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Sikora M, Gamper M, Zivanovic I, Münst J, Bischofberger H, Kociszewski J, Viereck V. Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy-An Update. J Clin Med 2024; 13:1377. [PMID: 38592248 PMCID: PMC10932143 DOI: 10.3390/jcm13051377] [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: 01/15/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are of interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed literature search using the keywords "incontinence" and "bulking" or "laser". Although the two approaches are less effective than sling insertions, there are specific conditions in which one or the other technique is more advantageous. Injecting bulking agents into the urethra only takes some minutes and works without general anesthesia. The method is particularly suited for elderly, frail, or obese patients with multiple comorbidities, but is also applicable for all patients and in combination with other therapies. Generally, the safety profile is good but differs between bulking materials. Two laser types-the Erbium:YAG laser with SMOOTH-mode and the fractional ablative CO2 laser-deliver heat into the tissue to induce tissue tightening and regeneration. Intravaginal laser therapy improves mild to moderate SUI, while studies describe how intraurethral laser therapy is also beneficial for severe SUI. Young women between childbirths, as well as postmenopausal women, may benefit from laser therapy. The method is safe, can be performed on an outpatient basis, and does not require any artificial material.
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Affiliation(s)
- Michal Sikora
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Marianne Gamper
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Irena Zivanovic
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Julia Münst
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Helena Bischofberger
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Jacek Kociszewski
- Department of Gynecology and Obstetrics, Evangelisches Krankenhaus Hagen-Haspe, 58135 Hagen, Germany;
| | - Volker Viereck
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
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González-Díaz E, Fernández Fernández C, Martin Corral AV, Gutierrez SH. Use of intraoperative ultrasound to improve tension-free vaginal tape-obturator placement: A pilot study. Int J Gynaecol Obstet 2023; 161:833-838. [PMID: 36637252 DOI: 10.1002/ijgo.14671] [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: 06/17/2022] [Revised: 12/06/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the use of intraoperative ultrasound (IUS) to achieve a postoperative optimal placement of the tension-free vaginal tape-obturator (TVT-O). METHODS A cohort study was performed among women who underwent TVT-O placement. In 25 women, ultrasound was used for the placement, and based on current evidence, the optimal intraoperative and postoperative ultrasound pattern was selected. They were compared with 25 women where IUS was not used. RESULTS IUS increased operative time (by 7.5 min), and in 36% (9/25) of cases it was necessary to perform some corrections based on the ultrasound findings. After 1 month, in patients of the IUS group, the tapes were more frequently placed at a distance of 3-5 mm (P = 0.01), and it was more common for it to be placed between 40% and 70% relative to the urethral length (P = 0.011). Of tapes placed with IUS, 76% (met the optimal postoperative ultrasound pattern, as opposed to only 48% placed without IUS (P = 0.041). No differences were found in the complications or the functional results at 1 month post-surgery. CONCLUSION The use of IUS for the placement of TVT-O allows us to position them optimally and avoid erroneous placements, although IUS increases the operative time without improving the functional results and the rate of complications.
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Affiliation(s)
- Enrique González-Díaz
- Pelvic Floor Unit, Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de León, León, Spain
| | - Camino Fernández Fernández
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de León (CAULE), León, Spain
| | - Ana Victoria Martin Corral
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de León (CAULE), León, Spain
| | - Silvia Herce Gutierrez
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de León (CAULE), León, Spain
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Bergström BS. Stress urinary incontinence is caused predominantly by urethral support failure. Int Urogynecol J 2022; 33:523-530. [PMID: 35064789 PMCID: PMC8885533 DOI: 10.1007/s00192-021-05024-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/28/2021] [Indexed: 12/26/2022]
Abstract
Whales are mammals that can dive to depths of > 1000 m without the high water pressure pushing open their mouth or anus. The same is true for the female urethra. The meatus externus and internus are seals that cannot be pushed open by high water pressures. Recent evidence suggests that the female meatus internus is pushed open when the bladder pressure exceeds the urethral pressure. For a relaxed detrusor, this opening is not possible for at least three reasons: the law of elastic collision, Pascal’s law of hydrostatics and the Hagen-Poiseuille law. The three laws do not support that urethral function failure is the predominant cause of stress urinary incontinence (SUI); however, they do support that urethral support failure is. Influential urogynecologists claim the opposite. TVT surgery, according to the integral theory of SUI (IT), has high failure rates because it does not principally prevent the urethra from hanging on a less mobile bladder neck. In the case of a long urethra, the tape is set too distally, and in hypomobile SUI, the use of a tension-free suburethral tape is unwarranted/ineffective, because the proximal urethra is not elevated above its resting position. A successful operation corrects urethral support failure and not urethral function failure.
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Affiliation(s)
- Bo S Bergström
- Department of Obstetrics & Gynecology Mora Hospital, 792 51, Mora, Sweden.
- Overlege at Nordfjord Hospital, N-6771, Nordfjordeid, Norway.
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Tamma A, Bjelic-Radisic V, Hölbfer S, Trutnovsky G, Tamussino K, Aigmüller T, Ulrich D. Sonographic sling position and cure rate 10-years after TVT- O procedure. PLoS One 2019; 14:e0209668. [PMID: 30615677 PMCID: PMC6322787 DOI: 10.1371/journal.pone.0209668] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/10/2018] [Indexed: 11/18/2022] Open
Abstract
AIM To examine the position of the TVT-O sling 10 years postoperatively and its association with outcome. METHODS A total of 124 patients who received a TVT-O sling at two centers in 2004 and 2007 were invited for follow-up. The position of the sling on perineal ultrasound was described relative to the bladder neck and the lower margin of the pubic symphysis at rest and on Valsalva. Objective cure was defined as a negative cough stress test at 300 ml. Subjective cure was evaluated with the Kings´ Health Questionnaire (KHQ), Incontinence Outcome Questionnaire (IOQ), Female Sexual Function Index Questionnaire (FSFI) and the Patient Global Impression of Improvement score (PGII). RESULTS 78 of 124 patients (57%) were available for follow-up 10 years after surgery. I Eleven (14%) had undergone reoperation and were excluded. Tapes were visualized in the remaining 67 (54%) women. The subjective and objective cure rates in this sub-cohort were 67% (45/67) and 77% (52/67), respectively. In these 67 women the mean distances from the bladder neck to the proximal edge of the tape (BNTD) during Valsalva maneuver were significantly higher in cured women compared to the not-cured women (11.2 vs. 9.4mm). The distance between tape and urethra (TUD) was significantly lower in cured vs. not cured patients (2.6 vs. 4.1mm). All women with a TUD of >5mm (n = 5) were incontinent. Tape position was not associated with overactive bladder symptoms. CONCLUSIONS Tape position near the bladder neck and large distance to the urethra is associated with incontinence 10 years after TVT-O.
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Affiliation(s)
- Ayman Tamma
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
- Department of Obstetrics and Gynecology, Wilhelminen Hospital, Vienna, Austria
| | - Vesna Bjelic-Radisic
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Susanne Hölbfer
- Department of Obstetrics and Gynecology, Wilhelminen Hospital, Vienna, Austria
| | - Gerda Trutnovsky
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Karl Tamussino
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Thomas Aigmüller
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Daniela Ulrich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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Pomian A, Majkusiak W, Kociszewski J, Tomasik P, Horosz E, Zwierzchowska A, Lisik W, Barcz E. Demographic features of female urethra length. Neurourol Urodyn 2018; 37:1751-1756. [PMID: 29427320 DOI: 10.1002/nau.23509] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/04/2018] [Indexed: 11/06/2022]
Abstract
AIMS To determine cohort urethral length, identify epidemiological factors influencing the parameter and to establish the percentage of cases with clinically relevant outsized urethras. METHODS Prospective cohort study conducted in two tertiary clinical centers between 2013 and 2017. Nine hundred and twenty seven consecutive adult, Caucasian females attending outpatients' clinics were included. The urethral length has been measured in pelvic floor ultrasound examination. The exclusion criteria were inadequate bladder filling (<200 mL; >400 mL), previous history of pelvic floor surgery, and no consent. RESULTS Urethral length varied from 19 to 45 mm. The distribution of the examined parameter was normal. Obese patients had significantly longer urethras as compared to non-obese subjects. Number of vaginal deliveries was connected with shorter urethral length. The limitations of the study are: analysis only of Caucasian patients and subjects without previous pelvic floor surgeries. CONCLUSIONS Differences in urethral length in the female population were demonstrated. Thirty percent of patients have atypical urethras that may be a risk factor for sling surgery failure. We therefore postulate introduction of urethral measurement before the procedure.
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Affiliation(s)
- Andrzej Pomian
- Ist Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Majkusiak
- Ist Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | | | - Paweł Tomasik
- Ist Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Edyta Horosz
- Ist Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Zwierzchowska
- Ist Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Lisik
- Deparment of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Barcz
- Ist Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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Majkusiak W, Pomian A, Tomasik P, Horosz E, Zwierzchowska A, Kociszewski J, Barcz E. Does the suburethral sling change its location? Int J Urol 2017; 24:848-853. [PMID: 28929543 DOI: 10.1111/iju.13448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 08/16/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To ascertain whether a phenomenon of sling migration exists after suburethral sling placement, whether this might be responsible for suboptimal sling location and persistent incontinence, and whether a link exists between sling dislocation or migration and risk factors, such as obesity or age. METHODS The present prospective cohort study was carried out in a group of 244 patients who underwent retropubic sling implantation. Sling location was determined by means of pelvic floor ultrasound, and calculated relative to the individual patient's urethral length measured before the procedure. The sling location was visualized on 1 day, and 1 and 6 months post-surgery. Overweight/obese and elderly patients were analyzed separately to assess the possible influence of those factors on sling location. RESULTS The mean urethral length in the studied cohort was 28.76 ± 3.67 mm. The mean tape position 1 day post-surgery was 66.18 ± 8.43% of the urethral length, and it did not change 1 and 6 months post-surgery in the whole group. Similar results were obtained in elderly and overweight/obese patients. CONCLUSIONS Suboptimal sling location appears to result from incorrect surgical technique, and should be diagnosed and treated early after the primary surgery. Sling location does not change after mid-term follow up.
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Affiliation(s)
- Wojciech Majkusiak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Pomian
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Tomasik
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Edyta Horosz
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Zwierzchowska
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Kociszewski
- Department of Gynecology and Obstetrics, Luteran Hospital, Hagen-Haspe, Germany
| | - Ewa Barcz
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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Rautenberg O, Zivanovic I, Kociszewski J, Kuszka A, Münst J, Eisele L, Viereck N, Walser C, Gamper M, Viereck V. Current Treatment Concepts for Stress Urinary Incontinence. PRAXIS 2017; 106:829e-836e. [PMID: 29143573 DOI: 10.1024/1661-8157/a002843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Initially, stress urinary incontinence should be treated by conservative measures, such as weight reduction, hormonal substitution, physiotherapy, pelvic floor exercise and/or the use of pessaries. Incontinence surgeries are only recommended in case of unsuccessful conservative therapy. Today, tension-free suburethral sling insertions represent the gold standard of incontinence surgery yielding very good outcomes (cure rates of 80–90 %). Pelvic-floor sonography provides important information on decision of surgical methods and the management of complications. Furthermore, intra- or paraurethral injection of bulking agents is a promising, minimally invasive surgical alternative. This article discusses treatment concepts, pre-, intra- and post-operative examinations, decision on surgical methods, operational details for surgical success, and the prevention and management of complications.
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Affiliation(s)
- Oliver Rautenberg
- 1 Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, 8501 Frauenfeld, Switzerland
| | - Irena Zivanovic
- 1 Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, 8501 Frauenfeld, Switzerland
| | - Jacek Kociszewski
- 2 Department of Gynecology and Obstetrics, Lutheran Hospital Hagen-Haspe, 58135 Hagen, Germany
| | - Andrzej Kuszka
- 2 Department of Gynecology and Obstetrics, Lutheran Hospital Hagen-Haspe, 58135 Hagen, Germany
| | - Julia Münst
- 1 Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, 8501 Frauenfeld, Switzerland
| | - Lilly Eisele
- 1 Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, 8501 Frauenfeld, Switzerland
| | - Nicole Viereck
- 1 Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, 8501 Frauenfeld, Switzerland
| | - Claudia Walser
- 1 Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, 8501 Frauenfeld, Switzerland
| | - Marianne Gamper
- 1 Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, 8501 Frauenfeld, Switzerland
| | - Volker Viereck
- 1 Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, 8501 Frauenfeld, Switzerland
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Bergström BS. The integral theory of female stress urinary incontinence is not scientifically sound. Neurourol Urodyn 2017; 37:1184-1187. [PMID: 29130525 DOI: 10.1002/nau.23426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Bo S Bergström
- Department of Obstetrics and Gynecology, Nordfjord Hospital, Nordfjordeid, Norway.,Chief of Department of Obstetrics and Gynecology, Mora Hospital, Lasarettsvägen, Mora, Sweden
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Rautenberg O, Zivanovic I, Kociszewski J, Kuszka A, Münst J, Eisele L, Viereck N, Walser C, Gamper M, Viereck V. [Not Available]. PRAXIS 2017; 106:829-836. [PMID: 28745112 DOI: 10.1024/1661-8157/a002743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Zusammenfassung: Eine Belastungsinkontinenz sollte immer zuerst konservativ behandelt werden. Schon eine Gewichtsreduktion, Hormonpräparate, Physiotherapie, Beckenbodentraining und/oder die Anwendung von Pessaren können zum Erfolg führen. Nach Ausschöpfen dieser Therapien werden heute Inkontinenzoperationen mit meist sehr guten Heilungschancen (ca. 80–90 %) angeboten. Der operative Goldstandard ist die suburethrale Schlingeneinlage. Die Pelvic-Floor-Sonografie liefert dazu sehr wichtige Hinweise zur Wahl der Operationstechnik und zur Behebung von Komplikationen. Ferner bildet die intra- oder paraurethrale Injektion von Bulking Agents eine vielversprechende, wenig invasive operative Alternative. In diesem Artikel werden Behandlungskonzepte, prä-, intra- und postoperative Untersuchungen, Wahl der Operationsmethode, operationstechnische Details für den Operationserfolg sowie Vorbeugung und Behandlung von Komplikationen diskutiert.
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Affiliation(s)
- Oliver Rautenberg
- 1 Blasen- und Beckenbodenzentrum, Frauenklinik, Kantonsspital Frauenfeld
| | - Irena Zivanovic
- 1 Blasen- und Beckenbodenzentrum, Frauenklinik, Kantonsspital Frauenfeld
| | - Jacek Kociszewski
- 2 Abteilung für Gynäkologie und Geburtshilfe, Evangelisches Krankenhaus Hagen-Haspe, Hagen, Deutschland
| | - Andrzej Kuszka
- 2 Abteilung für Gynäkologie und Geburtshilfe, Evangelisches Krankenhaus Hagen-Haspe, Hagen, Deutschland
| | - Julia Münst
- 1 Blasen- und Beckenbodenzentrum, Frauenklinik, Kantonsspital Frauenfeld
| | - Lilly Eisele
- 1 Blasen- und Beckenbodenzentrum, Frauenklinik, Kantonsspital Frauenfeld
| | - Nicole Viereck
- 1 Blasen- und Beckenbodenzentrum, Frauenklinik, Kantonsspital Frauenfeld
| | - Claudia Walser
- 1 Blasen- und Beckenbodenzentrum, Frauenklinik, Kantonsspital Frauenfeld
| | - Marianne Gamper
- 1 Blasen- und Beckenbodenzentrum, Frauenklinik, Kantonsspital Frauenfeld
| | - Volker Viereck
- 1 Blasen- und Beckenbodenzentrum, Frauenklinik, Kantonsspital Frauenfeld
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Dresler MM, Kociszewski J, Wlaźlak E, Pędraszewski P, Trzeciak A, Surkont G. Repeatability and reproducibility of measurements of the suburethral tape location obtained in pelvic floor ultrasound performed with a transvaginal probe. J Ultrason 2017; 17:101-105. [PMID: 28856017 PMCID: PMC5516079 DOI: 10.15557/jou.2017.0014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/08/2017] [Accepted: 02/12/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Implants used to treat patients with urogynecological conditions are well visible in US examination. The position of the suburethral tape (sling) is determined in relation to the urethra or the pubic symphysis. Aim of the study The study was aimed at assessing the accuracy of measurements determining suburethral tape location obtained in pelvic US examination performed with a transvaginal probe. Material and methods The analysis covered the results of sonographic measurements obtained according to a standardized technique in women referred for urogynecological diagnostics. Data from a total of 68 patients were used to analyse the repeatability and reproducibility of results obtained on the same day. Results The intraclass correlation coefficient for the repeatability and reproducibility of the sonographic measurements of suburethral tape location obtained with a transvaginal probe ranged from 0.6665 to 0.9911. The analysis of the measurements confirmed their consistency to be excellent or good. Conclusions Excellent and good repeatability and reproducibility of the measurements of the suburethral tape location obtained in a pelvic ultrasound performed with a transvaginal probe confirm the test’s validity and usefulness for clinical and academic purposes.
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Affiliation(s)
- Maria Magdalena Dresler
- Ultrasound Diagnostics Laboratory, Division of Operative Gynecology and Gynecologic Oncology, Gynecology and Obstetrics Department, Medical University of Łódź, Poland
| | - Jacek Kociszewski
- Frauenklinik, Evangelisches Krankenhaus Hagen-HaspeGmbH, Hagen, Germany
| | - Edyta Wlaźlak
- Ultrasound Diagnostics Laboratory, Division of Operative Gynecology and Gynecologic Oncology, Gynecology and Obstetrics Department, Medical University of Łódź, Poland
| | - Piotr Pędraszewski
- Gynecology and Obstetrics Unit, Voivodeship Hospital Complex, Płock, Poland
| | | | - Grzegorz Surkont
- Ultrasound Diagnostics Laboratory, Division of Operative Gynecology and Gynecologic Oncology, Gynecology and Obstetrics Department, Medical University of Łódź, Poland
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Wlaźlak E, Viereck V, Kociszewski J, Kuszka A, Rautenberg O, Walser C, Surkont G, Gamper M, Fehr MK. Role of intrinsic sphincter deficiency with and without urethral hypomobility on the outcome of tape insertion. Neurourol Urodyn 2017; 36:1910-1916. [PMID: 28139863 DOI: 10.1002/nau.23211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/25/2016] [Accepted: 12/10/2016] [Indexed: 11/10/2022]
Abstract
AIMS Intrinsic sphincter deficiency (ISD) is a known risk factor for therapy failure after tension-free vaginal tape (TVT) insertion. The purpose of this study was to investigate if the severity of ISD alone or other factors such as urethral mobility and tape localization influence outcomes. METHODS One hundred and nine women with urodynamically determined ISD, a TVT insertion, and a 6-month follow-up visit were included. Urethral length, mobility, and tape localization were evaluated by pelvic floor sonography. Patients were classified into three urethral mobility groups (hypomobile, normomobile, hypermobile). Surgical outcome was assessed by a combination of objective and subjective criteria. RESULTS Therapeutic success rate after TVT insertion was 81.6%. The severity of ISD did not associate with therapy failure. But urethral mobility (P < 0.0001), relative tape position (P = 0.0003), and tape-urethra distance (P < 0.0001) differed between cured and not cured patient groups. Patients with a relative tape position toward 1/2 of urethral length had a higher cure rate. Significantly different cure rates (P = 0.0003) were found for hypomobile (67%), normomobile (76%), and hypermobile (100%) urethras. For ISD patients with a hypomobile urethra, highest cure rates were obtained for tape-urethra distances between 2.5 and 3.5 mm. CONCLUSIONS The reduced cure rate for ISD patients was due to the subgroup with a hypomobile urethra. A prospective study is needed to confirm that slightly shorter tape-urethra distances and a relative tape position more toward the mid-urethra will lead to better outcomes for this patient group.
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Affiliation(s)
- Edyta Wlaźlak
- Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland
| | - Volker Viereck
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Jacek Kociszewski
- Department of Gynecology and Obstetrics, Lutheran Hospital Hagen-Haspe, Hagen, Germany
| | - Andrzej Kuszka
- Department of Gynecology and Obstetrics, Lutheran Hospital Hagen-Haspe, Hagen, Germany
| | - Oliver Rautenberg
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Claudia Walser
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Grzegorz Surkont
- Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland
| | - Marianne Gamper
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Mathias K Fehr
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
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12
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Ultrasound imaging in urogynecology - state of the art 2016. MENOPAUSE REVIEW 2016; 15:123-132. [PMID: 27980522 PMCID: PMC5137478 DOI: 10.5114/pm.2016.63060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 09/29/2016] [Indexed: 01/03/2023]
Abstract
The role of ultrasound imaging in urogynecology is not clearly defined. Despite significant developments in visualization techniques and interpretation of images, pelvic ultrasound is still more a tool for research than for clinical practice. Structures of the lower genitourinary tract and pelvic floor can be visualized from different approaches: transperineal, introital, transvaginal, abdominal or endoanal. According to contemporary guidelines and recommendations, the role of ultrasound in urogynecology is limited to the measurement of post-void residue. However, in many instances, including planning and audit of surgical procedures, management of recurrences or complications, ultrasound may be proposed as the initial examination of choice. Ultrasound may be used for assessment of bladder neck mobility before anti-incontinence procedures. On rare occasions it is helpful in recognition of pathologies mimicking vaginal prolapse such as vaginal cyst, urethral diverticula or rectal intussusception. In patients subjected to suburethral slings, causes of surgery failure or postsurgical voiding dysfunctions can be revealed by imaging. Many reports link the location of a tape close to the bladder neck to unfavorable outcomes of sling surgery. Some postoperative complications, such as urinary retention, mesh malposition, hematoma, or urinary tract injury, can be diagnosed by ultrasound. On the other hand, the clinical value of some applications of ultrasound in urogynecology, for example measurement of the bladder wall thickness as a marker of detrusor overactivity, has not been proved.
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Tomographic Ultrasound Imaging to Control the Placement of Tension-Free Transobturator Tape in Female Urinary Stress Incontinence. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6495858. [PMID: 27610378 PMCID: PMC5004038 DOI: 10.1155/2016/6495858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 07/12/2016] [Indexed: 11/17/2022]
Abstract
Purpose. The objective was to evaluate, by means of tomographic ultrasound imaging (TUI), the reliability of a novel approach for determining the position of the implanted tension-free transobturator tape (TOT). Furthermore, we analyzed the association between the position of the tape at rest and the subjective cure in stress incontinent women. Methods. This retrospective pilot study consists of 32 stress incontinent women, who underwent TOT procedure and routine sonographic control at day 1 postoperatively and at follow-up visit. TUI was applied on the resulting 4D volumes, thereby delivering 9 axial slices with a 4 mm interslice distance starting at the meatus urethrae internus in caudal direction. The reliability of the approach was tested by two examiners. Postoperative and follow-up ultrasound parameters of uncured and cured patients were analyzed. Results. Measurements of the position of the TOT demonstrated high intraclass correlation coefficients. We found minor differences between sonographic parameters at day 1 postoperatively and at follow-up after a median period of 321 days. In cured patients, the position of the tape was measured in a more caudal position than in uncured patients. Conclusions. TUI can be a reliable method for determining the position of the tape. Further studies are needed to evaluate whether the postoperatively determined position can be used as an indicator of future subjective cure.
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Zivanovic I, Rautenberg O, Lobodasch K, von Bünau G, Walser C, Viereck V. Urethral bulking for recurrent stress urinary incontinence after midurethral sling failure. Neurourol Urodyn 2016; 36:722-726. [DOI: 10.1002/nau.23007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/09/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Irena Zivanovic
- Department of Gynecology and Obstetrics; Cantonal Hospital; Frauenfeld Switzerland
| | - Oliver Rautenberg
- Department of Gynecology and Obstetrics; Cantonal Hospital; Frauenfeld Switzerland
| | - Kurt Lobodasch
- Department of Gynecology; German Red Cross Hospital Chemnitz-Rabenstein; Chemnitz Germany
| | | | - Claudia Walser
- Department of Gynecology and Obstetrics; Cantonal Hospital; Frauenfeld Switzerland
| | - Volker Viereck
- Department of Gynecology and Obstetrics; Cantonal Hospital; Frauenfeld Switzerland
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