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Plotti F, Rampello S, Terranova C, De Cicco Nardone C, Luvero D, Montera R, Di Donato V, Cavaliere AF, Campagna G, Ficarola F, Martinelli A, Angioli R. The True Impact of Voiding Dysfunctions after Transobturator Sub-Urethral Tape Procedures: A Systematic Review of Literature. J Clin Med 2024; 13:4762. [PMID: 39200904 PMCID: PMC11355201 DOI: 10.3390/jcm13164762] [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: 07/07/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/02/2024] Open
Abstract
Introduction: Transobturator techniques are frequently used for the surgical treatment of female stress urinary incontinence (SUI), due to their high success rates and few intraoperative complications. However, controversial results have been reported in the literature regarding their incidence. The aim of this study is to analyze the real incidence and trend over time of such complications, especially voiding dysfunctions and overactive bladder (OAB) symptoms. Methods: A comprehensive search using PubMed/MEDLINE, Scopus, and Cochrane databases was performed. The search string used was the following: (female stress urinary incontinence) AND (complication) AND ((midurethral sling) OR (transobturator tape) OR (TVT-O) OR (voiding dysfunctions) OR (de novo OAB) OR (recurrent UTI) OR (vaginal erosion)). We included randomized controlled trials, prospective controlled studies, prospective and retrospective observational studies. All selected articles were screened based on titles and abstracts. Relevant data were extracted and tabulated. Results: A total of 39 studies were included in our analysis. Transobturator tape procedures show a high objective cure rate for SUI, from 76.9% to 100%. Postoperative voiding dysfunctions are shown to be quite common, ranging from 0-22% of cases. Despite that, this percentage decreases to 0-1% after 12 months. De novo OAB incidence ranges from 3% to 14% at 12 months, with variability over time due to multiple factors. Tape-related complications usually occur after 12 months, with a variable incidence up to 7%. Urinary tract infections (UTIs) are quite common in the immediate postoperative period but sometimes can be recurrent, requiring long-term prophylactic antibiotic treatment. Conclusions: Voiding dysfunctions are generally transient complications, while de novo OAB may persist over time. An adequate preoperative counseling, along with accurate written informed consent, could enhance patient tolerance of these issues and contribute to long-term patient satisfaction.
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Affiliation(s)
- Francesco Plotti
- Research Unit of Gynaecology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Division of Obstetrics and Gynecology, Ospedale Isola Tiberina Gemelli Isola, 00186 Rome, Italy
| | - Stefania Rampello
- Research Unit of Gynaecology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Corrado Terranova
- Research Unit of Gynaecology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Carlo De Cicco Nardone
- Research Unit of Gynaecology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Daniela Luvero
- Research Unit of Gynaecology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Roberto Montera
- Research Unit of Gynaecology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Anna Franca Cavaliere
- Division of Obstetrics and Gynecology, Ospedale Isola Tiberina Gemelli Isola, 00186 Rome, Italy
| | - Giuseppe Campagna
- Division of Obstetrics and Gynecology, Ospedale Isola Tiberina Gemelli Isola, 00186 Rome, Italy
| | - Fernando Ficarola
- Obstetrics and Gynecological Unit, Department of Woman’s and Child’s Health, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Arianna Martinelli
- Research Unit of Gynaecology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Roberto Angioli
- Research Unit of Gynaecology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
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Yang JM, Huang WC. Ultrasound in Female Urinary Incontinence. J Med Ultrasound 2024; 32:14-20. [PMID: 38665347 PMCID: PMC11040483 DOI: 10.4103/jmu.jmu_25_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 04/28/2024] Open
Abstract
Urinary incontinence (UI) is a common health condition that may interfere with the quality of life. A comprehensive evaluation of female UI helps with effective and safe treatments. Ultrasound has gained popularity to explore UI recently because it can collect crucial information for treatment planning and counseling. Translabial and introital approaches are commonly and reliably applied to ultrasound. The images can be obtained using two-dimensional and three-dimensional ultrasounds. Ultrasound is the only modality capable of confirming the presence or absence of a mid-urethral sling (MUS) and is able to demonstrate bulking agents as well. Although some of the ultrasound findings may only be incidental or supplementary to the patient's symptoms, ultrasound benefits for investigating the pathophysiology of UI and surgical outcomes of MUS procedures. It is anticipated that standardization in terminology, measurement techniques, and reporting can be established in the near future.
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Affiliation(s)
- Jenn-Ming Yang
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chen Huang
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
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García-Mejido JA, Blasco-Hernandez P, Fernandez-Conde C, García-Pombo S, Fernández-Palacín A, Borrero C, Sainz-Bueno JA. Are Transperineal Ultrasound Parameters Useful to Predict Incontinence in Patients with Single-Incision Mini-Slings? Tomography 2022; 8:2556-2564. [PMID: 36287812 PMCID: PMC9609347 DOI: 10.3390/tomography8050213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022] Open
Abstract
It would be logical to think that single-incision mini-slings (SIMS) should behave like the rest of the tension-free vaginal tape and, therefore, to believe that they present a similar ultrasound appearance, but there are no studies on this matter. Therefore, the main aim of our research is to determine which ultrasound parameters are associated with stress urinary incontinence (SUI) in patients carrying SIMS. A prospective observational study was carried out including 94 patients who were candidates for SUI corrective surgery with SIMS between 1 January 2021 to 31 December 2021 at the Universitary Hospital of Valme (Seville, Spain). A transperineal ultrasound evaluation was performed (six months after surgery) in order to study: the bladder neck–symphyseal distance, the posterior urethro–vesical angle, the pubic symphysis–tape gap, the tape–urethral lumen distance, the sagittal tape angle, the tape position, the concordance of movement between the tape and the urethra, and the axial tape angle. A total of 92 patients completed the study (63 asymptomatic and 29 symptomatic). Statistical differences were observed in the concordance of movement between the tape and the urethra (84.1% vs. 25.0%; p: 0.001) and in the axial tape angle at rest (139.3 ± 19.0 vs. 118.3 ± 15.4; p: 0.003) and at Valsalva (145.1 ± 20.2 vs. 159.1 ± 9.0; p: 0.034). Sagittal tape angle at rest was higher in urge urinary incontinence (UUI) patients (132.5 ± 35.7 vs. 143.3 ± 29.8; p: 0.001) and mixed urinary incontinence (MUI) patients (132.5 ± 35.7 vs. 157.8 ± 23.6; p: 0.025) compared to asymptomatic patients. In conclusion, the concordance between the movement of the tape and the urethra is the most useful ultrasound parameter to define continence in patients with SIMS.
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Affiliation(s)
- José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, CP 41004 Seville, Spain
- Department of Obstetrics and Gynecology, Valme University Hospital, CP 41014 Seville, Spain
- Correspondence:
| | | | | | - Sara García-Pombo
- Department of Obstetrics and Gynecology, Valme University Hospital, CP 41014 Seville, Spain
| | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, CP 41004 Seville, Spain
| | - Carlota Borrero
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, CP 41004 Seville, Spain
- Department of Obstetrics and Gynecology, Valme University Hospital, CP 41014 Seville, Spain
| | - José Antonio Sainz-Bueno
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Seville, CP 41004 Seville, Spain
- Department of Obstetrics and Gynecology, Valme University Hospital, CP 41014 Seville, Spain
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Illiano E, Trama F, Li Marzi V, Mancini V, Carrieri G, Ruvolo CC, Califano G, Fabi C, Brancorsini S, Costantini E. Translabial ultrasound: a non-invasive technique for assessing "technical errors" after TOT failure. Int Urogynecol J 2022; 33:1023-1030. [PMID: 34191103 PMCID: PMC9021136 DOI: 10.1007/s00192-021-04897-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aims of this study were to evaluate by transperineal ultrasound if there were ultrasound-detectable changes over time in the dynamic behavior of the sling in patients who underwent transobturator tape (TOT), and to evaluate if dynamic translabial ultrasonography recognized factors that may be associated with failed surgery. METHODS This was a single-center prospective study. We included women who underwent "out-in" TOT for stress urinary incontinence (SUI). A dynamic translabial ultrasound was performed 6 months post-surgery and again at the last visit. The objective cure for SUI was defined as the absence of urine leakage during the stress test. We evaluated the bladder neck mobility at rest and during Valsalva; the position of the mesh along the urethra; the concordance of urethral movement with the sling during Valsalva; the symmetry of the lateral arms of the sling during straining; and the presence or absence of bladder neck funneling. RESULTS From December 2012 to February 2016, 80 consecutive patients were included. Six months after surgery, incontinent women compared with continent women had the sling in a proximal or distal position, that moved discordantly with the urethra (p < 0.0001), with asymmetry arm and bladder neck funneling (p < 0.0001). Continent patients had a significant improvement of urethrocele grade both at rest (p = 0.036) and during Valsalva (p = 0.045). CONCLUSIONS Technical and positioning errors can lead to the failure of anti-incontinence surgical treatment. Translabial ultrasound allows the correct positioning of the sling to be evaluated and any errors that need to be analyzed in order to then solve the failure.
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Affiliation(s)
- Ester Illiano
- Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Viale Tristano di Joannuccio, 05100, City Terni, TR, Italy
| | - Francesco Trama
- Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Viale Tristano di Joannuccio, 05100, City Terni, TR, Italy.
| | - Vincenzo Li Marzi
- Urology Clinic, Careggi Hospital, University of Florence, Florence, Italy
| | - Vito Mancini
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Consuelo Fabi
- Department of Experimental Medicine, Section of Terni, University of Perugia, Perugia, Italy
| | - Stefano Brancorsini
- Department of Experimental Medicine, Section of Terni, University of Perugia, Perugia, Italy
| | - Elisabetta Costantini
- Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Viale Tristano di Joannuccio, 05100, City Terni, TR, Italy
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