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Serati M, Giammò A, Carone R, Ammirati E, Gubbiotti M, Ruffolo A, Salvatore S, Scancarello C, Castronovo F, Caccia G, Braga A. Bulking agents for the treatment of recurrent stress urinary incontinence: a suitable option? Minerva Urol Nephrol 2022; 74:747-754. [PMID: 33949184 DOI: 10.23736/s2724-6051.21.04269-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The management of recurrent female stress urinary incontinence (SUI) still needs worldwide standardization. Few data on the role of urethral bulking agents (UBA) for the treatment of recurrent stress urinary incontinence exist. The aim of this study is to assess the efficacy and safety of urethral bulking agents for the treatment of recurrent SUI. METHODS A multicenter, prospective study was conducted in four tertiary referral centers in two countries. All consecutive women with urodynamically-proven recurrent SUI, and with a history of previous failed anti-incontinence surgical procedure (mid-urethral sling or single incision sling), treated by UBAs were included. We evaluated only patients who completed at least a 3-year follow-up. Data regarding subjective outcomes (International Consultation on Incontinence Questionnaire-Short Form, Patient Global Impression of Improvement, Urogenital Distress Inventory score and patient satisfaction score), objective cure (stress test) rates, and adverse events were collected during follow-up. Univariable and multivariable analyses was performed to investigate outcomes. RESULTS Forty-seven consecutive patients were enrolled. At 3-year follow-up, all women were available for the evaluation. At 3 years after surgery, 38 of 47 patients (81%) declared themselves cured. Similarly, at 3-year evaluation, 39 of 47 patients (83%) were objectively cured. Only five patients (10.6%) required re-operation for UBA failure. The urodynamic diagnosis of preoperative detrusor overactivity and the PDet Max filling phase ≥15 cmH<inf>2</inf>O (hazard ratio: 2.74; 95% CI, 1.64-10.7; P=0.009 and 1.62; 95% CI, 1.11-3.42; P=0.04, respectively) were the only predictors of failure. Only four complications were reported (8.5%). CONCLUSIONS The 3-year results of this study showed that bulking agents is an appropriately effective and safe option for the treatment of recurrent SUI. The presence of preoperative concomitant detrusor overactivity is associated with a significant decrease of the efficacy of this procedure.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy.,European Urogynecological Association (EUGA), Piacenza, Italy
| | - Alessandro Giammò
- Department of Neuro-Urology, Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Roberto Carone
- Department of Neuro-Urology, Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Enrico Ammirati
- Department of Neuro-Urology, Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Marilena Gubbiotti
- Department of Urology, San Donato Hospital, Arezzo, Italy.,InVita Research Center, Serafico Institute, Assisi, Perugia, Italy
| | - Alessandro Ruffolo
- Department of Obstetrics and Gynecology, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Fabiana Castronovo
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland - .,Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
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Braga A, Caccia G, Papadia A, Castronovo F, Salvatore S, Scancarello C, Torella M, Ghezzi F, Serati M. The subjective and objective very long-term outcomes of TVT in the COVID era: A 20-year follow-up. Int Urogynecol J 2022; 33:947-953. [PMID: 35230479 PMCID: PMC8886556 DOI: 10.1007/s00192-022-05094-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022]
Abstract
Introduction and hypothesis Few studies in literature have assessed the long-term durability and mesh-related complications of mid-urethral slings (MUSs). The aim of this study is to assess the efficacy and safety of retro-pubic tension-free vaginal tape (TVT) 20 years after implantation for the treatment of female stress urinary incontinence (SUI). Methods A prospective observational study was conducted in two urogynaecologic units in two countries. All the patients involved were consecutive women with urodynamically proven pure SUI treated by TVT. The patients underwent preoperative clinical and urodynamic evaluations. Subjective outcomes, objective outcomes and adverse events were recorded during the follow-up period. Results Fifty-two patients underwent a TVT surgical procedure. Twenty years after surgery, 32 out of 36 patients (88.8%) declared themselves cured (p = 0.98). Similarly, 33 out of these 36 patients (91.7%) were objectively cured (p = 0.98). No significant deterioration of subjective and objective cure rates was observed over time (p for trend 0.50 and 0.48). Fifteen of the 36 patients (41.6%) at the 20-year follow-up reported the onset of de novo overactive bladder (OAB) (p = 0.004). No significant vaginal bladder or urethral erosion or de novo dyspareunia was recorded and no patient required tape release or resection during this period. The cause of death of seven out of ten women who died in the last year of the follow-up period was coronavirus disease 19 (COVID 19). Conclusions The 20-year results of this study showed that TVT is a highly effective and safe option for the treatment of SUI. The impact of COVID 19 on the mortality rate of elderly women has drastically reduced the number of eligible patients for future evaluations in our region.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland. .,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Giorgio Caccia
- Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Andrea Papadia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Obstetrics and Gynaecology, EOC - Civico Hospital, Lugano, Switzerland
| | - Fabiana Castronovo
- Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Stefano Salvatore
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy
| | - Marco Torella
- Department of Gyanecology, Obstetric and Reproductive Science, Second University of Naples, Naples, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy
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