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Jha S, Jeppson PC, Dokmeci F, Marquini GV, Sartori MGF, Moalli P, Malik SA. Management of mixed urinary incontinence: IUGA committee opinion. Int Urogynecol J 2024; 35:291-301. [PMID: 38252279 PMCID: PMC10908639 DOI: 10.1007/s00192-023-05694-z] [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: 08/18/2023] [Accepted: 11/06/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Mixed urinary incontinence (MUI) is defined by the International Urogynecology Association (IUGA) and International Continence Society as the complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing. It therefore implies the coexistence of both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). MUI is a heterogeneous diagnosis that requires an assessment of its individual components of SUI and UUI. Management requires an individualised approach to the symptom components. The aim of this review is to identify the assessment/investigations and management options for MUI. METHODS A working subcommittee from the IUGA Research & Development (R&D) Committee was created and volunteers invited from the IUGA membership. A literature review was performed to provide guidance focused on the recommended assessment and management of MUI. The document was then evaluated by the entire IUGA R&D Committee and IUGA Board of Directors and revisions made. The final document represents the IUGA R&D Committee Opinion. RESULTS The R&D Committee MUI opinion paper provides guidance on the assessment and management of women with MUI and summarises the evidence-based recommendations. CONCLUSIONS Mixed urinary incontinence is a complex problem and successful management requires alleviation of both the stress and urge components. Care should be individualised based on patient preferences. Further research is needed to guide patients in setting goals and to determine which component of MUI to treat first. The evidence for many of the surgical/procedural treatment options for MUI are limited and needs to be explored in more detail.
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Affiliation(s)
- Swati Jha
- Department of Urogynecology, Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, UK.
| | - Peter C Jeppson
- The Woman's Center for Advanced Pelvic Surgery, The University of Arizona, Phoenix, AZ, USA
| | - Fulya Dokmeci
- Department of Obstetrics & Gynecology, Ankara School of Medicine, Ankara University, Ankara, Türkiye
| | - Gisele V Marquini
- Federal University of Uberlândia (UFU), Minas Gerais, Brazil and Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Marair G F Sartori
- Urogynecology Division, Gynecology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Pamela Moalli
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shazia A Malik
- Female Pelvic Medicine & Reconstructive Surgery, Department of Ob/Gyn, University of Arizona COMPhoenix, Tucson, AZ, USA
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Serna-Gallegos T, Dutta S, Crowder C, Wadensweiler P, Whitcomb EL, Guaderrama NM. Risk Factors for De Novo Overactive Bladder After Midurethral Sling. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:59-64. [PMID: 37326287 DOI: 10.1097/spv.0000000000001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
IMPORTANCE The low incidence of de novo overactive bladder (OAB) symptoms after a midurethral sling (MUS) procedure better informs preoperative counseling. OBJECTIVE The study aimed to measure the incidence and risk factors for de novo OAB after MUS. STUDY DESIGN This was a retrospective cohort study of de novo OAB symptoms in patients who underwent MUS surgery in a health maintenance organization between January 1, 2008, and September 30, 2016. Patients were identified using Current Procedural Terminology codes for MUS and International Classification of Diseases, Tenth Revision codes for urinary urgency, frequency, nocturia, OAB, and urgency urinary incontinence (UUI). The cohort of patients was identified by the absence of these International Classification of Diseases, Tenth Revision codes 12 months preoperatively and the presence of these codes within 6 months after surgery. This cohort was used to calculate the rate of de novo OAB after MUS surgery. Clinical and demographic factors were abstracted. Statistical analysis was performed using descriptive, χ2 , simple logistic, and multiple logistic regression. RESULTS During the study period, 13,893 patients underwent MUS surgery and 6,634 met the inclusion criteria. The mean age was 56.9 years, mean parity was 2.76, and mean body mass index was 28.9 (calculated as weight in kilograms divided by height in meters squared). Of these, 410 (6.1%) developed de novo OAB within 12 months. The most common symptoms were urgency (65.4%), UUI (42.2%), and frequency (19.8%). On multivariable regression modeling, de novo urgency and UUI were not associated with concurrent surgery ( P < 0.05). Increasing age and body mass index were associated with an increased risk of nocturia ( P < 0.05). CONCLUSIONS The incidence of de novo OAB after MUS surgery was 6.1%. This aligns with current literature and critically informs preoperative counseling for MUS surgery.
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Affiliation(s)
- Tasha Serna-Gallegos
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California, Irvine, Orange
| | - Sonia Dutta
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California, Irvine, Orange
| | - Carly Crowder
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California, Irvine, Orange
| | - Paul Wadensweiler
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California, Irvine, Orange
| | - Emily L Whitcomb
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Southern California Permanente Medical Group, Irvine, CA
| | - Noelani M Guaderrama
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Southern California Permanente Medical Group, Irvine, CA
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Gonzalez G, Arora A, Choi E, Bresee C, Perley J, Anger JT. Outcomes of the Supris® Sling in an Urban Latina Population. Urology 2021; 163:3-7. [PMID: 34637838 DOI: 10.1016/j.urology.2021.07.054] [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: 03/31/2021] [Revised: 06/20/2021] [Accepted: 07/23/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To analyze patient reported outcomes, safety, and efficacy of the Supris® mid-urethral sling in a diverse population. METHODS A retrospective chart review of 101 women who underwent a mid-urethral Supris® sling procedure was conducted. Baseline characteristics and peri-operative parameters were collected. Post-operative results and patient reported outcomes were collected at an average follow-up time of 19 months using the Urogenital Distress Inventory-6 (UDI-6) and Patient Global Impression of Improvement (PGI-I) validated questionnaires. Subjective cure rates were compared using the nonparametric Wilcoxon Rank Sum Test. RESULTS The median age of women was 57 years old, and 86.1% identified as Latina. 28% and 72% of women had a SUI and MUI diagnosis, respectively. Women, on average, used two pads pre-operatively and none post-operatively. There was a 3% surgical revision rate. 80 women completed the questionnaires. 82% of the MUI group reported being very much improved or much better. The SUI group reported being 94% very much improved or much better. The UDI-6 questions related to urgency and leakage of small amounts of urine were significantly different between the MUI and SUI groups (p = 0.002 and p = 0.044). CONCLUSIONS In our primarily Latina patient population, the majority of whom had MUI, the Supris® retropubic sling greatly improved symptoms. Although reported outcomes were excellent in both groups, those with pre-operative urge incontinence were more likely to experience urge symptoms post-operatively. Despite persistent urge symptoms, patients reported improvement of their overall symptoms.
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Affiliation(s)
- Gabriela Gonzalez
- Department of Urology, University of California, Davis School of Medicine, Sacramento, CA
| | - Aman Arora
- University of California, Davis School of Medicine, Sacramento, CA
| | - Eunice Choi
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Beverly Hills, CA
| | - Catherine Bresee
- Department of Statistics, Cedars Sinai Medical Center, Los Angeles, CA
| | | | - Jennifer T Anger
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Beverly Hills, CA.
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Wu E, High R, Lewis C, Kuehl TJ, Danford JM, Yandell PM. Retropubic mid-urethral slings and de novo urinary urgency and frequency: The role of retropubic hematomas. Neurourol Urodyn 2021; 40:1686-1694. [PMID: 34196027 DOI: 10.1002/nau.24738] [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: 11/10/2020] [Revised: 03/26/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022]
Abstract
AIMS This is a prospective cohort study comparing de novo lower urinary tract symptoms (LUTS) in subjects undergoing a retropubic mid-urethral sling who either did or did not develop a postoperative retropubic hematoma within 6 weeks of surgery. The secondary objective was to measure the incidence and prevalence of retropubic hematomas, and subject characteristics associated with retropubic hematomas. METHODS Eligible subjects were recruited before undergoing a retropubic mid-urethral sling with or without concurrent pelvic reconstructive surgery. Validated urinary symptom questionnaires were completed before surgery and at 6 weeks postoperatively. An abdominal ultrasound was used to establish baseline lower urinary tract imaging. Ultrasound was repeated immediately after surgery and 6 weeks later to assess for the presence of retropubic hematomas. RESULTS Ninety-four subjects were enrolled. Baseline urgency and frequency were measured in 35% (33/93) of subjects. At 6 weeks postoperatively, 2% (1/52) had de novo LUTS which were not associated with a retropubic hematoma at any time. Immediately after surgery, the incidence of retropubic hematomas was 17% (16/94) while the prevalence of retropubic hematomas 6 weeks after surgery was 4% (3/75). There was no significant difference in the change in hemoglobin before and after surgery between those with and without postoperative retropubic hematomas. CONCLUSIONS There is no significant association with de novo LUTS and retropubic hematomas. Though there is a 17% incidence of retropubic hematomas detected immediately after surgery, those with hematomas who were not lost to follow-up resolved by the 6-week postoperative visit and is of unclear clinical significance.
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Affiliation(s)
- Emily Wu
- Division of Urogynecology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA
| | - Rachel High
- Division of Urogynecology, University of Texas, Austin, Texas, USA
| | - Christopher Lewis
- Department of Obstetrics and Gynecology, Geisinger Health, Danville, Pennsylvania, USA
| | - Thomas J Kuehl
- Division of Urogynecology, Baylor Scott and White Medical Center, Temple, Texas, USA
| | - Jill M Danford
- Division of Urogynecology, University of Tennessee Health Science Center, Nashville, USA
| | - Paul M Yandell
- Division of Urogynecology, Baylor Scott and White Medical Center, Temple, Texas, USA
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Treat or Wait? Natural Perioperative Course of Overactive Bladder Symptoms at the Time of Midurethral Sling Placement. Female Pelvic Med Reconstr Surg 2021; 27:e348-e351. [PMID: 32947550 DOI: 10.1097/spv.0000000000000927] [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
OBJECTIVE The aims of this study were to describe the perioperative course of untreated overactive bladder (OAB) (urinary frequency [UF] and urgency urinary incontinence [UUI]) before and after isolated retropubic midurethral sling (MUS) and to identify the time point for spontaneous OAB symptom improvement in the most patients. METHODS This is a prospective cohort study of women undergoing an isolated MUS. Women completed the Urogenital Distress Inventory 6 and Incontinence Impact Questionnaire 7 preoperatively and weekly for 13 weeks postoperatively. Bothersome UF and UUI were defined as a response of "moderately" or "greatly" bothered on questions 1 and 2 of the Urogenital Distress Inventory. The treatment for OAB was deferred until 13 weeks after surgery. RESULTS Fifty-four women were included with a mean ± SD age of 48 ± 9 years. Preoperatively, 41% of women reported both bothersome UF and UUI. Six weeks after surgery, only 15% and 6% reported bothersome UF and UUI (P < 0.001 and P < 0.001, respectively). Between 6 and 13 weeks, percentages of bothersome symptoms remained low (11.7% UF and 5.8% UUI). In addition, the impact of these urinary symptoms on activities, relationships, and feelings became consistently negligible (Incontinence Impact Questionnaire 7 median score <1) at 5 weeks postoperatively. Only 3 women desired treatment for UUI after the study period. CONCLUSIONS Overactive bladder is common before and immediately after MUS. However, the majority of patients have spontaneous symptom resolution by 6 weeks after surgery; it may be reasonable to discontinue preoperatively initiated overactive bladder treatment or defer starting treatment until this time point.
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Urodynamics for the “Failed” Midurethral Sling. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00589-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Management of Postoperative Lower Urinary Tract Symptoms (LUTS) After Pelvic Organ Prolapse (POP) Repair. Curr Urol Rep 2018; 19:74. [DOI: 10.1007/s11934-018-0825-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Forde JC, Davila JL, Marks BK, Epstein M, Tsui JF, Weiss JP, Blaivas JG. Urogynecological conditions associated with overactive bladder symptoms in women. Can Urol Assoc J 2017; 11:E83-E87. [PMID: 28360952 DOI: 10.5489/cuaj.3962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Overactive bladder symptoms (OAB) affect 9-43% of women and are associated with underlying disorders, including pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The aim of this study is to identify urogynecological conditions associated with OAB symptoms. METHODS This prospective, institutional review board-approved study included women referred to a tertiary centre with lower urinary tract symptoms (LUTS). All women completed the self-administered OAB questionnaire (OABSS). Those with an OABSS ≥8, the cutoff, were considered to have OAB symptoms. Patients underwent a history and physical examination (including Baden-Walker prolapse grading and stress test), 24-hour voiding diary, pad test (for urinary incontinence), urinalysis, and uroflow with post-void residual volume. Patients were classified clinically into the following: idiopathic OAB, SUI, POP, bladder outlet obstruction (BOO) neurogenic bladder (NGB), recurrent urinary tract infection (UTI), and miscellaneous. RESULTS In total, 148 women met the inclusion criteria with a mean age of 67 years. Only 27% had no comorbid conditions and were considered idiopathic OAB. Associated urogynecological conditions included SUI in 37%, POP in 26%, miscellaneous conditions in 18%, recurrent UTI in 11%, NGB in 9%, and BOO in 8%. Some patients met criteria for more than one category, thus the total is greater than 100%. CONCLUSIONS In a tertiary care setting, a significant proportion of women with OAB symptoms have underlying conditions that may cause or contribute to their symptoms. Appropriate evaluation is desirable to enhance our understanding of the relationship of these conditions to the diagnosis, treatment, outcomes, and pathophysiology of OAB.
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Affiliation(s)
- James C Forde
- Deptartment of Urology, Weill Medical College of Cornell University, New York, NY, United States
| | - Jonathan L Davila
- Deptartment of Urology, SUNY Downstate Medical School, Brooklyn, NY, United States
| | - Brian K Marks
- Institute for Bladder and Prostate Research, New York, NY, United States
| | - Matthew Epstein
- Deptartment of Urology, SUNY Downstate Medical School, Brooklyn, NY, United States
| | - Johnson F Tsui
- Institute for Bladder and Prostate Research, New York, NY, United States
| | - Jeffrey P Weiss
- Deptartment of Urology, SUNY Downstate Medical School, Brooklyn, NY, United States; Institute for Bladder and Prostate Research, New York, NY, United States
| | - Jerry G Blaivas
- Deptartment of Urology, Weill Medical College of Cornell University, New York, NY, United States; Deptartment of Urology, SUNY Downstate Medical School, Brooklyn, NY, United States; Institute for Bladder and Prostate Research, New York, NY, United States
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Is Postpartum Urinary Retention a Neurogenic Phenomenon? CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Malde S, Moore JA. Autologous mid-urethral sling for stress urinary incontinence: Preliminary results and description of a contemporary technique. JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415815589900] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The objective of this article is to describe the preliminary results of a contemporary technique for autologous rectus fascial sling insertion for stress urinary incontinence (SUI). Methods: We retrospectively reviewed the case notes of all patients who underwent autologous mid-urethral sling (aMUS) insertion by a single surgeon at our institution over a four-year period (2008–2012). Our novel technique utilises a minimal suprapubic incision, a specially designed reusable retropubic needle and mid-urethral sling positioning in a tension-free fashion as opposed to a tensioned bladder neck sling. Results: Thirty-eight patients were identified. Fifty per cent reported pure SUI whilst 47% had mixed urinary incontinence. Patients used an average of four pads per day (one to eight), and 26% of patients had at least one previously failed SUI procedure. Post-operative symptom questionnaires revealed mean Patient Global Impression of Improvement (PGI) scores of 1.8 (1–4), indicating that the majority of patients were very much or much improved. Only 8% of patients reported de novo OAB symptoms. Intraoperative bladder perforation occurred in only two patients. There was no incidence of chronic pain, sexual dysfunction or erosion. Conclusion: In a heterogeneous group of women with primary or recurrent stress urinary incontinence, the aMUS was found to have good subjective short-term cure rates with acceptable patient-reported satisfaction scores. We report a low rate of de novo OAB symptoms, no cases of erosion and no chronic pelvic, groin, or vaginal pain. We believe that aMUS is a good alternative to synthetic mid-urethral sling surgery and could be offered to women contemplating surgery for SUI.
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Affiliation(s)
- Sachin Malde
- Department of Urology, Eastbourne District General Hospital, UK
| | - James A Moore
- Department of Urology, Eastbourne District General Hospital, UK
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Rutman MP, Cha DY, Blaivas JG. How do urodynamics findings influence the treatment of the typical patient with overactive bladder? Curr Urol Rep 2012; 13:370-8. [PMID: 22843014 DOI: 10.1007/s11934-012-0265-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Overactive bladder (OAB) is a clinical symptom complex whose hallmark is the symptom of urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence. Historically, urodynamics (UDS) evaluation has not been recommended in the initial evaluation of OAB, since it is defined primarily by clinical symptoms. As the pathophysiology of the OAB complex has become more clearly elucidated from recent studies, the role of UDS has again become a topic of discussion as a tool that can provide objective data to reflect these new findings. The utility of UDS in the diagnosis and treatment of OAB is still evolving, but in certain clinical scenarios, especially when empiric treatment has failed, it can provide definitive information that can identify associated pathologies and/or alter the treatment course. Herein, we will discuss the current literature regarding use of UDS in OAB patients and offer our own opinions as to its use.
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Affiliation(s)
- Matthew P Rutman
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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Predictors of postoperative antimuscarinics in women with mixed urinary incontinence after transobturator surgery. Int Urogynecol J 2012; 24:401-6. [PMID: 22797464 DOI: 10.1007/s00192-012-1880-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The study sought to identify the risk factors of postoperative use of antimuscarinics after transobturator surgery in women with mixed urinary incontinence (MUI) displaying both urodynamic stress urinary incontinence (SUI) and involuntary detrusor contraction (IDC) with leakage in urodynamic study. METHODS The clinical data of 103 patients with MUI who underwent transobturator tape (TOT) sling surgery were retrospectively reviewed. The patients were followed at least a year. To determine risk factors for postoperative use of antimuscarinics, variables of only those with P values < 0.05 on univariate analysis were included in the multivariate logistic regression analysis with forward stepwise building. RESULTS Eight-four (81.6 %) of 103 patients were included in this study. The cure rate of urge urinary incontinence (UUI) was 69.0 % (58/84). Antimuscarinics were prescribed postoperatively in 22 (26.2 %) of 84 patients. Variables affecting postoperative use of antimuscarinics were age, parity, episode of any UUI, preoperative use of antimuscarinics, predominant urgency incontinence type, detrusor pressure at maximum flow, and Urogenital Distress Inventory 6. Increasing age and preoperative use of antimuscarinics increased the odds of postoperative use of antimuscarinics following TOT surgery. CONCLUSION Patients who were older and had taken antimuscarinics preoperatively were significantly associated with postoperative use of antimuscarinics.
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Which women develop urgency or urgency urinary incontinence following midurethral slings? Int Urogynecol J 2012; 24:47-54. [PMID: 22722646 DOI: 10.1007/s00192-012-1844-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 05/20/2012] [Indexed: 10/28/2022]
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Carlos E, Fernando RE, Cristina G, Carlos B, Pedro A, Humberto V. A re-adjustable sling for female recurrent stress incontinence and sphincteric deficiency: Outcomes and complications in 125 patients using the Remeex sling system. Neurourol Urodyn 2010; 29:1429-32. [DOI: 10.1002/nau.20879] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Amaro JL, Yamamoto H, Kawano PR, Barros G, Gameiro MOO, Agostinho AD. Clinical and quality-of-life outcomes after autologous fascial sling and tension-free vaginal tape: a prospective randomized trial. Int Braz J Urol 2009; 35:60-6; discussion 66-7. [PMID: 19254400 DOI: 10.1590/s1677-55382009000100010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2008] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Evaluate the impact autologous fascial sling (AFS) and tension-free vaginal tape (TVT) procedures on quality-of-life in incontinent women. MATERIALS AND METHODS Forty-one women were randomly distributed into two groups. Group G1 (n = 21), underwent AFS and group G2 (n = 20) TVT implant. The clinical follow up was performed at 1, 6, 12 and 36 months. RESULTS TVT operative time was significantly shorter than AFS. Cure rates were 71% at 1 month, 57% at 6 and 12 months in G1. In G2, cure rates were 75% at 1 month, 70% at 6 months and 65% at 12 months; there was no significant difference between groups. As regards the satisfaction rate, there was no statistical difference between groups. Analysis of quality of life at 36 months revealed that there was no significant difference between groups. CONCLUSION Similar results between AFS and TVT, except for operative time were shorter in TVT.
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Affiliation(s)
- Joao L Amaro
- Department of Urology, School of Medicine, UNESP, Botucatu, Sao Paulo, Brazil.
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Risk factors associated with urge incontinence after continence surgery. J Urol 2009; 182:2805-9. [PMID: 19837421 DOI: 10.1016/j.juro.2009.08.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE We identified preoperative factors associated with bothersome urge urinary incontinence after incontinence surgery (Burch or sling). MATERIALS AND METHODS Postoperative urge urinary incontinence was defined as treatment for urge urinary incontinence 6 or more weeks after surgery. Variables thought to affect postoperative urge urinary incontinence included age, race, prior incontinence surgery or treatment, body mass index, pelvic organ prolapse quantification stage, frequency of stress and urge symptoms, incontinence episode frequency, concomitant surgery and urodynamic findings. Bivariate logistic regression models were fit in which each covariate was controlled for separately to ascertain potential importance. After controlling for surgery several baseline factors were associated with postoperative urge urinary incontinence (p <0.10) and used in multivariable modeling, including age, body mass index, prior incontinence surgery, prior anticholinergic medication, stress and urge symptom scores, detrusor overactivity and detrusor pressure at maximum flow. RESULTS Of 655 women who had surgical re-treatment for stress urinary incontinence 34 were excluded from study. Participants had a mean +/- SD age of 51 +/- 10 years. Stress and urge symptom scores were 19.3 +/- 4.6 and 6.4 +/- 3.9, respectively. Of the women 89 (14%) had prior incontinence surgery and 165 (27%) had taken anticholinergic medication. A total of 132 women (21%) required treatment for postoperative urge urinary incontinence (50 Burch, 82 sling). Odds of treatment for urge urinary incontinence after surgery were significantly higher after sling compared to Burch (OR 1.72, 95% CI 1.16-2.54, p = 0.007). A 10-point increase in preoperative Medical, Epidemiologic, and Social Aspects of Aging urge score, prior anticholinergic use and detrusor overactivity all independently increased the odds of urge urinary incontinence. CONCLUSIONS Women are almost twice as likely to need treatment for postoperative urge urinary incontinence after sling than Burch. Women with preoperative urge, detrusor overactivity or prior use of anticholinergic medications are more likely to have bothersome urge urinary incontinence postoperatively.
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Starkman JS. Overactive bladder symptoms following urethrolysis procedures. CURRENT BLADDER DYSFUNCTION REPORTS 2009. [DOI: 10.1007/s11884-009-0023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Surgical Choices for the Treatment of Bladder Outlet Obstruction After Sling Procedures. ACTA ACUST UNITED AC 2008. [DOI: 10.1097/spv.0b013e3181858333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reproductive factors associated with nocturia and urinary urgency in women: a population-based study in Finland. Am J Obstet Gynecol 2008; 199:153.e1-12. [PMID: 18486094 DOI: 10.1016/j.ajog.2008.03.054] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 01/02/2008] [Accepted: 03/21/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the association of nocturia and urinary urgency with reproductive factors, including parity, the postpartum period, the menopause, hormone replacement therapy, hysterectomy, and surgery for stress urinary incontinence (SUI). STUDY DESIGN In 2003-2004, questionnaires eliciting urinary symptoms, reproductive factors, SUI surgery, and potential confounders were mailed to 3000 randomly selected women aged 18-79 years, identified from the Finnish Population Register. Nocturia was defined as 2 or more voids/night. Sudden compelling desire to urinate often or always (scale of never, rarely, often, always) was regarded as urgency. Pregnant and puerperal (6 weeks after delivery) women and those reporting urinary tract infection were excluded. RESULTS Responses totaled 2002 (67%). Parity, postpartum (defined as six weeks to one year after delivery) and postmenopausal periods were associated with increased nocturia and SUI surgery with increased urgency (adjusted for age, comorbidity, medication, anthropometric, sociodemographic and lifestyle factors). Hormone therapy and hysterectomy were associated with neither symptom. CONCLUSION Reproductive factors associated with nocturia differed from those related to urgency.
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Starkman JS, Duffy JW, Wolter CE, Kaufman MR, Scarpero HM, Dmochowski RR. The Evolution of Obstruction Induced Overactive Bladder Symptoms Following Urethrolysis for Female Bladder Outlet Obstruction. J Urol 2008; 179:1018-23. [PMID: 18206925 DOI: 10.1016/j.juro.2007.10.051] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2007] [Indexed: 11/27/2022]
Affiliation(s)
- Jonathan S. Starkman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John W. Duffy
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher E. Wolter
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R. Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Harriette M. Scarpero
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger R. Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Starkman JS, Duffy JW, Wolter CE, Kaufman MR, Scarpero HM, Dmochowski RR. Refractory overactive bladder after urethrolysis for bladder outlet obstruction: management with sacral neuromodulation. Int Urogynecol J 2007; 19:277-82. [PMID: 17671752 DOI: 10.1007/s00192-007-0433-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 07/07/2007] [Indexed: 11/27/2022]
Abstract
Refractory overactive bladder (OAB) after urethrolysis for iatrogenic bladder outlet obstruction (BOO) is a clinical dilemma without established guidelines for management. We sought to evaluate the efficacy of sacral neuromodulation (SNM) in the management of this complex patient population. Retrospective review identified eight patients who underwent SNM secondary to refractory OAB after urethrolysis or sling take-down. SNM was performed with the Interstim device (Medtronic, Minneapolis) using a two-stage implant technique. SNM outcomes were determined subjectively during follow-up. Validated questionnaires were completed to assess symptom bother, patient satisfaction, and quality of life. Statistical analyses were conducted using Stata version 9.0. Six patients had a favorable response to SNM during test stimulation and underwent implantation of the implantable pulse generator (IPG). With follow-up of 15.7 +/- 11.1 months (6-34), all patients significantly improved, with three patients being dry and three patients having one to two urgency incontinence episodes per week. Patient-reported outcomes indicated that patients perceived themselves as very much improved (3) or much improved (3) after SNM, while those failing test stimulation perceived no change. Quality of life and symptom bother were significantly better in SNM responders vs nonresponders. SNM appears to be an effective and viable treatment option in this complex patient population. Further work is needed to determine clinical factors predictive of outcome and durability of response.
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Affiliation(s)
- Jonathan S Starkman
- Clinical Instructor, Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 MCN, Nashville, TN 37232-2765, USA.
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Holmgren C, Nilsson S, Lanner L, Hellberg D. Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence—A long-term follow-up. Eur J Obstet Gynecol Reprod Biol 2007; 132:121-5. [PMID: 16815624 DOI: 10.1016/j.ejogrb.2006.04.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Revised: 02/02/2006] [Accepted: 04/10/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND To determine risk factors for the appearance of de novo urgency symptoms, and subsequent accompanying problems, after the tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence. METHOD A structured preoperative analysis of the incontinence symptoms was made. A mailed questionnaire was distributed to 970 women that underwent the TVT procedure between 1995 and 2001. Average follow-up was 5.2 years (range 2-8 years). The questionnaire included specific questions on current urinary symptoms and incontinence. The disease-specific quality of life instruments IIQ-7 and UDI-6 were used to compare women with, and those without de novo urgency. RESULTS Seven hundred and sixty women (78.3%) responded and 463 of those were identified as genuine stress incontinence preoperatively. De novo urgency occurred in 67 (14.5%) of the women. The frequency was similar irrespective of duration since the TVT procedure. The women that reported de novo urgency symptoms were compared with those without symptoms. Risk factors for occurrence of de novo urgency symptoms were older age (64.7 years versus 60.9 years; p=0.01), parity (2.6 versus 2.3; p=0.05), history of cesarean section (9.5% versus 2.5%; odds ratio 5.4), and history of recurrent urinary infections (29.7% versus 18.8%; odds ratio 1.6, but non-significant. De novo urgency had a severe impact on quality of life, as compared to the remaining study population. CONCLUSION Old age, parity and history of cesarean section were risk factors for de novo urgency after TVT surgery. Postoperative de novo urgency symptoms are as bothersome for the patient as the preoperative stress urinary incontinence.
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Affiliation(s)
- Corinne Holmgren
- Department of Obstetrics and Gynecology, Falun Hospital, 79182 Falun, Sweden.
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Chapple CR, Brubaker L, Haab F, van Kerrebroeck P, Robinson D. Patient-perceived outcomes in the treatment of stress urinary incontinence: focus on urethral injection therapy. Int Urogynecol J 2006; 18:199-205. [PMID: 16847584 DOI: 10.1007/s00192-006-0148-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 05/08/2006] [Indexed: 10/24/2022]
Abstract
Intervention for stress urinary incontinence (SUI) is generally focused on minimizing urinary leakage. However, the overall impact of SUI therapy on patients' quality of life is, arguably, more important than leakage outcomes. We performed a literature search to investigate the effect of urethral injection therapy on quality of life. Significant quality-of-life improvements have been observed with a number of injectable agents, while there is a distinct lack of correlation between subjective and objective outcomes. Two studies comparing urethral injection therapy with surgical intervention found superior objective efficacy with surgery, but no significant differences in quality-of-life improvements. Personal goals of patients undergoing urethral injection are yet to be explored, but there may be willingness to trade a lower success rate in favor of a more minor treatment procedure. In conclusion, quality-of-life improvements after urethral injection appear significant and comparable to those obtained with surgery. Further study of patients' own perceptions, pre- and posttreatment, would be valuable.
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Affiliation(s)
- Christopher R Chapple
- Urology Research Department, J Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
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Segal J, Steele A, Vassallo B, Kleeman S, Silva AW, Pauls R, Walsh P, Karram M. Various surgical approaches to treat voiding dysfunction following anti-incontinence surgery. Int Urogynecol J 2006; 17:372-7. [PMID: 16429244 DOI: 10.1007/s00192-005-0018-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Accepted: 09/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aims of this study are to report the efficacy of retropubic urethrolysis, vaginal urethrolysis, and cutting of synthetic suburethral slings in treating postoperative voiding dysfunction that occurs after anti-incontinence surgery and to report the recurrence rate of stress urinary incontinence (SUI). METHODS All patients from January 1996 to October 2003 who presented with voiding dysfunction following an anti-incontinence procedure and who subsequently underwent either retropubic urethrolysis, vaginal urethrolysis, or synthetic suburethral sling takedown were included in the study. Pre- and postoperative irritative symptoms (urinary frequency or urgency), obstructive symptoms (hesitancy, voiding difficulty, and incomplete emptying), and stress urinary incontinence symptoms were obtained in a standardized fashion. The Incontinence Impact Questionnaire and Urogenital Distres Invetory quality of life (QOL) questionnaires were also obtained to objectify these symptoms. Other objective postoperative analysis included simple uroflowmetry, measurement of postvoid residual (PVR), and simple or subtracted cystometry. RESULTS Forty-four patients were included in the study (suburethral sling takedown = 14, vaginal urethrolysis = 20, and retropubic urethrolysis = 10), 77% of whom had objective follow-up. Preoperatively, 31 patients (70.5%) had irritative symptoms, 41 (93.2%) had obstructive symptoms, and 6 (13.6%) had symptoms of stress urinary incontinence (SUI), while postoperatively, these symptoms were found in 30 (68.2%), 11 (25.0%), and 18 (40.9%), respectively. Postoperatively, 6 patients (17.6%) had a PVR > 100 cc, 5 patients (14.7%) had a bladder contractions, and 16 patients (47.1%) demonstrated the sign or diagnosis of (SUI). Additionally, there was a statistically significant improvement in both QOL questionnaires. CONCLUSIONS Various surgical approaches may be used to treat voiding dysfunction following an anti-incontinence procedure. Following a vaginal or retropubic urethrolysis or takedown of a synthetic suburethral sling, obstructive symptoms are likely to improve, irritative symptoms may remain unchanged, and almost half will develop recurrence of SUI.
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Affiliation(s)
- Jeffrey Segal
- Center for Urogynecology, St. Barnabas Medical Center, NJ, USA.
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Segal JL, Vassallo B, Kleeman S, Silva WA, Karram MM. Prevalence of persistent and de novo overactive bladder symptoms after the tension-free vaginal tape. Obstet Gynecol 2005; 104:1263-9. [PMID: 15572487 DOI: 10.1097/01.aog.0000147596.44421.72] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess 1) the proportion of de novo urge incontinence and overactive bladder symptoms after a tension-free vaginal tape (TVT), and 2) the natural history of preoperative urge incontinence and overactive bladder symptoms after a TVT. METHODS A chart review was performed on all patients who underwent a TVT without concomitant procedures from November 1998 to November 2002. Preoperative and postoperative stress and mixed urinary incontinence symptoms as well as overactive bladder symptoms were assessed subjectively, as was the use of anticholinergics to treat overactive bladder symptoms. Two preoperative and postoperative validated quality-of-life questionnaires, the Incontinence Impact Questionnaire (IIQ-7) and Urinary Distress Inventory (UDI-6), were also compared. RESULTS Ninety-eight patients were included in the study. Postoperatively, de novo urge incontinence symptoms developed in 9.1%, de novo overactive bladder symptoms developed in 4.3%, and 8.7% started taking anticholinergics for the first time. After a TVT, the urge component resolved in 63.1% of those with preoperative symptoms of mixed incontinence, overactive bladder symptoms resolved in 57.3% of those with preoperative overactive bladder symptoms, and 57.7% of those who used anticholinergics preoperatively no longer needed to do so. There was also a statistically significant improvement in comparing the preoperative and postoperative IIQ-7 and UDI-6 scores. CONCLUSION The proportion of patients in whom de novo overactive bladder or urge incontinence symptoms developed postoperatively is low, and approximately 57% of patients with preoperative overactive bladder symptoms can expect resolution of these symptoms after a TVT.
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Affiliation(s)
- Jeffrey L Segal
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, Ohio, USA.
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