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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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Lourenço DB, Santos HOD, Hirakawa EY, Rios LAS, Lemos GC, Bianco B, Carneiro A. Does vaginal surgery for correction of pelvic organ prolapse improve urinary function? A prospective cohort study. Int Urogynecol J 2024; 35:149-156. [PMID: 37999760 DOI: 10.1007/s00192-023-05683-2] [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: 06/23/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) is caused by an imbalance in the stability of the pelvic organs, resulting in loss of support. The most common types of POP, anterior and apical, are associated with lower urinary tract symptoms (LUTS) such as bladder outlet obstruction and detrusor overactivity (DO). Vaginal surgery may improve LUTS and overall urinary symptoms. We assessed urodynamic (UD) parameters and urinary symptoms before and after vaginal surgery for POP correction. METHODS A prospective cohort of 59 women with symptomatic anterior and/or apical POP associated with urinary symptoms and with indications for vaginal surgery were included. POP surgeries included anterior colporrhaphy and vaginal hysterectomy with culdoplasty (VH) and with/without concomitant posterior colporrhaphy and mid-urethral sling (MUS). All participants underwent UD evaluation and answered urinary symptom questionnaires pre- and 3 months post-surgery. RESULTS Anterior colporrhaphy was performed in all patients: 45.7% with associated VH and 54.2% with concomitant MUS. Preoperative ICIQ-OAB score >8 points was significantly associated with DO (p<0.02) and decreased after surgery (9±4.3 to 3.2±3.0, p<0.001). All other questionnaires demonstrated improvements in urinary symptoms. Stress urinary incontinence rate decreased from 59.6% to 21% (p<0.001). Post-void residual (PVR) volume and Valsalva maneuver also decreased (p<0.001). CONCLUSIONS Pelvic organ prolapse surgery reduced the prevalence of urgency symptoms, and all questionnaires on urinary symptoms showed clinically significant improvement. Vaginal surgery for POP, even combined with MUS, significantly reduced PVR volume and improved urgency symptoms.
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Affiliation(s)
- Danilo B Lourenço
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Hugo O D Santos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Elizabeth Y Hirakawa
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Luis Augusto S Rios
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Gustavo C Lemos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Bianca Bianco
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil.
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
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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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Lin YH, Lee CK, Chang SD, Chien PC, Hsu YY, Tseng LH. Focusing on long-term complications of mid-urethral slings among women with stress urinary incontinence as a patient safety improvement measure: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26257. [PMID: 34128853 PMCID: PMC8213295 DOI: 10.1097/md.0000000000026257] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/20/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There are 3 different types of mid-urethral sling, retropubic, transobturator and single incision performed for women with stress urinary incontinence. Prior studies comparing these three surgeries merely focused on the successful rate or efficacy. But nevertheless, what is more clinically important dwells upon investigating postoperative complications as a safety improvement measure. METHODS A systematic review via PubMed, Ovid, and the Cochrane Database of Systematic Review and studies were applied based on the contents with clearly identified complications. Selected articles were reviewed in scrutiny by 2 individuals to ascertain whether they fulfilled the inclusion criteria: complications measures were clearly defined; data were extracted on study design, perioperative complications, postoperative lower urinary tract symptoms, postoperative pain, dyspareunia, and other specified late complications. RESULTS A total of 55 studies were included in the systemic review. Perioperative complications encompassed bladder perforation, vaginal injury, hemorrhage, hematoma, urinary tract infection. There were postoperative lower urinary tract symptoms including urine retention and de novo urgency. Furthermore, postoperative pain, tape erosion/ extrusion, further stress urinary incontinence surgery, and rarely, deep vein thrombosis and injury of inferior epigastric vessels were also reported. CONCLUSIONS Complications of mid-urethral sling are higher than previously thought and it is important to follow up on their long-term outcomes; future research should not neglect to address this issue as a means to improve patient safety.
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Affiliation(s)
- Yi-Hao Lin
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan
| | - Cheng-Kai Lee
- Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan City, Taiwan
| | - Shuenn-Dyh Chang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan
| | - Pei-Chun Chien
- Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan City, Taiwan
| | - Yu-Ying Hsu
- Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan City, Taiwan
| | - Ling-Hong Tseng
- Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan City, Taiwan
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Engen M, Svenningsen R, Schiøtz HA, Kulseng-Hanssen S. Mid-urethral slings in young, middle-aged, and older women. Neurourol Urodyn 2018; 37:2578-2585. [PMID: 30178571 DOI: 10.1002/nau.23583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 03/04/2018] [Indexed: 11/10/2022]
Abstract
AIMS To compare subjective and objective outcomes of mid-urethral sling (MUS) surgery in women in different age decades and the utilization rates for MUS in Norwegian women. METHODS Data from the national Norwegian Female Incontinence Registry on 21 832 women with stress or mixed urinary incontinence who underwent MUS surgery from 1998 to 2016 were used. Primary outcomes were treatment satisfaction and absence of objective stress leakage at 6-12 months follow-up and "MUS utilization rate." Secondary outcomes were increase in urgency incontinence symptoms and surgical complications. RESULTS Women in the sixth decade and older had more objective postoperative stress urinary leakage, and women in the seventh decade and older were less satisfied. Urgency incontinence symptoms (persistent and de novo) after MUS increased with age. Intermittent catheterization occurred significantly more often in the seventh decade and bladder perforation in the seventh and eighth decades. Women younger than the fifth decade had fewer complications, except the need for tape transection in the fourth decade. The "MUS utilization rate" increased in all age groups during the study period, but declined slightly in the oldest age group after 2010. CONCLUSION All age groups had a high percentage of "very satisfied" and no objective stress leakage at 6-12 months follow-up, but declining slightly with age after the sixth decade. Urgency incontinence symptom bother increased with age, but the overall complication rates were low. Our study strengthens the argument that management of stress urinary incontinence with MUS seems suitable regardless of age.
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Affiliation(s)
- Madeleine Engen
- Department of Obstetrics and Gynecology, Baerum Hospital, Baerum, Norway
| | - Rune Svenningsen
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - Hjalmar A Schiøtz
- Department of Obstetrics and Gynecology, Vestfold Hospital Trust, Tønsberg, Norway
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Patient goal achievement 2 years after a tension-free vaginal tape operation. Int Urogynecol J 2018; 30:43-46. [PMID: 29995162 DOI: 10.1007/s00192-018-3716-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/26/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The primary aim of this study was to investigate long-term patient-reported goals after a tension-free vaginal tape (TVT) operation for stress urinary incontinence (SUI). METHODS In this prospective study involving 67 women, patients completed the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) preoperatively and stated three goals for the operation. Postoperatively, a visual analog scale (VAS) ranging from zero (none) to ten (worst) estimated the extent to which goals were achieved. Goals were divided into five groups: symptoms, quality of life (QoL) (physical), QoL (emotional), sexual function, avoidance, and others. Short-term achievement of goal was estimated after 3 months and long-term achievement of goals after a mean of 28.2 months. RESULTS A total of 201 goals were stated, most of which (38%) were in the group concerning QoL in physical domains. Mean VAS score for all goals was 9.1 after 3 months and 8.5 at long-term follow-up. ICIQ-UI SF preoperatively was mean 14.9; 3 months' postoperatively mean 1.4; and at long-term 3.8. The small rise in ICIQ-UI SF at long-term follow-up was statistically insignificant and due to urge urinary incontinence (UUI). CONCLUSIONS Our study showed that patients achieved their goals to a high degree and maintained them at long-term follow-up. Most goals concerned QoL in physical domains. Although a proportion of women experienced episodes of UUI at the long-term follow-up, VAS score was not significantly changed.
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Marcelissen T, Van Kerrebroeck P. Overactive bladder symptoms after midurethral sling surgery in women: Risk factors and management. Neurourol Urodyn 2017. [PMID: 28631830 DOI: 10.1002/nau.23328] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Overactive bladder syndrome (OAB) including urgency and urgency urinary incontinence (UUI) occurs frequently after stress urinary incontinence (SUI) surgery. It is important to identify the risk factors for the occurrence of OAB symptoms in order to adequately inform the patient before surgery. Furthermore, when facing OAB after sling surgery it is crucial to know how to manage these symptoms. METHODS We conducted a literature review in order to assess the risk factors and management of OAB symptoms after SUI surgery. We searched for relevant articles in PubMed that specifically addressed the topic of OAB symptoms after midurethral sling surgery. RESULTS The incidence of de novo and persistent urgency and UUI is reported around 15% and 30%, respectively. Several studies demonstrated that women with mixed incontinence who have a predominant urge component will have worse outcomes after surgery. Older age was also found to be a predictive factor in three studies. Furthermore, urodynamic signs of overactive bladder (eg, DO, low bladder capacity, elevated detrusor pressure) can predict postoperative urgency or UUI. The management of OAB symptoms after SUI surgery is essentially the same as in idiopathic OAB. However, before commencing therapy it is crucial to rule out other factors than can cause urgency, including bladder outlet obstruction, urinary tract infection, or sling erosion. CONCLUSIONS OAB symptoms are frequently reported after sling surgery. Women with mixed incontinence and older women are at risk of developing post-operative OAB symptoms. We have proposed an algorithm for the treatment of these symptoms which can be useful in clinical practice.
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Affiliation(s)
- Tom Marcelissen
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
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Bartley JM, Ramirez V, Killinger KA, Boura JA, Gupta P, Gaines N, Gilleran JP, Peters KM. Outcomes of Sacral Neuromodulation in Patients with Prior Surgical Treatment of Stress Urinary Incontinence and Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2016; 23:8-12. [PMID: 27636222 DOI: 10.1097/spv.0000000000000324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of sacral neuromodulation in patients with prior stress urinary incontinence (SUI) or pelvic organ prolapse (POP) surgery. METHODS Women in our prospective neuromodulation database were evaluated. Patients with a history of prior SUI/POP surgery were compared to those without. Medical records at baseline were reviewed, and primary outcome was defined as moderate/marked improvement on Global Response Assessment (GRA) at 3 months. Secondary outcomes were measured using bladder diaries and Overactive Bladder Symptom Severity (OABq-SS)/health-related quality of life (HRQOL). Data were analyzed with Pearson χ test, Fisher exact test, Wilcoxon rank-sum test, and repeated-measures analyses. RESULTS Of 210 subjects, 108 (51%) had prior SUI/POP surgery. Patients with SUI/POP surgery had more prior hysterectomies. At 3 months, there was no difference between groups on GRA outcomes. On the bladder diary, both groups had improvement in median voids per 24 hours, urgency severity, and urge incontinence over 2 years. On the GRA, fewer patients in the SUI/POP group were treatment responders at 12 and 24 months. For urinary urgency, a few in this group were moderately/markedly improved at 6 months, and a higher proportion are reported still leaking urine at 6 and 12 months. Similar proportions in each group reported moderate/marked improvement in leaking. Satisfaction was similar between groups. The OABq-SS/HRQOL scores improved, and there was no difference between the groups. CONCLUSION Sacral neuromodulation improves bladder symptoms in women with prior SUI/POP surgery, but response may be slightly less in those with prior surgery due to underlying bladder or pelvic floor issues.
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Affiliation(s)
- Jamie M Bartley
- From the *Oakland University William Beaumont School of Medicine, Rochester, MI; and †Beaumont Health, Royal Oak, MI
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Willis-Gray MG, Dieter AA, Geller EJ. Evaluation and management of overactive bladder: strategies for optimizing care. Res Rep Urol 2016; 8:113-22. [PMID: 27556018 PMCID: PMC4968994 DOI: 10.2147/rru.s93636] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Overactive bladder (OAB) is a common condition affecting millions of men and women worldwide. It is an embarrassing condition with far-reaching consequences. Although many treatment options exist, no single treatment has been proven to be most effective. Often a combination of therapy is required to successfully manage OAB symptoms. In this review, we provide an overview of OAB, including risk factors for development of OAB; keys to diagnosis; therapeutic options including conservative and medical management, as well as treatments for refractory OAB; when to consider referral to a specialist; and resources for clinicians and patients. The aim of this review is to inform clinicians regarding OAB management in order to improve patient counseling and care.
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Affiliation(s)
- Marcella G Willis-Gray
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexis A Dieter
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth J Geller
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Five-year follow-up study of Monarc transobturator tape for surgical treatment of primary stress urinary incontinence. Int Urogynecol J 2016; 27:1653-1659. [PMID: 27085545 DOI: 10.1007/s00192-016-3019-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 03/24/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We hypothesized that transobturator tape (TOT) is safe and efficacious for the treatment of urodynamic stress incontinence in the long term. METHODS We conducted a prospective study of patients with confirmed urodynamic stress incontinence (USI) who underwent a MonarcTM TOT procedure in a tertiary center between February 2006 and March 2009 without other concurrent surgical procedures. Urodynamics were conducted at 1 and 3 years postoperatively. Subjective evaluation included Incontinence Impact Questionnaire (IIQ-7), Urinary Distress Inventory Questionnaire (UDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Objective cure was defined as no urinary leakage demonstrable on provocative filling cystometry and/ or 1-h pad test of <2 g. Subjective cure was based on a negative response to question 3 in UDI-6. Paired-samples t test, chi-square, and Fisher exact tests were applied; p < 0.05 was considered significant. The log-rank tests were used to compare event-free survival. RESULTS Sixty patients were enrolled, and 56 were evaluated at 5 years postoperatively. The majority were middle aged, postmenopausal, and overweight. Mean operating time was 31.1 ± 8.9 min, intraoperative complications were minor, and median period of follow-up was 80.3 ± 9.6 months. At 5 years of follow-up, objective and subjective cure rates were 89.3 % and 87.5 %, respectively. No mesh-related complications were seen. One patient needed a repeat midurethral sling procedure, and one patient each had bladder and bowel cancer. CONCLUSION Monarc TOT was safe and retained its high cure rate in the short- and long-term treatment of stress urinary incontinence.
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Abstract
PURPOSE OF REVIEW Transvaginal placements of synthetic mid-urethral slings and vaginal meshes have largely superseded traditional tissue repairs in the current era because of presumed efficacy and ease of implant with device 'kits'. The use of synthetic material has generated novel complications including mesh extrusion, pelvic and vaginal pain and mesh contraction. In this review, our aim is to discuss the management, surgical techniques and outcomes associated with mesh removal. RECENT FINDINGS Recent publications have seen an increase in presentation of these mesh-related complications, and reports from multiple tertiary centers have suggested that not all patients benefit from surgical intervention. SUMMARY Although the true incidence of mesh complications is unknown, recent publications can serve to guide physicians and inform patients of the surgical outcomes from mesh-related complications. In addition, the literature highlights the growing need for a registry to account for a more accurate reporting of these events and to counsel patients on the risk and benefits before proceeding with mesh surgeries.
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Blaivas JG, Purohit RS, Benedon MS, Mekel G, Stern M, Billah M, Olugbade K, Bendavid R, Iakovlev V. Safety considerations for synthetic sling surgery. Nat Rev Urol 2015; 12:481-509. [DOI: 10.1038/nrurol.2015.183] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Lee D, Bacsu C, Zimmern PE. Meshology: a fast-growing field involving mesh and/or tape removal procedures and their outcomes. Expert Rev Med Devices 2014; 12:201-16. [DOI: 10.1586/17434440.2015.985655] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bing MH, Gimbel H, Greisen S, Paulsen LB, Soerensen HC, Lose G. Clinical risk factors and urodynamic predictors prior to surgical treatment for stress urinary incontinence: a narrative review. Int Urogynecol J 2014; 26:175-85. [PMID: 25248411 DOI: 10.1007/s00192-014-2489-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 08/06/2014] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Knowledge about clinical risk factors and the value of urodynamic testing is important to optimize treatment strategy and secure true informed consent. METHODS We reviewed the relevant literature to clarify the evidence regarding clinical risk factors and the predictive value of urodynamic testing in patients with urinary incontinence, where surgery is considered. Because of the paucity of evidence based on randomized controlled trials, we conducted a narrative review of the published literature. RESULTS Clinical risk factors in terms of mixed urinary incontinence, previous incontinence surgery, body mass index (BMI) ≥ 35, age ≥ 75, and presence of diabetes mellitus were significantly related to decreased outcome of incontinence surgery. Furthermore, noninvasive and invasive urodynamic parameters indicating detrusor overactivity, voiding difficulties, low urethral pressure, and bladder-neck immobility were related to poorer outcome of surgery. CONCLUSIONS This study summarized the available evidence regarding preoperative clinical risk factors and urodynamic parameters indicating decreased or adverse outcome of surgery, and this report also provides clinical recommendations.
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Affiliation(s)
- Mette Hornum Bing
- Department Gynecology/Obstetrics, Herlev University Hospital, Herlev, Denmark,
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Complicaciones del tratamiento de incontinencia urinaria y prolapso de la pelvis. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bacsu C, Zimmern P. Complications of treatment of urinary incontinence and pelvic organ prolapse. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70154-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Svenningsen R, Staff AC, Schiøtz HA, Western K, Kulseng-Hanssen S. Long-term follow-up of the retropubic tension-free vaginal tape procedure. Int Urogynecol J 2013; 24:1271-8. [DOI: 10.1007/s00192-013-2058-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 01/19/2013] [Indexed: 11/30/2022]
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Objective Cure Rates and Patient Satisfaction After the Transobturator Tape Procedure During 6.5-Year Follow-Up. J Minim Invasive Gynecol 2013; 20:73-8. [DOI: 10.1016/j.jmig.2012.09.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 09/12/2012] [Accepted: 09/22/2012] [Indexed: 11/18/2022]
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Complications of synthetic slings used in female stress urinary incontinence and applicability of the new IUGA-ICS classification. Eur J Obstet Gynecol Reprod Biol 2012; 165:347-51. [PMID: 22944381 DOI: 10.1016/j.ejogrb.2012.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 07/21/2012] [Accepted: 08/03/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To analyze different complications of synthetic suburethral slings, and to apply the new "IUGA-ICS classification of complications directly related to the insertion of prosthesis (meshes, implants, tapes) and grafts in female pelvic floor surgery" to the list of complications, check its applicability, and give suggestions regarding possible improvements. STUDY DESIGN This study is an analysis of complications of synthetic suburethral slings. Data on type of complication, time interval between the insertion of the prosthesis and the onset of symptoms of complication, type and nature of prosthesis, and management process were documented. Additional descriptions of the sling position in relation to lower urinary tract, shrinkage or prominence of the prosthesis, and intra-operative nature of the prosthetic material were collected for analysis. RESULTS From the year 2003 to 2010, 376 women with complications of synthetic suburethral slings were managed surgically and the data were analyzed. Overactive bladder (OAB) at 54%, lower urinary tract obstruction (48%), vaginal exposure (19%), and pain (14%) were the most frequent complications. Infection, fistulae, urinary tract penetration, and groin/thigh pain were other complications. The new IUGA-ICS classification could be applied to most of the types of complications, a notable exception being de novo development of overactive bladder. Also category 4B of IUGA-ICS classifications encompasses a wide clinical variety of complications and may need reconsideration. CONCLUSION De novo OAB seems to be the commonest complication of synthetic suburethral slings, followed by obstruction, vaginal exposure, and long term pain. The new IUGA-ICS classification on complications has good general applicability; some minor changes may be useful in the future.
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Moossdorff-Steinhauser HF, Berghmans B. Effects of percutaneous tibial nerve stimulation on adult patients with overactive bladder syndrome: A systematic review. Neurourol Urodyn 2012; 32:206-14. [DOI: 10.1002/nau.22296] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 07/06/2012] [Indexed: 11/06/2022]
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El-Gamal O, Soliman M, Tawfik A, Abdel Raheem A. Use of autologous rectus fascia in a new transobturator hybrid sling for treatment of female stress urinary incontinence: A pilot study. Scand J Urol 2012; 47:57-62. [DOI: 10.3109/00365599.2012.700319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Heinonen P, Ala-Nissilä S, Kiilholma P, Laurikainen E. Tension-free vaginal tape procedure without preoperative urodynamic examination: Long-term outcome. Int J Urol 2012; 19:1003-9. [DOI: 10.1111/j.1442-2042.2012.03078.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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Ajust single incision transobturator sling procedure for stress urinary incontinence: results after 1-year follow-up. Int Urogynecol J 2012; 23:1265-70. [PMID: 22584919 DOI: 10.1007/s00192-012-1740-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 03/04/2012] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Data on the Ajust, a new single-incision sling procedure for female stress urinary incontinence (SUI) management, remain scarce and limited to a 1-year follow-up. Our goal was to assess the efficacy of this procedure after a 1-year follow-up. METHODS This prospective evaluation involved 95 consecutive patients implanted with Ajust at a single centre. All patients had SUI on urodynamics due to urethral hypermobility, 33 % had preoperative overactive bladder (OAB) symptoms and none had detrusor overactivity. Ninety-two patients were treated on an outpatient basis, and 3 patients had general anaesthesia. Postoperative assessment was conducted at 1, 6, 12 months, and yearly thereafter. The main outcome measure was pad usage. Secondary parameters were self-reported SUI episodes, OAB symptoms, data of clinical examination, satisfaction using the Patient Global Impression of Improvement (PGI-I) scale, postoperative pain, and adverse events. RESULTS After a mean follow-up of 21 ± 6 months (12-32), 76 out of 95 patients used no pads or one dry security pad, showing a success rate of 80 %. Seventy-nine out of 95 patients had no more SUI-related leakage. Only 6 patients experienced late recurrence of SUI after 6 months' follow-up. Perioperative complications included 1 case of vaginal hematoma, 1 case of acute urinary retention, 2 cases of urinary tract infection, all managed conservatively. Half of the patients had no pain after day 1, free of medications. Late complications were vaginal erosion in 1 case, and pain during exertion in 2 cases. CONCLUSIONS The Ajust single incision transobturator sling is a safe and effective procedure, with durable results after 1 year.
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Factors associated with urge urinary incontinence after surgery for stress urinary incontinence. Female Pelvic Med Reconstr Surg 2012; 17:120-4. [PMID: 22453782 DOI: 10.1097/spv.0b013e3182179b95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : The objectives of the study were to estimate the severity of urge urinary incontinence (UUI) after surgery for stress incontinence and identify factors associated with symptom severity. METHODS : Four hundred thirty-eight women who underwent surgery for stress incontinence over a 10-year period completed a mailed questionnaire protocol that included validated instruments to assess lower urinary tract function and mental and physical well-being. Bivariate analysis and generalized linear models were used to identify factors associated with severity of UUI as measured by the urge incontinence domain of the Incontinence Symptom Index. RESULTS : Urge urinary incontinence was experienced daily by 35.9% of patients. Factors independently associated with higher UUI severity scores were preoperative mixed urinary incontinence (P = 0.006), depression (P < 0.001), aging (P < 0.001), and longer follow-up times (P = 0.01). Pubovaginal sling (P = 0.001) and urethral vaginal suspension (P = 0.04) had higher severity scores than Tension-Free Vaginal Tape. CONCLUSIONS : Daily episodes of UUI are experienced by slightly more than one third of women after surgery for stress incontinence. Identification of factors associated with UUI may help physicians to modify treatment and patient expectations.
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Transurethral holmium laser intravesical tape excision following TVT procedure: results from seven patients in a 12-month follow-up. Int Urogynecol J 2011; 23:769-77. [PMID: 21953414 DOI: 10.1007/s00192-011-1574-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 09/14/2011] [Indexed: 10/17/2022]
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Comparison of late complications of retropubic and transobturator slings in stress urinary incontinence. Int Urogynecol J 2011; 23:321-5. [DOI: 10.1007/s00192-011-1535-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 07/22/2011] [Indexed: 11/26/2022]
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Predictors for overactive bladder symptoms after pelvic organ prolapse surgery. Curr Opin Obstet Gynecol 2011; 23:366-70. [PMID: 21836508 DOI: 10.1097/gco.0b013e32834a926e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the predictors for overactive bladder (OAB) symptoms after pelvic organ prolapse (POP) surgery. RECENT FINDINGS In general, an improvement on OAB can be expected after POP surgery. There are few studies which study the predictors of OAB after POP surgery and most studies had a different perspective. Some studies made conclusions on the basis of multivariate analysis, in which all relevant factors were taken into account. On the basis of these studies, it seems that various factors influence the results on OAB symptoms after POP surgery. Predictors for improvement gave a confusing and sometimes contradicting results. The role of preoperative detrusor overactivity is unclear, improvement as well as persistence of OAB was found. Further, the detrusor opening pressure and maximum flow rate seem to play a role. The absence of bothersome OAB preoperatively was a further predictor for absence of postoperative symptoms. Further, it was found that the individual OAB symptoms had different predictors. All together, the results of the various studies are inconclusive. It is therefore at present essentially still impossible to reliably predict the presence of OAB after POP surgery. SUMMARY More research is necessary on the predictors for OAB after POP surgery.
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Implantation of Artificial Urinary Sphincter in Patients With Post-Prostatectomy Incontinence, and Preoperative Overactive Bladder and Mixed Symptoms. J Urol 2011; 185:2254-9. [DOI: 10.1016/j.juro.2011.02.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Indexed: 11/23/2022]
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Drahoradova P, Martan A, Svabik K, Zvara K, Otava M, Masata J. Longitudinal trends with improvement in quality of life after TVT, TVT O and Burch colposuspension procedures. Med Sci Monit 2011; 17:CR67-72. [PMID: 21278690 PMCID: PMC3524710 DOI: 10.12659/msm.881389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 08/23/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Comparison of the quality of life (QoL) trends after TVT, TVT O and Burch colposuspension (BCS) procedures and comparison of long-term subjective and objective outcomes. MATERIAL/METHODS The study included 215 women who underwent a TVT, TVT O or BCS procedure. We monitored QoL after each procedure and the effect of complications on the QoL as assessed by the IQOL questionnaire over a 3-year period. RESULTS The study was completed by 74.5% of women after TVT, 74.5% after TVT O, and 65.2% after BCS procedure. In the long-term, the QoL improved from 46.9 to 88.7 and remained stable after BCS; after TVT and TVT O, it declined, but only after TVT O was the decline statistically significant compared to BCS. The IQOL for women with post-operative complications has a clear descending tendency. The effect of the complications is highly significant (p<0.001). Only the OAB complication had a statistically significant effect on QoL p<0.001. Preexistent OAB does not negatively affect postoperative results of anti-incontinence surgery. CONCLUSIONS There was a statistically significant decline with the longitudinal values of IQOL with TVT O, but not with TVT or BCS. Anti-incontinence operations significantly improve quality of life for women with MI, but compared to the SI group, the quality of life is worse when measured at a longer time interval after the operation. Anti-incontinence operations significantly improve quality of life, and the difference in preoperative status in the long-term follow-up is demonstrable.
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Affiliation(s)
- Petra Drahoradova
- Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and General Teaching Hospital in Prague, Prague, Czech Republic.
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Lleberia-Juanós J, Bataller-Sánchez E, Pubill-Soler J, Mestre-Costa M, Ribot-Luna L, Vizcaíno MAC. De novo urgency after tension-free vaginal tape versus transobturator tape procedure for stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2011; 155:229-32. [PMID: 21257255 DOI: 10.1016/j.ejogrb.2010.12.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 06/15/2010] [Accepted: 12/27/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the frequency of de novo urgency after tension-free vaginal tape (TVT) compared with the transobturator tape (TOT) procedure in women with stress urinary incontinence (SUI). STUDY DESIGN Prospective study of all consecutive women with urodynamically confirmed SUI undergoing anti-incontinence surgery between January 2000 and January 2008. All procedures were performed by experienced urogynaecologists well trained in TVT and TOT surgery. Assessments were carried out at 1, 6, 12 and, 36 months after surgery. RESULTS The study population included 366 women (mean age 59.5 years), 243 in the TVT group and 123 in the TOT group. The groups were similar in terms of demographics, preoperative data, and cure rates. De novo urgency occurred in 13.4% of patients at 6 months after surgery, in 19.3% at 12 months, and in 22.1% at 36 months. De novo urgency was significantly more frequent in the TVT group than in the TOT group at 12 (22.2% vs 11.2%, P=0.025), 24 (24.8% vs 12.3%, P=0.033), and 36 (0% vs 24.7%, P=0.034) months. Cure rates were similar in both groups. The final adjusted cure rate was 87.3% (319/366). CONCLUSION Treatment of SUI using the TOT procedure was associated with a lower rate of de novo urgency.
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Koski ME, Enemchukwu EA, Padmanabhan P, Kaufman MR, Scarpero HM, Dmochowski RR. Safety and efficacy of sling for persistent stress urinary incontinence after bulking injection. Urology 2011; 77:1076-80. [PMID: 21216448 DOI: 10.1016/j.urology.2010.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 10/07/2010] [Accepted: 10/13/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the impact of injectable agents on subsequent incontinence surgery outcomes to assess safety and efficacy of this treatment combination. Periurethral bulking agents are a minimally invasive treatment option for stress urinary incontinence (SUI), but often lack durability necessitating further surgical intervention. METHODS Retrospective review of 43 patients with SUI following bulking agent who underwent subsequent sling placement from November 2000 to September 2009 were evaluated for demographics, symptoms, urodynamics (UDS), bulking agent characteristics, concomitant procedures, pad requirements per day (PPD), subjective outcomes, and complications. RESULTS Mean patient age was 67 years, with mean follow-up of 37.3 months. All demonstrated SUI, and mixed urinary incontinence (MUI) was noted in 81.4%. Almost half (48.8%) had undergone a prior antiincontinence procedure. Mean number of injections was 3. After a bulking injection, 25 autologous fascia pubovaginal slings, 13 midurethral slings, and 5 biological pubovaginal slings were placed. Concomitant pelvic surgery was performed in 37.2%. Postoperatively, mean PPD decreased from 5.3 to 0.65, with a 60.5% subjective cure rate (no pads or leakage under any circumstances). No association was seen between number or type of injection, or type of sling with regards to patient outcomes. Results were significantly related to concomitant surgery (P = .007). SUI recurred in 8 patients (18.6%), which was not statistically associated with other parameters. Complications included urinary retention (8 patients) de novo urgency (1 patient), UTI (4 patients), abdominal wound infection (3 patients), and cystotomy (1 patient). CONCLUSIONS Prior treatment with bulking agents does not appear to negatively affect outcomes for future antiincontinence surgery in our patient population.
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Affiliation(s)
- Michelle E Koski
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-0001, USA.
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Fong EDM, Nitti VW. Review article: Mid-urethral synthetic slings for female stress urinary incontinence. BJU Int 2010; 106:596-608. [PMID: 21050350 DOI: 10.1111/j.1464-410x.2010.09544.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
• Mid-urethral synthetic slings (MUSS) have grown in acceptance and popularity to gain a foremost position in stress urinary incontinence (SUI) surgery. • There are numerous studies that provide a large amount of Level 1 and 2 evidence that support the concept of a sling placed at the level of the mid-urethra. • Long-term follow-up has been published for the original tension-free vaginal tape (TVT) procedure with the most recent publication providing Level 2 evidence with mean follow-up of 11.5 years of 69/91 (77%) of patients from the original series. There was objective cure was in 90% of women and 77% considered themselves subjectively cured, based on the Patient Global Impression of Improvement. • Level 1 evidence with long-term follow-up has been provided comparing colposuspension to TVT at 2 and 5 years. At 5 years for the primary efficacy variable of a negative 1 h stress pad test, there was no difference in success (81% vs 90%). • Two recent meta-analyses provide Level 1 evidence comparing outcomes for retropubic vs transobturator MUSS. One included 18 studies, randomized and cohort: cohort studies had a 12.3% failure rate for transobturator and 13.7% failure for the retropubic approach, randomized studies showed 5.7% failure in the transobturator vs 7.8% in the retropubic group. The other meta-analysis included 11 studies published 2008-2009, which found that the short-term cure rate was borderline inferior for the transobturator tape group (odds ratio 0.62; 95% confidence interval 0.37-1.00), nearly reaching statistical significance (P= 0.05). • This review details further comparator evidence and evidence for use in specific patient groups (elderly, obese, intrinsic sphincter deficiency, mixed UI).
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Affiliation(s)
- Eva D M Fong
- Department of Urology, New York University Langone Medical Center, New York, NY 10016, USA
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The prevalence and risk factors of overactive bladder symptoms and its relation to pelvic organ prolapse symptoms in a general female population. Int Urogynecol J 2010; 22:569-75. [PMID: 21104400 PMCID: PMC3072516 DOI: 10.1007/s00192-010-1323-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 11/04/2010] [Indexed: 12/02/2022]
Abstract
Introduction and hypothesis To study the prevalence and risk factors of overactive bladder (OAB) symptoms and its relationship with symptoms of pelvic organ prolapse (POP). Methods This is a cross-sectional study including women aged between 45 and 85 years, registered in eight general practices. All women were asked to self complete the validated Dutch translated questionnaires. All symptoms were dichotomized as present or absent based on responses to each symptom and degree of bother. Results Forty-seven percent of the women filled out the questionnaire. Prevalence of urgency was 34% and the prevalence of any OAB symptoms 49%. Prevalence of OAB symptoms increased with advancing age. Symptoms of POP were an independent risk factor for symptomatic OAB. Other risk factors were continence and prolapse surgery in the past, age above 75, overweight, postmenopausal status and smoking. Conclusions The prevalence of any OAB symptoms was 49%. POP symptoms were an independent risk factor for symptomatic OAB.
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Ashok K, Wang A. Detrusor overactivity: an overview. Arch Gynecol Obstet 2010; 282:33-41. [PMID: 20191279 DOI: 10.1007/s00404-010-1407-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 02/09/2010] [Indexed: 11/27/2022]
Abstract
Detrusor overactivity (DO) is a common clinical problem having profound effects on the quality of life (QOL) of women. With the use of meshes in the antiincontinence surgery, a new onset of DO, de novo DO has become an important issue in postoperative QOL of women. A systematic review of English language literature was conducted from Pubmed and publications of the last 7 years were analyzed and presented in this review. Multiple pathological events in the urothelium, sub-urothelium and possibly in the detrusor muscle seem to underlie the pathophysiology of DO. A variety of approaches, from life style modification to minimal-invasive surgery are available to treat DO and it is the responsibility of the physician to properly select and apply these modalities with the ultimate aim in improving the QOL of the patients. It is imperative to know the various pathophysiological processes that underlie the causation of DO to select proper management approach.
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Affiliation(s)
- Kiran Ashok
- Department of Urogynecology, Chang-Gung Memorial Hospital, Linkou, Taiwan.
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Han JY, Song C, Park J, Jung HC, Lee KS, Choo MS. A long-term study of the effects of the tension-free vaginal tape procedure for female stress urinary incontinence on voiding, storage, and patient satisfaction: a post-hoc analysis. Korean J Urol 2010; 51:40-4. [PMID: 20414409 PMCID: PMC2855463 DOI: 10.4111/kju.2010.51.1.40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 09/22/2009] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We assessed the long-term effects of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence (SUI) on voiding, storage, and patient satisfaction. MATERIALS AND METHODS This retrospective study examined the records of 134 patients who had undergone the TVT procedure for SUI and were followed up for more than 5 years. Voiding function was evaluated by measuring maximum urinary flow rate (MFR), post-void residual urine volume (PVR), and storage function by using a voiding diary. Patients were asked to describe their satisfaction with the operation. RESULTS MFR was lower at 1 month compared with the preoperative level, but had recovered to preoperative levels by 5 years postoperatively. However, some patients with >50%, 25-50%, and <25% decreases in the MFR at 1 month postoperatively showed a decrease in the MFR of >50% at 5 years. PVR increased over the 5 postoperative years. Of the patients with urgency and urgency incontinence, 43.8% and 48.1% showed improvement, respectively, whereas new patients developed postoperatively. Thus, the total number of patients with urgency or urgency incontinence remained similar over the 5 years. In those with a changed voiding pattern, patient satisfaction was negatively affected by de novo urgency and urgency incontinence and decreased MFR. CONCLUSIONS Any obstructive effect of the TVT procedure diminished over time in most patients, although a decrease in the MFR was sustained in some patients. With regard to overactive bladder symptoms, some patients were cured and some patients complained of de novo symptoms. The most major factor affecting patient satisfaction was de novo urgency.
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Affiliation(s)
- Ji-Yeon Han
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Long-term efficacy of the tension-free vaginal tape procedure for the treatment of urinary incontinence. Int Urogynecol J 2010; 21:679-83. [DOI: 10.1007/s00192-009-1083-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 12/10/2009] [Indexed: 11/25/2022]
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Maintaining standards for surgery for female urinary incontinence. Maturitas 2010; 65:5-10. [DOI: 10.1016/j.maturitas.2009.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 10/22/2009] [Indexed: 11/20/2022]
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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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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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Ziv E, Stanton SL, Abarbanel J. Significant improvement in the quality of life in women treated with a novel disposable intravaginal device for stress urinary incontinence. Int Urogynecol J 2009; 20:651-8. [DOI: 10.1007/s00192-009-0824-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 01/27/2009] [Indexed: 11/28/2022]
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Factors predictive of outcome in tension-free vaginal tape procedure for urinary stress incontinence in a teaching hospital. Int Urogynecol J 2009; 20:775-80. [DOI: 10.1007/s00192-009-0851-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 02/18/2009] [Indexed: 11/29/2022]
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A critical overview of the evidence base for the contemporary surgical management of stress incontinence. Curr Opin Urol 2008; 18:370-6. [DOI: 10.1097/mou.0b013e3282fdf8d5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nilsson CG, Palva K, Rezapour M, Falconer C. Eleven years prospective follow-up of the tension-free vaginal tape procedure for treatment of stress urinary incontinence. Int Urogynecol J 2008; 19:1043-7. [PMID: 18535753 DOI: 10.1007/s00192-008-0666-z] [Citation(s) in RCA: 328] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 05/18/2008] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the long-term effectiveness and safety of the tension-free vaginal tape (TVT) procedure. In a Nordic three-center prospective observational cohort study, 90 women with primary stress incontinence had a TVT operation performed in local anesthesia. Assessment included a 24-h pad test, a stress test, physical examination, and a visual analog scale for assessing the degree of bother. Patient's global impression of cure was obtained, and condition specific quality of life questionnaires were used. Seventy-seven percent of the initial cohort of 90 women and 89% of those alive and capable of cooperating were assessed 11.5 years after the TVT operation. Ninety percent of the women had both a negative stress test and a negative pad test being objectively cured. Subjective cure by patients global impression was found in 77%, 20% being improved and only 3% regarded the operation as a failure. No late-onset adverse effects of the operation were found, and no case of tape erosion was seen. The TVT procedure is safe and effective for more than 10 years.
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Affiliation(s)
- C G Nilsson
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Haartmaninkatu 2, Helsinki, POB 140, 00029 HUS, Finland.
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Lee SH, Kim TB, Kim KH, Jung H, Lee MS, Yoon SJ. Preliminary Report on a Modified Surgical Technique Using Canal Transobturator Tape for the Treatment of Female Stress Urinary Incontinence. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.12.1119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sung Hoon Lee
- Department of Urology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Tae Beom Kim
- Department of Urology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Khae Hawn Kim
- Department of Urology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Han Jung
- Department of Urology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Min Sung Lee
- Department of Urology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Sang Jin Yoon
- Department of Urology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
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Torres Zambrano G, Lujan Galán M, Martín García C, García Tello A, Rodríguez N, Berenguer Sánchez A. [Urinary stress incontinence: surgical experience in our center]. Actas Urol Esp 2007; 31:858-62. [PMID: 18020210 DOI: 10.1016/s0210-4806(07)73740-3] [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: 11/19/2022]
Abstract
INTRODUCTION For the treatment of the urinary stress incontinence, there are many techniques, and today the gold standard is that described by Burch. We compared the global and each technique results about rates of postoperative continence and complications seen in our experience. MATERIALS AND METHODS We made a retrospective analysis of 292 women that have the first surgery for urinary stress incontinence in our centre, between 1991 and 2006. We considered cure the patient who did not have any level of incontinence postoperative, we made a Kaplan-Meier analysis for the postoperative continence evaluation. Besides we studied the behaviour of the postoperative complications found. RESULTS Mean age was 53.6 years old, and mean time of follow up was 15.6 months. The vaginal techniques were the most practised (138), followed by the TVT (57), abdominal Burch (38), vaginal wall Sling (33), and the less was the laparoscopic Burch (26). The best rates of postoperative continence after 2 years were observed in the patients treated by TVT (87.6%), then with vaginal wall Sling (84.9%), laparoscopic Burch (59.3%), abdominal Burch (59.1%), and the worst with vaginal techniques (48.2%) (p = 0.007). We found more urgency and urge incontinence in the patients treated by TVT (36.8% y 21.1% respectively), and postoperative pain with vaginal techniques (36.2%). Postoperative urine retention and postoperative high residual urine more with the vaginal wall sling (54.5%) and vaginal techniques (26.1%) respectively. CONCLUSIONS We have the best results for the incontinence treatment in our population with the TVT technique.
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