence shows that the traditional suburethral sling probably leads to more continent women in the medium term (one to five years) (69% vs 59% after colposuspension: OR 1.70, 95% CI 1.22 to 2.37). High-quality evidence shows that women were less likely to need repeat continence surgery after a traditional sling operation than after colposuspension (RR 0.15, 95% CI 0.05 to 0.42). We found no evidence of a difference in perioperative complications between the two groups, but the CI was very wide and the quality of evidence was very low (RR 1.24, 95% CI 0.83 to 1.86). Traditional suburethral sling operation versus mid-urethral slings Fourteen trials compared traditional sling operations and mid-urethral sling operations. Depending on judgements about what constitutes a clinically important difference between interventions with regard to continence, traditional suburethral slings are probably no better, and may be less effective, than mid-urethral slings in terms of number of women continent in the medium term (one to five years) (67% vs 74%; OR 0.67, 95% CI 0.44 to 1.02; n = 458; moderate-quality evidence). One trial reported more continent women with the traditional sling after 10 years (51% vs 32%: OR 2.22, 95% CI 1.07 to 4.61). Mid-urethral slings may be associated with fewer perioperative complications (RR 1.74, 95% CI 1.16 to 2.60; low-quality evidence). One type of traditional sling operation versus another type of traditional sling operation Nine trials compared one type of traditional sling operation with another. The different types of traditional slings, along with the number of different materials used, mean that trial results could not be pooled due to clinical heterogeneity. Complications were reported by two trials - one comparing non-absorbable Goretex with a rectus fascia sling, and the second comparing Pelvicol with a rectus fascial sling. The impact was uncertain due to the very low quality of evidence. AUTHORS' CONCLUSIONS Low-quality evidence suggests that women may be more likely to be continent in the medium term (one to five years) after a traditional suburethral sling operation than after colposuspension. It is very uncertain whether there is a difference in urinary incontinence after a traditional suburethral sling compared with a mid-urethral sling in the medium term. However, these findings should be interpreted with caution, as long-term follow-up data were not available from most trials. Long-term follow-up of randomised controlled trials (RCTs) comparing traditional slings with colposuspension and mid-urethral slings is essential. Evidence is insufficient to suggest whether traditional suburethral slings may be better or worse than other management techniques. This review is confined to RCTs and therefore may not identify all of the adverse effects that may be associated with these procedures. A brief economic commentary (BEC) identified three eligible economic evaluations, which are not directly comparable due to differences in methods, time horizons, and settings. End users of this review will need to assess the extent to which methods and results of identified economic evaluations may be applicable (or transferable) to their own setting.
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Affiliation(s)
- Lucky Saraswat
- Aberdeen Royal InfirmaryObstetrics and GynaecologyForesterhillAberdeenUKAB25 2ZD
| | - Haroon Rehman
- Aberdeen Royal Infirmary, NHS GrampianDepartment of OrthopaedicsForesterhillAberdeenScotlandUKAB25 2ZD
| | - Muhammad Imran Omar
- European Association of UrologyArnhemNetherlands
- University of AberdeenAcademic Urology UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - June D Cody
- Newcastle Universityc/o Cochrane Incontinence, Population Health Sciences InstituteBaddiley‐Clark Building, Richardson RoadNewcastle upon TyneTyne and WearUKNE2 4AX
| | - Patricia Aluko
- Newcastle Universityc/o Cochrane Incontinence, Population Health Sciences InstituteBaddiley‐Clark Building, Richardson RoadNewcastle upon TyneTyne and WearUKNE2 4AX
| | - Cathryn MA Glazener
- University of AberdeenHealth Services Research Unit3rd Floor, Health Sciences BuildingForesterhillAberdeenScotlandUKAB25 2ZD
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Fok CS, Gao X, Lin H, Thomas-White KJ, Mueller ER, Wolfe AJ, Dong Q, Brubaker L. Urinary symptoms are associated with certain urinary microbes in urogynecologic surgical patients. Int Urogynecol J 2018; 29:1765-1771. [PMID: 30116843 DOI: 10.1007/s00192-018-3732-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/18/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Persistent and de novo symptoms decrease satisfaction after urogynecologic surgery. We investigated whether the preoperative bladder microbiome is associated with urinary symptoms prior to and after urogynecologic surgery. METHODS One hundred twenty-six participants contributed responses to the validated OABq symptom questionnaire. Catheterized (bladder) urine samples and vaginal and perineal swabs were collected immediately preoperatively. Bacterial DNA in the urine samples and swabs was sequenced and classified. RESULTS Preoperative symptom severity was significantly worse in sequence-positive patients. Higher OABq Symptom Severity (OABqSS) scores (more symptomatic) were associated with higher abundance in bladder urine of two bacterial species: Atopobium vaginae and Finegoldia magna. The presence of Atopobium vaginae in bladder urine also was correlated with its presence in either the vagina or perineum. CONCLUSIONS Two specific bacterial species detected in bladder urine, Atopobium vaginae and Finegoldia magna, are associated with preoperative urinary symptom severity in women undergoing POP/SUI surgery. The reservoir for Atopobium vaginae may be adjacent pelvic floor niches. This observation should be validated in a larger cohort to determine whether there is a microbiologic etiology for certain preoperative urinary symptoms.
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Affiliation(s)
- Cynthia S Fok
- Departments of Obstetrics & Gynecology and Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.,Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Xiang Gao
- Department of Public Health, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Huaiying Lin
- Department of Public Health, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Krystal J Thomas-White
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.,, Menlo Park, CA, USA
| | - Elizabeth R Mueller
- Departments of Obstetrics & Gynecology and Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Alan J Wolfe
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Qunfeng Dong
- Department of Public Health, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Linda Brubaker
- Departments of Obstetrics & Gynecology and Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA. .,Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego, 9500 Gilman Drive MC 0971, La Jolla, CA, 92121, USA.
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Effect of Concurrent Prolapse Surgery on Stress Urinary Incontinence Outcomes After TVTO. Female Pelvic Med Reconstr Surg 2018; 23:244-249. [PMID: 28106648 DOI: 10.1097/spv.0000000000000364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES A variety of pelvic organ prolapse (POP) surgeries are performed concomitant to midurethral sling (MUS) placement. It is unknown whether differing POP surgeries may affect stress urinary incontinence outcomes after MUS placement. METHODS We performed a retrospective cohort analysis of patients undergoing TVT obturator system in conjunction with a variety of POP repair (cystocele with mesh graft, cystocele with cadaveric fascia, colpocleisis, and sacrocolpopexy). Primary outcomes included validated measures of stress urinary incontinence (International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms), measured preoperatively and at 6 week, 1 year, and 2 years postoperatively. Secondary outcomes included validated questionnaire items focused on obstructive and irritative symptoms. Multivariate analyses using mixed-effects regressions were used to assess for differences in outcomes based on POP repair type. RESULTS A total of 102 patients were identified for study analysis (cystocele with mesh graft, n = 45; cystocele with cadaveric fascia, n = 37; sacrocolpopexy, n = 16; colpocleisis, n = 4). Four patients undergoing colpocleisis were excluded from primary analysis given lack of sufficient cohort size. When adjusted for effects of covariates, significant improvements in primary and secondary outcomes were seen throughout follow-up in comparison with baseline. In general, multivariate analysis demonstrated no significant differences between surgeries when assessing primary and secondary outcomes. The only statistically significant difference in change over time comprised CM, which demonstrated superior improvement in International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (preoperative vs 2 year, P = 0.04). CONCLUSIONS Regardless of POP surgery type, patients demonstrate improvements in validated SUI outcomes through 2 years. Multivariate analysis suggests that there is little difference in SUI outcomes after TVT obturator system across several different POP repair types.
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Abstract
BACKGROUND Urinary incontinence is a common and potentially debilitating problem. Stress urinary, incontinence as the most common type of incontinence, imposes significant health and economic burdens on society and the women affected. Open retropubic colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure to correct stress urinary incontinence. OBJECTIVES The review aimed to determine the effects of open retropubic colposuspension for the treatment of urinary incontinence in women. A secondary aim was to assess the safety of open retropubic colposuspension in terms of adverse events caused by the procedure. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 5 May 2015), and the reference lists of relevant articles. We contacted investigators to locate extra studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group. DATA COLLECTION AND ANALYSIS Studies were evaluated for methodological quality or susceptibility to bias and appropriateness for inclusion and data extracted by two of the review authors. Trial data were analysed by intervention. Where appropriate, a summary statistic was calculated. MAIN RESULTS This review included 55 trials involving a total of 5417 women.Overall cure rates were 68.9% to 88.0% for open retropubic colposuspension. Two small studies suggested lower incontinence rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggested lower incontinence rates after open retropubic colposuspension compared to anticholinergic treatment. Evidence from six trials showed a lower incontinence rate after open retropubic colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (risk ratio (RR) for incontinence 0.46; 95% CI 0.30 to 0.72 before the first year, RR 0.37; 95% CI 0.27 to 0.51 at one to five years, RR 0.49; 95% CI 0.32 to 0.75 in periods beyond five years).Evidence from 22 trials in comparison with suburethral slings (traditional slings or trans-vaginal tape or transobturator tape) found no overall significant difference in incontinence rates in all time periods evaluated (as assessed subjectively RR 0.90; 95% CI 0.69 to 1.18, within one year of treatment, RR 1.18; 95%CI 1.01 to 1.39 between one and five years, RR 1.11; 95% CI 0.97 to 1.27 at five years and more, and as assessed objectively RR 1.24; 95% CI 0.93 to 1.67 within one year of treatment, RR 1.12; 95% CI 0.82 to 1.54 for one to five years follow up, RR 0.70; 95% CI 0.30 to 1.64 at more than five years). However, subgroup analysis of studies comparing traditional slings and open colposuspension showed better effectiveness with traditional slings in the medium and long term (RR 1.35; 95% CI 1.11 to 1.64 from one to five years follow up, RR 1.19; 95% CI 1.03 to 1.37).In comparison with needle suspension, there was a lower incontinence rate after colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42 to 1.03), after the first year (RR 0.56; 95% CI 0.39 to 0.81), and beyond five years (RR 0.32; 95% CI 15 to 0.71).Patient-reported incontinence rates at short, medium and long-term follow-up showed no significant differences between open and laparoscopic retropubic colposuspension, but with wide confidence intervals. In two trials incontinence was less common after the Burch (RR 0.38; 95% CI 0.18 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five year follow-up. There were few data at any other follow-up times.In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Voiding problems are also more common after sling procedures compared to open colposuspension. AUTHORS' CONCLUSIONS Open retropubic colposuspension is an effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85% to 90%. After five years, approximately 70% of women can expect to be dry. Newer minimal access sling procedures look promising in comparison with open colposuspension but their long-term performance is limited and closer monitoring of their adverse event profile must be carried out. Open colposuspension is associated with a higher risk of pelvic organ prolapse compared to sling operations and anterior colporrhaphy, but with a lower risk of voiding dysfunction compared to traditional sling surgery. Laparoscopic colposuspension should allow speedier recovery but its relative safety and long-term effectiveness is not yet known. A Brief Economic Commentary (BEC) identified five studies suggesting that tension-free vaginal tape (TVT) and laparoscopic colposuspension may be more cost-effective compared with open retropubic colposuspension.
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Affiliation(s)
- Marie Carmela M Lapitan
- National Institutes of Health Manila, University of the Philippines ManilaDivision of UrologyTaft AveManilaPhilippines1000
| | - June D Cody
- Newcastle Universityc/o Cochrane Incontinence GroupInstitute of Health & SocietyBaddiley‐Clarke Building, Richardson RoadNewcastle upon TyneTyne and WearUKNE2 4AX
| | - Atefeh Mashayekhi
- Newcastle UniversityInstitute of Health & SocietyBaddiley‐Clark BuildingRichardson RoadNewcastle Upon TyneUKNE2 4AX
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Petrikovets A, Mahajan ST. De Novo Overactive Bladder Symptoms After Sling Placement. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0405-8] [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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Virseda-Chamorro M, Salinas-Casado J, Tapia-Herrero AM, Pesquera L, Méndez-Rubio S, Esteban-Fuertes M, Resel-Forskelma L, Moreno-Sierra J. Effect of pelvic organ prolapse repair on detrusor overactivity in women following incontinence surgery: A multivariate analysis. Neurourol Urodyn 2017; 36:2083-2088. [DOI: 10.1002/nau.23242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 12/30/2016] [Accepted: 01/16/2017] [Indexed: 11/08/2022]
Affiliation(s)
| | - Jesús Salinas-Casado
- Department of Urology; Hospital Clínico de San Carlos, Complutense University; Madrid Spain
| | | | - Laura Pesquera
- Department of Urology; Hospital Clínico de San Carlos, Complutense University; Madrid Spain
| | | | | | - Luis Resel-Forskelma
- Department of Urology; Hospital Clínico de San Carlos, Complutense University; Madrid Spain
| | - Jesús Moreno-Sierra
- Department of Urology; Hospital Clínico de San Carlos, Complutense University; Madrid Spain
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Effect of a New Risk Calculator on Patient Satisfaction With the Decision for Concomitant Midurethral Sling During Prolapse Surgery: A Randomized Controlled Trial. Female Pelvic Med Reconstr Surg 2016; 23:17-22. [PMID: 27682745 DOI: 10.1097/spv.0000000000000339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether use of a new personalized risk calculator increases patient satisfaction with the decision whether or not to have a prophylactic midurethral sling (MUS) during pelvic organ prolapse (POP) surgery. METHODS We performed a randomized controlled trial involving English-speaking women without symptoms of stress urinary incontinence (SUI) with ≥ stage 2 POP who planned to undergo POP surgery with 1 of 4 fellowship-trained urogynecologists at a single academic center. Women with a history of prior POP or incontinence surgery, or who were pregnant, or unable to complete study forms were excluded. Participants were randomly assigned to standard preoperative counseling or preoperative counseling with the use of a validated, online risk calculator for de novo SUI after POP surgery. The primary outcome was patient satisfaction with the decision for prophylactic MUS placement during POP surgery at 3 months postoperative assessed using the Satisfaction with Decision Scale for Pelvic Floor Disorders. RESULTS Sixty-three women were approached for participation. Forty-two agreed to participate, 41 underwent randomization, and 33 had POP surgery and completed 3-month follow-up. Of these 33, 17 were randomized to the risk calculator and 16 to standard counseling. The mean age was 61.2 ± 9.1 years, and 41% (14/33) had a prophylactic MUS. At 3 months postoperative, there was no difference in Satisfaction with Decision Scale for Pelvic Floor Disorders scores between groups (4.67 ± 0.46 [intervention] vs 4.78 ± 0.34 [control]; P = 0.61). CONCLUSIONS Use of the de novo SUI risk calculator did not increase patient satisfaction with the decision regarding MUS placement during POP surgery.
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Postoperative appointments: which ones count? Int Urogynecol J 2016; 27:1873-1877. [PMID: 27311601 DOI: 10.1007/s00192-016-3052-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Although postoperative complications in women undergoing reconstructive pelvic surgery (RPS) have been characterized, little is known regarding the timeline of these occurrences. We aimed to determine the timeframe after RPS during which the majority of complications occur, to assist with planning intervals between postoperative visits. METHODS Women undergoing RPS were identified through billing information. Demographic, surgical, and complications data were extracted from electronic medical records. The Pelvic Floor Complication scale is a surgical scale tailored to women undergoing RPS. It contains three subscales: intraoperative, immediately postoperative, and delayed complications. We applied this scale to each postoperative visit (at 2, 6, and 13 weeks). RESULTS 396 women underwent RPS and 125 patients had 179 complications, most of which (66 %) were identified by the 2-week visit. Complications at the 2-week visit consisted of urinary tract infection (UTI; 46 %), wound infection (10.0 %), and urinary retention (9.4 %). The majority of serious complications (venous thromboembolism [VTE], ileus, small bowel obstruction [SBO], readmission, and reoperation [1 incarcerated hernia and 1 sling release]) were diagnosed by 2 weeks. One patient was readmitted for ileus at between 2 and 6 weeks. At between 6 and 13 weeks, 1 patient was readmitted with SBO; 1 VTE was diagnosed; and 1 required reoperation for a prolapsed fallopian tube. In contrast, two thirds of the complications seen at the 13-week visit were due to granulation tissue, suture erosion or mesh erosion. CONCLUSIONS The majority of non-mesh-related complications occur within the first 2 weeks after RPS, whereas mesh and suture complications are more likely to be identified at the 13-week visit.
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Al-Zahrani AA, Gajewski J. Long-term patient satisfaction after retropubic and transobturator mid-urethral slings for female stress urinary incontinence. J Obstet Gynaecol Res 2016; 42:1180-5. [DOI: 10.1111/jog.13035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 03/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Ali A. Al-Zahrani
- Department of Urology, College of Medicine; University of Dammam; Alkhobar Saudi Arabia
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Abstract
BACKGROUND Urinary incontinence is a common and potentially debilitating problem. Open retropubic colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure to correct stress urinary incontinence. OBJECTIVES The review aimed to determine the effects of open retropubic colposuspension for the treatment of urinary incontinence in women. A secondary aim was to assess the safety of open retropubic colposuspension in terms of adverse events caused by the procedure. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 5 May 2015), and the reference lists of relevant articles. We contacted investigators to locate extra studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group. DATA COLLECTION AND ANALYSIS Studies were evaluated for methodological quality or susceptibility to bias and appropriateness for inclusion and data extracted by two of the review authors. Trial data were analysed by intervention. Where appropriate, a summary statistic was calculated. MAIN RESULTS This review included 55 trials involving a total of 5417 women.Overall cure rates were 68.9% to 88.0% for open retropubic colposuspension. Two small studies suggested lower incontinence rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggested lower incontinence rates after open retropubic colposuspension compared to anticholinergic treatment. Evidence from six trials showed a lower incontinence rate after open retropubic colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (risk ratio (RR) for incontinence 0.46; 95% CI 0.30 to 0.72 before the first year, RR 0.37; 95% CI 0.27 to 0.51 at one to five years, RR 0.49; 95% CI 0.32 to 0.75 in periods beyond five years).Evidence from 22 trials in comparison with suburethral slings (traditional slings or trans-vaginal tape or transobturator tape) found no overall significant difference in incontinence rates in all time periods evaluated (as assessed subjectively RR 0.90; 95% CI 0.69 to 1.18, within one year of treatment, RR 1.18; 95%CI 1.01 to 1.39 between one and five years, RR 1.11; 95% CI 0.97 to 1.27 at five years and more, and as assessed objectively RR 1.24; 95% CI 0.93 to 1.67 within one year of treatment, RR 1.12; 95% CI 0.82 to 1.54 for one to five years follow up, RR 0.70; 95% CI 0.30 to 1.64 at more than five years). However, subgroup analysis of studies comparing traditional slings and open colposuspension showed better effectiveness with traditional slings in the medium and long term (RR 1.35; 95% CI 1.11 to 1.64 from one to five years follow up, RR 1.19; 95% CI 1.03 to 1.37).In comparison with needle suspension, there was a lower incontinence rate after colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42 to 1.03), after the first year (RR 0.56; 95% CI 0.39 to 0.81), and beyond five years (RR 0.32; 95% CI 15 to 0.71).Patient-reported incontinence rates at short, medium and long-term follow-up showed no significant differences between open and laparoscopic retropubic colposuspension, but with wide confidence intervals. In two trials incontinence was less common after the Burch (RR 0.38; 95% CI 0.18 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five year follow-up. There were few data at any other follow-up times.In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. Voiding problems are also more common after sling procedures compared to open colposuspension. AUTHORS' CONCLUSIONS Open retropubic colposuspension is an effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85% to 90%. After five years, approximately 70% of women can expect to be dry. Newer minimal access sling procedures look promising in comparison with open colposuspension but their long-term performance is limited and closer monitoring of their adverse event profile must be carried out. Open colposuspension is associated with a higher risk of pelvic organ prolapse compared to sling operations and anterior colporrhaphy, but with a lower risk of voiding dysfunction compared to traditional sling surgery. Laparoscopic colposuspension should allow speedier recovery but its relative safety and long-term effectiveness is not yet known.
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Affiliation(s)
- Marie Carmela M Lapitan
- Division of Urology, National Institutes of Health Manila, University of the Philippines Manila, Taft Ave, Manila, Philippines, 1000
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Zyczynski HM, Albo ME, Goldman HB, Wai CY, Sirls LT, Brubaker L, Norton P, Varner RE, Carmel M, Kim HY. Change in Overactive Bladder Symptoms After Surgery for Stress Urinary Incontinence in Women. Obstet Gynecol 2015; 126:423-430. [PMID: 26241434 PMCID: PMC4526119 DOI: 10.1097/aog.0000000000000929] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess change in overactive bladder (OAB) symptoms up to 5 years after surgery and to identify associated predictors of change from baseline. METHODS This is a secondary analysis of data from three multicenter urinary incontinence (UI) surgical trials of women with stress-predominant mixed UI assigned to Burch colposuspension, autologous fascial sling, or retropubic or transobturator midurethral slings. The primary outcome was improvement of 70% or greater from baseline in symptoms measured by the Urinary Distress Inventory-Irritative subscale. Surgical groups were compared within respective trials. Generalized linear models were fit using 1-year and up to 5-year data. RESULTS Significant improvements in Urinary Distress Inventory-Irritative scores were reported by each surgical group 1 year after surgery (P<.001). Most women (50-71%) reported improvement in OAB symptoms. Improvements were similar between midurethral sling groups at 1 year (65.5% compared with 70.7%, P=.32; odds ratio [OR] 0.83, 95% confidence interval [CI] 0.57-1.20 for retropubic compared with transobturator sling) and throughout the 5-year follow-up period. More women reported OAB symptom improvement after Burch compared with pubovaginal sling (67.9% compared with 56.6%, P=.01; OR 1.59, 95% CI 1.10-2.31 for Burch compared with sling); this group difference at 1 year persisted throughout the 5-year follow-up. At 1-year, 50.0-64.3% of patients reported 70% greater improvement in UI. This proportion declined to 36.5-54.1% at 5 years (P<.001). Preoperative use of anticholinergics and urodynamic parameters was not predictive of OAB symptom change after surgery. CONCLUSION Most women with stress-predominant mixed UI experienced significant improvement in OAB symptoms after incontinence surgery although this initial improvement diminished over time. Obesity blunted symptom improvement. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Halina M Zyczynski
- University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, Pennsylvania; the University of California San Diego Health Systems, San Diego, California; Cleveland Clinic, Cleveland, Ohio; the University of Texas Southwestern, Dallas, Texas; William Beaumont Hospital, Royal Oak, Michigan; Loyola University Chicago Stritch School of Medicine, Maywood, Illinois; the University of Utah, Salt Lake City, Utah; the University of Alabama at Birmingham, Birmingham, Alabama; and New England Research Institutes, Watertown, Massachusetts
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The role of bladder neck suspension in the era of mid-urethral sling surgery. World J Urol 2015; 33:1235-41. [PMID: 26173874 DOI: 10.1007/s00345-015-1622-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 06/12/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Mid-urethral slings are currently considered to be the gold standard for the surgical treatment of stress urinary incontinence, replacing bladder neck suspension techniques which previously occupied this position. In recent years, however, there have been concerns with regard to the use of synthetic material in vaginal surgery. METHODS We performed a review of the literature to discuss the role of bladder neck suspension techniques in the current clinical setting. CONCLUSIONS Bladder neck suspension techniques consist of vaginal techniques, needle suspension techniques and retropubic techniques. The latter two techniques have been proven to offer durable outcomes for stress urinary incontinence. As compared to autologous slings, the long-term success rates may be considered inferior, but so is the rate of complication, resulting in higher patient satisfaction. Bladder neck suspension techniques may have a role in treating recurrent and/or persisting stress urinary incontinence after (failed) sling surgery and remain of particular interest in patients with stress urinary incontinence when performing concomitant surgery, for example for prolapse.
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Challenges in the Treatment of Overactive Bladder in the Octogenarian Female. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-014-0281-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kenton K, Stoddard AM, Zyczynski H, Albo M, Rickey L, Norton P, Wai C, Kraus SR, Sirls LT, Kusek JW, Litman HJ, Chang RP, Richter HE. 5-year longitudinal followup after retropubic and transobturator mid urethral slings. J Urol 2014; 193:203-10. [PMID: 25158274 DOI: 10.1016/j.juro.2014.08.089] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE Few studies have characterized longer-term outcomes after retropubic and transobturator mid urethral slings. MATERIALS AND METHODS Women completing 2-year participation in a randomized equivalence trial who had not undergone surgical re-treatment for stress urinary incontinence were invited to participate in a 5-year observational cohort. The primary outcome, treatment success, was defined as no re-treatment or self-reported stress incontinence symptoms. Secondary outcomes included urinary symptoms and quality of life, satisfaction, sexual function and adverse events. RESULTS Of 597 women 404 (68%) from the original trial enrolled in the study. Five years after surgical treatment success was 7.9% greater in women assigned to the retropubic sling compared to the transobturator sling (51.3% vs 43.4%, 95% CI -1.4, 17.2), not meeting prespecified criteria for equivalence. Satisfaction decreased during 5 years but remained high and similar between arms (retropubic sling 79% vs transobturator sling 85%, p=0.15). Urinary symptoms and quality of life worsened with time (p <0.001), and women with a retropubic sling reported greater urinary urgency (p=0.001), more negative impact on quality of life (p=0.02) and worse sexual function (p=0.001). There was no difference in the proportion of women experiencing at least 1 adverse event (p=0.17). Seven new mesh erosions were noted (retropubic sling 3, transobturator sling 4). CONCLUSIONS Treatment success decreased during 5 years for retropubic and transobturator slings, and did not meet the prespecified criteria for equivalence with retropubic demonstrating a slight benefit. However, satisfaction remained high in both arms. Women undergoing a transobturator sling procedure reported more sustained improvement in urinary symptoms and sexual function. New mesh erosions occurred in both arms over time, although at a similarly low rate.
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Affiliation(s)
| | | | - Halina Zyczynski
- University of Pittsburgh, Magee-Women's Research Institute, Pittsburgh, Pennsylvania
| | - Michael Albo
- University of California San Diego, San Diego, California
| | | | | | | | - Stephen R Kraus
- University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | | | - John W Kusek
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | | | - Robert P Chang
- New England Research Institutes, Watertown, Massachusetts
| | - Holly E Richter
- University of Alabama at Birmingham, Birmingham, Alabama for the Urinary Incontinence Treatment Network
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Abstract
PURPOSE OF REVIEW Patient-reported outcomes and satisfaction are recognized as being equally important as traditional objective measures of success following midurethral sling (MUS) procedures. The objective of this article is to review the success after MUSs in the context of patient satisfaction. RECENT FINDINGS Patient satisfaction for both transobturator and retropubic MUSs at 2 years is high with rates up to 88%. Factors that positively influence satisfaction include improvement in quality of life and reduction in severity of symptoms. Satisfaction has been found to be negatively impacted by persistent stress incontinence, preoperative urinary urgency, mixed urinary incontinence, detrusor overactivity, and selected comorbidities such as diabetes. Factors, such as postoperative incomplete bladder emptying, irritative voiding, and complications after MUS surgery, can also influence satisfaction adversely. SUMMARY Combining patient-reported outcome measures with customary objective measures offer a more comprehensive assessment of success. Even though the data are limited, the short-term and intermediate-term rates of satisfaction are promising for both transobturator and retropubic MUSs. Future studies should focus on further elucidating long-term predictors of satisfaction after MUS placement.
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Aigmueller T, Bjelic-Radisic V, Kargl J, Hinterholzer S, Laky R, Trutnovsky G, Kolovetsiou-Kreiner V, Tamussino K. Reasons for dissatisfaction ten years after TVT procedure. Int Urogynecol J 2013; 25:213-7. [DOI: 10.1007/s00192-013-2213-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/17/2013] [Indexed: 10/26/2022]
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Patient satisfaction after midurethral sling surgery for stress urinary incontinence. Obstet Gynecol 2013; 121:1009-1016. [PMID: 23635737 DOI: 10.1097/aog.0b013e31828ca49e] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify factors that may contribute to patient satisfaction with outcome in women who received retropubic and transobturator midurethral slings. METHODS Satisfaction was assessed 12 months postsurgery as a planned analysis in 597 participants from a multicenter randomized trial comparing retropubic with transobturator midurethral slings using the Incontinence Surgery Satisfaction Questionnaire. Significantly related variables associated with satisfaction in univariable analyses were entered into multivariable logistic regression models to test their independent association with satisfaction. RESULTS One year after surgery, 264 (88.6%) in the retropubic group and 263 (88.0%) in the transobturator group completed satisfaction questionnaires. Both treatment groups demonstrated a high level of satisfaction with respect to urine leakage (retropubic 85.9% compared with transobturator 90.0%; P=.52), urgency to urinate, frequency of urination, capability of physical activity, social activity, ability to engage in sexual activity, and from an emotional standpoint. Baseline characteristics associated with reduced satisfaction were higher Medical, Epidemiologic, and Social Aspects of Aging Questionnaire urgency subscale scores, detrusor overactivity, and diabetes mellitus. The severity of both objective (frequency of incontinence episodes, pad test weight) and subjective (Incontinence Impact Questionnaire and Urogenital Distress Inventory score) measures of incontinence at baseline and the patients' perceptions of preoperative severity of incontinence and expectations of achieving postoperative cure or improvement were not statistically different between satisfied and unsatisfied patients. In the final multivariable model, satisfaction was associated with overall treatment success (odds ratio [OR] 2.57, 95% confidence interval [CI] 1.29-5.13], greater reduction in Urogenital Distress Inventory (OR 0.97, 95% CI 0.96-0.98) and Incontinence Impact Questionnaire scores (OR 0.99, 95% CI 0.98-0.99), and fewer complications (OR 0.55, 95% CI 0.30-0.99). CONCLUSION The high level of satisfaction seen after midurethral sling procedures is associated with greater objective and patient-perceived improvement of stress incontinence and fewer complications. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00325039. LEVEL OF EVIDENCE II.
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Khullar V, Marschall-Kehrel D, Espuna-Pons M, Kelleher CJ, Tully SE, Piault EC, Brubaker L, Fianu-Jonasson A, Weinstein D, Bergqvist A, Kvasz M. European content validation of the Self-Assessment Goal Achievement (SAGA) questionnaire in patients with overactive bladder. Int Urogynecol J 2013; 24:1529-36. [DOI: 10.1007/s00192-012-2039-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/29/2012] [Indexed: 11/30/2022]
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Zyczynski HM, Rickey L, Dyer KY, Wilson T, Stoddard AM, Gormley EA, Hsu Y, Kusek JW, Brubaker L. Sexual activity and function in women more than 2 years after midurethral sling placement. Am J Obstet Gynecol 2012; 207:421.e1-6. [PMID: 22840975 DOI: 10.1016/j.ajog.2012.06.053] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 05/17/2012] [Accepted: 06/27/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to assess prospectively the effects of midurethral sling surgery on sexual function and activity. STUDY DESIGN Sexual activity and function was assessed in 597 women with stress urinary incontinence who were enrolled in a randomized equivalence trial of retropubic compared with transobturator midurethral slings. Repeated measures analysis of variance was used to assess changes in Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire scores over a 2-year period. RESULTS Significant, similar improvements in sexual function were seen in both midurethral sling groups. Mean Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire scores increased from 32.8 at baseline to 37.6 at 6 months and 37.3 at 24 months (P < .0001). Dyspareunia, incontinence during sex, and fear of incontinence during sex each significantly improved after surgery. Preoperative urge incontinence was associated with abstinence after surgery (P = .02); postoperative urge incontinence negatively impacted sexual function (P = .047). CONCLUSION Midurethral sling surgery for stress urinary incontinence significantly improves sexual function, although coexistent urge incontinence has a negative impact.
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Affiliation(s)
- Halina M Zyczynski
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
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Segal S, Arya LA, Smith AL. Functional Outcomes for Incontinence and Prolapse Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2012; 7:179-186. [PMID: 23066437 PMCID: PMC3468911 DOI: 10.1007/s11884-012-0136-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The majority of women with pelvic organ prolapse and stress urinary incontinence report more than one symptom that affects urinary, bowel, or sexual function. Most research studies on outcomes following surgery for pelvic organ prolapse and stress incontinence focus on anatomic outcomes and relief of symptoms specific to prolapse and/or stress incontinence. Pelvic symptoms related to voiding function such as de novo urgency or incontinence, bowel function, and sexual function are clinically important outcomes but are infrequently reported. Deterioration of pelvic symptoms postoperatively is associated with decreased patient satisfaction, which underscores the importance of effectively assessing functional and anatomic treatment outcomes. Future studies of reconstructive pelvic surgery should routinely include multiple domain functional outcomes specifically addressing voiding, defecatory, and sexual function.
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Affiliation(s)
- Saya Segal
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 1000 Courtyard, Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Lily A. Arya
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 1000 Courtyard, Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Ariana L. Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, 299 South 8th Street, Philadelphia, PA 19104, USA
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Whiteside JL. Making sense of urodynamic studies for women with urinary incontinence and pelvic organ prolapse: a urogynecology perspective. Urol Clin North Am 2012; 39:257-63. [PMID: 22877707 DOI: 10.1016/j.ucl.2012.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The support for routine urodynamic testing in the management of women with urinary incontinence or pelvic organ prolapse is eroding. The reasons for this change largely reflect the growing evidence that urodynamic testing in this context renders little additional information over basic office assessment. The clinical features of urodynamic testing and its diagnostic and prognostic precision and accuracy are all problematic. As our understanding of female lower urinary tract dysfunction improves, the inadequacy of urodynamic testing to meaningfully improve patient and clinician decision making has become more apparent.
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Affiliation(s)
- James L Whiteside
- Department of Obstetrics and Gynecology, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
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Richter HE, Brubaker L, Stoddard AM, Xu Y, Zyczynski HM, Norton P, Sirls LT, Kraus SR, Chai TC, Zimmern P, Gormley EA, Kusek JW, Albo ME. Patient related factors associated with long-term urinary continence after Burch colposuspension and pubovaginal fascial sling surgeries. J Urol 2012; 188:485-9. [PMID: 22704099 PMCID: PMC3560926 DOI: 10.1016/j.juro.2012.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Indexed: 01/09/2023]
Abstract
PURPOSE We examined preoperative and postoperative patient related factors associated with continence status up to 7 years after surgery for stress urinary incontinence. MATERIALS AND METHODS Women randomized to Burch colposuspension or fascial sling surgery and assessed for the primary outcome of urinary continence 2 years after surgery were eligible to enroll in a prospective observational study. Survival analysis was used to investigate baseline and postoperative factors in the subsequent risk of stress urinary incontinence, defined as self-report of stress urinary incontinence symptoms, incontinence episodes on a 3-day diary or surgical re-treatment. RESULTS Of the women who participated in the randomized trial 74% (482 of 655) were enrolled in the followup study. Urinary continence rates decreased during a period of 2 to 7 years postoperatively from 42% to 13% in the Burch group and from 52% to 27% in the sling group, respectively. Among the baseline factors included in the first multivariable model age (p = 0.03), prior stress urinary incontinence surgery (p = 0.02), menopausal status (0.005), urge index (0.006), assigned surgery (p = 0.01) and recruiting site (p = 0.02) were independently associated with increased risk of incontinence. In the final multivariable model including baseline and postoperative factors, Burch surgery (p = 0.01), baseline variables of prior urinary incontinence surgery (p = 0.04), menopausal status (p = 0.03) and postoperative urge index (p <0.001) were each significantly associated with a greater risk of recurrent urinary incontinence. CONCLUSIONS Preoperative and postoperative urgency incontinence symptoms, Burch urethropexy, prior stress urinary incontinence surgery and menopausal status were negatively associated with long-term continence rates. More effective treatment of urgency urinary incontinence in patients who undergo stress urinary incontinence surgery may improve long-term overall continence status.
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Affiliation(s)
- Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th St. South, 176 F, Suite 10382, Birmingham, Alabama 35249, USA.
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Abstract
BACKGROUND Urinary incontinence is a common and potentially debilitating problem. Open retropubic colposuspension is a surgical treatment which involves lifting the tissues near the bladder neck and proximal urethra in the area behind the anterior pubic bones to correct deficient urethral closure. OBJECTIVES To assess the effects of open retropubic colposuspension for the treatment of urinary incontinence. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register (searched 13 March 2012), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings, and the reference lists of relevant articles. We contacted investigators to locate extra studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in women with symptoms or urodynamic diagnoses of stress or mixed urinary incontinence that included open retropubic colposuspension surgery in at least one trial group. DATA COLLECTION AND ANALYSIS Studies were evaluated for methodological quality or susceptibility to bias and appropriateness for inclusion and data extracted by two of the review authors. Trial data were analysed by intervention. Where appropriate, a summary statistic was calculated. MAIN RESULTS This review included 53 trials involving a total of 5244 women.Overall cure rates were 68.9% to 88.0% for open retropubic colposuspension. Two small studies suggested lower incontinence rates after open retropubic colposuspension compared with conservative treatment. Similarly, one trial suggested lower incontinence rates after open retropubic colposuspension compared to anticholinergic treatment. Evidence from six trials showed a lower incontinence rate after open retropubic colposuspension than after anterior colporrhaphy. Such benefit was maintained over time (risk ratio (RR) for incontinence 0.51; 95% CI 0.34 to 0.76 before the first year, RR 0.43; 95% CI 0.32 to 0.57 at one to five years, RR 0.49; 95% CI 0.32 to 0.75 in periods beyond five years).Evidence from 20 trials in comparison with suburethral slings (trans-vaginal tape or transobturator tape) found no significant difference in incontinence rates in all time periods assessed.In comparison with needle suspension, there was a lower incontinence rate after colposuspension in the first year after surgery (RR 0.66; 95% CI 0.42 to 1.03), after the first year (RR 0.48; 95% CI 0.33 to 0.71), and beyond five years (RR 0.32; 95% CI 15 to 0.71).Patient-reported incontinence rates at short, medium and long-term follow-up showed no significant differences between open and laparoscopic retropubic colposuspension, but with wide confidence intervals. In two trials incontinence was less common after the Burch (RR 0.38; 95% CI 0.18 to 0.76) than after the Marshall Marchetti Krantz procedure at one to five year follow-up. There were few data at any other follow-up times.In general, the evidence available does not show a higher morbidity or complication rate with open retropubic colposuspension compared to the other open surgical techniques, although pelvic organ prolapse is more common than after anterior colporrhaphy and sling procedures. AUTHORS' CONCLUSIONS Open retropubic colposuspension is an effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85% to 90%. After five years, approximately 70% of patients can expect to be dry. Newer minimal access procedures such as tension-free vaginal tape look promising in comparison with open colposuspension but their long-term performance is not known and closer monitoring of their adverse event profile must be carried out. Laparoscopic colposuspension should allow speedier recovery but its relative safety and long-term effectiveness is not known yet.
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28
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Abstract
Underreported and undertreated, stress urinary incontinence leads to decreased quality of life in sufferers and financial burdens for both the patient and the healthcare industry. Nurse practitioners should understand their role in identifying, diagnosing, and treating the condition.
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