Impact of urinary and climacteric symptoms on social and sexual life after surgical treatment of stress urinary incontinence in women: a long-term outcome

A Pilot Randomized Placebo Controlled Trial of Electroacupuncture for Women with Pure Stress Urinary Incontinence

BACKGROUND

Acupuncture is a potential conservative therapy for women with stress urinary incontinence (SUI). There is limited evidence to support its effectiveness due to the poor quality of existing studies.

METHODS

We performed a pilot randomized, controlled trial to preliminarily assess the efficacy of electroacupuncture (EA) in women with pure SUI. A total of 80 women with pure SUI were randomly assigned to receive EA with deep needling at BL33 and BL35 (n = 40) or sham EA with non-penetrating needling at sham acupoints (n = 40) three sessions per week for 6 weeks. The women were followed for 24 weeks. The primary outcome was the change from baseline in the amount of urine leakage measured by a 1-hour pad test after 6 weeks. The secondary outcomes included the 72-hour incontinence episode frequency (IEF), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, and patient self-evaluation of therapeutic effect. Adverse events (AEs) were monitored throughout the trial.

RESULTS

The median decrease from baseline of urine leakage measured by the 1-hour pad test was 2.5 g [interquartile range (IQR): 1.80-14.6 in the EA group, which was greater than the median decrease of 0.05 g (IQR: -2.80-+0.50) in the sham EA group after 6 weeks (p<0.01). The differences between groups in the decrease from baseline of 72-hour IEF became statistically significant at week 30 with a median decrease of 3.25 g (IQR: 1.25-5.69) in the EA group, and a median decrease of 1.00 g (IQR: -0.69-+2.88) in the sham EA group (p = 0.01). The participants in the EA group showed greater decreases in ICIQ-SF score and higher ratings in the help they received from the treatment than those in the sham EA group at weeks 6,18 and 30 (all p<0.05). No obvious AEs were observed in either group.

CONCLUSION

EA may effectively and safely relieve urinary incontinence symptoms and improve quality of life in women with pure SUI. EA demonstrated more than a placebo effect. Since this is a pilot study, results should be interpreted with caution.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02445573.

TVT-Exact and midurethral sling (SLING-IUFT) operative procedures: a randomized study

OBJECTIVES

The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI).

METHODS

A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients - using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II).

RESULTS

Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact - at 94.5% and SLING-IUFT - at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLING-IUFT group.

CONCLUSION

the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVT-Exact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness.

Muscle invasive bladder cancer: from diagnosis to survivorship

Bladder cancer is the fifth most commonly diagnosed cancer and the most expensive adult cancer in average healthcare costs incurred per patient in the USA. However, little is known about factors influencing patients' treatment decisions, quality of life, and responses to treatment impairments. The main focus of this paper is to better understand the impact of muscle invasive bladder cancer on patient quality of life and its added implications for primary caregivers and healthcare providers. In this paper, we discuss treatment options, side effects, and challenges that patients and family caregivers face in different phases along the disease trajectory and further identify crucial areas of needed research.

Female incontinence: long-term results of slings

PURPOSE OF REVIEW

Several different sling procedures are currently in use and most of them are newly developed. Despite the fact that they are widely in use, knowledge about their long-term efficacy, morbidity, and functional sequeal is scarce. The aim of the present review is to provide an update of several different procedures.

RECENT FINDINGS

The tension-free vaginal tape is the best studied and documented procedure with excellent long-term outcome data and low rates of complications. Tension-free vaginal tape appears to be followed by significantly higher objective cure rates than transobturator tape. Concerning comparison of different types of transobturator tape, no significant differences were found so far. Minislings still need to be evaluated concerning long-term safety and efficacy.

SUMMARY

Tension-free vaginal tape and transobturator tape are equally effective; for assessment of new approaches, surgical long-term data are mandatory.

Quality of life after SPARC sling procedure: a long-term retrospective analysis

INTRODUCTION

To asses the effects on quality of life (QoL) in women with stress urinary incontinence after a SPARC sling procedure.

METHODS

This is a long-term retrospective study. The study cohort consisted of 54 women: 46 were available for follow-up examination and 8 were contacted by telephone.

RESULTS

The median follow-up was 5.3 years. The QoL assessed by using a visual analogue scale improved significantly from 6.9 at baseline to 2.8. The IIQ-7 (Incontinence Impact Questionnaire-Short Form) general score decreased from an average of 56.7 at baseline to 17.5 at the follow-up investigation. Using the Patient Global Impression of Improvement questionnaire, 57.4% of women characterized themselves as very much better, 20.4% as much better and 11.1% as a little better. Eighty-seven percent of women regarded themselves as satisfied, but 13% were dissatisfied with the outcome of the SPARC sling procedure.

CONCLUSION

In this study a significant and stable long-term improvement in QoL could be observed in women undergoing SPARC sling procedure.

Etiology and predictors of urinary incontinence and its effect on quality of life

AIM

Urinary incontinence associated with dementia can result in medical comorbidities. We aimed to determine the prevalence of urinary incontinence and to identify the etiology and factors associated with urinary incontinence in dementia patients.

METHODS

Patients with an Mini-Mental State Examination (MMSE) score of more than 10, attending the memory clinic were recruited. Basic demographic data, types and duration of dementia, use of cholinesterase inhibitor and other drugs with anticholinergic effects, carer stress and presence of urinary incontinence in the previous 6 months were recorded. Urodynamic studies were carried out in those patients with urinary incontinence.

RESULTS

One hundred and forty-four subjects with a mean age of 78 years (standard deviation 6.8) were included. Forty-eight (33.3%) had urinary incontinence. There was no statistically significant difference between continent and incontinent groups regarding age, MMSE, duration of dementia, use of cholinesterase inhibitor and of drugs with anticholinergic effects. Presence of nocturia of more than twice per night (odds ratio [OR] 4, 95% confidence interval [CI] 1.7, 9.2), use of walking aids (OR 2.6, 95% CI 1.1, 5.9) and male sex (OR 1.36, 95% CI 1.1, 5.2) were independent predictors of urinary incontinence. Urodynamic studies showed that 21 subjects had detrusor overactivity, 13 had bladder outlet obstruction, two with low compliance bladder, two with small bladder capacity, four with detrusor hyperactivity and impaired contractility.

CONCLUSION

Urinary incontinence commonly occurs in dementia subjects. Poor mobility and presence of nocturia increase the risk of urinary incontinence. Correction of the possible reversible factors may help to reduce the prevalence of urinary incontinence in patients with dementia and reduce carer stress.

Impact of gynecological surgery on female sexual function

Sexual function is complex and involves interaction of many factors, including emotional connection, body image, intact physical response and partner sexual function. Disease processes such as abnormal uterine bleeding, endometriosis, urinary incontinence and pelvic organ prolapse may have a negative impact on various parameters of sexual health. Gynecological surgery to address these common complaints may correct the pathological process. However, despite improvements in symptoms related to the disease, improvements in sexuality are not guaranteed and occasionally there may be deteriorations. This review will summarize the current literature assessing sexual symptoms following benign gynecological surgery, including hysterectomy, and bilateral salpingo-oophorectomy, tubal ligation, anti-incontinence surgery and pelvic organ prolapse reconstruction with and without mesh. In the majority of cases, sexual function and quality of life benefit from these surgical interventions. However, it is critical that physicians remain aware of the potential for negative outcomes. Subjects who experience worsening should undergo thorough evaluation early in the postoperative period in order to mitigate symptoms. Treatment modalities for sexual dysfunction following surgery should be the focus of future research.

Nonsurgical transurethral collagen denaturation for stress urinary incontinence in women: 12-month results from a prospective long-term study

STUDY OBJECTIVE

To assess efficacy of nonsurgical transurethral collagen denaturation (Renessa) in women with stress urinary incontinence (SUI) caused by bladder outlet hypermobility.

DESIGN

Continuing, prospective, 36-month, open-label, single-arm clinical trial. Twelve-month results from intent-to-treat (ITT) analysis are reported. Canadian Task Force classification II-2.

SETTING

Thirteen physician offices or ambulatory treatment centers.

PATIENTS

Women with SUI secondary to bladder outlet hypermobility for 12 months or longer who failed earlier conservative treatment and had not received earlier surgical or bulking agent therapy.

INTERVENTIONS

Women were treated as outpatients and received an oral antibiotic and local periurethral anesthesia before undergoing treatment with transurethral radiofrequency collagen denaturation.

MEASUREMENTS AND MAIN RESULTS

Voiding diaries and in-office stress pad weight tests yield objective assessments. Subjective measures include the Incontinence Quality of Life (I-QOL), Urogenital Distress Inventory (UDI-6), and Patient Global Impression of Improvement (PGI-I) instruments. In total, 136 women received treatment (ITT population). Patients experienced significant reductions versus baseline in median number of leaks caused by activity/day and activity/week (p <.0026 for both), with 50% of patients reporting 50% or more reduction. Pad weight tests revealed that 69% of women had 50% or more reduction in leakage (median reduction 15.2 g; p <.0001); 45% were dry (29% no leaks; 16% < 1-g leakage). Significant improvements occurred in median scores on the I-QOL (+9.5 [range -66.0 to 91.0]; p <.0001) and mean scores on the UDI-6 (-14.1 +/- 24.7; p <.0001). Furthermore, 71.2% showed I-QOL score improvement, including 50.3% with 10-point or greater improvement, and 49.6% reported on the PGI-I that they were "a little," "much," or "very much" better.

CONCLUSION

At 12 months, treatment of SUI with nonsurgical transurethral collagen denaturation resulted in significant improvements in activity-related leaks and quality of life.

Improvement of quality of life, anxiety and depression after surgery in patients with stress urinary incontinence: results of a longitudinal short-term follow-up

Objective

The objective of this study was to compare the effect of incontinence surgery and pelvic floor training on quality of life (QOL), anxiety and depression in patients with stress urinary incontinence (SUI).

Methods

In a prospective longitudinal study, females with proven SUI were asked to complete a set of standardized questionnaires (sociodemographic data sheet, FACT-G, I-QOL, HADS) before and eight weeks after treatment. The comparison groups consisted of a surgical treatment group and a conservative group that underwent supervised pelvic floor training for eight weeks.

Results

From the 67 female patients included in the study a number of 53 patients completed both assessment time points (mean age 57.4, mean years of SUI 7.6). The surgical treatment group consisted of 32 patients of which 21 patients received a modified Burch colposuspension and 11 patients a tension-free mid-urethral tape suspension. The 21 patients in the conservative group attended eight once-weekly supervised pelvic floor training sessions.

After treatment the surgical intervention group showed a significantly higher improvement of QOL (FACT-G and I-QOL) and anxiety (HADS) than the pelvic floor training group.

Conclusion

For female patients with SUI surgery yielded a better outcome than pelvic floor training with regard to quality of life and anxiety.

Progress in Female Sexual Dysfunction

INTRODUCTION

Female sexual dysfunction (FSD) is a significant age-related, progressive and highly prevalent problem that affects a substantial number of women that causes personal distress and has negative effects on quality of life and interpersonal relationships.

DEFINITIONS

The female sexual response cycle consists of three phases: desire, arousal, and orgasm, and is initiated by non-adrenergic/non-cholinergic, e.g. vasoactive intestinal polypeptide and nitric oxide, neurotransmitters that maintain vascular and non-vascular smooth muscle relaxation resulting in increased pelvic blood flow, vaginal lubrication, and clitoral and labial engorgement. Furthermore, hormonal status may influence female sexual function. For the diagnosis of FSD, a detailed history should be taken initially, followed by a physical examination and laboratory studies.

CONCLUSION

Due to the fact that there has been little research and attention on FSD, our knowledge in this field is quite limited and there is still no approved therapy. Future advances in evaluation and treatment of female sexual problems are forthcoming.

Misrepresenting random sampling? A systematic review of research papers in the Journal of Advanced Nursing

AIM

This paper discusses the theoretical limitations of the use of random sampling and probability theory in the production of a significance level (or P-value) in nursing research. Potential alternatives, in the form of randomization tests, are proposed.

BACKGROUND

Research papers in nursing, medicine and psychology frequently misrepresent their statistical findings, as the P-values reported assume random sampling. In this systematic review of studies published between January 1995 and June 2002 in the Journal of Advanced Nursing, 89 (68%) studies broke this assumption because they used convenience samples or entire populations. As a result, some of the findings may be questionable.

DISCUSSION

The key ideas of random sampling and probability theory for statistical testing (for generating a P-value) are outlined. The result of a systematic review of research papers published in the Journal of Advanced Nursing is then presented, showing how frequently random sampling appears to have been misrepresented. Useful alternative techniques that might overcome these limitations are then discussed. REVIEW LIMITATIONS: This review is limited in scope because it is applied to one journal, and so the findings cannot be generalized to other nursing journals or to nursing research in general. However, it is possible that other nursing journals are also publishing research articles based on the misrepresentation of random sampling. The review is also limited because in several of the articles the sampling method was not completely clearly stated, and in this circumstance a judgment has been made as to the sampling method employed, based on the indications given by author(s).

CONCLUSION

Quantitative researchers in nursing should be very careful that the statistical techniques they use are appropriate for the design and sampling methods of their studies. If the techniques they employ are not appropriate, they run the risk of misinterpreting findings by using inappropriate, unrepresentative and biased samples.

Prevalence and outcomes of continence surgery in community dwelling women

PURPOSE

Published outcomes of continence surgery are based largely on cohort studies and a smaller number of randomized trials. There is no consensus on the outcomes that should be considered and patient reported outcomes have not always been included. We determined the prevalence of continence surgery as well as patient reported outcomes in community dwelling women.

MATERIALS AND METHODS

We performed a 2-stage national cross-sectional mailed survey. A short questionnaire used to identify women with a history of continence surgery was sent to 45,000 representative American households. Eligible women with a history of continence surgery received a followup questionnaire to assess patient reported outcomes, including current symptom frequency, bother and overall satisfaction.

RESULTS

Of the 24,581 women 967 (4%) had a history of continence surgery, including 73% who currently reported incontinence in the preceding month, 58% who reported incontinence in the preceding week and 53% who reported current use of pads or other absorbent material. Of those who reported incontinence 83% reported current stress incontinence symptoms, including 62% with stress and urge symptoms. A third of the women had been treated with surgery in the last 5 years. The proportion of women satisfied with the results of surgery decreased from 67% who recalled initial satisfaction to 45% who reported current satisfaction.

CONCLUSIONS

Almost 4% of women had undergone continence surgery and continence rates were lower than most published figures. However, some women reported satisfaction with surgery even when they did not achieve continence. Patient satisfaction and other patient reported outcomes might be considered with continence rates when determining surgical success rates.