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Shoukry M, Hassouna ME, AbdEl-Kerim A, El-Salmy S. Rolled vaginal wall flap for the treatment of stress urinary incontinence. AFRICAN JOURNAL OF UROLOGY 2011. [DOI: 10.1007/s12301-011-0001-7] [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] Open
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Lemack GE. Use of urodynamics prior to surgery for urinary incontinence: How helpful is preoperative testing? Indian J Urol 2007; 23:142-7. [PMID: 19675791 PMCID: PMC2721523 DOI: 10.4103/0970-1591.32065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
It has not yet been definitively demonstrated that preoperative evaluation of women with stress urinary incontinence with urodynamic testing enhances presurgical counseling, more effectively models patients' expectations or improves postoperative outcome. Nonetheless, urodynamic testing is frequently utilized in the assessment of women with stress urinary incontinence and clearly accomplishes a number of goals when utilized for this purpose. For example, there are data to suggest that the risk of voiding dysfunction can be mitigated by utilizing data obtained from urodynamic testing to identify women more likely to void ineffectively after conventional stress incontinence procedures. Furthermore, it has been suggested though not proven, that patients with more severe forms of stress incontinence as identified by urodynamic testing, might be less likely to improve after surgery compared to others with more modest degrees of incontinence. Since urodynamic testing is invasive, costly and not always available, it is imperative that the usefulness of such testing be carefully explored and its utility appropriately defined. In this review, we discuss urodynamic techniques to assess stress urinary incontinence, particularly focusing on the ability of leak point pressure testing and urethral pressure profilometry to predict which patients would most likely benefit from surgery and which might be more likely to experience adverse events following surgery.
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Affiliation(s)
- Gary E. Lemack
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Comiter CV. Surgery insight: management of failed sling surgery for female stress urinary incontinence. ACTA ACUST UNITED AC 2007; 3:666-74. [PMID: 17149383 DOI: 10.1038/ncpuro0657] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 10/18/2006] [Indexed: 02/07/2023]
Abstract
Sling surgery has replaced Burch colposuspension as the most common surgery for women with stress urinary incontinence (SUI). While incontinence surgery has become a routine part of urologic care, the management of surgical complications and recurrent incontinence can be quite difficult. It is important that the urologic surgeon is well informed about the most common complications that are associated with sling surgery, and how to best manage them. In addition, the management of recurrent incontinence following sling surgery should follow a stepwise approach, with appropriate diagnostic studies, conservative treatment if possible, and surgery if necessary. While sling surgery in the patient with urethral hypermobility is often straightforward, reoperation for recurrent incontinence can be more technically challenging. In the patient with a fixed and incompetent urethra, periurethral bulking agents, pubovaginal sling, spiral sling, or artificial urinary sphincter placement may be indicated.
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Affiliation(s)
- Craig V Comiter
- Section of Urology, University of Arizona Health Sciences Center, Box 245077, 1501 North Campbell Avenue, Tucson, AZ 85724, USA.
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Bladder Calculus Formation and Recurrent Stress Incontinence Subsequent to Stamey'S Operation. Taiwan J Obstet Gynecol 2005. [DOI: 10.1016/s1028-4559(09)60158-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Emir L, Erol D, Ak H, Sunay M. A new technique combining both polypropylene and vaginal wall sling procedures: can it minimize the risk of urethral and vaginal erosion occurring with synthetic materials? World J Urol 2005; 23:221-4. [PMID: 15997396 DOI: 10.1007/s00345-005-0503-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 03/18/2005] [Indexed: 11/28/2022] Open
Abstract
We describe a new technique combining in situ vaginal wall and polypropylene mesh slings that may decrease potential erosive complications caused by synthetic materials. A folded mucosal patch harboring the polypropylene mesh was placed between mid-urethra and bladder neck. Using this technique, 12 consecutive women (age range 44-66 years) were operated. Preoperative evaluation included a detailed history, pelvic examination, stress test, cystourethroscopy, basic urodynamic evaluation (cystometry, Valsalva leak point pressure measurement), and urine culture. Based on these evaluations, three, seven, and two patients had type I, II, and III stress urinary incontinence, respectively. A paraurethral cyst excision was carried out in one patient and anterior colporrhaphy in four patients during the same operation. No ischemia or sloughing at the operation site occurred in any case. Pelvic examination was repeated in all patients after 3 and 6 months of follow-up and symptoms were determined after 12 months of follow-up in eight patients by telephone interview. Average follow-up was 10 months (range: 6-14 months). None of the patients were incontinent, or complained of sexual dysfunction or erosive complications after 1 year. Since there are two distinct barriers between the sling and both urethra and vagina, our technique covers all advantages of a sling procedure with synthetic materials and avoids the risk of urethral and vaginal erosion. The other advantage of this technique is the concomitant utilization of the vaginal wall as sling material.
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Affiliation(s)
- Levent Emir
- I Clinic of Urology, Ankara Teaching and Research Hospital, Ministry of Health, Ankara, Turkey.
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Lemack GE. Urodynamic assessment of patients with stress incontinence: how effective are urethral pressure profilometry and abdominal leak point pressures at case selection and predicting outcome? Curr Opin Urol 2004; 14:307-11. [PMID: 15626870 DOI: 10.1097/00042307-200411000-00002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Disagreement exists as to the extent of evaluation required prior to offering surgical intervention for the treatment of stress urinary incontinence in women. While few would argue that additional information can be gleaned from a properly performed urodynamic investigation, it remains unclear exactly which women would most benefit from such preoperative study, and if urodynamic evaluation definitively improves treatment outcome. Since such invasive studies may not be widely available in certain areas, can be costly, and are associated with a low, but defined risk of bladder infection, it is imperative that the appropriate indication for preoperative urodynamic evaluation be carefully defined. This review highlights recent reports and controversies concerning the use of urodynamics (focusing on leak point pressure testing and urethral pressure profilometry) prior to surgical treatment for stress urinary incontinence. RECENT FINDINGS There remains no clear consensus as to whether urodynamic testing enhances surgical outcome of stress urinary incontinence treatments by improving case selection or altering the surgical approach based on study findings. As treatment strategies for stress urinary incontinence have developed over the last several years to a more uniform approach, it is less clear that the severity of stress urinary incontinence, based on either abdominal leak point pressure or urethral pressure profilometry will influence the choice of surgical technique. Furthermore, there is little evidence to suggest that patients with more severe forms of stress urinary incontinence by urodynamic testing fare more poorly after the most commonly offered surgical treatment than those with less severe forms. There are certain sub-populations of women who appear to be at higher risk of voiding dysfunction following incontinence surgery, and urodynamic testing may aid in identifying this group. SUMMARY It is not apparent that either abdominal leak point pressure measurement or urethral pressure profilometry can accurately predict which patients will achieve the best outcome of surgical treatment for stress urinary incontinence. Other parameters assessed during urodynamic evaluation might provide prognostic information regarding the risk of voiding dysfunction postoperatively and the possibility of persistent urge-related leakage following surgery, though not directly predict cure. A multi-institutional randomized study comparing the outcome between patients in whom treatment was determined with the urodynamic information known, compared with patients in whom this information was unknown would further enhance our understanding of the usefulness of urodynamics in the preoperative evaluation of women with stress urinary incontinence.
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Affiliation(s)
- Gary E Lemack
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Costantini E, Mearini L, Mearini E, Pajoncini C, Guercini F, Bini V, Porena M. Assessing outcome after a modified vaginal wall sling for stress incontinence with intrinsic sphincter deficiency. Int Urogynecol J 2004; 16:138-46; discussion 146. [PMID: 15789147 DOI: 10.1007/s00192-004-1173-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2003] [Accepted: 04/25/2004] [Indexed: 11/29/2022]
Abstract
Forty women with stress incontinence, intrinsic sphincter deficiency (ISD), associated or not with urethral hypermobility, a Valsalva leak point pressure (VLLP)<60 cmH(2)0 and a maximum urethral closure pressure<30 cmH(2)0 underwent in situ vaginal wall sling. The main modification to the technique was the use of two small Marlex meshes placed at the lateral edges of the sling. Outcome was assessed by pad use, surgical results and patients' satisfaction. Data of 39/40 patients were analyzed after a minimum follow-up of 1 year. After surgery 30/39 patients were completely dry (no pads), stress incontinence disappeared in 22/39, and 30/39 patients were satisfied with outcome. Reasons for dissatisfaction included recurrence of stress incontinence in three, infections in one and urge incontinence in five. Overall results are good given this category of patients. The vaginal wall sling can be recommended for patients with ISD because the results are promising, it corrects urethral hypermobility and, in our experience, it does not cause obstruction if correctly performed.
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Affiliation(s)
- Elisabetta Costantini
- Department of Urology, University of Perugia, Via Brunamonti 51, 06100 , Perugia, Italy.
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Mubiayi N, Inguenault C, Crépin G, Cosson M. Le kyste épithélial d’inclusion après enfouissement de la muqueuse vaginale. Diagnostic et prise en charge. ACTA ACUST UNITED AC 2003; 31:1013-7. [PMID: 14680781 DOI: 10.1016/j.gyobfe.2003.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Surgical treatment in which a vaginal mucosa island is buried leads to a risk of epithelial inclusion cyst formation. The aim of this study is to describe this complication, assess incidence, precise facilitating factors and discuss treatment. PATIENTS AND METHOD This study concerned 84 patients operated on between January 1996 and December 1998. They were treated with modified vaginal wall sling procedure. Fifty women were post-menopausal and 22 had estrogenotherapy. All patients had post-operative surveillance. The mean post-operative follow-up was 19 months (range: 1-68 months). Epithelial inclusion cyst formation diagnosis reposed exclusively on clinical assessment.Results. - Seven out of the 84 patients (8.3%) were diagnosed with epithelial inclusion cyst formation within 19 months of their operation (range: 3-34 months). Out of the seven patients, four were post-menopausal and three had received estrogenotherapy for many years. In six cases, epithelial inclusion cyst was symptomatically revealed by perineal pain or dysuria. These cases were successfully treated by cyst marsupialisation without recurrent incontinence. DISCUSSION AND CONCLUSION The results of this short study show that epithelial inclusion cyst formation is a specific complication of surgical procedures burying a full thickness of vaginal mucosa and that estrogen impregnation seems to be the main facilitating factor. Successful treatment of symptomatic cases of epithelial inclusion cyst can be achieved by marsupialisation.
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Affiliation(s)
- N Mubiayi
- Pôle de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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THE IN SITU ANTERIOR VAGINAL WALL SLING:. J Urol 2001. [DOI: 10.1097/00005392-200112000-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The etiology of stress incontinence is not completely understood. In the past, bladder neck suspensions were performed to correct anatomic abnormalities of the bladder neck and urethral hypermobility. This procedure was attractive because of its simplicity, low morbidity, and excellent early success rate. With time, the successes seen with bladder neck suspensions have not proven to be durable, and alternative surgical procedures have been developed. Until recently, the indications for bladder neck suspension were types I and II stress incontinence; slings were reserved for type III incontinence. However, slings have been shown to be as effective as and more durable than bladder neck suspensions for treatment of all types of stress incontinence; therefore, their popularity has spread. The success of distal urethral slings suggests that it is not necessary to correct anatomic hypermobility to correct stress incontinence. A plethora of new procedures and materials has emerged, leading to an increased need for well-controlled, objective outcome studies in order to understand the impact of these surgeries on our patients.
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Affiliation(s)
- L V Rodríguez
- Department of Urology, UCLA School of Medicine, 924 Westwood Boulevard, Suite 520, Los Angeles, CA 90024, USA.
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Choe JM, Kothandapani R, James L, Bowling D. Autologous, cadaveric, and synthetic materials used in sling surgery: comparative biomechanical analysis. Urology 2001; 58:482-6. [PMID: 11549510 DOI: 10.1016/s0090-4295(01)01205-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare the biomechanical properties of allografts, autografts, and synthetic materials used in sling surgery using the Instron tensinometer. METHODS The sling grafts we studied consisted of autologous tissues (dermis, rectus fascia, and vaginal mucosa), cadaver tissues (decellularized dermis and freeze-dried, gamma-irradiated fascia lata), and synthetics (Gore-Tex and polypropylene mesh). The sling grafts were constructed into two types of slings: full strip sling (FSS) versus patch suture sling (PSS). The slings were loaded onto the Instron tensinometer and uniaxially loaded in tension until failure. From the load deformation curve, the mechanical properties of the sling grafts were compared. RESULTS A total of 140 sling grafts were analyzed. In rank order for the FSSs, cadaver allografts had the strongest tensile strength followed by the synthetics and autologous tissues (P <0.05). The tensile strength of the FSSs was greater than for the PSSs for all groups (P </=0.001). In rank order for the PSSs, the synthetics and dermal tissues (autograft and allograft) had the highest tensile strength followed by cadaver fascia lata, rectus fascia, and vaginal mucosa (P <0.05). CONCLUSIONS The tensile strength of the FSS was greater than that of the PSS for the autograft, allograft, and synthetic tissues. The autograft and allograft tissues were significantly weaker as a PSS. The synthetics were more durable as a PSS compared with the organic tissues. When a PSS is constructed from autograft and allograft tissues, the risk of suture pull-through and recurrent stress incontinence must be considered.
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Affiliation(s)
- J M Choe
- Urodynamics and Continence Center, Division of Urology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Abstract
The pubovaginal sling, reintroduced in the late 1970s by Maguire and Blaivas, has become the gold standard for managing anatomic incontinence. Newer technology, materials, surgical techniques and even new theories on the mechanism of action are evolving to further reduce the morbidity of these procedures and improve patient satisfaction. In the following review, we will highlight some of the exciting advances we have witnessed over the last year and try to put them into perspective for the reader.
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Affiliation(s)
- F E Govier
- Department of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
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Abstract
The past decade has witnessed significant changes not only in our understanding of intrinsic sphincter deficiency, but also in our surgical approach to this problem. It became evident that the patient's medical condition, expectations, and degree of incontinence should define the approach in order to make the greatest impact on quality of life. The present review describes the current concepts and surgical approaches to intrinsic sphincter deficiency, namely slings, injectables, and artificial sphincters.
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Affiliation(s)
- G M Ghoniem
- Tulane University School of Medicine, Department of Urology, New Orleans, Louisiana 70112, USA.
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