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Grigoryan B, Kasyan G, Pushkar D. Autologous Slings in Female Stress Urinary Incontinence Treatment: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int Urogynecol J 2024; 35:759-773. [PMID: 38520517 DOI: 10.1007/s00192-024-05768-6] [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: 09/05/2023] [Accepted: 02/16/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study is to evaluate the efficacy and safety of autologous fascial slings (AFS) compared with other surgical methods for female stress urinary incontinence (SUI) treatment. METHODS The search was performed on studies published before September 2023 to identify articles assessing the effectiveness and safety of AFS compared with other surgical methods in female SUI. Inclusion criteria were randomized controlled trials (RCTs) and adult women with SUI. Exclusion criteria were other urinary incontinence types, combined pharmacological treatment, pregnancy, and lactation. This systematic review was conducted according to the Population, Intervention, Comparison, and Outcome framework, Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist, and was registered in the Prospective Register of Systematic Reviews. RESULTS Twenty RCTs were included in the systematic review and 10 RCTs in the meta-analysis. Comparison between AFS and synthetic midurethral slings (SMUS) did not show any statistically significant differences in the cure rate, frequency of urinary retention, or self-catheterization. SMUS showed more long-term postoperative complications (RR = 0.12, 95% CI: 0.03 to 0.50, p = 0.004), AFS had more in de novo urgency cases: (RR = 2.84, 95% CI: 1.13 to 7.10, p = 0.03). Operation time of SMUS was lower: (RR = 2.87, 95% CI: 2.56 to 3.19, p < 0.00001, I2 = 97%). SMUS showed significantly lower hospital stay duration: (RR = 1.92, 95% CI: 1.44 to 2.41, p < 0.00001). CONCLUSIONS In this systematic review and meta-analysis, autologous slings demonstrated the same efficacy in comparison with SMUS in the management of SUI in women. AFS showed lower incidence of long-term postoperative complications. SMUS demonstrated lower operation time, hospital stay and de novo urgency.
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Affiliation(s)
- Bagrat Grigoryan
- Moscow Urological Center, Botkin Hospital, 2nd Botkinsky pr-d, 5, 125284, Moscow, Russia.
- Department of Urology, Russian University of Medicine, Moscow, Russia.
| | - George Kasyan
- Moscow Urological Center, Botkin Hospital, 2nd Botkinsky pr-d, 5, 125284, Moscow, Russia
- Department of Urology, Russian University of Medicine, Moscow, Russia
- Department of Urology, Yerevan State Medical University named after M. Heratsi, Yerevan, Armenia
| | - Dmitry Pushkar
- Moscow Urological Center, Botkin Hospital, 2nd Botkinsky pr-d, 5, 125284, Moscow, Russia
- Department of Urology, Russian University of Medicine, Moscow, Russia
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Smith AR, Mansfield SA, Bradley CS, Kenton KS, Helmuth ME, Cameron AP, Kirkali Z, Emi Bretschneider C, Andreev V, Sarma A, Lane G, Collins SA, Cella D, Henry Lai H, Harte SE, Griffith JW. Relationships Between Urinary and Nonurinary Symptoms in Treatment-Seeking Women in LURN. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:123-131. [PMID: 37428882 PMCID: PMC10751379 DOI: 10.1097/spv.0000000000001388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
IMPORTANCE Physical health and psychological health represent modifiable factors in the causal pathway of lower urinary tract symptoms (LUTS). OBJECTIVES Understand the relationship between physical and psychological factors and LUTS over time. STUDY DESIGN Adult women enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network observational cohort study completed the LUTS Tool and Pelvic Floor Distress Inventory, including urinary (Urinary Distress Inventory), prolapse (Pelvic Organ Prolapse Distress Inventory), and colorectal anal (Colorectal-Anal Distress Inventory) subscales at baseline, 3 months, and 12 months. Physical functioning, depression, and sleep disturbance were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires; relationships were assessed using multivariable linear mixed models. RESULTS Of 545 women enrolled, 472 had follow-up. Median age was 57 years; 61% and 78% reported stress urinary incontinence and overactive bladder, respectively; and 81% reported obstructive symptoms. The PROMIS depression scores were positively associated with all urinary outcomes (range, 2.5- to 4.8-unit increase per 10-unit increase in depression score; P < 0.01 for all). Higher sleep disturbance scores were associated with higher urgency, obstruction, LUTS Total Severity, Urinary Distress Inventory, and Pelvic Floor Distress Inventory (1.9- to 3.4-point increase per 10-unit increase, all P < 0.02). Better physical functioning was associated with less severe urinary symptoms except stress urinary incontinence (2.3- to 5.2-point decrease per 10-unit increase, all P < 0.01). All symptoms decreased over time; however, no association was detected between baseline PROMIS scores and trajectories of LUTS over time. CONCLUSIONS Nonurologic factors demonstrated small to medium cross-sectional associations with urinary symptom domains, but no significant association was detected with changes in LUTS. Further work is needed to determine whether interventions targeting nonurologic factors reduce LUTS in women.
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Affiliation(s)
| | | | | | | | | | | | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | | | | | | | - Sarah A. Collins
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - David Cella
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - H. Henry Lai
- Washington University in St. Louis, St. Louis, MO
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI
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da Fonseca LC, Giarreta FBA, Peterson TV, Locali PKM, Baracat EC, Ferreira EAG, Haddad JM. A randomized trial comparing vaginal laser therapy and pelvic floor physical therapy for treating women with stress urinary incontinence. Neurourol Urodyn 2023; 42:1445-1454. [PMID: 37449372 DOI: 10.1002/nau.25244] [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: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Female stress urinary incontinence (SUI) is considered a major public health issue. Physical therapy is an important conservative treatment; however, it is primarily limited by poor long-term compliance. Furthermore, surgical treatment entails significant risks. Therefore, new treatment techniques must be identified. OBJECTIVE To compare the use of laser therapy and pelvic floor (PF) physical therapy for treating postmenopausal women with SUI. METHODS This pilot study enrolled 40 women with a clinical and urodynamic diagnosis of SUI who were randomized into two groups: those who received erbium-doped yttrium-aluminum-garnet (Er:YAG) laser therapy implemented over three sessions with a 1-month interval (n = 20) and those who received physical therapy with supervision twice a week for 3 months (n = 20). In total, 16 women completed the treatment in each group. The patients were assessed for PF function using the modified Oxford scale and for pelvic organ prolapse using the Pelvic Organ Prolapse Quantification System. The 1-h pad test and quality of life questionnaires, King's Health Questionnaire (KHQ), and Incontinence Quality of Life (IQOL) were also administered. Patients were re-evaluated at 1, 3, 6, and 12 months after treatment. RESULTS The mean patient age was 62.7 ± 9.1 and 57.9 ± 6.1 years, median Oxford score at baseline was 3 (2-4.5) and 4 (3-4), mean IQOL score was 79.8 ± 17 and 74.6 ± 18 for physical therapy group (PTG) and laser group (LG), respectively. For the amount of urine leak in the 1-h pad test evaluation, we found significance for the interaction of group and time points only for the Laser intragroup. The cure rate, that is, the rate of reaching an insignificant score in the pad test, at 6 and 12 months was 43.75% and 50% in PTG and 62.5% and 56.25% in the LG, respectively (p > 0.05). IQOL scores demonstrated considerable improvement in both groups (p > 0.05). Upon comparing the initial and follow-up results, the LG showed an improvement at all consultations, whereas the PTG showed improvements at 1, 3, and 6 months but not at 12 months after treatment. KHQ analysis revealed a considerable improvement in the quality of life (QOL) of patients over time, with no substantial difference between the groups. QOL comparison before and after treatment revealed that the vaginal LG improved more consistently in some domains. Only the PTG showed a significant increase in the mean Oxford score from pretreatment to 1 and 3 months after treatment (p < 0.001 and p = 0.002, respectively). However, no statistically significant difference was observed between the groups. CONCLUSION Both treatments are safe and have a positive influence on the impact of UI on patients' QOL. The laser caused a greater reduction in the urinary loss, as measured using the weight of pad test, at 6-month and 12-month after treatment without difference with PTG at the end of the follow-up.
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Affiliation(s)
- Lucília C da Fonseca
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Thais V Peterson
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Edmund C Baracat
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
| | - Elizabeth A Gonçalves Ferreira
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
- Department of Physical Therapy, Speech and Occupational Therapy, Medical School, Universidade de São Paulo, Sao Paulo, Brazil
| | - Jorge Milhem Haddad
- Gynecology Department, Medical School, Urogynecology Division of Obstetrics, Universidade de São Paulo, Sao Paulo, Brazil
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Juhl CS, Bjørk J, Glavind K. Treatment of stress urinary incontinence with polyacrylamide hydrogel in an office setting: patient perspectives. Int Urogynecol J 2022; 33:2169-2176. [DOI: 10.1007/s00192-022-05135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/08/2022] [Indexed: 10/18/2022]
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Sabadell J, Montero-Armengol A, Salicrú S, Catalán-Martínez M, Gil-Moreno A, Poza JL. Long-term outcomes of transobturator suburethral tapes for female stress urinary incontinence. Neurourol Urodyn 2021; 41:391-398. [PMID: 34783388 DOI: 10.1002/nau.24835] [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: 09/23/2021] [Revised: 10/18/2021] [Accepted: 10/29/2021] [Indexed: 11/07/2022]
Abstract
AIMS The aim is to evaluate long-term effectiveness and safety of transobturator midurethral slings (TO-MUS) for treating female stress urinary incontinence (SUI). Possible risk factors for failure and complications are also evaluated. METHODS A descriptive retrospective study was performed among women with SUI treated at a tertiary urogynecology unit between January 2004 and December 2006. Women with stress-predominant mixed urinary incontinence or with associated pelvic organ prolapse were also included. Postoperative follow-up was performed at 1, 6, and 12 months and yearly thereafter. Outcomes were classified as cured, improved or failed. RESULTS Of 896 women operated on over the study period, 565 were suitable for the analysis. Of them, 327 women completed the 5-year, 225 the 7-year, and 172 the 10-year follow-up periods. Success rates were 77.6%, 73.8%, and 73.2% at 5, 7, and 10 years, respectively. On multivariate Cox regression models age, body mass index, and previous incontinence surgery were related to failure. Complications of any type were described in 24.9% of patients, although most of them were mild. Only concomitant prolapse surgery was related to intraoperative and peroperative complications and the inside-out route to an increased odds of groin pain (odds ratio = 4.0). CONCLUSIONS This study showed that TO-MUS is an effective and safe procedure in the long-term. The expected outcomes and possible side effects profile should be discussed in detail during the counseling process before opting for a treatment option.
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Affiliation(s)
- Jordi Sabadell
- Unit of Urogynecology and Pelvic Floor, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anabel Montero-Armengol
- Unit of Urogynecology and Pelvic Floor, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sabina Salicrú
- Unit of Urogynecology and Pelvic Floor, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marina Catalán-Martínez
- Unit of Urogynecology and Pelvic Floor, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Gil-Moreno
- Unit of Urogynecology and Pelvic Floor, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose L Poza
- Unit of Urogynecology and Pelvic Floor, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
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Collins SA. Surgical Management of Stress Incontinence. Clin Obstet Gynecol 2021; 64:297-305. [PMID: 33904837 DOI: 10.1097/grf.0000000000000614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim was to describe contemporary surgical procedures for the treatment of stress urinary incontinence (SUI) in women. The 4 most commonly performed surgical procedures for the treatment of SUI were reviewed using standardized terminology. We addressed the history and evolution of the procedures as well as the mechanisms of action by which they work. Efficacy and safety data were also presented. Midurethral Sling, Pubovaginal Sling, Retropubic Colposuspension, and Urethral Bulking are safe and effective procedures. Midurethral Sling, Pubovaginal Sling, Retropubic Colposuspension, and Urethral Bulking are contemporary procedures for the treatment of SUI in women.
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Affiliation(s)
- Sarah A Collins
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Sabadell J, Pereda‐Núñez A, Ojeda‐de‐los‐Santos F, Urbaneja M, González‐García C, Camps‐Lloveras N, Pérez‐Plantado À, Canet‐Rodríguez J, Pérez‐Espejo MP, Rodríguez‐Mias N, Sarasa‐Castelló N, Palau M, Montero‐Armengol A, Salicrú S, Gil‐Moreno A, Poza JL. Polypropylene and polyvinylidene fluoride transobturator slings for the treatment of female stress urinary incontinence: 1-Year outcomes from a multicentre randomized trial. Neurourol Urodyn 2021; 40:475-482. [PMID: 33259073 PMCID: PMC7839450 DOI: 10.1002/nau.24586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/02/2020] [Accepted: 11/15/2020] [Indexed: 11/06/2022]
Abstract
AIMS To compare the effectiveness and safety of polypropylene (PP) and polyvinylidene fluoride (PVDF) transobturator tapes (TOT) for the treatment of female stress urinary incontinence (SUI). METHODS This is a multicentre randomized trial. Women with SUI or stress-predominant mixed urinary incontinence and scheduled for a TOT procedure were randomized to PP or PVDF slings. The primary outcome was 1-year cure or improvement rate using composite criteria. Complications were also compared. Relationships with outcomes were analyzed using multivariable logistic regressions models. RESULTS From April 2016 to January 2018 285 participants were randomized. PP and PVDF slings showed similar high cure or improvement rate (91.0% vs. 95.6%, p = .138). Improvement in validated questionnaires was also similar. PVDF slings were associated with a lower rate of de novo urgency incontinence (adjusted odds ratio = 0.35; 95% confidence interval = 0.15-0.80). We found no statistical differences in complications rates, although a higher incidence of long-term pain events were observed in the PP group. The study is underpowered to find differences in specific complications owing to the low number of events. CONCLUSION PP and PVDF TOTs are equally effective, although PVDF is associated with fewer cases of de novo urgency incontinence. Further studies are needed to give robust conclusions on safety profiles.
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Affiliation(s)
- Jordi Sabadell
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
- General Surgery Research Group, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Anna Pereda‐Núñez
- Pelvic Floor Unit, Department of Obstetrics and GynecologyHospital General de GranollersBarcelonaSpain
| | | | - Manuel Urbaneja
- Department of GynecologyHospital Virgen del RocíoSevillaSpain
| | | | - Narcís Camps‐Lloveras
- Functional Urology and Urodynamics Unit, Department of Urology, Hospital Universitari de BellvitgeUniversitat de BarcelonaBarcelonaSpain
| | - Àngela Pérez‐Plantado
- Department of Gynecology, Hospital de MataróConsorci Sanitari del MaresmeBarcelonaSpain
| | | | | | - Nuria Rodríguez‐Mias
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Núria Sarasa‐Castelló
- Pelvic Floor Unit, Department of Obstetrics and GynecologyHospital General de GranollersBarcelonaSpain
| | - Marta Palau
- Department of GynecologyHospital Virgen del RocíoSevillaSpain
| | - Anabel Montero‐Armengol
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Sabina Salicrú
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Antonio Gil‐Moreno
- Department of Gynecology, Hospital Universitari Vall d'HebronVall d'Hebron Barcelona Hospital CampusBarcelonaSpain
- Biomedical Research Group in Gynecology, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red (CIBERONC)Instituto de Salud Carlos IIIMadridSpain
| | - Jose L. Poza
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
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