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Carlson K, Andrews M, Bascom A, Baverstock R, Campeau L, Dumoulin C, Labossiere J, Locke J, Nadeau G, Welk B. 2024 Canadian Urological Association guideline: Female stress urinary incontinence. Can Urol Assoc J 2024; 18:83-102. [PMID: 38648655 PMCID: PMC11034962 DOI: 10.5489/cuaj.8751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Kevin Carlson
- Southern Alberta Institute of Urology & Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Matthew Andrews
- Division of Urology, Department of Surgery, Memorial University, St. John’s, NL, Canada
| | | | - Richard Baverstock
- Southern Alberta Institute of Urology & Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | | | - Joe Labossiere
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Geneviève Nadeau
- Division of Urology, Department of Surgery, Université Laval, Quebec, QC, Canada
| | - Blayne Welk
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
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Bolovis DI, Schreibmayer M, Hitzl W, Brucker CVM. Retrospective analysis of apical prolapse correction by unilateral pectineal suspension: perioperative and short-term results. Int Urogynecol J 2023; 34:1877-1884. [PMID: 36786854 PMCID: PMC10415474 DOI: 10.1007/s00192-023-05479-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/13/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We have previously published the novel method of unilateral pectineal suspension (UPS) for apical prolapse correction. UPS provides mesh-free midline uterus suspension using a single non-absorbable suture to attach the anterior cervix to the lateral part of the iliopectineal ligament. The purpose of this retrospective cohort study was to analyze the short-term efficacy, perioperative complication rate, and overall patient acceptance of the new UPS surgical concept. METHODS Forty-seven patients with POP-Q stage 2-4 who underwent robotic UPS between January 1, 2020 and December 31, 2021 were included in the study. Patient data were taken retrospectively from the patient files. Treatment success was the primary endpoint, measured both objectively using a defined composite endpoint and subjectively according to patients' acceptance 3-6 months after surgery during a follow-up examination. Secondary outcome measures included complications and conversions, and effect of additional procedures on operative time. RESULTS Treatment success as measured by the defined composite endpoint was 93.6% for the entire cohort. No complications or conversions occurred. Mean operation time for isolated UPS was 46.5 min (n = 33 patients). UPS can be easily combined with additional surgical procedures for repair of remaining pelvic floor defects, incontinence surgery or other indications. Additional procedures performed had a significant influence on operation time (p < 0.0005, n = 14). CONCLUSIONS UPS shows highly favorable results when looking at an unselected cohort of patients in need of primary POP surgery with respect to established quality parameters of POP repair.
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Affiliation(s)
- Dimitrios Ilias Bolovis
- University Women's Hospital, Paracelsus Medical University, Nuremberg, Germany.
- Georg Simon Ohm Technical University, Nuremberg, Germany.
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria.
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria.
- Department of Obstetrics and Gynecology, Klinikum Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany.
| | - Michael Schreibmayer
- University Women's Hospital, Paracelsus Medical University, Nuremberg, Germany
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
- Barmherzige Brüder Krankenhaus, St. Veit/Glan, Austria
| | - Wolfgang Hitzl
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria
| | - Cosima Veronika Maria Brucker
- University Women's Hospital, Paracelsus Medical University, Nuremberg, Germany
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
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Warty RR, Smith V, Patabendige M, Fox D, Mol B. Clarifying the unmet clinical need during medical device innovation in women's health - A narrative review. Health Care Women Int 2023; 45:811-839. [PMID: 37000043 DOI: 10.1080/07399332.2023.2190983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/10/2023] [Indexed: 04/01/2023]
Abstract
Medical technologies are pervasive across women's health, spanning across obstetric and gynecological care. FemTech, the sector responsible for developing these technologies, is growing at 15.6% per annum. However, there are concerns of disconnects between new product development (NPD) and the care afforded to women in consequence of implementing these innovations. The most crucial stage of NPD involves understanding the clinical need. Without a clear need and clinical use case, innovators risk developing solutions which do not address the issues women and caregivers experience. Thus, the product will miss the market and experience limited uptake. Tools for performing clinical needs assessments and defining the use case are being developed. This review provides an analysis of their strengths and weaknesses to inform FemTech innovators of the available resources. We further discuss concepts for creating a unified approach to assessing unmet needs such that technologies have a higher chance of improving women's healthcare.
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Affiliation(s)
- Ritesh Rikain Warty
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Vinayak Smith
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Malitha Patabendige
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Deborah Fox
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Ben Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Kulaksiz D, Toprak T, Cubuk A, Yilmaz M, Verit A. A modified mid-urethral sling technique for stress urinary incontinence: Three-year results of a prospective randomized trial in comparison with original transobturator tape procedure. Int Urogynecol J 2022:10.1007/s00192-022-05381-5. [PMID: 36214818 DOI: 10.1007/s00192-022-05381-5] [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: 06/22/2022] [Accepted: 09/18/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) is the most common subtype of urinary incontinence, which causes many social, psychological, and economic problems. Mid-urethral sling (MUS) surgery is popular worldwide for the treatment of SUI. We aimed to define a new modified mid-urethral sling technique (mMUS) in SUI treatment and to compare it with transobturator tape (TOT) surgery in terms of safety and efficiency. METHODS A prospective, randomized study was planned with 126 women suffering from SUI. The patients were randomly divided into two groups, TOT and mMUS. In mMUS, the obturator membrane was not perforated. The objective and subjective symptoms, pain, quality-of-life measures, and side effect profiles were assessed in a 3-year follow-up. The visual analogue scale (VAS) was used for postoperative pain assessment. The International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Patient Global Impression of Improvement (PGI-I) were used for cure assessment scales. RESULTS In total, 96 patients completed 3-year follow-up (TOT, n = 49 and mMUS, n = 47). There was no statistical difference between the procedures in terms of cure rates (87.75% and 87.23%, respectively; p = 0.614). Mean VAS scores at 8 and 24 h postoperatively were significantly higher in the TOT group (p < 0.05). There was no significant difference between the groups in VAS scores after 24 h. There was no significant difference between groups in terms of pad test results, ICIQ, or PGI scores at baseline and 36 months after surgery. CONCLUSIONS We showed that the mMUS procedure was as safe and effective as TOT, with less postoperative groin pain and complications.
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Affiliation(s)
- Deniz Kulaksiz
- Trabzon Faculty of Medicine, Department of Obstetrics and Gynecology, University of Health Sciences, Trabzon, Turkey.
| | - Tuncay Toprak
- Fatih Sultan Mehmet Training and Research Hospital, Department of Urology, University of Health Sciences, Istanbul, Turkey
| | - Alkan Cubuk
- Faculty of Medicine, Department of Urology, Kırklareli University, Kirklareli, Turkey
| | - Mehmet Yilmaz
- Faculty of Medicine, Department of Urology, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Ayhan Verit
- Fatih Sultan Mehmet Training and Research Hospital, Department of Urology, University of Health Sciences, Istanbul, Turkey
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Tang B, Wang J, Chen D, Wan H, Han X, Wang Q, Zhao Z, Li M. The outcome of patients with stress urinary incontinence combined with pelvic organ prolapse treated by mid‐urethral linear suspension. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Biao Tang
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Jing Wang
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Dexin Chen
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Hong Wan
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Xu Han
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Qinjie Wang
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Zhigang Zhao
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
| | - Ming Li
- Department of Gynaecology and Obstetrics of SiChuan Provincial Maternity and Child Health Care Hospital Cheng Du China
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Karadag MA, Demir F, Sonmez G, Keske M. Multiple Endoclip Retraction Technique (MERT) in Laparoscopic Burch. JSLS 2022; 26:JSLS.2022.00034. [PMID: 36071999 PMCID: PMC9439286 DOI: 10.4293/jsls.2022.00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: The multiple endoclip retraction technique (MERT) was developed based on our experience with suturing renal parenchyma in laparoscopic partial nephrectomy. In this study we prospectively evaluated the one-year results of cases treated by transperitoneal laparoscopic Burch with the MERT. Methods: The patients were evaluated with stress test, one-hour pad test, and were requested to complete the International Continence Society Incontinence Questionnaire short form (ICIQ-SF) in the postoperative period. The follow-up periods were postoperative 3, 6, and 12 months. Results: The primary outcome of this study was surgical success, defined as being cured of stress urinary incontinence (SUI) (no symptoms), experiencing improved symptoms of SUI in ICIQ-SF and negative stress test, and less than 2g urine leakage in a one-hour pad test. No statistically significant difference was found in terms of age, number of children, and body mass index (BMI) in patients according to the results of the 12 month postoperative stress test. We found statistically significant improvements at all control months in terms of stress test and pad weight. ICIQ-SF results showed a significant decrease at three months in patients who recovered after the operation. This rate has not changed in following control months. However, there was no statistical change in ICIQ-SF values in patients who did not recover after the operation. Conclusion: MERT seems to be one of the safe and effective modifications in the management of SUI with good one year outcomes when performed by suitably trained experienced surgeons.
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Affiliation(s)
- Mert Ali Karadag
- Department of Urology, University of Health Sciences Medical Faculty of Kayseri, Kayseri City Hospital, Kayseri, Turkey
| | - Fatih Demir
- Department of Urology, University of Health Sciences Medical Faculty of Kayseri, Kayseri City Hospital, Kayseri, Turkey
| | - Gokhan Sonmez
- Department of Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Murat Keske
- Department of Urology, University of Health Sciences Medical Faculty of Kayseri, Kayseri City Hospital, Kayseri, Turkey
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Bolovis D, Brucker C. Unilateral pectineal suspension – A new surgical approach for apical correction of pelvic organ prolapse. Facts Views Vis Obgyn 2022; 14:177-181. [DOI: 10.52054/fvvo.14.2.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objectives: There are numerous vaginal and abdominal surgical approaches for the treatment of pelvic organ prolapse (POP). Even the standard techniques show great variability due to modifications depending on anatomy, available instruments and materials. Recently, the role of hysterectomy in prolapse surgery as well as the use of synthetic meshes have been questioned. Here, we present a standardised mesh-free minimally invasive pelvic floor reconstruction technique with uterus preservation.
Materials and Methods: Unilateral pectineal suspension (UPS) is carried out in five defined steps with the use of the da Vinci Xi ® surgical system. The desired anatomical result is simulated by intraoperative uterus manipulation. The cranial part of the pectineal ligament is used for lateral fixation. A non-absorbable suture is placed between the pectineal ligament and the anterior cervix to suspend the uterus in its natural anatomical position.
Main outcome measures: For outcome measurement, degree of prolapse was assessed pre- and postoperatively according to the POP-Q system.
Results: Unilateral pectineal suspension offers several advantages. Medial tension-free positioning of the uterus is achieved. The use of the cervix as fixation structure allows for excellent pelvic floor support and stable results. Normal pelvic floor mobility and natural axis of the vagina are restored.
Conclusions: Unilateral pectineal suspension is an efficient minimal-invasive mesh-free procedure which allows uterus preservation and offers reliable level I support respecting the physiological pelvic anatomy. In addition, there is no need for ureteral dissection or bowel manipulation. The technique offers clinical standardization and can easily be integrated into the spectrum of modern surgical POP repair.
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Marquini GV, Bella ZIKDJD, Sartori MGF. Burch Procedure: A Historical Perspective. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:511-518. [PMID: 35181882 PMCID: PMC9948263 DOI: 10.1055/s-0042-1744312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The Burch procedure (1961) was considered the gold standard treatment for stress urinary incontinence (SUI) before the midurethral slings (MUSs) were introduced, in 2001. OBJECTIVE This historical perspective of the Burch's timeline can encourage urogynecological surgeons to master the Burch technique as one of the options for surgical treatment of SUI. SEARCH STRATEGY AND SELECTION CRITERIA A bibliographic search was performed in the PubMed and National Library of Medicine (NIH) databases with the terms Burch colposuspension AND history AND stress urinary incontinence in the last 20 years. The original article by Burch (1961) was included. The references were read by three authors. The exclusion criterion was studies in non-English languages. Biomedical Library Special Collections were included as historical relevant search. DATA COLLECTION, ANALYSIS AND MAIN RESULTS Some modifications of the technique have been made since the Burch procedure was first described. The interest in this technique has been increasing due to the negative publicity associated with vaginal synthetic mesh products. Twenty-nine relevant articles were included in the present review article, and numerous trials have compared Burch colposuspension with MUS. CONCLUSION This historical perspective enables the scientific community to review a standardized technique for SUI. Burch colposuspension should be considered an appropriate surgical treatment for women with SUI, and an option in urogynecological training programs worldwide.
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Ding DC, Li PC. Stem-cell therapy in stress urinary incontinence: A review. Tzu Chi Med J 2022. [DOI: 10.4103/tcmj.tcmj_145_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Patel M, Khullar V. Urogynaecology and Ehlers-Danlos syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2021; 187:579-585. [PMID: 34799982 DOI: 10.1002/ajmg.c.31959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 12/11/2022]
Abstract
Ehlers-Danlos syndrome (EDS) can lead to a presentation to urogynaecology services with multiple symptoms including vaginal prolapse, overactive bladder symptoms, voiding dysfunction, bladder pain syndrome, recurrent urinary tracts infections, stress urinary incontinence, recurring bladder diverticula, vesicoureteral reflux, pelvic floor pain or spasms, and complicated postnatal perineal wounds. This article explores the pathophysiology of these conditions in causing urinary urgency, incontinence, and infections; highlighting the key investigations and management considerations for women with EDS including conservative, pharmacological, and surgical.
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Affiliation(s)
- Mittal Patel
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, Paddington, London, UK
| | - Vik Khullar
- Department of Urogynaecology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, Paddington, London, UK
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Caldwell L, White AB. Stress Urinary Incontinence: Slings, Single-Incision Slings, and Nonmesh Approaches. Obstet Gynecol Clin North Am 2021; 48:449-466. [PMID: 34416931 DOI: 10.1016/j.ogc.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Synthetic midurethral slings offer optimal cure rates for the minimally invasive treatment of stress urinary incontinence in women. Performed via a retropubic or transobturator technique, midurethral sling approaches demonstrate comparable efficacy, with unique adverse event profiles. Single incision slings were introduced to minimize the complication of groin pain with full-length transobturator slings and enhance operative recovery. The earliest therapies for stress urinary incontinence including urethral bulking, retropubic colposuspension, and autologous sling offer alternative methods of surgical management without using synthetic mesh. These methods boast satisfactory efficacy with low rates of complications, and may be ideal for appropriately selected patients.
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Affiliation(s)
- Lauren Caldwell
- Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, University of Texas at Austin, Dell Medical School, 1301 West 38th Street, Suite 705, Austin, TX 78705, USA
| | - Amanda B White
- Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, University of Texas at Austin, Dell Medical School, 1301 West 38th Street, Suite 705, Austin, TX 78705, USA.
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Karmakar D, Dwyer PL, Murray C, Schierlitz L, Dykes N, Zilberlicht A. Long-term effectiveness and safety of open Burch colposuspension vs retropubic midurethral sling for stress urinary incontinence-results from a large comparative study. Am J Obstet Gynecol 2021; 224:593.e1-593.e8. [PMID: 33316277 DOI: 10.1016/j.ajog.2020.11.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/12/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND There are few adequately powered long-term trials comparing midurethral sling and Burch colposuspension. Recent concerns about synthetic mesh with new stringent clinical and research governance support the need for evidence to facilitate shared decision making. OBJECTIVE This study aimed to compare long-term outcomes of open Burch colposuspension with the retropubic midurethral sling. STUDY DESIGN A matched cohort study of 1344 women with urodynamic stress incontinence (without intrinsic sphincter deficiency) who underwent surgery for stress urinary incontinence. Women had either open Burch colposuspension or the retropubic midurethral sling, from January 2000 to June 2018, in a tertiary center. Follow-up was by chart review and one-time phone follow-up until 2019, using a dedicated database. Primary outcomes were the presence or absence of stress urinary incontinence on follow-up, the success of index surgery based on response to validated questionnaires of patient-reported outcomes, and retreatment rates. Secondary outcomes are described below. Matching (1:3) was done at baseline to avoid confounding. RESULTS The study included 1344 women who had either Burch colposuspension (336) or retropubic midurethral sling (1008). Mean follow-up was 13.1 years for Burch colposuspension and 10.1 years for retropubic midurethral sling. In the Burch colposuspension group, 83.0% of patients (279 of 336) reported no ongoing stress urinary incontinence at the time of the latest follow-up vs 85.0% (857 of 1008) in the retropubic midurethral sling group (P=.38). Success in terms of the latest reported International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (defined as International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score of ≤6) where these data were available were similar within both groups: 76.0% (158 of 208 where this was available) in Burch colposuspension vs 72.1% (437 of 606 where this was available) in retropubic midurethral sling (P=.32). Where this information was available, success defined by a Patient Global Impression of Improvement of "very much improved" and "much improved" was similar between Burch colposuspension and retropubic midurethral sling groups (84.1% [243 of 289] vs 82.0% [651 of 794]; P=.88). Where data were available, 88.1% of women (178 of 202) in the Burch colposuspension group said they were very likely to recommend the surgery to family or a friend vs 85.0% (580 of 682) in retropubic midurethral sling (P=.30).Overall, 3.6% needed repeat incontinence procedures (13 in Burch colposuspension group [3.8%] vs 35 in retropubic midurethral sling group [3.5%]; P=.73). The incidence of mesh exposure was 1.0 %. Notably, 1 Burch colposuspension patient had a suture in the bladder during follow-up; 5 patients have reported long-standing pain across the study population. Overall, 51 women reported new-onset overactive bladder symptoms on follow-up: 10 of 336 (3.0%) had Burch colposuspension and 41 of 1008 (4.1%) had retropubic midurethral sling (P=.41). The need for future prolapse surgery per index procedure was 3.3% after Burch colposuspension vs 1.1% postretropubic midurethral sling (P=.01). Moreover, 9 of the 11 patients who needed a prolapse repair after Burch colposuspension required a posterior repair. The incidence of long-term severe voiding difficulty needing self-catheterization was similar in both groups (0.3% in Burch colposuspension and 0.5 % in retropubic midurethral sling group; P=1.00). CONCLUSION This study shows no difference in success, patient satisfaction, or complications between Burch colposuspension and retropubic midurethral sling, although the risk of posterior compartment prolapse operations after Burch colposuspension is increased. Reoperation rates for incontinence were similar in both groups. Chronic pain was a rare outcome.
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Affiliation(s)
- Debjyoti Karmakar
- Department of Urogynaecology, Mercy Health, Melbourne, Victoria, Australia.
| | - Peter L Dwyer
- Department of Urogynaecology, Mercy Health, Melbourne, Victoria, Australia
| | - Christine Murray
- Department of Urogynaecology, Mercy Health, Melbourne, Victoria, Australia
| | - Lore Schierlitz
- Department of Urogynaecology, Mercy Health, Melbourne, Victoria, Australia
| | - Nicola Dykes
- Department of Urogynaecology, Mercy Health, Melbourne, Victoria, Australia
| | - Ariel Zilberlicht
- Department of Urogynaecology, Mercy Health, Melbourne, Victoria, Australia
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Kaufmann A. [Therapeutic options in female stress urinary incontinence]. Aktuelle Urol 2021; 52:245-254. [PMID: 33873214 DOI: 10.1055/a-1439-9628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Stress urinary incontinence in female patients is characterised by loss of urine without the need to urinate. Causes are manifold and require a good knowledge of the pelvic floor structures and the functionality of the bladder's occlusion system. Before any treatment can be initiated, differentiated diagnostic investigation must uncover the causes in order to be able to show incontinent women the ideal therapeutic options. In addition to conservative treatment strategies, there are several surgical alternatives available that can be used depending on the functional and/or anatomical deficit. Surgical correction produces good results, although a minor rate of possible complications must be accepted.
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Affiliation(s)
- Albert Kaufmann
- Kliniken Maria Hilf GmbH, Zentrum für Kontinenz und Neuro-Urologie, Mönchengladbach
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Naumann G. Quo Vadis Urogynecology 2020 - Innovative Treatment Concepts for Urinary Incontinence and Pelvic Organ Prolapse. Geburtshilfe Frauenheilkd 2021; 81:183-190. [PMID: 33574622 PMCID: PMC7870286 DOI: 10.1055/a-1302-7803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/01/2020] [Indexed: 12/15/2022] Open
Abstract
The current treatment for urinary incontinence and pelvic organ prolapse includes a wide range of innovative options for conservative and surgical therapies. Initial treatment for pelvic floor dysfunction consists of individualized topical estrogen therapy and professional training in passive and active pelvic floor exercises with biofeedback, vibration plates, and a number of vaginal devices. The method of choice for the surgical repair of stress urinary incontinence consists of placement of a suburethral sling. A number of different methods are available for the surgical treatment of pelvic organ prolapse using either a vaginal or an abdominal/endoscopic approach and autologous tissue or alloplastic materials for reconstruction. This makes it possible to achieve optimal reconstruction both in younger women, many of them affected by postpartum trauma, and in older women later in their lives. Treatment includes assessing the patient's state of health and anesthetic risk profile. It is important to determine a realistically achievable patient preference after explaining the individualized concept and presenting the alternative surgical options.
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Affiliation(s)
- Gert Naumann
- Frauenklinik, Helios Klinikum Erfurt, Universitätsfrauenklinik, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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Kerr PS, Martinez A, Dafashy TJ, Farhan B. An underutilized technique: The robotic Burch Colposuspension. UROLOGY VIDEO JOURNAL 2020. [DOI: 10.1016/j.urolvj.2020.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Keršič M, Keršič M, Kunič T, Garzon S, Laganà AS, Barbič M, Lukanović A, Lukanović D. Single-Incision Mini-Sling for the Treatment of Female Stress Urinary Incontinence: Is it Actually Inferior to Transobturator Vaginal Tape and Tension-Free Vaginal Tape? Gynecol Minim Invasive Ther 2020; 9:123-130. [PMID: 33101912 PMCID: PMC7545044 DOI: 10.4103/gmit.gmit_78_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/04/2020] [Accepted: 03/17/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives: The aim of the study was to report the extended long-term results of the use of single-incision mini-sling (SIMS), tension-free vaginal tape (TVT), and transobturator tape (TOT) for the treatment of female stress urinary incontinence (SUI) at the Department of Gynecology and Obstetrics of the University Medical Center Ljubljana. Materials and Methods: Enrolled women were evaluated by Patient Global Impression of Severity (PGI-S), Patient Global Impression of Improvement (PGI-I), Sandvik severity scale, Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI) Short Form and data about diagnosis, procedures, complications, reoperations, postoperative results, and satisfaction with procedure were recorded. Results: In analyzed group of patients (n = 357), 116 (32%) underwent SIMS procedure, 189 (53%) TOT, and 52 (15%) TVT. The SIMS, TOT, and TVT groups did not differ significantly from each other in PGI-S, PGI-I, Sandvik severity scale, UDI-6, IIQ-7, and ICIQ-UI Short Form or in postoperative complication rate. Repeat surgery was needed in 9.5% after SIMS, in 13.2% of TOT patients and in 23.1% of TVT patients (P = 0.194). Urinary retention occurred in 9.5% of the SIMS patients, in 9.5% of the TOT patients, and in 13.5% of the TVT patients (P = 0.682). Mesh erosion/inflammation occurred in 3.4% of the SIMS patients, in 6.3% of the TOT patients, and in 3.8% of the TVT patients (P = 0.485). Conclusion: The efficacy and safety of SIMS, TOT, and TVT in the surgical treatment of SUI are comparable. The choice of the technique should be based on the relative pros and cons of techniques and the surgeon's experience.
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Affiliation(s)
- Matej Keršič
- Department of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Maruša Keršič
- Department of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Tina Kunič
- Department of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Matija Barbič
- Department of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Adolf Lukanović
- Department of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - David Lukanović
- Department of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
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Total laparoscopic multi-compartment native tissue repair of pelvic organ prolapse and stress urinary incontinence. Int Urogynecol J 2020; 32:1039-1041. [PMID: 32840657 DOI: 10.1007/s00192-020-04506-y] [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: 06/04/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
AIM OF THE VIDEO In this video we present the surgical management of a 59-year-old woman with stress urinary incontinece (SUI) and pelvic organ prolapse (POP) who had a history of rheumatoid arthritis and endometrial hyperplasia with atypia. METHODS A concomitant laparoscopic hysterectomy with bilateral oophorectomy and a multi-compartment laparoscopic native tissue repair of the POP, combined with a Burch urethropexy, was performed to restore pelvic floor defects and treat the underlying endometrial pathology. CONCLUSION Total laparoscopic multi-compartment repair of POP and/or SUI using native tissue appears to be a viable alternative to both laparoscopic procedures using synthetic meshes and vaginal native tissue repairs. Although not a routine option for the majority of patients with POP and SUI, this procedure may be offered in selected cases, where native tissue repair of the pelvic floor is preferred.
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Akdemir Y, Dincer F, Buyukuysal C, Ozmen U, Harma M, Harma MI. Comparison of outcomes of Burch colposuspension and transobturator tape and single incision needleless procedures (DynaMesh ®-SIS minor) for the surgical treatment of female stress urinary incontinence patients who underwent combined pelvic reconstructive surgery or hysterectomy. Int Urol Nephrol 2020; 52:1665-1673. [PMID: 32594287 DOI: 10.1007/s11255-020-02549-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/18/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Women with stress urinary incontinence (SUI) often require combined pelvic reconstructive surgeries because of shared risk factors of pelvic organ prolapse. The purpose of this study was to evaluate efficacies of Burch colposuspension, transobturator tape (TOT), and single-incision needleless (DynaMesh®-SIS minor) procedures in patients with SUI who also underwent combined pelvic reconstructive surgery or hysterectomy. METHODS We performed this retrospective cohort study that comprising 122 patients who either underwent Burch colposuspension (n:43), TOT (n:40), or SIS (n:39) procedures along with pelvic reconstructive surgery or hysterectomy between January 2010 and July 2018. During the clinical follow-up, we analyzed cure rates, and surgical success rates of SUI surgery, quality of life, and symptom severity by IIQ-7, UDI-6, SSI, SSQ-8, OAB-V8, and PGI-I scale scores. The primary outcome was surgical success, whereas secondary outcomes included complications and patient-reported outcomes in the quality of life. RESULTS We found that surgical success rates were higher in Burch group than SIS group and higher in TOT group than in SIS group (88.4% vs 61.5% and 87.5% vs 61.5%, p = 0.003). The quality of life was lower in SIS group than in Burch group. CONCLUSIONS Both Burch and TOT are effective procedures in patients with SUI who require additional pelvic surgeries. Although surgical outcomes of SIS procedure in patients with SUI who underwent concomitant pelvic surgeries in our study were not promising, further studies with SIS are needed to clarify these observations.
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Affiliation(s)
- Yesim Akdemir
- Department of Obstetrics and Gynaecology, School of Medicine, Bulent Ecevit University, Zonguldak BEÜ, Esenköy, Kozlu, 67000, Zonguldak, Turkey.
| | - Fadime Dincer
- Department of Obstetrics and Gynaecology, School of Medicine, Bulent Ecevit University, Zonguldak BEÜ, Esenköy, Kozlu, 67000, Zonguldak, Turkey
| | - Cagatay Buyukuysal
- Department of of Biostatistics, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Ulku Ozmen
- Department of Obstetrics and Gynaecology, School of Medicine, Bulent Ecevit University, Zonguldak BEÜ, Esenköy, Kozlu, 67000, Zonguldak, Turkey
| | - Muge Harma
- Department of Obstetrics and Gynaecology, School of Medicine, Bulent Ecevit University, Zonguldak BEÜ, Esenköy, Kozlu, 67000, Zonguldak, Turkey
| | - Mehmet Ibrahim Harma
- Department of Obstetrics and Gynaecology, School of Medicine, Bulent Ecevit University, Zonguldak BEÜ, Esenköy, Kozlu, 67000, Zonguldak, Turkey
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19
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Which procedure for stress urinary incontinence? Colposuspension. Curr Opin Urol 2020; 30:279-280. [PMID: 31913204 DOI: 10.1097/mou.0000000000000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Liedl B, Sutherland S, Gunnemann A, Witczak M, Wagenlehner F. Urethral closure is by a musculo-elastic mechanism, not pressure transmission. Neurourol Urodyn 2019; 38:1793-1794. [PMID: 31215068 DOI: 10.1002/nau.24064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/19/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Bernhard Liedl
- Zentrum für Rekonstruktive Urogenitalchirurgie, Urologische Klinik Planegg, Planegg, Germany
| | | | - Alfons Gunnemann
- Klinik für Urologie und Kinderurologie, Klinikum Lippe, Detmold, Germany
| | - Magdalena Witczak
- Beckenbodenzentrum Planegg, Gynäkologie, Urologische Klinik Planegg, Planegg, Germany
| | - Florian Wagenlehner
- Klinik für Urologie, Andrologie und Kinderurologie, Justus-Liebig-Universität Gießen, Gießen, Germany
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Veit-Rubin N, Dubuisson J, Ford A, Dubuisson JB, Mourad S, Digesu A. Burch colposuspension. Neurourol Urodyn 2019; 38:553-562. [PMID: 30620096 PMCID: PMC6850136 DOI: 10.1002/nau.23905] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/20/2018] [Indexed: 01/23/2023]
Abstract
Aims To evaluate the historic and pathophysiologic issues which led to the development of Burch colposuspension, to describe anatomic and technical aspects of the operation and to provide an update on current evidence. Methods We have performed a focused literature review and have searched the current available literature about historic dimension, technical descriptions, and efficacy of Burch colposuspension. Results Burch colposuspension, performed either by an open or a laparoscopic approach, is an effective surgical treatment for stress urinary incontinence. Conclusions In current recommendations, Burch colposuspension remains an option for secondary treatment. Because midurethral slings have recently become under scrutiny, it may return as a first‐line treatment procedure. Both open and laparoscopic Burch colposuspension should therefore nowadays be provided in fellowship programs worldwide.
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Affiliation(s)
- Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean Dubuisson
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Abigail Ford
- Department of Urogynaecology, St. Mary's Hospital, Imperial College London, London, Unted Kingdom
| | | | | | - Alex Digesu
- Department of Urogynaecology, St. Mary's Hospital, Imperial College London, London, Unted Kingdom
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