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Braga A, Serati M. New Advances in Female Pelvic Floor Dysfunction Management. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1010. [PMID: 37374214 DOI: 10.3390/medicina59061010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
Pelvic floor dysfunctions (PFDs), which include various disorders such as urinary and anal incontinence, pelvic organ prolapse, and sexual disorders, are widespread amongst females, so much so that they affect one fifth of adult women [...].
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy
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Serati M, Giammò A, Carone R, Ammirati E, Gubbiotti M, Ruffolo A, Salvatore S, Scancarello C, Castronovo F, Caccia G, Braga A. Bulking agents for the treatment of recurrent stress urinary incontinence: a suitable option? Minerva Urol Nephrol 2022; 74:747-754. [PMID: 33949184 DOI: 10.23736/s2724-6051.21.04269-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The management of recurrent female stress urinary incontinence (SUI) still needs worldwide standardization. Few data on the role of urethral bulking agents (UBA) for the treatment of recurrent stress urinary incontinence exist. The aim of this study is to assess the efficacy and safety of urethral bulking agents for the treatment of recurrent SUI. METHODS A multicenter, prospective study was conducted in four tertiary referral centers in two countries. All consecutive women with urodynamically-proven recurrent SUI, and with a history of previous failed anti-incontinence surgical procedure (mid-urethral sling or single incision sling), treated by UBAs were included. We evaluated only patients who completed at least a 3-year follow-up. Data regarding subjective outcomes (International Consultation on Incontinence Questionnaire-Short Form, Patient Global Impression of Improvement, Urogenital Distress Inventory score and patient satisfaction score), objective cure (stress test) rates, and adverse events were collected during follow-up. Univariable and multivariable analyses was performed to investigate outcomes. RESULTS Forty-seven consecutive patients were enrolled. At 3-year follow-up, all women were available for the evaluation. At 3 years after surgery, 38 of 47 patients (81%) declared themselves cured. Similarly, at 3-year evaluation, 39 of 47 patients (83%) were objectively cured. Only five patients (10.6%) required re-operation for UBA failure. The urodynamic diagnosis of preoperative detrusor overactivity and the PDet Max filling phase ≥15 cmH<inf>2</inf>O (hazard ratio: 2.74; 95% CI, 1.64-10.7; P=0.009 and 1.62; 95% CI, 1.11-3.42; P=0.04, respectively) were the only predictors of failure. Only four complications were reported (8.5%). CONCLUSIONS The 3-year results of this study showed that bulking agents is an appropriately effective and safe option for the treatment of recurrent SUI. The presence of preoperative concomitant detrusor overactivity is associated with a significant decrease of the efficacy of this procedure.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy.,European Urogynecological Association (EUGA), Piacenza, Italy
| | - Alessandro Giammò
- Department of Neuro-Urology, Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Roberto Carone
- Department of Neuro-Urology, Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Enrico Ammirati
- Department of Neuro-Urology, Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Marilena Gubbiotti
- Department of Urology, San Donato Hospital, Arezzo, Italy.,InVita Research Center, Serafico Institute, Assisi, Perugia, Italy
| | - Alessandro Ruffolo
- Department of Obstetrics and Gynecology, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Fabiana Castronovo
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland - .,Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
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Braga A, Caccia G, Papadia A, Castronovo F, Salvatore S, Scancarello C, Torella M, Ghezzi F, Serati M. The subjective and objective very long-term outcomes of TVT in the COVID era: A 20-year follow-up. Int Urogynecol J 2022; 33:947-953. [PMID: 35230479 PMCID: PMC8886556 DOI: 10.1007/s00192-022-05094-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022]
Abstract
Introduction and hypothesis Few studies in literature have assessed the long-term durability and mesh-related complications of mid-urethral slings (MUSs). The aim of this study is to assess the efficacy and safety of retro-pubic tension-free vaginal tape (TVT) 20 years after implantation for the treatment of female stress urinary incontinence (SUI). Methods A prospective observational study was conducted in two urogynaecologic units in two countries. All the patients involved were consecutive women with urodynamically proven pure SUI treated by TVT. The patients underwent preoperative clinical and urodynamic evaluations. Subjective outcomes, objective outcomes and adverse events were recorded during the follow-up period. Results Fifty-two patients underwent a TVT surgical procedure. Twenty years after surgery, 32 out of 36 patients (88.8%) declared themselves cured (p = 0.98). Similarly, 33 out of these 36 patients (91.7%) were objectively cured (p = 0.98). No significant deterioration of subjective and objective cure rates was observed over time (p for trend 0.50 and 0.48). Fifteen of the 36 patients (41.6%) at the 20-year follow-up reported the onset of de novo overactive bladder (OAB) (p = 0.004). No significant vaginal bladder or urethral erosion or de novo dyspareunia was recorded and no patient required tape release or resection during this period. The cause of death of seven out of ten women who died in the last year of the follow-up period was coronavirus disease 19 (COVID 19). Conclusions The 20-year results of this study showed that TVT is a highly effective and safe option for the treatment of SUI. The impact of COVID 19 on the mortality rate of elderly women has drastically reduced the number of eligible patients for future evaluations in our region.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland. .,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Giorgio Caccia
- Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Andrea Papadia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Obstetrics and Gynaecology, EOC - Civico Hospital, Lugano, Switzerland
| | - Fabiana Castronovo
- Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Stefano Salvatore
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy
| | - Marco Torella
- Department of Gyanecology, Obstetric and Reproductive Science, Second University of Naples, Naples, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy
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Gomelsky A, Steckenrider H, Dmochowski RR. Urgency and urgency incontinence following stress urinary incontinence surgery: A review of evaluation and management. Indian J Urol 2022; 38:268-275. [PMID: 36568453 PMCID: PMC9787445 DOI: 10.4103/iju.iju_147_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/30/2022] [Accepted: 07/04/2022] [Indexed: 12/27/2022] Open
Abstract
The presence of urgency urinary incontinence (U/UUI) after sling surgery is a common reason for dissatisfaction and imposition on quality of life. We aimed to evaluate and analyze the pathophysiology, evaluation, and treatment of U/UUI after sling surgery. A MEDLINE review was performed for relevant, English-language articles relating to storage and emptying symptoms after sling surgery. U/UUI may persist, be improved, or worsen in women with preoperative mixed urinary incontinence and may appear de novo in those women originally presenting with pure stress urinary incontinence (SUI). While the exact mechanism is not clear, partial bladder outlet obstruction (BOO) should always be suspected, especially in those women with worsened or de novo symptoms soon after sling surgery. Initial workup should elucidate the temporality, quality, and bother associated with symptoms and to evaluate the woman for urinary tract infection (UTI), pelvic organ prolapse (POP), or perforation of the lower urinary tract. The utility of urodynamics in attaining a definitive diagnosis of BOO is inconclusive. Treatment options include reevaluation of the patient after sling incision or after addressing UTI, POP, and perforation of the bladder or urethra. Women also typically undergo a multitiered approach to storage lower urinary tract symptoms outlined in the American Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Overactive Bladder Guidelines. While improvement is typically seen with multimodality treatment, all women should be counseled regarding need for additional treatment for U/UUI, BOO, and SUI in the future.
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Affiliation(s)
- Alex Gomelsky
- Department of Urology, LSU Health Shreveport, Shreveport, LA, USA
| | | | - Roger R. Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Tennessee, USA,
E-mail:
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3-Year follow-up of tension-free vaginal tape-ABBREVO procedure for the treatment of pure urodynamic stress urinary incontinence: efficacy and adverse effects. Int Urogynecol J 2019; 31:739-744. [PMID: 31463528 DOI: 10.1007/s00192-019-04096-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The tension-free vaginal tape ABBREVO (TVT-A) is a new surgical procedure for the treatment of female stress urinary incontinence (SUI). However, data reporting medium- and long-term outcomes are lacking. The aim of the study was to assess the efficacy and safety of TVT-A in patients with at least a 3-year follow-up. METHODS All consecutive women who complained of pure SUI symptoms with urodynamically proven SUI undergoing a TVT-A procedure were prospectively enrolled. Data regarding subjective outcomes (International Consultation on Incontinence Questionnaire-Short Form, Patient Global Impression of Improvement and patient satisfaction scores), objective cure (stress test) rates and adverse events were collected during follow-up. Univariate analysis was performed to investigate outcomes. RESULTS A total of 41 women underwent TVT-A implantation. At 3-year follow-up, 40 women (97.5%) were available for the evaluation. We did not find any significant change in surgical outcomes during this time. At 3 years after surgery, 36 of 40 (90%) patients were subjectively cured (p for trend 0.18) and 37 out of 40 (92.5%) patients were objectively cured (p for trend 0.22). The univariate analysis did not find any risk factor statistically associated with the recurrence of SUI. A significant trend of de novo overactive bladder (OAB) occurrence was registered at the 3-year follow-up (p for trend = 0.03). No serious late complications or groin-thigh pain were reported. CONCLUSIONS TVT-A implantation is a highly effective option for the treatment of women with pure SUI.
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Pereira E Silva R, Gomes Olival V, Ponte C, Palma Dos Reis J, Colaço J, Grilo I, Nunes F. Overactive Bladder Symptoms after Transobturator Sling Surgery for Pure Stress Urinary Incontinence: A Cross-Sectional Comparative Study. Urol Int 2018; 100:428-433. [PMID: 29649817 DOI: 10.1159/000488204] [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: 10/09/2017] [Accepted: 03/06/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Transobturator tape (TOT) surgery has been associated with increased overactive bladder (OAB) although much controversy exists. METHODS In a cross-sectional study, women who underwent TOT surgery for pure stress incontinence (MonarcTM) answered the 6 questions of the symptom bother (SB) subscale of the OAB questionnaire - short form (OABq-SF) and an additional question regarding whether symptoms began after surgery. Women with SB score over the 4th quartile (≥30/100) were reassessed after a longer follow-up. Patients from primary care were recruited as controls. RESULTS We recruited 213 patients (135 in the TOT group and 78 age-adjusted controls). The mean age of operated patients was 58.7 ± 10.1 years with a mean follow-up of 25.9 ± 13.2 months. OABq-SF SB scores did not differ between the TOT group and controls (respectively, 18.5 ± 30 and 15.5 ± 6.7, p = 0.202). A total of 48% patients reported no relationship between symptoms and surgery. Highly symptomatic operated patients were reassessed after a longer follow-up (46.3 ± 10.6 months). The mean score in the second follow-up (n = 25) was not statistically different from the first assessment (46.4 ± 22.7 and 58.1 ± 19.8, p = 0.059). CONCLUSIONS Women who underwent TOT surgery did not show increased OAB SB scores when compared to controls. Our study suggests that OAB symptoms may thus be present but overlooked during initial clinical assessment.
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Affiliation(s)
| | - Vanessa Gomes Olival
- Department of Gynecology and Obstetrics, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Carolina Ponte
- Department of Urology, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | | | - João Colaço
- Department of Gynecology and Obstetrics, Hospital de Cascais, Cascais, Portugal
| | - Isabel Grilo
- Department of Gynecology and Obstetrics, Hospital de Cascais, Cascais, Portugal
| | - Filomena Nunes
- Department of Gynecology and Obstetrics, Hospital de Cascais, Cascais, Portugal
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Braga A, Caccia G, Sorice P, Cantaluppi S, Coluccia AC, Di Dedda MC, Regusci L, Ghezzi F, Uccella S, Serati M. Tension-free vaginal tape for treatment of pure urodynamic stress urinary incontinence: efficacy and adverse effects at 17-year follow-up. BJU Int 2018; 122:113-117. [PMID: 29468798 DOI: 10.1111/bju.14136] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology; EOC - Beata Vergine Hospital; Mendrisio Switzerland
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology; EOC - Beata Vergine Hospital; Mendrisio Switzerland
| | - Paola Sorice
- Department of Obstetrics and Gynecology; G. Fornaroli Hospital; Magenta Italy
| | - Simona Cantaluppi
- Department of Obstetrics and Gynecology; University of Insubria; Varese Italy
| | | | | | - Luca Regusci
- Department of Obstetrics and Gynecology; EOC - Beata Vergine Hospital; Mendrisio Switzerland
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology; University of Insubria; Varese Italy
| | - Stefano Uccella
- Department of Woman and Child Health; Fondazione Policlinico Gemelli; Rome Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology; University of Insubria; Varese Italy
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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: 27] [Impact Index Per Article: 3.9] [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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Petrikovets A, Mahajan ST. De Novo Overactive Bladder Symptoms After Sling Placement. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0405-8] [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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Intravesical OnabotulinumtoxinA Injection for Overactive Bladder Patients with Frailty, Medical Comorbidities or Prior Lower Urinary Tract Surgery. Toxins (Basel) 2016; 8:91. [PMID: 27023603 PMCID: PMC4848618 DOI: 10.3390/toxins8040091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 02/01/2023] Open
Abstract
Overactive bladder (OAB) symptoms increase with age and involve several comorbidities. OnabotulinumtoxinA (BoNT-A) intravesical injection is a treatment choice for patients who are intolerant of or refractory to antimuscarinics. However, the increased risk of urinary tract infection and elevated post-void residual (PVR) volume post-treatment require resolution. Male sex, baseline PVR > 100 mL, and comorbidities are independent risk factors of adverse events (AEs) such as acute urinary retention (AUR). Intravesical BoNT-A injection is safe and effective for OAB patients with frailty, medical comorbidities such as Parkinson's disease (PD), chronic cerebrovascular accidents (CVA), dementia, or diabetes, or a history of prior lower urinary tract surgery (prostate or transvaginal sling surgery). Post-treatment, 60% of frail elderly patients had a PVR volume > 150 mL and 11% had AUR. Although intravesical BoNT-A injection is safe for PD patients, CVA patients had higher strain voiding rates. Diabetic patients were at increased risk of large PVR urine volume and general weakness post-treatment. Treatment results were similar between patients with and without a history of prostate or transvaginal sling surgery. Possible AEs and bladder management strategies should be conveyed to patients before treatment. Careful patient selection is important, and therapeutic safety and efficacy should be carefully balanced.
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Miotla P, Futyma K, Cartwright R, Bogusiewicz M, Skorupska K, Markut-Miotla E, Rechberger T. Effectiveness of botulinum toxin injection in the treatment of de novo OAB symptoms following midurethral sling surgery. Int Urogynecol J 2015; 27:393-8. [PMID: 26364180 PMCID: PMC4766229 DOI: 10.1007/s00192-015-2839-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
Abstract
Introduction and hypothesis Intravesical onabotulinumtoxinA (Botox®) is effective for idiopathic overactive bladder (OAB) symptoms. Our primary objective was to compare the efficacy of onabotulinumtoxinA for women with de novo OAB after midurethral sling (MUS) surgery and women with idiopathic OAB. Methods Women enrolled in this prospective study had idiopathic (n = 53) or de novo (n = 49) OAB symptoms after MUS, with at least one episode of urgency urine incontinence per day. OnabotulinumtoxinA (100 U) was administered in 20 intradetrusor injections. Postvoid residual volumes were checked at 2, 4 and 12 weeks. Participants completed a 3-day bladder diary and the King’s Health Questionnaire (KHQ) before and 12 weeks after treatment. Results After 12 weeks, 22 patients (41.5 %) in the idiopathic OAB and 19 patients (38.8 %) in the de novo OAB groups were completely dry. OnabotulinumtoxinA injections had a significant benefit within both groups (p <0.001) to decrease both the daily numbers of voids (−2.39 and −2.0) and incontinence episodes (−1.38 and −1.44), with no significant difference between groups. We observed an increase of mean voided volume of >90 ml in both groups. Urinary retention was observed in four patients. Conclusions We observed similar improvement in OAB symptoms after intravesical onabotulinumtoxinA injections within both groups. The rates of retention and requirement for catheterization even for women with a prior MUS were acceptable. These observational data provide evidence that onabotulinumtoxinA can effectively treat patients with OAB following stress urinary incontinence surgery.
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Affiliation(s)
- Pawel Miotla
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland.
| | - Konrad Futyma
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Rufus Cartwright
- Department of Epidemiology and Biostatistics; Department of Urogynaecology, Imperial College London, London, UK
| | - Michal Bogusiewicz
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Katarzyna Skorupska
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
| | - Ewa Markut-Miotla
- Department of Paediatric Nursing, Medical University of Lublin, Lublin, Poland
| | - Tomasz Rechberger
- 2nd Department of Gynaecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954, Lublin, Poland
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