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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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Does the Polydimethylsiloxane Urethral Injection (Macroplastique®) Improve Sexual Function in Women, in Fertile Age, Affected by Stress Urinary Incontinence? Medicina (B Aires) 2023; 59:medicina59030580. [PMID: 36984580 PMCID: PMC10057603 DOI: 10.3390/medicina59030580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Background and Objectives: Stress urinary incontinence (SUI) negatively affects women’s quality of life, including sexual function. The aim of the current study was to evaluate the effect of polydimethylsiloxane (Macroplastique®) on sexual function in women of fertile age affected by SUI. Materials and Methods: Single-center prospective study. Sexually active women of fertile age with symptoms of pure SUI, which were urodynamically proven, were submitted to intraurethral Macroplastique® injection. At 6-months follow-up, their sexual function was evaluated with Female Sexual Function Index (FSFI), while the SUI cure rate was objectively assessed through a negative stress test and subjectively by a Patient Global Impression of Improvement (PGI-I) score < 3. The difference of coital incontinence prevalence was assessed between the baseline and the 6-month follow-up. Peri- and postoperative complications of Macroplastique® injection were recorded and classified according to the Clavien–Dindo system. Results: Twenty-one women fulfilled inclusion criteria and were submitted to Macroplastique® procedure. The concerning sexual function, desire, satisfaction, and overall FSFI score significantly improved. Since other domains were less impaired at the baseline, we could not assess significant improvement for all of them. We observed a complete regression of coital incontinence (0/21, 0%) in comparison with the baseline (5/21, 23.8%; p = 0.04). The objective SUI cure rate was 76% (16/21), while the subjective SUI cure rate was 80.9% (17/21). One woman developed de novo overactive bladder, and two women developed postoperative voiding dysfunction (self-solved in 24 h). Conclusions: The Macroplastique® urethral injection was demonstrated to be safe and effective in improving sexual function in sexually active women of fertile age affected by pure SUI, urodinamically proven at 6-months follow-up.
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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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Update on Urethral Bulking for Stress Urinary Incontinence in Women. Curr Urol Rep 2022; 23:203-209. [PMID: 35781870 DOI: 10.1007/s11934-022-01099-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Urethral bulking agents are an effective treatment for stress urinary incontinence in select females. The material and techniques used for urethral bulking are constantly evolving. With the introduction of several new agents, there is an ongoing debate over which agent is the most effective, durable, and safe. RECENT FINDINGS Current available bulking agents include Bulkamid®, Macroplastiue®, Durasphere®, Coaptite®, or Urolastic®. Each of these agents has its own biophysical properties that affect its efficacy and safety. Evidence evaluating bulking agents has increased over time but there is no definitive data that suggest superiority of one agent over another. The ideal urethral bulking agent for female stress incontinence has yet been identified. Currently available agents have acceptable short-term and medium-term efficacy with few adverse events.
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Serati M, Braga A, Salvatore S, Torella M, Di Dedda MC, Scancarello C, Cimmino C, De Rosa A, Frigerio M, Candiani M, Ruffolo AF. Up-to-Date Procedures in Female Stress Urinary Incontinence Surgery: A Concise Review on Bulking Agents Procedures. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060775. [PMID: 35744038 PMCID: PMC9227870 DOI: 10.3390/medicina58060775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
To avoid complications related to mid-urethral slings (MUS), alternative procedures to treat stress urinary incontinence (SUI), such as urethral bulking agents (UBAs) have been adopted. The aim of this review is to narratively report the efficacy and safety of UBAs for SUI treatment. For this review, research from PubMed and EMBASE was performed to evaluate relevant studies that were undertaken from January 2012 to January 2022. Nineteen prospective studies were included. Several definitions of subjective and objective success were adopted. At a follow-up of <24 months, significant improvement was widely observed, even if with a heterogeneous rate of success between 32.7−90%, and a reinjection rate of 8.3−77.3%. Compared with other procedures, MUS resulted as significantly superior to UBAs but was balanced by a higher complication rate. Acute urinary retention, urinary tract infection and de novo urgency, and other complications, such as injection site rupture, urethral erosion and particle migration have been described after UBAs. SUI after UBAs treatment resulted in improvements in all studies and can be considered a safe and effective option to treat SUI. However, homogenous and longer-term data lack, limiting general recommendations. Thus, larger RCTs evaluating long-term effects are required.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
- Correspondence: ; Tel.: +39-0332-299-309
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC—Beata Vergine Hospital, 6850 Mendrisio, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milano, Italy; (S.S.); (M.C.); (A.F.R.)
| | - Marco Torella
- Department of Obstetrics and Gynecology, Second Faculty, 80129 Naples, Italy;
| | - Maria Carmela Di Dedda
- Department of Obstetrics and Gynecology, ASST FBF-SACCO Macedonio Melloni Hospital, 20129 Milano, Italy;
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
| | - Chiara Cimmino
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
| | - Andrea De Rosa
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
| | | | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milano, Italy; (S.S.); (M.C.); (A.F.R.)
| | - Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milano, Italy; (S.S.); (M.C.); (A.F.R.)
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Xu SF, Abulikim K, Wu XY, Cheng Y, Ling Q, Rao K, Cui K, Chen Z, Du GH, Yuan XY. Morphological and histological changes in the urethra after intraurethral nonablative erbium YAG laser therapy: an experimental study in beagle dogs. Lasers Med Sci 2022; 37:3137-3146. [PMID: 35614283 PMCID: PMC9525421 DOI: 10.1007/s10103-022-03575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/14/2022] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to investigate the morphological and histological changes in the urethra in beagle dogs after intraurethral Er:YAG laser irradiation in nonablative mode to confirm the safety of this therapy. Six 2-year-old healthy female virgin beagle dogs (13 ± 1.51 kg) were used in this study. The animals were divided into 2 groups: the sham group, which received sham treatment (n = 3) involving insertion of an intraurethral cannula and laser delivery handpiece into the urethra without laser irradiation, and the experimental group (n = 3), which received intraurethral Er:YAG laser irradiation. The laser irradiation parameters were set according to clinical criteria (4 mm spot size, 1.5 J/cm2, 1.4 Hz, and 4 pulses) in nonablative mode. All animals received three sequential sessions at 4-week intervals. Urethrography and urethroscopy were performed in the 12th week and 13th week, respectively, after the first treatment. After urethroscopy, the animals were sacrificed, and urethral tissue was harvested for histological investigations. All procedures were performed under general anesthesia (40 mg/kg 3% sodium pentobarbital, i.v.). Transforming growth factor β1 (TGF-β1) and α-smooth muscle actin (α-SMA) expression levels were measured to evaluate the biochemical characteristics of the scar. Urethral stricture was not found by urethrography or urethroscopy in either group. Urethral epithelium thickness and collagen expression under the urethral mucosa were significantly increased in the experimental group compared with the sham group. However, there were no significant differences in TGF-β1 and α-SMA expression between the experimental group and sham group (p > 0.05). Urethral stricture is not found in beagle dogs after clinically relevant intraurethral nonablative mode Er:YAG laser irradiation. Proliferation of urethral collagen and the urethral mucosa may be one of the mechanisms by which urine leakage symptoms can be improved.
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Affiliation(s)
- Sheng-Fei Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, Hubei Province, 430030, People's Republic of China
| | - Kuerbanjiang Abulikim
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, Hubei Province, 430030, People's Republic of China
| | - Xiao-Yu Wu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, Hubei Province, 430030, People's Republic of China
| | - Yu Cheng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, Hubei Province, 430030, People's Republic of China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, Hubei Province, 430030, People's Republic of China
| | - Ke Rao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, Hubei Province, 430030, People's Republic of China
| | - Kai Cui
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, Hubei Province, 430030, People's Republic of China
| | - Zhong Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, Hubei Province, 430030, People's Republic of China
| | - Guang-Hui Du
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, Hubei Province, 430030, People's Republic of China
| | - Xiao-Yi Yuan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, Hubei Province, 430030, People's Republic of China.
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Autologous pubovaginal sling for recurrent stress urinary incontinence after two or more failed synthetic midurethral sling. Eur J Obstet Gynecol Reprod Biol 2022; 272:213-216. [PMID: 35381543 DOI: 10.1016/j.ejogrb.2022.03.024] [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: 11/01/2021] [Revised: 01/19/2022] [Accepted: 03/11/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine efficacy and safety of salvage autologous pubovaginal sling (PVS) placement after a two or more failed synthetic midurethral sling. METHODS Women undergoing autologous PVS placement for two or more failed synthetic MUS between 2008 and 2019 were identified. Those patients were conducted a follow-up examination. Outcomes of surgery were assessed using the cough stress test with a full bladder and symptom questionnaire, including Incontinence Visual Analogue Scale (I-VAS) and Incontinence Quality of Life (I-QOL) questionnaire. Surgical results were categorized into three classes: cured, improved, and failed. Secondary measures included patients' recommendation of autologous fascial sling (AFS). RESULTS A total of 18 eligible patients met the criteria, of whom median age at surgery was 67 (52-74) years with a median follow-up of 80 (12-144) months. Preoperatively, all patients were identified by urodynamic test with Valsalva leak point pressure (VLPP) < 60 cmH2O. All patients had concomitant part sling excision combined with urethrolysis at the salvage operation. At the follow-up examination, sixteen in eighteen (88.89%) patients were cured and improved. The postoperative total score and each individual domain in I-QOL improved significantly compared with the baseline (p < 0.001). Postoperative I-VAS was significantly lower than preoperative (1.3 ± 0.6 vs. 7.8 ± 2.2, p < 0.001). A total of 16 patients (88.89%) recommended the AFS to others. Neither perioperative blood transfusions nor other complications above Clavien level 3 were observed. CONCLUSIONS Our study indicates that autologous PVS is effective and safe in women with recurrent stress urinary incontinence after two or more failed synthetic MUS.
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Pixel-CO 2 laser for the treatment of stress urinary incontinence. Lasers Med Sci 2021; 37:1061-1067. [PMID: 34382127 PMCID: PMC8918174 DOI: 10.1007/s10103-021-03353-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/07/2021] [Indexed: 12/26/2022]
Abstract
Abstract The aim of this study was to assess the safety and efficacy of a minimally invasive pixel-CO2 laser procedure for the treatment of stress urinary incontinence (SUI). This was a prospective, open-label study with a cohort of 59 women. Patients were treated intravaginally with a fractional/pixel CO2 laser every 4–6 weeks for a total of three treatments and assessed at 3, 6, and 12 months. Evaluation tools included a Sandvik severity score based on a validated questionnaire, 1-h pad test, vaginal health index score (VHIS), validated female sexual function index (FSFI), patient’s impression of disease severity (PGI-S), global impression of improvement (PGI-I), and the short-term pelvic floor impact questionnaire (PFIQ-7) to assess improvements in quality of life. Reduction in SUI severity was noticed throughout the duration of the study, as compared to the baseline in which 2% of the patients were defined as “slight,” 73% “moderate,” and 25% “severe.” Gradual improvement of symptoms resulted in redistribution of severity score and the best outcome observed between 3 and 6 months. Sanitary pad weight declined from an average of 35.45 g per day at baseline to 12.47 g at the 3rd treatment, and increased to 23.06 g at 12 months. Vaginal acidity changes showed a similar pattern. No serious adverse events were reported. Pixel-CO2 laser is safe and effective for treating SUI. Additional maintenance treatments should be considered during the 6–12-month post-treatment period in order to maintain the beneficial effects. Brief summary Pixel-CO2 laser is a safe and effective treatment for SUI. Maintenance treatments should be considered at 6–12 months.
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Healthcare professional's choice for surgical management of stress urinary incontinence in a U.K. tertiary hospital. Eur J Obstet Gynecol Reprod Biol 2021; 263:7-14. [PMID: 34129963 DOI: 10.1016/j.ejogrb.2021.05.039] [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] [Received: 04/09/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE In July 2018, NHS England, introduced a pause on vaginal mesh, including the mid-urethral sling (MUS) for treatment of stress urinary incontinence (SUI). NICE guidelines recommend MUS as one of the surgical options for SUI. The aim of our study was to investigate healthcare professionals choices for surgical treatment of SUI, if conservative measures failed. STUDY DESIGN The urogynaecology department at our tertiary level hospital devised a questionnaire using SurveyMonkey. This was distributed via email to 1058 healthcare professionals of different medical backgrounds. The surgical options were based on the NICE guideline and its patient decision making aid. We also used surgical information from the British society of Urogynaecology (BSUG) and British association of urological surgeons (BAUS). RESULTS We received 214 responses of which 204 were complete. Twenty six percent of replies were from obstetricians and gynaecologists, 36 % had over 20 years experience and 79 % were female. Forty four percent had no previous knowledge of surgical options. Mid-urethral sling was the most popular choice based on description, success and specific complications. Urethral bulking agent was the only option that increased in popularity after describing complications. Twenty two percent would avoid surgery due to the risk of complications. CONCLUSION This is the first study evaluating healthcare professionals surgical choice for SUI. Despite negative media publicity and NHS pause on MUS, it was still the most popular choice before and after informing of specific complications. The urethral bulking agent was the only surgical treatment, which increased in popularity after considering complications.
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McVey A, Qu LG, Chan G, Perera M, Brennan J, Chung E, Gani J. What a mesh! An Australian experience using national female continence surgery trends over 20 years. World J Urol 2021; 39:3931-3938. [PMID: 33837448 DOI: 10.1007/s00345-021-03691-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/30/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To review the evolution of female continence surgical practice in Australia over the last 20 years and observe whether vaginal mesh controversies impacted these trends. MATERIALS AND METHODS From January 2000 to December 2019, medicare benefit schedule codes for female continence procedures were identified and extracted for: mesh sling, fascial sling, bulking agent, female urethral prosthesis, colposuspension, and removal of sling. Population-adjusted incidences per 100,000 persons were calculated using publicly available demographic data. Three discrete phases were defined over the study time frame for analysis: 2000-2006; 2006-2017, and 2017-2019. Interrupted time-series analyses were conducted to assess for impact on incidence at 2006 and 2017. RESULTS There were 119,832 continence procedures performed in Australia from 2000 to 2019, with the mid-urethral sling (MUS) the most common (72%). The majority of mesh (n = 63,668, 73%) and fascial sling (n = 1864, 70%) procedures were in women aged < 65 years. Rates of mesh-related procedures steeply declined after 2017 (initial change: -21 cases per 100,000; subsequent rate change: -12 per 100,000, p < 0.001). Non-mesh related/bulking agents increased from + 0.34 during 2006-2017 to + 2.1 per 100,000 after 2017 (p < 0.001). No significant change in mesh extraction was observed over 2006-2017 (+ 0.06 per 100,000, p = 0.192). There was a significant increase in mesh extraction procedures after 2017 (0.83 per 100,000, p < 0.001). CONCLUSION Worldwide, controversy surrounding vaginal mesh had a significant impact on Australian continence surgery trends. The most standout trends were observed after the 2017 Australian class-action lawsuit and Senate Inquiry.
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Affiliation(s)
- Aoife McVey
- Department of Urology, Austin Health, Melbourne, VIC, Australia
| | - Liang G Qu
- Department of Urology, Austin Health, Melbourne, VIC, Australia
| | - Garson Chan
- Department of Urology, Austin Health, Melbourne, VIC, Australia
- Division of Urology, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marlon Perera
- Department of Urology, Austin Health, Melbourne, VIC, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Janelle Brennan
- Department of Urology, Bendigo Health, Bendigo, VIC, Australia
| | - Eric Chung
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Johan Gani
- Department of Urology, Austin Health, Melbourne, VIC, Australia
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Shek KL, Dietz HP. Ultrasound imaging of slings and meshes in urogynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:526-538. [PMID: 33206433 DOI: 10.1002/uog.23545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
Imaging is used increasingly in urogynecology. One of the main applications is in the assessment of synthetic implants. Ultrasound is particularly useful for this purpose as most such implants appear highly echogenic on ultrasound but are not visible using other imaging techniques. The worldwide success of synthetic mid-urethral slings, introduced in the late 90s, led to the subsequent introduction of transvaginal mesh in 2003-2004. Widespread use of synthetic implants for both urinary incontinence and prolapse has caused a rise in implant-related complications and increasing negative publicity and litigation, with many products removed from the market. It is not surprising that there is increasing demand for the assessment and evaluation of sling and mesh implants using imaging. This review article discusses the role of translabial/transperineal ultrasound in the evaluation of synthetic implants used in the treatment of urinary incontinence and pelvic organ prolapse. The discussion focuses on those applications of the technique that are useful for surgeons dealing with patients after mesh and/or sling placement. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K L Shek
- Liverpool Hospital, Western Sydney University, Liverpool, Australia
- Nepean Clinical School, University of Sydney, Penrith, Australia
| | - H P Dietz
- Nepean Clinical School, University of Sydney, Penrith, Australia
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Perioperative Adverse Events for Stress Urinary Incontinence Surgery: A National Analysis. Female Pelvic Med Reconstr Surg 2021; 27:e187-e190. [PMID: 32427624 DOI: 10.1097/spv.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to compare perioperative morbidity of stress urinary incontinence surgery using data from a nationwide cohort. METHODS This is a retrospective cohort study of the American College of Surgeons' National Surgical Quality Improvement Program database from 2005 to 2016. Stress urinary incontinence surgery was defined using current procedural terminology (CPT) for abdominal retropubic colposuspension (CPT 51840, 51841), laparoscopic retropubic colposuspension (CPT 51990, 51992), and suburethral sling (CPT 57288). Patients were excluded if they underwent any concomitant surgery except for cystoscopy (CPT 52000). Surgical approach and perioperative morbidity were examined using suburethral sling as the referent population. Patient characteristics, operative data, and 30-day postoperative events were collected. RESULTS Overall, 19,093 women underwent a stress urinary incontinence surgery: 317 abdominal retropubic colposuspension, 357 laparoscopic retropubic colposuspension, and 18,419 suburethral sling. Patients undergoing abdominal retropubic suspension had more inpatient procedures compared with suburethral sling and laparoscopic retropubic colposuspension (65% vs 10.4% and 17.6%, P < 0.001) and longer length of stay (1.6 ± 2.9 vs 0.3 ± 2.7 and 0.3 ± 0.6, respectively, P < 0.001). Abdominal retropubic colposuspension had the longest odds ratio time compared with suburethral sling (72.0 ± 64.6 vs 38.1 ± 34.2 minutes, P < 0.001). Composite morbidity was significantly higher for abdominal retropubic colposuspension compared with suburethral sling and laparoscopic retropubic colposuspension (7.9% vs 3.4% and 2.0%, P < 0.001). After adjusting for comorbidities, composite morbidity was higher for abdominal retropubic suspension (P = 0.007) compared with suburethral sling. CONCLUSIONS Compared with suburethral sling, laparoscopic retropubic colposuspension had the lowest 30-day comorbidity and abdominal retropubic colposuspension had the highest 30-day comorbidity.
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Modified Autologous Transobturator Tape Surgery - A Prospective Comparison With Transobturator Tape Surgery. Urology 2020; 146:72-78. [DOI: 10.1016/j.urology.2020.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022]
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Savvas C, Araklitis G, Shah C, Robinson D, Cardozo L. Urethral bulking agent found in a urethral caruncle which did not respond to topical oestrogens: A case report. Case Rep Womens Health 2020; 28:e00268. [PMID: 33163369 PMCID: PMC7609486 DOI: 10.1016/j.crwh.2020.e00268] [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] [Received: 10/19/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background Urethral caruncles are lesions occurring at the urethral orifice, around the posterior lip of the urethra. They are the most common benign growth of the female urethra. They are often asymptomatic and found incidentally on clinical examination. When symptomatic they commonly present with bleeding. Treatment includes vaginal oestrogens or, failing that, surgical excision. We present an unusual finding after excision of a urethral caruncle. Case A patient with a background of stress urinary incontinence had numerous pelvic surgeries, including colposuspension, tension-free vaginal tape (TVT) and Macroplastique (a urethral bulking agent). She developed bleeding from a 3 cm urethral caruncle, which did not improve with vaginal oestrogens. She proceeded to have a surgical excision of the caruncle. Histology revealed a foreign material with surrounding foreign-body-type multinucleate giant cell reaction. The material was compatible with Macroplastique. Conclusion This case report describes an unusual and unexpected histological finding. Macroplastique is injected in the urethra, 10–15 mm from the bladder neck. We suspect the caruncle dragged the Macroplastique material out through the urethral meatus. If urethral caruncles are not adequately treated with vaginal oestrogens, surgery should be considered. Urethral caruncles are lesions occurring at the urethral orifice, around the posterior lip of the urethra They are the most common benign growths of the female urethra When symptomatic they commonly present with bleeding. Treatment includes topical oestrogens or failing that, surgical excision. The presence of a urethral bulking agent in a caruncle, which did not respond to topical oestrogen, is reported.
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Affiliation(s)
- Christopher Savvas
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, SE5 9RS, UK
| | - George Araklitis
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, SE5 9RS, UK
| | - Chirag Shah
- Department of Histopathology, King's College Hospital, SE5 9RS, UK
| | - Dudley Robinson
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, SE5 9RS, UK
| | - Linda Cardozo
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, SE5 9RS, UK
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Use of bioactive extracellular matrix fragments as a urethral bulking agent to treat stress urinary incontinence. Acta Biomater 2020; 117:156-166. [PMID: 33035698 DOI: 10.1016/j.actbio.2020.09.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 12/25/2022]
Abstract
Injection of urethral bulking agents is a low-risk, minimally invasive surgical procedure to treat stress urinary incontinence (SUI). In this study, we developed a promising injectable bulking agent comprising extracellular matrix fragments of adipose-derived stem cell sheets (ADSC ECM) and investigated its effectiveness in urethral bulking therapy. The structural integrity and proteins of ADSC sheet ECM were well retained in decellularized ADSC ECM fragments. To locate transplanted ADSC ECM fragments, they were labeled with ultrasmall super-paramagnetic iron oxide nanoparticles, which enabled in vivo monitoring after implantation in a SUI rat model for up to 4 weeks. When ADSC ECM fragments were injected into the rat urethra, they became fully integrated with the surrounding tissue within 1 week. Four weeks after transplantation, host cells had regenerated within the ADSC ECM fragment injection area. Moreover, new smooth muscle tissue had formed around the ADSC ECM fragments, as confirmed by positive staining of myosin. These results indicate that injection of ECM fragments may be a promising minimally invasive approach for treating SUI.
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Savvas C, Araklitis G, Hunter J, Robinson D, Cardozo L. An unusual late complication with tension-free vaginal tape (TVT): A case report. Case Rep Womens Health 2020; 28:e00252. [PMID: 32939345 PMCID: PMC7479271 DOI: 10.1016/j.crwh.2020.e00252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Stress urinary incontinence is a common problem affecting women's quality of life. The retropubic mid-urethral sling accounts for the majority of surgical interventions for stress incontinence. Complications of the procedure are rare. We present an unusual late complication with tension-free vaginal tape (TVT). CASE Two years after insertion of a TVT for stress incontinence, a patient noticed a foreign body intermittently exiting through her anus. Initial clinical examinations and investigations were unremarkable. Five years after insertion she represented with faecal matter in the vagina and a TVT erosion. Imaging confirmed a colo-vaginal fistula. She underwent a vaginal excision of the TVT but this did not cure her problem and she subsequently had a laparoscopic sigmoid colectomy. Thereafter she remained well and asymptomatic. CONCLUSION This case report describes an unusual late complication. It is likely that the left arm of the mesh entered the serosa of the sigmoid colon and eroded into it over time. Complications associated with TVT are rare, but when they occur they need to be recorded. Only surgeons who have experience and expertise in the procedure should perform it, such as subspecialty trained urogynaecologists.
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Affiliation(s)
- Christopher Savvas
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, London SE5 9RS, UK
| | - George Araklitis
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, London SE5 9RS, UK
| | - Jo Hunter
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, London SE5 9RS, UK
| | - Dudley Robinson
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, London SE5 9RS, UK
| | - Linda Cardozo
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, London SE5 9RS, UK
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Alcalay M, Ben Ami M, Greenshpun A, Hagay Z, Schiff E. Fractional-Pixel CO 2 Laser Treatment in Patients With Urodynamic Stress Urinary Incontinence: 1-Year Follow-Up. Lasers Surg Med 2020; 53:960-967. [PMID: 32965724 DOI: 10.1002/lsm.23329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/07/2020] [Accepted: 09/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Vaginal pixelated low power and long pulses (LPLP) CO2 laser has been suggested as an optional treatment for stress urinary incontinence (SUI) with many studies reporting short-term improvements. The objective of this study was to assess the 1-year subjective and objective efficacy of vaginal CO2 laser in women with urodynamic SUI. STUDY DESIGN/MATERIALS AND METHODS This was a prospective multicenter study. Patients with confirmed urodynamic SUI graded as mild or moderate were included. We used three sessions of fractional pixelated CO2 laser for vaginal application and followed up the patients at 6 and 12 months. We used the following measures at follow-up: 1-hour pad test (ICS protocol), questionnaires including Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ), Patient Global Impression of Improvement (PGI-I), and a 3-day urinary diary. The urodynamic assessment was repeated at 6 months. RESULTS Fifty-two patients with SUI had three laser treatments, of whom 48 completed a 6-month follow-up and 42 patients completed 12-month follow-up. No serious adverse events were recorded during the study period. A significant reduction on the 1-hour pad test was found from baseline (6.3 ± 1.6 g) to the 12-month follow-up (3.7 ± 1.4 g, P < 0.05) was found. PGI-I showed 75.0%, 61.9%, and 64.3% improvements at 3, 6, and 12 months, respectively. PFDI improved significantly and consistently from baseline until 12 months (37.2 ± 3.89 to 16.1 ± 3.7, P < 0.05). Similarly, PFIQ showed significant improvements from the first treatment up to 12 months. Urodynamic assessment at 6 months showed that 41.4% of patients had no stress incontinence. CONCLUSION The vaginal CO2 laser was found to be effective for mild-to-moderate SUI over a follow-up period of 1 year, according to a variety of objective and subjective parameters. The wide range of parameters enables optimal patient consultation and subsequent treatment. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Menachem Alcalay
- Department of Obstetrics and Gynecology, Urogynecology Unit, Pade Poria Medical Center, Tiberias, Israel, 1520800.,Azrieli School of Medicine, Bar Ilan University, Ramat Gan, Israel, 5290002.,Department of Obstetrics and Gynecology, Urogynecology Unit, Sheba Medical Center, Ramat Gan, Israel, 5262000
| | - Moshe Ben Ami
- Department of Obstetrics and Gynecology, Urogynecology Unit, Pade Poria Medical Center, Tiberias, Israel, 1520800.,Azrieli School of Medicine, Bar Ilan University, Ramat Gan, Israel, 5290002
| | - Anatoly Greenshpun
- Department of Obstetrics and Gynecology, Urogynecology Unit, Pade Poria Medical Center, Tiberias, Israel, 1520800.,Azrieli School of Medicine, Bar Ilan University, Ramat Gan, Israel, 5290002
| | - Zion Hagay
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, 761044
| | - Eyal Schiff
- Department of Obstetrics and Gynecology, Urogynecology Unit, Sheba Medical Center, Ramat Gan, Israel, 5262000.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, 6901125
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Abstract
PURPOSE OF REVIEW After the Food and Drug Administration Public Health Notification in 2011 regarding transvaginal mesh, there has been a decline in the use of mid-urethral slings (MUS). However, they are an effective treatment option for stress urinary incontinence (SUI) with minimal complications. The management of recurrent SUI after sling continues to be debated. RECENT FINDINGS Long-term follow-up after primary MUS confirms its efficacy and safety. There remains no level 1 evidence for the best next step after a failed MUS. Preferred treatment strategies include placing a repeat MUS with more recent evidence demonstrating no difference in cure rates between transobturator tape and retropubic approach. Pubovaginal slings (PVS) and urethral bulking agents are also acceptable treatment options. A newer bulking agent, polyacrylamide hydrogel, demonstrated excellent short-term success rates in patients after a failed sling. SUMMARY MUS is an effective treatment option for SUI. Patients who develop recurrent urinary incontinence are a heterogeneous population who must be evaluated for detrusor overactivity, misplaced sling, unrecognized ISD. Patients with ISD are more likely to benefit by a PVS. Other patients with demonstrated recurrent SUI will likely do well with a repeat MUS.
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Daly CME, Mathew J, Aloyscious J, Hagen S, Tyagi V, Guerrero KL. Urethral bulking agents: a retrospective review of primary versus salvage procedure outcomes. World J Urol 2020; 39:2107-2112. [PMID: 32816136 DOI: 10.1007/s00345-020-03413-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Urethral bulking agents (UBA) have traditionally been offered as salvage procedures for recurrent stress urinary incontinence (SUI). We compare the success of UBA in patients that had undergone a previous procedure for SUI (Salvage-UBA) to the SUI surgery naïve (Primary-UBA). We hypothesised a positive effect in both Primary and Salvage-UBA with potentially poorer rates of response in the salvage group. METHODS Retrospective case series of patients having their first UBA (2010-2018). Primary outcome was to assess any difference in patient reported success between groups. Patient-reported improvement was assessed on a 4-point scale: 'cured, improved, no change, worse' and treatment 'success' defined as 'cured' or 'improved'. A multivariate analysis, adjusting for plausible differences between groups, was undertaken in IBM SPSS Statistics (2016). RESULTS 135 Primary-UBA and 38 Salvage-UBA were performed. Complete follow-up was obtained for 114 patients (66%): 86 Primary and 28 Salvage. Median follow-up time: 33 months. In 2012, 47% (8/17) of all UBA were Salvage-UBA, whilst in 2018, the majority were Primary-UBA (92%, 46/50). Success was not significantly different between Salvage-UBA 75% (21/28) versus Primary-UBA 67% (58/86) (Wald χ2 = 0.687, df = 1, p = 0.407). Top-up rates were similar: 14% (n = 4/28, Salvage-UBA) versus 15% (n = 13/86, Primary-UBA) (χ2 = 0.011, df = 1, p = 0.914). CONCLUSION The number of women opting for UBA has increased substantially. No significant differences were noted for success with Salvage-UBA compared to Primary-UBA.
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Affiliation(s)
- Ciara M E Daly
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland.
| | - Jini Mathew
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Judey Aloyscious
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Suzanne Hagen
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Veenu Tyagi
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Karen L Guerrero
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland
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Rodríguez D, Jaffer A, Hilmy M, Zimmern P. Bladder neck and urethral erosions after Macroplastique injections. Low Urin Tract Symptoms 2020; 13:93-97. [PMID: 32783393 DOI: 10.1111/luts.12337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/16/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
AIMS To evaluate the presentation, risk factors, diagnostic workup, management, and outcomes of Macroplastique (MPQ) erosions. METHODS We performed a retrospective chart review of women experiencing MPQ erosion at two tertiary care centers (United States and United Kingdom). Data collected included age, presenting symptoms, parity, comorbidities, hormone replacement therapy, sexual activity, and smoking status. Previous surgical history, time from MPQ injection, urine culture results, and cystoscopic and imaging findings were also reviewed. Development of stress urinary incontinence (SUI) after MPQ removal and subsequent SUI treatments were recorded. RESULTS From 2012 to 2018, 18 patients were identified with a median follow-up time of 24 months (interquartile range [IQR] 8-33). All patients presented with recurrent urinary tract infections (rUTI) and had cystoscopic evidence of MPQ erosion. The most common location of erosion was the bladder neck area (72%). Median time to presentation since MPQ injection was 14 months (IQR 11-35). The majority of patients (72%) had a previous history of anti-incontinence surgery. The overall success rate of endoscopic management defined as resolution of presenting symptoms including rUTI was 80%. The majority of patients (80%) developed recurrent SUI following MPQ resection with 33% requiring a subsequent autologous fascial sling placement. CONCLUSION MPQ erosions present predominantly with UTI, sometimes years after the original injection, and may necessitate endoscopic management with satisfactory results in most patients. Following excision of MPQ, these patients are highly likely to experience SUI recurrence and need to be appropriately counseled. Some may require additional subsequent autologous fascial sling placement for treatment of their SUI symptoms.
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Affiliation(s)
- Dayron Rodríguez
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ata Jaffer
- Department of Urology, York Teaching Hospital, York, UK
| | - Mustafa Hilmy
- Department of Urology, York Teaching Hospital, York, UK
| | - Philippe Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Rodríguez D, Carroll T, Alhalabi F, Carmel M, Zimmern PE. Outcomes of Macroplastique injections for stress urinary incontinence after suburethral sling removal. Neurourol Urodyn 2020; 39:994-1001. [DOI: 10.1002/nau.24321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/03/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Dayron Rodríguez
- Department of UrologyUniversity of Texas Southwestern Medical CenterDallas Texas
| | - Timothy Carroll
- Department of UrologyUniversity of Texas Southwestern Medical CenterDallas Texas
| | - Feras Alhalabi
- Department of UrologyUniversity of Texas Southwestern Medical CenterDallas Texas
| | - Maude Carmel
- Department of UrologyUniversity of Texas Southwestern Medical CenterDallas Texas
| | - Philippe E. Zimmern
- Department of UrologyUniversity of Texas Southwestern Medical CenterDallas Texas
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Serati M, Mancini V, Balzarro M. Urethral bulking agents for the treatment of female stress urinary incontinence. Int Urogynecol J 2020; 31:1493-1494. [PMID: 31900546 DOI: 10.1007/s00192-019-04221-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
| | - Vito Mancini
- Department of Urology and Renal Transplantation, Università di Foggia, Foggia, Italy
| | - Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Old wine into new wineskins: an update for female stress urinary incontinence. Curr Opin Obstet Gynecol 2019; 31:494-500. [PMID: 31652150 DOI: 10.1097/gco.0000000000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review minimally invasive modifications of traditional surgeries for female stress urinary incontinence (SUI) in light of increased demand. RECENT FINDINGS Prior to the synthetic mid-urethral sling (MUS), traditional procedures were used to correct SUI. Often these were retropubic colposuspension procedures for a hypermobile urethra and fascial slings for sphincter deficiency but fell out of favor because of increased morbidity compared with synthetic MUS. As controversy rages over use of mesh in female pelvic reconstructive surgery, more women desire nonmesh alternatives. Traditional approaches have been modified to enable colposuspensions and fascial slings to be performed minimally invasively without minimizing efficacy. SUMMARY Minimally invasive modifications to traditional procedures for SUI have been available for about a decade but interest has been recently reignited in the setting of patient concern over mesh.
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3-Year follow-up of tension-free vaginal tape-ABBREVO procedure for the treatment of pure urodynamic stress urinary incontinence: efficacy and adverse effects. Int Urogynecol J 2019; 31:739-744. [PMID: 31463528 DOI: 10.1007/s00192-019-04096-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The tension-free vaginal tape ABBREVO (TVT-A) is a new surgical procedure for the treatment of female stress urinary incontinence (SUI). However, data reporting medium- and long-term outcomes are lacking. The aim of the study was to assess the efficacy and safety of TVT-A in patients with at least a 3-year follow-up. METHODS All consecutive women who complained of pure SUI symptoms with urodynamically proven SUI undergoing a TVT-A procedure were prospectively enrolled. Data regarding subjective outcomes (International Consultation on Incontinence Questionnaire-Short Form, Patient Global Impression of Improvement and patient satisfaction scores), objective cure (stress test) rates and adverse events were collected during follow-up. Univariate analysis was performed to investigate outcomes. RESULTS A total of 41 women underwent TVT-A implantation. At 3-year follow-up, 40 women (97.5%) were available for the evaluation. We did not find any significant change in surgical outcomes during this time. At 3 years after surgery, 36 of 40 (90%) patients were subjectively cured (p for trend 0.18) and 37 out of 40 (92.5%) patients were objectively cured (p for trend 0.22). The univariate analysis did not find any risk factor statistically associated with the recurrence of SUI. A significant trend of de novo overactive bladder (OAB) occurrence was registered at the 3-year follow-up (p for trend = 0.03). No serious late complications or groin-thigh pain were reported. CONCLUSIONS TVT-A implantation is a highly effective option for the treatment of women with pure SUI.
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Skorupska K, Rechberger T, Bogusiewicz M, Adamiak-Godlewska A, Kwiatkowska A, Miotła P. Current trends in urogynecological surgeries in Poland. Int Urogynecol J 2019; 31:1627-1632. [PMID: 31367888 PMCID: PMC7363671 DOI: 10.1007/s00192-019-04064-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/17/2019] [Indexed: 10/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) treatment has become more common in the world's health care systems, and the demand for pelvic floor disorder rehabilitation has been projected to increase by 35% between 2010 and 2030. Restitution procedures vary, but after the US Food and Drug Administration (FDA) notifications, the global use of mesh in vaginal surgeries has significantly decreased. The aim of this study is to show trends in urogynecological surgeries in Poland. METHODS Retrospective analysis was performed of data obtained between 2009 and 2017 from the National Health Fund Information Centre website. Vaginal hysterectomies (VH), POP and urinary incontinence (UI) surgeries were considered. RESULTS In the study, 327,294 hospitalizations between 2009 and 2017 were considered: 29,821 VH, 265,147 POP and 53,328 UI procedures. Between 2009 and 2015, a rapid increase in the number of POP procedures was observed (r2 = 0.94, b = 1711, p < 0.001). The following years, however, were characterized by a marked decline in the number of POP surgeries. In addition, the number of vaginal suspensions with mesh dropped by 24.7%, posterior and anterior repair by 8.5%, and posterior repair by 7.5%, but the number of anterior repair procedures increased slightly by 1.5%. Moreover, between 2015 and 2017, the number of vaginal hysterectomies decreased by 9%. The number of UI surgeries had increased between 2011 and 2015 and then remained at a relatively stable level. A similar trend was observed for tape procedures, whereas the popularity of colposuspension has declined noticeably. CONCLUSIONS The impact of FDA notifications has been observed in Poland as a decrease in TVM surgeries.
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Affiliation(s)
- Katarzyna Skorupska
- 2nd Department of Gynecology, Medical University in Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland.
| | - Tomasz Rechberger
- 2nd Department of Gynecology, Medical University in Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Michał Bogusiewicz
- 2nd Department of Gynecology, Medical University in Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Aneta Adamiak-Godlewska
- 2nd Department of Gynecology, Medical University in Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Agnieszka Kwiatkowska
- 2nd Department of Gynecology, Medical University in Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Paweł Miotła
- 2nd Department of Gynecology, Medical University in Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
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Rectus Fascia Versus Fascia Lata for Autologous Fascial Pubovaginal Sling: A Single-Center Comparison of Perioperative and Functional Outcomes. Female Pelvic Med Reconstr Surg 2019; 26:493-497. [PMID: 31343622 DOI: 10.1097/spv.0000000000000761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare perioperative and functional outcomes of autologous fascia lata versus rectus fascia pubovaginal sling in female patients with stress urinary incontinence (SUI). METHODS The charts of all patients undergoing pubovaginal sling for SUI from 2012 to 2017 at a single center were retrospectively reviewed. Patients were divided into 2 groups: those with the sling harvested from the fascia lata (FL group) and those with the sling harvested from the rectus fascia (RF group). RESULTS Between 2012 and 2017, 105 women underwent pubovaginal slings: 21 using FL and 84 using RF. Operative time did not differ significantly between the FL and RF groups (84 vs 81.9 minutes; P=0.68). Estimated blood loss was lower in the FL group (91.7 vs 141.6 mL; P=0.04). There were more wound complications in the RF group, although this was not statistically significant (0% vs 14.3%; P=0.12). Overall complications were comparable between FL and RF groups (52.4% vs 48.9%; P=0.81), but the proportion of Clavien grade 2 or greater were higher in the RF group (4.8% vs 20.2%; P=0.11). Overall, wound complications accounted for 29.3% of postoperative complications in the RF group (12/41). Functional outcomes were comparable between FL and RF groups, with similar rates of patients without SUI symptoms after 1 month (82.4% vs 76.4%; P=0.74), 1 year (55.6% vs 63.8%; P=0.76), and at the latest follow-up (66.7% vs 65.8%; P=0.87). CONCLUSIONS When compared with rectus fascia for pubovaginal sling, fascia lata may decrease perioperative morbidity, especially wound complications, without compromising functional outcomes.
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Carter E, Cartwright R. Surgical interventions for stress urinary incontinence. BMJ 2019; 365:l2350. [PMID: 31167751 DOI: 10.1136/bmj.l2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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