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Ruffolo AF, Lallemant M, Garabedian C, Deseure A, Kerbage Y, Rubod C, Cosson M. The impact of pregnancy and childbirth on stress urinary incontinence in women previously submitted to mid-urethral sling: A systematic review and metanalysis. Neurourol Urodyn 2024; 43:1631-1646. [PMID: 38725418 DOI: 10.1002/nau.25485] [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: 01/28/2024] [Revised: 04/09/2024] [Accepted: 04/30/2024] [Indexed: 08/22/2024]
Abstract
INTRODUCTION There is no guideline or clinical consensus concerning the mid-urethral sling (MUS) operation for stress urinary incontinence (SUI) and future pregnancies. The aim of this systematic review and metanalysis is to evaluate the impact of pregnancy and of delivery on SUI in women who previously sustained a MUS surgery. METHODS We performed a systematic review and meta-analysis, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, and selected seven publications for inclusion in the analysis. RESULTS Recurrence of SUI after childbirth in women previously submitted to MUS was 22% (95% confidence interval [CI]: 18.0%-26.0%; I2 = 0%) while the reintervention rate for SUI the 5% (95% CI: 2.0%-8.0%; I2 = 47.34%) in the included studies. There was not statistically significant difference between women who delivered (both vaginally and by caesarian section) or not after MUS in SUI recurrence (RR 1.01, 95% CI 0.73-1.40; p = 0.96 and I2-test of 41% p = 0.18) and in SUI reintervention (RR 1.45, 95% CI 0.91-2.30; p = 0.12 and I2-test of 0% p = 0.38) with homogeneity among studies. There was no difference between women who delivered vaginally or by caesarian section both for recurrence of SUI (RR 1.24, 95%CI 0.77-2.01; p = 0.37 and I2-test of 0% p = 0.60) and reintervention (RR 1.61, 95% CI 0.76-3.42; p = 0.22 and I2-test of 0% p = 0.47). BMI ≥ 30 kg/m2, urinary incontinence (UI) before and during pregnancy emerged as risk factors for postpartum UI relapse. CONCLUSION Childbirth do not affect SUI relapse or reintervention in women previously submitted to MUS. In the same population of patients, no difference was highlighted concerning the mode of delivery for the outcome SUI relapse or reintervention. Previous MUS surgery may not be an appropriate indication for cesarean birth in subsequent pregnancy.
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Affiliation(s)
| | - Marine Lallemant
- Department of Gynecology, Jeanne de Flandre University Hospital, Lille, France
| | - Charles Garabedian
- Department of Gynecology, Jeanne de Flandre University Hospital, Lille, France
| | - Aurore Deseure
- Department of Gynecology, Jeanne de Flandre University Hospital, Lille, France
| | - Yohan Kerbage
- Department of Gynecology, Jeanne de Flandre University Hospital, Lille, France
| | - Chrystèle Rubod
- Department of Gynecology, Jeanne de Flandre University Hospital, Lille, France
| | - Michel Cosson
- Department of Gynecology, Jeanne de Flandre University Hospital, Lille, France
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Fleischmann N, Chughtai B, Plair A, Hurtado E, Jacobson N, Segal S, Panza J, Cichowski SB. Urethral Bulking. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:667-682. [PMID: 39051928 DOI: 10.1097/spv.0000000000001548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
OBJECTIVE This Clinical Practice Statement aims to provide clinicians with evidence-based guidance for the use of urethral bulking agents (UBAs) in the treatment of stress urinary incontinence (SUI). METHODS We conducted a structured search of the English literature published from January 1960 to November 2022. Search terms identified studies of both current and historic UBAs. Data extracted at the time of full-text review included type of study, research setting, number of participants, age group, bulking agent, primary outcome, secondary outcome, efficacy, and complications. RESULTS One thousand five hundred ninety-four nonduplicate articles were identified using the search criteria. After limiting the article types to randomized control led trials, prospective studies, guideline documents, reviews, meta-analyses, and case reports of complications, 395 studies were screened. CONCLUSIONS Based on our findings, we propose the following recommendations for clinicians when considering UBA: First, UBA is indicated in cases of demonstrable SUI. Intrinsic sphincter deficiency is not predictive of patient outcomes. Second, patients should be counseled on the risks, lack of long-term efficacy data, potential need for repeat injections, possible need for surgery for recurrent SUI, implications for future procedures, and pelvic imaging findings that may be observed after UBA. Third, UBA may be considered for initial management of SUI. Fourth, UBA is an option for patients with persistent or recurrent SUI after a sling procedure. Fifth, clinicians may prioritize UBA over surgery in specific patient populations. Sixth, polyacrylamide hydrogel demonstrates marginally improved safety and durability data over other available agents.
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Affiliation(s)
| | | | - Andre Plair
- Stony Brook Medicine University Hospital, Stony Brook, NY
| | | | - Nina Jacobson
- Hackensack Meridian School of Medicine/Jersey Shore University Medical Center, Neptune, NJ
| | - Saya Segal
- Weill Cornell Medical College, New York, NY
| | - Joseph Panza
- University of Rochester Medical Center, Rochester, NY
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Lau HH, Davila GW, Chen YY, Sartori MGF, Jármy-Di Bella ZIK, Tsai JM, Liu YM, Su TH. FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence. Int J Gynaecol Obstet 2023; 161:367-385. [PMID: 36786495 DOI: 10.1002/ijgo.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a global problem. It can significantly adversely impact a woman's quality of life. The use of synthetic mesh in vaginal surgery is controversial, especially when used for pelvic organ prolapse surgery. Although negative effects have been reported, the synthetic mesh midurethral sling (MUS) is considered to be safe and effective in the surgical treatment of SUI. OBJECTIVES To provide evidence-based data and recommendations for the obstetrician/gynecologist who treats women with SUI and performs or plans to perform MUS procedures. METHODS Academic searches of MEDLINE, the Cochrane Library, Embase, and Google Scholar articles published between 1987 and March 2020 were performed by a subgroup of the Urogynecology and Pelvic Floor Committee, International Federation of Gynecology and Obstetrics (FIGO). SELECTION CRITERIA The obtained scientific data were associated with a level of evidence according to the Oxford University Centre for Evidence-Based Medicine and GRADE Working Group system. In the absence of concrete scientific evidence, the recommendations were made via professional consensus. RESULTS The FIGO Urogynecology and Pelvic Floor Committee reviewed the literature and prepared this evidence-based recommendations document for the use of MUS for women with SUI. CONCLUSIONS Despite the extensive literature, there is a lack of consensus in the optimal surgical treatment of SUI. These recommendations provide a direction for surgeons to make appropriate decisions regarding management of SUI. The MUS is considered safe and effective in the treatment of SUI, based on many high-quality scientific publications and professional society recommendations. Comprehensive long-term data and systemic reviews are still needed, and these data will become increasingly important as women live longer. These recommendations will be continuously updated through future literature reviews.
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Affiliation(s)
- Hui-Hsuan Lau
- MacKay Medical College, New Taipei City, Taiwan.,Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - G Willy Davila
- Center for Urogynecology and Pelvic Health, Holy Cross Medical Group, Fort Lauderdale, Florida, USA
| | - Ying-Yu Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Marair G F Sartori
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Jung-Mei Tsai
- MacKay Medical College, New Taipei City, Taiwan.,College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan.,Department of Nursing, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Min Liu
- Department of Medical Research, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Tsung-Hsien Su
- MacKay Medical College, New Taipei City, Taiwan.,Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,Department of Nursing, MacKay Memorial Hospital, Taipei, Taiwan
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Sun B, Liu Y, Su T, Sun Y, Liu Z. Electroacupuncture for stress-related urinary incontinence in elderly women: data analysis from two randomised controlled studies. BMJ Support Palliat Care 2022; 12:e164-e170. [PMID: 31919102 PMCID: PMC9120373 DOI: 10.1136/bmjspcare-2019-002034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the efficacy of electroacupuncture (EA) in elderly and non-elderly women with stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI). METHODS This study was a secondary analysis of two randomised controlled trials involving 252 women with SUI and 132 women with stress-predominant MUI who were treated with the same EA regimen. Elderly women were defined as those aged >60 years. The main outcome measure was the proportion of patients with ≥50% decrease in the mean 72-hour urinary incontinence episode frequency (IEF) from baseline to week 6. Overall, 1004 women were recruited in the SUI and MUI trials. In the EA group, those with urge-predominant or balanced MUI at baseline were excluded from the current study, resulting in a sample size of 384. RESULTS Out of 384 patients with SUI or stress-predominant MUI who were treated with EA, 371 completed the study. After 6-week treatment, the proportion of women who achieved ≥50% decrease in mean 72-hour IEF from baseline was 57.3% (51/89) in the elderly group and 60.70% (173/285) in the non-elderly group; the between-group difference was not significant (3.11%, 95% CI -9.83% to 16.05%; p=0.637). Similar outcomes were observed at weeks 4, 16 and 28. Both groups showed reduction in the 72 -hour IEF, amount of urine leakage (assessed by 1-hour pad test) and International Consultation on Incontinence Questionnaire-Short Form score from baseline with no significant between-group difference. No obvious EA-related adverse events were observed during the study. CONCLUSION EA may be an effective and safe alternative treatment for SUI or stress-predominant MUI in both elderly and non-elderly women. Age may not affect the treatment outcomes of acupuncture. TRIAL REGISTRATION NUMER NCT01784172, NCT02047032.
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Affiliation(s)
- Biyun Sun
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - Tongsheng Su
- Shanxi Province Hospital of Traditional Chinese Medicine, Xian, Shanxi, China
| | - Yuanjie Sun
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Khalifa AO, Kavran M, Mahran A, Isali I, Woda J, Flask CA, Penn MS, Hijaz AK. Stromal derived factor-1 plasmid as a novel injection for treatment of stress urinary incontinence in a rat model. Int Urogynecol J 2019; 31:107-115. [PMID: 30666428 DOI: 10.1007/s00192-019-03867-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/02/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS SDF-1 chemokine enhances tissue regeneration through stem cell chemotaxis, neovascularization and neuronal regeneration. We hypothesized that non-viral delivery of human plasmids that express SDF-1 (pSDF-1) may represent a novel regenerative therapy for stress urinary incontinence (SUI). METHODS Seventy-six female rats underwent vaginal distention (VD). They were then divided into four groups according to treatment: pSDF-1 (n = 42), sham (n = 30), PBS (n = 1) and luciferase-tagged pSDF-1 (n = 3). Immediately after VD, the pSDF-1 group underwent immediate periurethral injection of pSDF-1, and the sham group received a vehicle injection followed by leak point pressure (LPP) measurement at the 4th, 7th and 14th days. Urogenital tissues were collected for histology. H&E and trichrome slides were analyzed for vascularity and collagen/muscle components of the sphincter. For the luciferase-tagged pSDF-1 group, bioluminescence scans (BLIs) were obtained on the 3rd, 7th and 14th days following injections. Statistical analysis was conducted using ANOVA with post hoc LSD tests. The Mann-Whitney U test was employed to make pair-wise comparisons between the treated and sham groups. We used IBM SPSS, version 22, for statistical analyses. RESULTS BLI showed high expression of luciferase-tagged pSDF-1 in the pelvic area over time. VD resulted in a decline of LPP at the 4th day in both groups. The pSDF1-treated group demonstrated accelerated recovery that was significantly higher than that of the sham-treated group at the 7th day (22.64 cmH2O versus 13.99 cmH2O, p < 0.001). Functional improvement persisted until the 14th day (30.51 cmH2O versus 24.11 cmH2O, p = 0.067). Vascularity density in the pSDF-1-treated group was higher than in the sham group at the 7th and 14th days (p < 0.05). The muscle density/sphincter area increased significantly from the 4th to 14th day only in the pSDF-1 group. CONCLUSIONS Periurethral injection of pSDF-1 after simulated childbirth accelerated the recovery of continence and regeneration of the urethral sphincter in a rat SUI model. This intervention can potentially be translated to the treatment of post-partum urinary incontinence.
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Affiliation(s)
- Ahmad O Khalifa
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.,Department of Urology, Menoufia University, Shibin El Kom, Egypt
| | - Michael Kavran
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Amr Mahran
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Ilaha Isali
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | | | - Chris A Flask
- Departments of Radiology, Case Western Reserve University, Cleveland, OH, USA.,Departments of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Departments of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Marc S Penn
- Summa Health Heart and Vascular Institute, Akron, OH, USA
| | - Adonis K Hijaz
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
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Engen M, Svenningsen R, Schiøtz HA, Kulseng-Hanssen S. Mid-urethral slings in young, middle-aged, and older women. Neurourol Urodyn 2018; 37:2578-2585. [PMID: 30178571 DOI: 10.1002/nau.23583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 03/04/2018] [Indexed: 11/10/2022]
Abstract
AIMS To compare subjective and objective outcomes of mid-urethral sling (MUS) surgery in women in different age decades and the utilization rates for MUS in Norwegian women. METHODS Data from the national Norwegian Female Incontinence Registry on 21 832 women with stress or mixed urinary incontinence who underwent MUS surgery from 1998 to 2016 were used. Primary outcomes were treatment satisfaction and absence of objective stress leakage at 6-12 months follow-up and "MUS utilization rate." Secondary outcomes were increase in urgency incontinence symptoms and surgical complications. RESULTS Women in the sixth decade and older had more objective postoperative stress urinary leakage, and women in the seventh decade and older were less satisfied. Urgency incontinence symptoms (persistent and de novo) after MUS increased with age. Intermittent catheterization occurred significantly more often in the seventh decade and bladder perforation in the seventh and eighth decades. Women younger than the fifth decade had fewer complications, except the need for tape transection in the fourth decade. The "MUS utilization rate" increased in all age groups during the study period, but declined slightly in the oldest age group after 2010. CONCLUSION All age groups had a high percentage of "very satisfied" and no objective stress leakage at 6-12 months follow-up, but declining slightly with age after the sixth decade. Urgency incontinence symptom bother increased with age, but the overall complication rates were low. Our study strengthens the argument that management of stress urinary incontinence with MUS seems suitable regardless of age.
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Affiliation(s)
- Madeleine Engen
- Department of Obstetrics and Gynecology, Baerum Hospital, Baerum, Norway
| | - Rune Svenningsen
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - Hjalmar A Schiøtz
- Department of Obstetrics and Gynecology, Vestfold Hospital Trust, Tønsberg, Norway
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Reoperations for Female Stress Urinary Incontinence: A Finnish National Register Study. Eur Urol Focus 2018; 4:754-759. [DOI: 10.1016/j.euf.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/18/2017] [Accepted: 05/17/2017] [Indexed: 01/17/2023]
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YASA C, GUNGOR UGURLUCAN F, DURAL O, YUMRU H, GUNAYDIN C, YALCIN O. Transobturator Tape Operation for the Treatment of Stress Urinary Incontinence in Postmenopausal Women Aged Over 65 Years. Low Urin Tract Symptoms 2017; 10:153-157. [DOI: 10.1111/luts.12154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/07/2016] [Accepted: 07/11/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Cenk YASA
- Department of Obstetrics and Gynecology; Istanbul University School of Medicine; Istanbul Turkey
| | - Funda GUNGOR UGURLUCAN
- Department of Obstetrics and Gynecology; Istanbul University School of Medicine; Istanbul Turkey
| | - Ozlem DURAL
- Department of Obstetrics and Gynecology; Istanbul University School of Medicine; Istanbul Turkey
| | - Harika YUMRU
- Department of Obstetrics and Gynecology; Istanbul University School of Medicine; Istanbul Turkey
| | - Cansu GUNAYDIN
- Department of Obstetrics and Gynecology; Istanbul University School of Medicine; Istanbul Turkey
| | - Onay YALCIN
- Department of Obstetrics and Gynecology; Istanbul University School of Medicine; Istanbul Turkey
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