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Rapp DE, Farhi J, DeNovio A, Barquin D, Mallawaarachchi I, Ratcliffe SJ, Hutchison D, Greene KL. Comparison of In-person FPMRS-directed Pelvic Floor Therapy Program Versus Unsupervised Pelvic Floor Exercises Following Prostatectomy. Urology 2023; 178:54-60. [PMID: 37353089 DOI: 10.1016/j.urology.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To compare comprehensive continence outcomes in patients receiving pelvic floor muscle training (PFMT) vs standard unsupervised home pelvic floor exercise therapy (UPFE). METHODS As part of the UVA prostatectomy functional outcomes program, participating patients complete a 12-month PFMT program under FPMRS specialist supervision. We performed a retrospective review of prospectively collected longitudinal outcomes in patients receiving PFMT vs UPFE through 12-month follow-up. Primary study outcome was ICIQ-MLUTS SUI domain score (SDS). Secondary outcomes included daily pad use (PPD), SUI Cure (SDS=0), and quality of life score (IIQ-7). Multilevel mixed effects linear regression was used to model SDS over time. RESULTS Analysis included 40 men. No difference in patient characteristics was seen in comparison of PFMT vs UPFE cohorts (P = NS, all comparisons). Mean predicted SDS was significantly better in the PFMT vs UPFE cohorts at 6-month (0.81 ± 0.21 vs 1.75 ± 0.34, respectively) (P = .014) and 12-month (0.72 ± 0.17 vs 1.67 ± 0.30, respectively) (P = .004) time points. At 12-month follow-up, 11 (55%) vs 4 (20%) patients reported absence of SUI in PFMT vs UPFE cohorts, respectively. Predicted probabilities of SUI cure in PFMT vs UPFE cohorts at 12months were 0.52 ± 0.14 vs 0.23 ± 0.13, respectively (P = .14). At 12-month follow-up, the mean predicted PPD and IIQ score was 0.19 ± 0.10 vs 0.79 ± 0.33 and 2.86 ± 0.86 vs 2.55 ± 1.07 in PFMT vs UPFE cohorts, respectively (P = NS). CONCLUSION In-person, FMPRS-directed PFMT is associated with improved SUI domain scores following robotic-assisted laparoscopic prostatectomy, a finding durable through 12-month follow-up.
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Affiliation(s)
- David E Rapp
- Department of Urology, University of Virginia, Charlottesville, VA.
| | - Jacques Farhi
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Anthony DeNovio
- University of Virginia School of Medicine, Charlottesville, VA
| | - David Barquin
- University of Virginia School of Medicine, Charlottesville, VA
| | | | - Sarah J Ratcliffe
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Dylan Hutchison
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Kirsten L Greene
- Department of Urology, University of Virginia, Charlottesville, VA
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Hutchison D, Ali M, Zillioux J, Ortiz NM, Smith R, Rapp DE. Pelvic Floor Muscle Training in the Management of Female Pelvic Floor Disorders. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Krzastek SC, Rapp DE. Concurrent Repair of Stress Incontinence and Pelvic Organ Prolapse: Impact on Surgical Outcomes and Additional Considerations. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00521-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Effect of Concurrent Prolapse Surgery on Stress Urinary Incontinence Outcomes After TVTO. Female Pelvic Med Reconstr Surg 2018; 23:244-249. [PMID: 28106648 DOI: 10.1097/spv.0000000000000364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES A variety of pelvic organ prolapse (POP) surgeries are performed concomitant to midurethral sling (MUS) placement. It is unknown whether differing POP surgeries may affect stress urinary incontinence outcomes after MUS placement. METHODS We performed a retrospective cohort analysis of patients undergoing TVT obturator system in conjunction with a variety of POP repair (cystocele with mesh graft, cystocele with cadaveric fascia, colpocleisis, and sacrocolpopexy). Primary outcomes included validated measures of stress urinary incontinence (International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms), measured preoperatively and at 6 week, 1 year, and 2 years postoperatively. Secondary outcomes included validated questionnaire items focused on obstructive and irritative symptoms. Multivariate analyses using mixed-effects regressions were used to assess for differences in outcomes based on POP repair type. RESULTS A total of 102 patients were identified for study analysis (cystocele with mesh graft, n = 45; cystocele with cadaveric fascia, n = 37; sacrocolpopexy, n = 16; colpocleisis, n = 4). Four patients undergoing colpocleisis were excluded from primary analysis given lack of sufficient cohort size. When adjusted for effects of covariates, significant improvements in primary and secondary outcomes were seen throughout follow-up in comparison with baseline. In general, multivariate analysis demonstrated no significant differences between surgeries when assessing primary and secondary outcomes. The only statistically significant difference in change over time comprised CM, which demonstrated superior improvement in International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (preoperative vs 2 year, P = 0.04). CONCLUSIONS Regardless of POP surgery type, patients demonstrate improvements in validated SUI outcomes through 2 years. Multivariate analysis suggests that there is little difference in SUI outcomes after TVT obturator system across several different POP repair types.
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McCoy O, Vaughan T, Nickles SW, Ashley M, MacLachlan LS, Ginsberg D, Rovner E. Outcomes of Autologous Fascia Pubovaginal Sling for Patients with Transvaginal Mesh Related Complications Requiring Mesh Removal. J Urol 2016; 196:484-9. [PMID: 26997314 DOI: 10.1016/j.juro.2016.02.2976] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE We reviewed the outcomes of the autologous fascial pubovaginal sling as a salvage procedure for recurrent stress incontinence after intervention for polypropylene mesh erosion/exposure and/or bladder outlet obstruction in patients treated with prior transvaginal synthetic mesh for stress urinary incontinence. MATERIALS AND METHODS In a review of surgical databases at 2 institutions between January 2007 and June 2013 we identified 46 patients who underwent autologous fascial pubovaginal sling following removal of transvaginal synthetic mesh in simultaneous or staged fashion. This cohort of patients was evaluated for outcomes, including subjective and objective success, change in quality of life and complications between those who underwent staged vs concomitant synthetic mesh removal with autologous fascial pubovaginal sling placement. RESULTS All 46 patients had received at least 1 prior mesh sling for incontinence and 8 (17%) had received prior transvaginal polypropylene mesh for pelvic organ prolapse repair. A total of 30 patients underwent concomitant mesh incision with or without partial excision and autologous sling placement while 16 underwent staged autologous sling placement. Mean followup was 16 months. Of the patients 22% required a mean of 1.8 subsequent interventions an average of 6.5 months after autologous sling placement with no difference in median quality of life at final followup. At last followup 42 of 46 patients (91%) and 35 of 46 (76%) had achieved objective and subjective success, respectively. There was no difference in subjective success between patients treated with a staged vs a concomitant approach (69% vs 80%, p = 0.48). CONCLUSIONS Autologous fascial pubovaginal sling placement after synthetic mesh removal can be performed successfully in patients with stress urinary incontinence as a single or staged procedure.
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Affiliation(s)
- Olugbemisola McCoy
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Taylor Vaughan
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - S Walker Nickles
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Matt Ashley
- Department of Urology, University of Southern California, Los Angeles, California
| | | | - David Ginsberg
- Department of Urology, University of Southern California, Los Angeles, California
| | - Eric Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina.
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Satisfaction in patients undergoing concurrent pelvic floor surgery for stress urinary incontinence and pelvic organ prolapse. Female Pelvic Med Reconstr Surg 2014; 20:23-6. [PMID: 24368484 DOI: 10.1097/spv.0000000000000051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Simultaneous repair of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) is common. In these cases, determinants of patient satisfaction are complicated given that surgical success may be achieved in one component but not the other. We sought to assess satisfaction in patients undergoing multiple pelvic surgeries. METHODS We performed a review of 89 women undergoing concomitant POP repair and midurethral sling (MUS) placement. Focus was placed on patient-reported satisfaction rates. Validated measures were used to evaluate outcomes after MUS [International Consultation on Incontinence Questionnaire (ICIQ)-Female Lower Urinary Tract Symptoms, SUI item; pad use] and POP repair (ICIQ-Vaginal Symptoms; POPQ stage). RESULTS At 1-year evaluation, 78 (88%) women reported satisfaction. Assessment identified combined cure of both POP/SUI in 64 (72%) patients, in contrast to failure of MUS, POP repair, and both repairs in 15 (17%) patients, 9 (10%) patients, and 1 (1%) patient, respectively. Subset analysis revealed dissatisfaction in 5% (3/64) of patients achieving complete cure of both SUI and POP. In contrast, 40% (6/15) were dissatisfied if there was failure to cure SUI, 22% (2/9) if failure to cure POP, and the patient with failure of both was not dissatisfied. The ICIQ-Vaginal Symptoms domain score for vaginal bulge was the only assessed outcome demonstrating a statistical relationship with patient-reported satisfaction. CONCLUSIONS Among women achieving cure of both SUI and POP via concurrent surgical repair, 95% reported satisfaction. Interestingly, a variety of outcomes measures fail to correlate with satisfaction. Further, in patients with complete cure of concurrent pelvic surgeries, a percentage still report dissatisfaction, highlighting the complicated nature of patient satisfaction.
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Firoozi F, Gill B, Ingber MS, Moore CK, Rackley RR, Goldman HB, Vasavada SP. Increasing Patient Preparedness for Sacral Neuromodulation Improves Patient Reported Outcomes Despite Leaving Objective Measures of Success Unchanged. J Urol 2013; 190:594-7. [DOI: 10.1016/j.juro.2013.03.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Farzeen Firoozi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bradley Gill
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael S. Ingber
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Courtenay K. Moore
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Raymond R. Rackley
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Howard B. Goldman
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sandip P. Vasavada
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Welk BK, Herschorn S. The autologous fascia pubovaginal sling for complicated female stress incontinence. Can Urol Assoc J 2012; 6:36-40. [PMID: 22396366 DOI: 10.5489/cuaj.11117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this study is to review our contemporary experience with autologous fascia pubovaginal slings (AF-PVS) in the era of the midurethral sling. METHODS A retrospective review was completed to identify all patients who underwent an AF-PVS between 2002 and 2009. A cross-sectional questionnaire was used to assess postoperative urinary-specific quality of life (consisting of the Urogenital Distress Inventory [UDI-6] and the Incontinence Impact Questionnaires [IIQ-7]). RESULTS We identified 33 patients. They had failed a median of two previous incontinence treatments. Of these patients, 16 (48%) had failed a previous midurethral sling, and of these half had experienced a significant mesh erosion necessitating mesh removal. Preoperative median incontinence pad usage was 5/day. After a median follow-up of 16 months from the time of AF-PVS, the median pad usage had decreased to 1/day (p = 0.003). A third of the patients had postoperative urgency, and only 1 patient continues to use intermittent catheterization. The median IIQ-7 score was 19/100, and the median UDI-6 score was 44/100. Overall quality of life was mixed-to-delighted in 62% of patients. CONCLUSIONS The AF-PVS has reasonable outcomes in a diverse population of patients, despite failure of other treatment modalities.
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Affiliation(s)
- Blayne K Welk
- Sunnybrook Hospital, Division of Urology, University of Toronto, Toronto, ON
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Li H, Gill BC, Nowacki AS, Montague DK, Angermeier KW, Wood HM, Vasavada SP. Therapeutic durability of the male transobturator sling: midterm patient reported outcomes. J Urol 2012; 187:1331-5. [PMID: 22341294 DOI: 10.1016/j.juro.2011.11.091] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE The male transobturator AdVance™ sling is a viable option for mild to moderate post-prostatectomy incontinence. As this treatment is relatively new, our study provides an analysis of efficacy through patient reported outcomes and pad use. MATERIALS AND METHODS A telephone survey and chart review were conducted on all patients receiving a sling before 2010 by either of 2 surgeons at a large academic institution. The survey included the Patient Global Impression of Improvement and Severity instruments, pad use characteristics before and after sling surgery, and items assessing durability of efficacy. Patient determined (subjective) success was very much or much better on the Patient Global Impression of Improvement without subsequent incontinence therapy. Quantitative success was defined as a decrease to 2 or fewer pads per day. We assessed therapeutic durability in a subanalysis of patients interviewed twice, first in a prior study. RESULTS From initial office followup to 2 years, quantitative success decreased from 87.3% to 62.5% and pad use doubled from a mean±SD of 0.8±1.7 to 1.7±2.5 pads per day. Patient determined success was 53.6% at 2 years. A subgroup of 25 patients interviewed at 7 and 29 months after sling surgery had quantitative success significantly decrease by 20% (p=0.03), subjective success decrease by 4% (p=0.56) and pad use significantly increase (p=0.01) from 1.4±2.2 to 2.3±3.2 pads per day. CONCLUSIONS Most patients receiving the AdVance sling did see improvement in post-prostatectomy incontinence and a decrease in pad use, but in 20% of patients this benefit decreased with time. Nevertheless, patients remained satisfied and perceived the treatment as successful.
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Affiliation(s)
- Hanhan Li
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio 44195, USA
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Siracusano S, Ciciliato S, Lampropoulou N, Cucchi A, Visalli F, Talamini R. Porcine small intestinal submucosa implant in pubovaginal sling procedure on 48 consecutive patients: long-term results. Eur J Obstet Gynecol Reprod Biol 2011; 158:350-3. [PMID: 21741749 DOI: 10.1016/j.ejogrb.2011.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 06/02/2011] [Accepted: 06/09/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The long-term efficacy of pubovaginal sling (PVS) procedure with porcine small intestinal submucosa (SIS) implant was retrospectively assessed. STUDY DESIGN Forty-eight patients with SUI underwent a pubovaginal sling with SIS. Patient evaluation included history, physical examination with stress test and prolapse assessment by Baden-Walker classification, routine laboratory tests, 24h-pad test, and multichannel urodynamic measurement. Postoperatively the patients were classified as cured, improved and unchanged or failed. A King's Health Questionnaire (KHQ) was performed to verify post-operatively the quality of life of these patients. RESULTS At median follow-up of 76 months 33/48 (69%) were cured, 6/48 (12%) were improved while 9/48 (19%) were failed or unchanged. No urinary retention or dyspareunia was reported and no vaginal erosion or adverse tissue reaction was detected. The descriptive statistics of KHQ scores by dimensions was done in 32/48 patients (67%). Failed or unchanged patients showed worse scores than cured and improved patients in all KHQ dimensions showing an overall overlapping between objective and subjective results although these findings are weakened due to the lack of a preoperative evaluation of QoL. CONCLUSIONS PVS procedure using SIS cannot offer a durable option for the treatment of SUI as reported by the current mininvasive techniques.
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Cameron AP, Haraway AM. The treatment of female stress urinary incontinence: an evidenced-based review. Open Access J Urol 2011; 3:109-20. [PMID: 24198643 PMCID: PMC3818941 DOI: 10.2147/oaju.s10541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To review the literature on the surgical and nonsurgical treatment options for stress urinary incontinence in women, focusing exclusively on randomized clinical trials and high quality meta-analyses. MATERIALS AND METHODS A computer-aided and manual search for published randomized controlled trials and high quality meta-analyses investigating both conservative and surgical treatment options for stress urinary incontinence. In the case of a treatment that is not studied in these formats large case series have been used. RESULTS Articles were reviewed and the results summarized on pelvic floor physical therapy, pharmacotherapy, bulking agents, and surgery (open and minimally invasive). CONCLUSION There are numerous high quality studies in the literature. It can be difficult to make definitive conclusions on the most appropriate treatment options due to the variability in the outcomes used to define success in these articles. There is also a dire lack of studies evaluating and comparing the surgical options for patients with intrinsic sphincter deficiency.
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Affiliation(s)
- Anne P Cameron
- Department of Urology, Division of Neurourology and Pelvic Floor Reconstruction, University of Michigan Health System, Ann Arbor, MI, USA
| | - Allen McNeil Haraway
- Department of Urology, Division of Neurourology and Pelvic Floor Reconstruction, University of Michigan Health System, Ann Arbor, MI, USA
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The Suprapubic Arch Sling Procedure for Treatment of Stress Urinary Incontinence: A 5-Year Retrospective Study. Eur Urol 2010; 57:897-901. [DOI: 10.1016/j.eururo.2009.09.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 09/25/2009] [Indexed: 11/21/2022]
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TOT for treatment of stress urinary incontinence: how should we assess its equivalence with TVT? Int Urogynecol J 2010; 21:947-53. [DOI: 10.1007/s00192-010-1138-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
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Zimmern P, Kobashi K, Lemack G. Outcome measure for stress urinary incontinence treatment (OMIT): Results of two society of urodynamics and female urology (SUFU) surveys. Neurourol Urodyn 2010; 29:715-8. [DOI: 10.1002/nau.20840] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Stav K, Dwyer PL, Rosamilia A, Lee J. Long-term outcomes of patients who failed to attend following midurethral sling surgery - A comparative study and analysis of risk factors for non-attendance. Aust N Z J Obstet Gynaecol 2010; 50:173-8. [PMID: 20522076 DOI: 10.1111/j.1479-828x.2010.01138.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kobi Stav
- Department of Urogynaecology, Melbourne University, Mercy Hospital for Women, 163 Studley Road, Heidelberg, Victoria 3084, Australia.
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Patient perceived effectiveness of a new male sling as treatment for post-prostatectomy incontinence. J Urol 2010; 183:247-52. [PMID: 19913826 DOI: 10.1016/j.juro.2009.08.159] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Objective measures show the AdVance() sling provides some benefit in post-prostatectomy incontinence. To our knowledge no validated, patient determined outcomes have been used to assess this procedure. We described the patient perceived effectiveness and postoperative complications. MATERIALS AND METHODS A retrospective chart review was followed by a telephone survey consisting of the Patient Global Impression of Improvement, Patient Global Impression of Severity, and questions about recommending the surgery, daily pad use and complications. Successful outcomes were Patient Global Impression of Improvement responses of very much better or much better without further incontinence treatment. Objective success is defined as pad-free or a reduction to 2 or less pads daily. RESULTS A total of 35 patients received the sling a median of 25 months after prostatectomy. Telephone surveys were administered a mean of 35 weeks after the sling procedure and 33 patients were contacted. Of the cases 18 (51.4%) and 21 (60%) were patient determined and objective successes, respectively. Of the patients with subjective treatment failure 3 would recommend the surgery to a friend and 12 were undecided or would not. Furthermore, no patients with subjective treatment failure were pad-free and 10 (58.8%) had pads that were mostly wet on changing. For the entire population a reduction in median daily pad use from 2.5 to 1 was observed as well as a strong association (p <0.01) between Patient Global Impression of Improvement and Patient Global Impression of Severity responses. Three individuals pursued further treatment with bulking agents and 3 had retention that resolved. CONCLUSIONS The AdVance sling is safe, and demonstrates similar subjective and objective outcomes. The procedure can benefit some individuals with post-prostatectomy incontinence and, therefore, may be another treatment option for this condition.
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Effect of Transobturator Tape on Overactive Bladder Symptoms and Urge Urinary Incontinence in Women With Mixed Urinary Incontinence. Obstet Gynecol 2009; 113:617-623. [DOI: 10.1097/aog.0b013e31819639e3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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