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Wang Q, Jiang XX, Que YZ, Wan XY, Lin CQ. Development and Validation of a Risk Prediction Model for Female Stress Urinary Incontinence in Rural Fujian, China. Risk Manag Healthc Policy 2024; 17:1101-1112. [PMID: 38707519 PMCID: PMC11069356 DOI: 10.2147/rmhp.s457332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/19/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose With China's rapidly aging population and the rising proportion of obese people, an increase in the number of women suffering from urinary incontinence (UI) is to be expected. In order to identify high-risk groups before leakage occurs, we aimed to develop and validate a model to predict the risk of stress UI (SUI) in rural women. Patients and methods This study included women aged 20-70 years in rural Fujian who participated in an epidemiologic survey of female UI conducted between June and October 2022. Subsequently the data was randomly divided into training and validation sets in a ratio of 7:3. Univariate and multivariate logistic regression analyses were used to identify independent risk factors as well as to further construct a nomogram for risk prediction. Finally, concordance index (C-index), calibration curve and decision curve analysis were applied to evaluate the performance of the predictive models. Results A total of 5290 rural females were enrolled, of whom 771 (14.6%) had SUI. Age, body mass index (BMI), postmenopausal status, number of vaginal deliveries, vaginal delivery of large infant, constipation and family history of pelvic organ prolapse (POP) and SUI were included in the nomogram. C-index of this prediction model for the training and validation sets was 0.835 (95% confidence interval [CI] = 0.818-0.851) and 0.829 (95% CI = 0.796-0.858), respectively, and the calibration curves and decision analysis curves for both the training and validation sets showed that the model was well-calibrated and had a positive net benefit. Conclusion This model accurately estimated the SUI risk of rural women in Fujian, which may serve as an effective primary screening tool for the early identification of SUI risk and provide a basis for further implementation of individualized early intervention. Moreover, the model is concise and intuitive, which makes it more operational for rural women with scarce medical resources.
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Affiliation(s)
- Qi Wang
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Fujian Provincial Key Laboratory of Women and Children’s Critical Diseases Research, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Xiao-Xiang Jiang
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Fujian Provincial Key Laboratory of Women and Children’s Critical Diseases Research, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yan-Zhen Que
- Department of Gynecology and Obstetrics, Shaxian General Hospital, Sanming, People’s Republic of China
| | - Xiao-Ying Wan
- Department of Gynecology and Obstetrics, Shaxian General Hospital, Sanming, People’s Republic of China
| | - Chao-Qin Lin
- Department of Gynecology, Fujian Maternity and Child Health Hospital, Fujian Provincial Key Laboratory of Women and Children’s Critical Diseases Research, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China
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Karjalainen PK, Tolppanen AM, Wihersaari O, Nieminen K, Mattsson NK, Jalkanen JT. Changes in Stress Urinary Incontinence Symptoms after Pelvic Organ Prolapse Surgery: a Nationwide Cohort Study (FINPOP). Int Urogynecol J 2024; 35:909-919. [PMID: 38546868 PMCID: PMC11052860 DOI: 10.1007/s00192-024-05760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/04/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Various strategies are employed to manage stress urinary incontinence (SUI) during pelvic organ prolapse (POP) surgery. This study was aimed at facilitating shared decision-making by evaluating SUI symptom changes, staged SUI procedures, and their prognostic factors following POP surgery without concomitant SUI intervention. METHODS We analyzed 2,677 POP surgeries from a population-based observational cohort, excluding patients with prior SUI surgery. The outcome measures were subjective SUI utilizing the Pelvic Floor Distress Inventory-20 questionnaire and number of subsequent SUI procedures. Multivariable linear models were applied to identify predictors of persistent SUI, procedures for persistent SUI, and de novo SUI. The primary assessment occurred at the 2-year follow-up. RESULTS At baseline, 50% (1,329 out of 2,677) experienced SUI; 35% (354 out of 1,005) resolved, an additional 14% (140 out 1,005) improved, and 5.1% (67 out of 1,308) underwent a procedure for persistent SUI. De novo SUI symptoms developed in 20% (218 out of 1,087), with 3.2% (35 out of 1,087) reporting bothersome symptoms; 0.8% (11 out of 1,347) underwent a procedure for de novo SUI. High baseline symptom severity increased the risk of persistent SUI (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.65-2.53), whereas advanced preoperative apical prolapse decreased the risk (aOR 0.89, 95% CI 0.85-0.93). De novo SUI was more common with advancing age (aOR 1.03, 95% CI 1.01-1.05), baseline urgency urinary incontinence (aOR 1.21, 95% CI 1.06-1.38), and after transvaginal mesh surgery (aOR 1.93, 95% CI 1.24-3.00). It was not dependent on the compartment or preoperative degree of prolapse. CONCLUSIONS In a pragmatic setting, POP surgery results in a low rate of subsequent SUI procedures.
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Affiliation(s)
- Päivi K Karjalainen
- Department of Obstetrics and Gynecology, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Hoitajantie 3, 40620, Jyväskylä, Finland.
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | | | - Olga Wihersaari
- Department of Obstetrics and Gynecology, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Hoitajantie 3, 40620, Jyväskylä, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kari Nieminen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | | | - Jyrki T Jalkanen
- Wellbeing Services County of Central Finland, Jyväskylä, Finland
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Polanco Pujol L, Caño Velasco J, Rodríguez Fernández E, Cancho Gil MJ, Lledó García E, López-Fando Lavalle L, Hernández Fernández C. Prevalence and management of urinary incontinece after pelvic organ prolapse surgery (sacrocolpopexy). A literature review. Actas Urol Esp 2024:S2173-5786(24)00015-5. [PMID: 38369286 DOI: 10.1016/j.acuroe.2024.02.008] [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: 10/20/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Stress urinary incontinence (SUI) is frequently associated with pelvic organ prolapse (POP) and may occur after its surgical treatment. AIM To determine the incidence, risk factors and management of SUI during and after POP surgery through a review of the available literature. MATERIALS AND METHOD Narrative literature review on the incidence and management of SUI after POP surgery after search of relevant manuscripts indexed in PubMed, EMBASE and Scielo published in Spanish and English between 2013 and 2023. RESULTS Occult SUI is defined as visible urine leakage when prolapse is reduced in patients without SUI symptoms. De novo SUI develops after prolapse surgery without having previously existed. In continent patients, the number needed to treat (NNT) to prevent one case of de novo SUI is estimated to be 9 patients and about 17 to avoid repeat incontinence surgery. In patients with occult UI, the NNT to avoid repeat incontinence surgery is around 7. Patients with POP and concomitant SUI are the group most likely to benefit from combined surgery with a more favorable NNT (NNT 2). CONCLUSION Quality studies on combined surgery for treatment SUI and POP repair are lacking. Continent patients with prolapse should be warned of the risk of de novo SUI, although concomitant incontinence treatment is not currently recommended. Incontinence surgery should be considered on an individual basis in patients with prolapse and SUI.
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Affiliation(s)
- L Polanco Pujol
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - J Caño Velasco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - M J Cancho Gil
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - E Lledó García
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Kim MJ, Lee Y, Suh DH, Lee S, Jeon MJ. External validation of the de novo stress urinary incontinence prediction model after pelvic organ prolapse surgery in Korean women: a retrospective cohort study. BMC Womens Health 2023; 23:656. [PMID: 38066537 PMCID: PMC10704704 DOI: 10.1186/s12905-023-02812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND De novo stress urinary incontinence (SUI) may develop following pelvic organ prolapse surgery. Performing prophylactic continence surgery may reduce the risk of de novo SUI and subsequent continence surgery; however, it may increase the risk of complications. Therefore, many surgeons try to identify women at high risk for de novo SUI and perform continence surgery selectively. Recently, a model for predicting the risk of de novo SUI after prolapse surgery was developed using data from the Outcomes following vaginal Prolapse repair and midUrethral Sling (OPUS) trial; its prediction accuracy was significantly better than that of the stress test alone. However, few studies have verified its prediction accuracy in discrete populations. The aim of this study was to externally validate the prediction model for de novo SUI after prolapse surgery in Korean women. METHODS This retrospective cohort study included 320 stress-continent women who underwent prolapse surgery for pelvic organ prolapse quantification stage 2-4 anterior or apical prolapse and who completed a 1-year follow-up. Predicted probabilities by the de novo SUI online risk calculator were compared with observed outcomes and quantitated using the model's area under the curve and calibration plot. Subgroup analyses were also performed by the type of prolapse surgery. RESULTS The de novo SUI prediction model showed moderate discrimination in our study cohort; area under the curve (95% confidence interval) = 0.73 (0.67-0.78) in the whole cohort, 0.69 (0.61-0.78) in women who underwent native tissue repair or colpocleisis, and 0.74 (0.65-0.82) in those who underwent sacrocolpopexy. Calibration curves demonstrated that the model accurately predicted the observed outcomes of de novo SUI in women who underwent native tissue repair or colpocleisis but underestimated outcomes in those who underwent sacrocolpopexy. The predicted probability cutoff points corresponding to an actual risk of 50% were 40% in women who underwent native tissue repair or colpocleisis and 30% in those who underwent sacrocolpopexy. CONCLUSIONS The de novo SUI prediction model is acceptable for use in Korean women and may aid in shared decision-making regarding prophylactic continence procedure at the time of prolapse surgery.
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Affiliation(s)
- Min Ju Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Youjoung Lee
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sungyoung Lee
- Department of Genomic Medicine, Center for Precision Medicine, Seoul National University Hospital, Seoul, Korea
| | - Myung Jae Jeon
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea.
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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Xiao T, Cao Y, Zhen C, Chen Z, Huang W, Su Z. Nomogram Analysis Based on Clinical and Sonographic Characteristics for the Assessment of Postpartum Stress Urinary Incontinence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2591-2601. [PMID: 37341131 DOI: 10.1002/jum.16295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/06/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES We aimed to develop and validate a nomogram integrating clinical and sonographic characteristics for the individualized SUI risk evaluation in the early postpartum stage. METHODS This was a prospective cross-sectional study. From June 2020 to September 2022, singleton primiparas who underwent TPUS examination at 6-8 weeks postpartum were recruited. They were divided into the training and validation cohorts at a ratio of 8:2 according to the temporal split. All subjects were interviewed before TPUS examination. Univariate and multivariate logistic analyses were performed to develop three models: the clinical, sonographic, and combined models. The ROC curve was plotted to evaluate model discrimination ability. Finally, the combined model was selected to establish the nomogram. The nomogram's discrimination, calibration, and clinical usefulness were evaluated in the training and validation cohorts. RESULTS The performance of the combined model was better than that of the clinical and sonographic models. Six predictors (BMI, delivery mode, lateral episiotomy, SUI during pregnancy, cystocele, and bladder neck funneling) remained in the combined model. The nomogram based on the combined model had good discrimination with AUCs of 0.848 (95% CI: 0.796-0.900) and 0.872 (95% CI: 0.789-0.955) in the training and validation cohorts, respectively, and the calibration curve showed good efficiency in assessing postpartum SUI. Decision curve analysis showed that the nomogram was clinically useful. CONCLUSIONS The nomogram based on clinical and sonographic characteristics showed good efficiency in assessing postpartum SUI risk and can be a convenient and reliable tool for individual SUI risk assessment.
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Affiliation(s)
- Ting Xiao
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
- Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China
| | - Yunqing Cao
- Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China
| | - Chaojiong Zhen
- Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China
| | - Ziman Chen
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Weijun Huang
- Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China
| | - Zhongzhen Su
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
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Barbier H, Carberry CL, Karjalainen PK, Mahoney CK, Galán VM, Rosamilia A, Ruess E, Shaker D, Thariani K. International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction. Int Urogynecol J 2023; 34:2657-2688. [PMID: 37737436 PMCID: PMC10682140 DOI: 10.1007/s00192-023-05629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/22/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This manuscript from Chapter 2 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) reviews the literature involving the clinical evaluation of a patient with POP and associated bladder and bowel dysfunction. METHODS An international group of 11 clinicians performed a search of the literature using pre-specified search MESH terms in PubMed and Embase databases (January 2000 to August 2020). Publications were eliminated if not relevant to the clinical evaluation of patients or did not include clear definitions of POP. The titles and abstracts were reviewed using the Covidence database to determine whether they met the inclusion criteria. The manuscripts were reviewed for suitability using the Specialist Unit for Review Evidence checklists. The data from full-text manuscripts were extracted and then reviewed. RESULTS The search strategy found 11,242 abstracts, of which 220 articles were used to inform this narrative review. The main themes of this manuscript were the clinical examination, and the evaluation of comorbid conditions including the urinary tract (LUTS), gastrointestinal tract (GIT), pain, and sexual function. The physical examination of patients with pelvic organ prolapse (POP) should include a reproducible method of describing and quantifying the degree of POP and only the Pelvic Organ Quantification (POP-Q) system or the Simplified Pelvic Organ Prolapse Quantification (S-POP) system have enough reproducibility to be recommended. POP examination should be done with an empty bladder and patients can be supine but should be upright if the prolapse cannot be reproduced. No other parameters of the examination aid in describing and quantifying POP. Post-void residual urine volume >100 ml is commonly used to assess for voiding difficulty. Prolapse reduction can be used to predict the possibility of postoperative persistence of voiding difficulty. There is no benefit of urodynamic testing for assessment of detrusor overactivity as it does not change the management. In women with POP and stress urinary incontinence (SUI), the cough stress test should be performed with a bladder volume of at least 200 ml and with the prolapse reduced either with a speculum or by a pessary. The urodynamic assessment only changes management when SUI and voiding dysfunction co-exist. Demonstration of preoperative occult SUI has a positive predictive value for de novo SUI of 40% but most useful is its absence, which has a negative predictive value of 91%. The routine addition of radiographic or physiological testing of the GIT currently has no additional value for a physical examination. In subjects with GIT symptoms further radiological but not physiological testing appears to aid in diagnosing enteroceles, sigmoidoceles, and intussusception, but there are no data on how this affects outcomes. There were no articles in the search on the evaluation of the co-morbid conditions of pain or sexual dysfunction in women with POP. CONCLUSIONS The clinical pelvic examination remains the central tool for evaluation of POP and a system such as the POP-Q or S-POP should be used to describe and quantify. The value of investigation for urinary tract dysfunction was discussed and findings presented. The routine addition of GI radiographic or physiological testing is currently not recommended. There are no data on the role of the routine assessment of pain or sexual function, and this area needs more study. Imaging studies alone cannot replace clinical examination for the assessment of POP.
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Affiliation(s)
- Heather Barbier
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cassandra L Carberry
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University/Women & Infants Hospital, Providence, RI, USA
| | - Päivi K Karjalainen
- Department of Obstetrics and Gynecology, Hospital Nova of Central Finland, Jyväskylä, Finland
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | | | - Anna Rosamilia
- Urogynaecologist and Reconstructive Pelvic Floor Surgeon, Cabrini Hospital, Malvern, Victoria, Australia.
- Monash Health, Monash University Department of O&G, Hudson Institute of Medical Research, Melbourne, Australia.
| | - Esther Ruess
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
| | - David Shaker
- Rural Clinical School Rockhampton Australia, Mater Private Hospital Rockhampton Australia, University of Queensland, St Lucia, Australia
| | - Karishma Thariani
- Fellowship in Urogynaecology & Pelvic Reconstructive Surgery, Consultant Urogynaecologist, Centre for Urogynaecology & Pelvic Health, New Delhi, India
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Kim Y, Rowley JE, Ortega MV, James KE, Von Bargen E. Incidence of de novo stress urinary incontinence following minimally invasive sacrocolpopexy. Int Urogynecol J 2023; 34:1599-1605. [PMID: 36645440 DOI: 10.1007/s00192-022-05434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/29/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate the incidence and risk factors of postoperative de novo stress urinary incontinence (SUI) in stress-continent women following minimally invasive sacrocolpopexy without an anti-incontinence procedure. METHODS We completed a multicenter, retrospective cohort study of women undergoing laparoscopic sacrocolpopexy without concurrent anti-incontinence procedures from October 2006 through January 2021. RESULTS Of the 169 women who underwent minimally invasive sacrocolpopexy, 17.1% (n=30) developed de novo SUI, and 7.1% eventually underwent a midurethral sling placement. On logistic regression, BMI, preoperative urinary urgency, and history of transvaginal mesh repair were found to be significantly associated with and predictive of de novo SUI. When the concordance index (C-index) was calculated with the model published by Jelovsek et al. for women who developed de novo SUI within 12 months of the prolapse surgery, the current de novo SUI calculator was able to discriminate de novo SUI outcome (C-index = 0.71). CONCLUSIONS The incidence of de novo SUI after minimally invasive sacrocolpopexy without anti-incontinence procedure correlates directly with higher BMI, preoperative urinary urgency, and transvaginal mesh history for POP. Preoperative counseling for minimally invasive sacrocolpopexy should include discussing the risk of de novo SUI and preoperative factors that may increase this risk.
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Affiliation(s)
- Youngwu Kim
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.
| | | | - Marcus V Ortega
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Kaitlyn E James
- Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Von Bargen
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
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Zhao X, Niu J, Liu Y. Strengthen the sacral ligament and paravagina by equilibrium control severe pelvic organ prolapse. Front Surg 2023; 9:1054008. [PMID: 36704520 PMCID: PMC9871633 DOI: 10.3389/fsurg.2022.1054008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To evaluate and analyze the clinical effect of the combination of laparoscopic sacrocolpopexy (LSC), sacral ligament fusion and vaginal suspension in the treatment of severe pelvic organ prolapse. Methods A total of 76 cases of patients with pelvic organ prolapse in our hospital between January 2010 to December 2020 were enrolled for research. They had been evaluated pre- and post-operative through pelvic organ prolapse quantification (POP-Q) system, Pelvic Floor Dysfunction Questionnaire Short Form (PFDI-20), Pelvic Floor Function Impact Questionnaire Short form (PFIQ-7), and the Sexual Function Questionnaire Score (PIQS-31). Results All 76 patients went through the procedure successfully without any complications. None of the 76 cases had relapsed. Post-operational results of PFDI-20 and PFIQ-7 were evidently lower than pre-operational results, post-operational results of PIQS-31 were higher than before operation. Conclusions For patients with severe pelvic organ prolapse,a balanced control of the pelvic floor centred on the preservation of the stereoscopic ring around the cervix through revascularization is significantly effective, and has no recurrence after surgery, high patient satisfaction, fewer postoperative complications. It is safe and reliable and worthy of clinical application and promotion.
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Li Y, Li L, Li B, Liao W, Liu T, Shen F, Hong L. Mechanical stretching induces fibroblasts apoptosis through activating Piezo1 and then destroying actin cytoskeleton. Int J Med Sci 2023; 20:771-780. [PMID: 37213676 PMCID: PMC10198138 DOI: 10.7150/ijms.81666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/06/2023] [Indexed: 05/23/2023] Open
Abstract
The anatomical positions of pelvic floor organs are maintained by ligaments and muscles. Stress urinary incontinence (SUI) occurs when the pelvic floor tissues are repeatedly stimulated by excessive mechanical tension that exceeds the bearing capacity of ligaments or muscles. Besides, cells respond mechanically to mechanical stimulation by reconstituting the Piezo1 and cytoskeletal system. The aim of this study is to determine how Piezo1 and actin cytoskeleton are involved in the mechanized stretch (MS) induced apoptosis of human anterior vaginal wall fibroblasts (hAVWFs) and the mechanism. A four-point bending device was used to provide mechanical stretching to establish a cellular mechanical damage model. The apoptosis of hAVWFs cells in non-SUI patients was significantly increased by MS, which exhibited apoptosis rates comparable to those of SUI patients. Based on these findings, Piezo1 connects the actin cytoskeleton to the apoptosis of hAVWFs cells, providing an idea for the clinical diagnosis and treatment of SUI. However, the disassembly of the actin cytoskeleton suppressed the protective effect of Piezo1 silencing on MS. Based on these findings, Piezo1 connects the actin cytoskeleton to apoptosis of hAVWFs, providing new insight for the clinical diagnosis and treatment of SUI.
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Affiliation(s)
- Yang Li
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, P. R. China
| | - Lu Li
- Department of Gynecology and Obstetrics, the People's Hospital of Three Gorges University/ the First People's Hospital of Yichang
| | - Bingshu Li
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, P. R. China
| | - Wenxin Liao
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, P. R. China
| | - Tingting Liu
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, P. R. China
| | - Fujin Shen
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, P. R. China
- ✉ Corresponding authors: Dr. Li Hong, Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan 430060, Hubei Province, P.R. China, E-mail: ; Dr. Fujin Shen, Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan 430060, Hubei Province, P.R. China, E-mail:
| | - Li Hong
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, P. R. China
- ✉ Corresponding authors: Dr. Li Hong, Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan 430060, Hubei Province, P.R. China, E-mail: ; Dr. Fujin Shen, Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan 430060, Hubei Province, P.R. China, E-mail:
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Giugale L, Sridhar A, Ferrante KL, Komesu YM, Meyer I, Smith AL, Myers D, Visco AG, Paraiso MFR, Mazloomdoost D, Gantz M, Zyczynski HM. Long-term Urinary Outcomes After Transvaginal Uterovaginal Prolapse Repair With and Without Concomitant Midurethral Slings. Female Pelvic Med Reconstr Surg 2022; 28:142-148. [PMID: 35272320 PMCID: PMC8928054 DOI: 10.1097/spv.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Many health care providers place concomitant midurethral slings during pelvic organ prolapse repair, yet growing evidence supports staged midurethral sling placement. OBJECTIVES The aim of this study was to compare urinary function after transvaginal uterovaginal prolapse repair with and without midurethral sling. STUDY DESIGN Secondary analysis of the Study of Uterine Prolapse Procedures Randomized Trial (hysterectomy with uterosacral ligament suspension vs mesh hysteropexy). Our primary outcome was Urinary Distress Inventory score (UDI-6) through 5 years compared between women with and without a concomitant sling within prolapse repair arms. Sling effect was adjusted for select clinical variables and interaction terms (α = .05). RESULTS The sling group included 90 women (43 hysteropexy, 47 hysterectomy), and the no-sling group included 93 women (48 hysteropexy, 45 hysterectomy). At baseline, the sling group reported more bothersome stress (66% vs 36%, P < 0.001) and urgency incontinence (69% vs 48%, P = 0.007). For hysteropexy, there were no significant long-term differences in UDI-6 scores or bothersome urine leakage between sling groups. For hysterectomy, women with sling had better UDI-6 scores across time points (adjusted mean difference, -5.1; 95% confidence interval [CI], -9.9 to -0.2); bothersome stress and urgency leakage were less common in the sling group (stress adjusted odds ratio, 0.1 [95% CI, 0.0-0.4]; urge adjusted odds ratio, 0.5 [95% CI, 0.2-1.0]). Treatment for stress incontinence over 5 years was similar in the sling (7.9%) versus no-sling (7.6%) groups. CONCLUSIONS Five-year urinary outcomes of concomitant midurethral sling may vary by type of transvaginal prolapse surgery, with possible benefit of midurethral sling at the time of vaginal hysterectomy with apical suspension but not after mesh hysteropexy.
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Affiliation(s)
- Lauren Giugale
- University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh PA
| | | | | | | | - Isuzu Meyer
- University of Alabama at Birmingham, Birmingham AL
| | - Ariana L. Smith
- Department of Surgery, Division of Urology, University of Pennsylvania Philadelphia PA
| | - Deborah Myers
- Brown University/Women & Infants Hospital, Providence RI
| | | | | | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
| | - Marie Gantz
- RTI International, Research Triangle Park NC
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Hendrickson WK, Xie G, Rahn DD, Amundsen CL, Hokanson JA, Bradley M, Smith AL, Sung VW, Visco AG, Luo S, Jelovsek JE. Predicting outcomes after intradetrusor onabotulinumtoxina for non-neurogenic urgency incontinence in women. Neurourol Urodyn 2022; 41:432-447. [PMID: 34859485 PMCID: PMC9014828 DOI: 10.1002/nau.24845] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 01/03/2023]
Abstract
AIMS Develop models to predict outcomes after intradetrusor injection of 100 or 200 units of onabotulinumtoxinA in women with non-neurogenic urgency urinary incontinence (UUI). METHODS Models were developed using 307 women from two randomized trials assessing efficacy of onabotulinumtoxinA for non-neurogenic UUI. Cox, linear and logistic regression models were fit using: (1) time to recurrence over 12 months, (2) change from baseline daily UUI episodes (UUIE) at 6 months, and (3) need for self-catheterization over 6 months. Model discrimination of Cox and logistic regression models was calculated using c-index. Mean absolute error determined accuracy of the linear model. Calibration was demonstrated using calibration curves. All models were internally validated using bootstrapping. RESULTS Median time to recurrence was 6 (interquartile range [IQR]: 2-12) months. Increasing age, 200 units of onabotulinumtoxinA, higher body mass index (BMI) and baseline UUIE were associated with decreased time to recurrence. The c-index was 0.63 (95% confidence interval [CI]: 0.59, 0.67). Median change in daily UUIE from baseline at 6 months was -3.5 (IQR: -5.0, -2.3). Increasing age, lower baseline UUIE, 200 units of onabotulinumtoxinA, higher BMI and IIQ-SF were associated with less improvement in UUIE. The mean absolute error predicting change in UUIE was accurate to 1.6 (95% CI: 1.5, 1.7) UUI episodes. The overall rate of self-catheterization was 17.6% (95% CI: 13.6%-22.4%). Lower BMI, 200 units of onabotulinumtoxinA, increased baseline postvoid residual and maximum capacity were associated with higher risk of self-catheterization. The c-index was 0.66 (95% CI: 0.61, 0.76). The three calculators are available at http://riskcalc.duke.edu. CONCLUSIONS After external validation, these models will assist clinicians in providing more accurate estimates of expected treatment outcomes after onabotulinumtoxinA for non-neurogenic UUI in women.
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Affiliation(s)
- Whitney K. Hendrickson
- Department of OBGYN, Division of Urogynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - Gongbo Xie
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, USA
| | - David D. Rahn
- Department of OBGYN, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cindy L. Amundsen
- Department of OBGYN, Division of Urogynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - James A. Hokanson
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Megan Bradley
- Department of Obstetrics, Gynecology and Reproductive Services, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ariana L. Smith
- Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vivian W. Sung
- Department of OBGYN, Division of Urogynecology and Pelvic Reconstructive Surgery, Women and Infants Hospital, Brown University, Providence, Rhode Island, USA
| | - Anthony G. Visco
- Department of OBGYN, Division of Urogynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - Sheng Luo
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, USA
| | - J. Eric Jelovsek
- Department of OBGYN, Division of Urogynecology, Duke University Medical Center, Durham, North Carolina, USA
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Sato H, Abe H, Ikeda A, Miyagawa T, Tsukada S. Severity of cystocele and risk factors of postoperative stress urinary incontinence after laparoscopic sacrocolpopexy for pelvic organ prolapse. Gynecol Minim Invasive Ther 2022; 11:28-35. [PMID: 35310120 PMCID: PMC8926053 DOI: 10.4103/gmit.gmit_2_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/21/2021] [Accepted: 05/12/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives: Materials and Methods: Results: Conclusion:
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13
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Oh S, Lee S, Hwang WY, Suh DH, Jeon MJ. Development and validation of a prediction model for bothersome stress urinary incontinence after prolapse surgery: a retrospective cohort study. BJOG 2021; 129:1158-1164. [PMID: 34854216 DOI: 10.1111/1471-0528.17036] [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: 06/05/2021] [Revised: 10/01/2021] [Accepted: 10/31/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop and validate a prediction model for bothersome stress urinary incontinence after prolapse surgery and to compare it with an existing clinical prediction model (CUPIDO model). DESIGN Retrospective cohort study. SETTING Two tertiary hospitals in South Korea. POPULATION A total of 1142 patients who underwent prolapse surgery with or without a concomitant midurethral sling. METHODS To construct a prediction model, we performed logistic regression using both exhaustive and stepwise variable selection, validating the model both internally and externally. MAIN OUTCOME MEASURES Bothersome stress urinary incontinence defined as the presence of bothersome symptoms of stress urinary incontinence and/or subsequent continence procedure one year after surgery. RESULTS Postoperative bothersome stress urinary incontinence occurred in 10% of patients. A model containing six predictors (age, diabetes mellitus, subjective urinary incontinence, prolapse reduction stress test result, type of prolapse surgery, and a concomitant midurethral sling) showed excellent performance for predicting bothersome stress urinary incontinence (area under the curve 0.74, 95% confidence interval 0.62-0.86) and outperformed the CUPIDO model (area under the curve 0.63, 95% confidence interval 0.49-0.76; DeLong's test P = 0.014). CONCLUSIONS This prediction model might be a useful tool to guide patient decision making regarding a concomitant continence procedure at the time of prolapse surgery. The predictive value of this model needs to be validated further in cohorts with different characteristics. TWEETABLE ABSTRACT The proposed prediction model for bothersome stress urinary incontinence after prolapse surgery outperforms an existing model.
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Affiliation(s)
- S Oh
- Department of Obstetrics and Gynaecology, Seoul National University Hospital, Seoul, Korea
| | - S Lee
- Center for Precision Medicine, Seoul National University Hospital, Seoul, Korea
| | - W Y Hwang
- Department of Obstetrics and Gynaecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - D H Suh
- Department of Obstetrics and Gynaecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - M J Jeon
- Department of Obstetrics and Gynaecology, Seoul National University Hospital, Seoul, Korea.,Department of Obstetrics and Gynaecology, Seoul National University College of Medicine, Seoul, Korea
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Djusad S, Nizomy IR, Hakim S, Priyatini T, Moegni F, Meutia AP, Santoso BI. Incidence and characteristics of de novo stress urinary incontinence after pelvic organ prolapse vaginal repair. MEDICAL JOURNAL OF INDONESIA 2021. [DOI: 10.13181/mji.oa.204163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Some patients who undergo pelvic floor reconstruction for pelvic organ prolapse (POP) may experience a de novo stress urinary incontinence (SUI) postoperatively. We aimed to investigate the incidence and characteristics of de novo SUI in patients who underwent pelvic floor reconstruction at the national referral hospital in Indonesia.
METHODS This cross-sectional study evaluated 108 patients who underwent pelvic floor reconstruction due to POP between January 2016 and December 2017. Per the inclusion criteria, 75 women were enrolled using a consecutive sampling. The incidence of de novo SUI was determined 6–12 months postoperatively using the Indonesian version of the questionnaire for urinary incontinence diagnosis and objectively using the cough stress test during gynecologic examination after a negative preoperative prolapse reduction stress test.
RESULTS The average age, parity, body mass index, and years since menopause onset were 56.17 (4.67) years, 3.17 (1.07), 28.58 (5.18) kg/m2, and 12.8 (7.0) years, respectively. De novo SUI was seen in 8.0% (6 of 75) patients at 6–7 months postoperatively, with 3 (50.0%) had severe POP and 3 (50.0%) had a mild POP. Most of these patients (4 of 6, 66.7%) had undergone procedures other than colpocleisis for POP reconstruction.
CONCLUSIONS The incidence of de novo SUI after gynecologic surgery for POP at a national referral hospital in Indonesia is 8%. Most patients were aged <60 years, had a parity of <4, were nonobese, were menopausal, and had diabetes.
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A web-based fuzzy risk predictive-decision model of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery. Curr Urol 2021; 15:131-136. [PMID: 34552451 PMCID: PMC8451324 DOI: 10.1097/cu9.0000000000000035] [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: 07/04/2020] [Accepted: 09/16/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions affecting women's health and quality of life. In 50% of cases, SUI occurs after POP surgery, which is called de novo SUI. Predicting the risk of de novo SUI is a complex multi-attribute decision-making process. The current study made available a Decision Support System in the form of a fuzzy calculator web-based application to help surgeons predict the risk of de novo SUI. Materials and methods: We first identified 12 risk factors and the diagnostic criteria for de novo SUI by means of a systematic review of the literature. Then based upon an expert panel, all risk factors were prioritized. A set of 232 fuzzy rules for the prediction of de novo SUI was determined. A fuzzy expert system was developed using MATLAB software and Mamdani Inference System. The risk prediction model was then evaluated using retrospective data extracted from 30 randomly selected medical records of female patients over the age of 50 without symptoms of urinary incontinence who had undergone POP surgery. Finally, the proposed results of the predictive system were compared with the results of retrospective medical record data review. Results: The results of this online calculator show that the accuracy of this risk prediction model, at more than 90%, compared favorably to other SUI risk prediction models. Conclusions: A fuzzy logic-based clinical Decision Support System in the form of an online calculator for calculating SUI prognosis after POP surgery in women can be helpful in predicting de novo SUI.
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16
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Zhao W, Wang G, Xu P, Wu T, Chen B, Ren H, Li X. Analysis of High-Risk Factors Associated with the Progression of Subaneurysmal Aorta to Abdominal Aortic Aneurysm in Rural Area in China. Clin Interv Aging 2021; 16:1573-1580. [PMID: 34465986 PMCID: PMC8402982 DOI: 10.2147/cia.s321921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To determine the risk factors associated with the progress of subaneurysmal aorta (SAA) to abdominal aortic aneurysm (AAA) and provide a reference for the prevention of AAA in rural areas. Methods A total of 747 SAA patients screened by the Health Management Center of the Second Hospital of Lanzhou University from January 2015 to January 2016 were recruited. The ratio of SAA progressing to AAA was observed through 5 years of follow-up. Logistic stepwise regression analysis was performed to analyze the high-risk factors. The relevant clinical prediction model score table (Nom) was made and the C-index and calibration chart were used to verify the prediction ability of the model. Results Of the 747 patients diagnosed with SAA, 260 developed to AAA, with an incidence of 34.8%. Univariate analysis showed that age (62–65 years old), abdominal aorta diameter greater than 2.7 cm, smoking after 30 years old, moderate to severe hypertension, and blood pressure variability were the important high-risk factors of SAA progressing to AAA. Logistic regression analysis showed that these factors were statistically significant. The nomogram of clinical prediction model score showed that when 50–60% of SAA developed to AAA, the score was 189–201 and the C-index was 0.883, verifying the moderate predictive ability of this model. Conclusion Age, smoking habit, degree of hypertension, and control situation were high-risk factors associated with the progression of SAA to AAA. The control of the above high-risk factors was imperative for the prevention of AAA in rural areas without sufficient medical resources.
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Affiliation(s)
- Wenjun Zhao
- Department of Ultrasound, Imaging, Healthy Management Centre, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
| | - Gang Wang
- Department of Neurosurgeon, Neurology, Neurologist, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
| | - Ping Xu
- Department of Ultrasound, Imaging, Ultrasound Centre, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
| | - Tingting Wu
- Department of Ultrasound, Imaging, Ultrasound Centre, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
| | - Binjuan Chen
- Department of Ultrasound, Imaging, Ultrasound Centre, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
| | - Haijun Ren
- Department of Neurosurgeon, Neurology, Neurologist, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
| | - Xingjie Li
- Department of Ultrasound, Imaging, Healthy Management Centre, The Second Hospital of Lanzhou University, Lanzhou City, 730000, Gansu Province, People's Republic of China
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Abstract
This article discusses a few of the most prominent controversies currently confronting providers and patients when planning for surgical repair of pelvic organ prolapse including preoperative counseling and patient preparedness, preoperative urodynamics and concomitant anti-incontinence procedures, uterine preservation, total versus supracervical hysterectomy at the time of sacrocolpopexy, same-day discharge, and use of telemedicine for routine postoperative care. These current controversies reflect some of the larger questions and themes confronting the field at this time, and this discussion serves to highlight opportunities for further research and stimulate the constructive debate that moves the field forward.
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Affiliation(s)
- Alexis Anne Dieter
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Georgetown University School of Medicine, 106 Irving Street, Northwest, Suite 405 South, Washington, DC 20010, USA.
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18
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Zhang BY, Wong JMH, A Koenig N, Lee T, Geoffrion R. Risk factors for urinary retention after urogynecologic surgery: A retrospective cohort study and prediction model. Neurourol Urodyn 2021; 40:1182-1191. [PMID: 33891339 DOI: 10.1002/nau.24676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/22/2021] [Accepted: 03/29/2021] [Indexed: 11/06/2022]
Abstract
AIMS Postoperative urinary retention (POUR) is a common complication of urogynecological surgery. Our study aimed to identify demographic and perioperative risk factors to construct a prediction model for POUR in urogynecology. METHODS Our retrospective cohort study reviewed all patients undergoing pelvic reconstructive surgeries at our tertiary care center (Jan 1, 2013-May 1, 2019). Demographic, pre-, intra- and postoperative variables were collected from medical records. The primary outcome, POUR, was defined as (1) early POUR (E-POUR), failing initial trial of void or; (2) late POUR (L-POUR), requiring an indwelling catheter or intermittent catheterization on discharge. Risk factors were identified through univariate and multivariate logistic regression analyses. A clinical prediction model was constructed with the most significant and clinically relevant risk factors. RESULTS In 501 women, 182 (36.3%) had E-POUR and 61 of these women (12.2% of the entire cohort) had L-POUR. Multivariate logistic regression revealed preoperative postvoid residual (PVR) over 200 ml (odds ratio [OR]: 3.17; p = 0.026), voiding dysfunction symptoms extracted from validated questionnaires (OR: 3.00; p = 0.030), and number of concomitant procedures (OR: 1.30 per procedure; p = 0.021) as significant predictors of E-POUR; preoperative PVR more than 200 ml (OR: 4.07; p = 0.011) and antiincontinence procedure with (OR: 3.34; p = 0.023) and without (OR: 2.64; p = 0.019) concomitant prolapse repair as significant predictors of L-POUR. A prediction model (area under the curve: 0.70) was developed for E-POUR. CONCLUSIONS Elevated preoperative PVR is the most significant risk factor for POUR. Alongside other risk factors, our prediction model for POUR can be used for patient counseling and surgical planning in urogynecologic surgery.
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Affiliation(s)
- Bei Yuan Zhang
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey Man Hay Wong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole A Koenig
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Terry Lee
- Center for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roxana Geoffrion
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
The multifactorial pathophysiology of pelvic floor disorder accounts for the coexistence of several pelvic floor disorders in many women. Up to 54% of women with pelvic organ prolapse (POP) report concurrent stress urinary incontinence (SUI). While POP is a risk factor for coexistent SUI, apical and anterior prolapse can also conceal SUI symptoms that are unmasked by POP repair, resulting in de novo SUI postoperatively. It is important for pelvic reconstructive surgeons to consider the relationship between POP and urinary incontinence in presurgical planning and to discuss with patients the risks and advantages of concurrent versus staged anti-incontinence procedures.
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20
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Urinary retention is rare after colpocleisis and concomitant midurethral sling: a 10-year experience. Int Urogynecol J 2021; 32:729-736. [PMID: 33547907 DOI: 10.1007/s00192-021-04705-1] [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: 08/19/2019] [Accepted: 11/04/2019] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The optimal method of managing stress urinary incontinence (SUI) in women undergoing colpocleisis remains unclear, especially in a setting of urinary retention. We aim to compare postoperative retention after colpocleisis with or without concomitant midurethral sling (MUS). METHODS A retrospective chart review of all women who underwent colpocleisis with or without MUS from October 2007 to October 2017 was performed. Women with preoperative and 2-week postoperative post-void residual volume (PVR) measurements were included. Urinary retention was defined as PVR of ≥100 ml. Analysis included t tests/Wilcoxon rank, Chi-squared/Fisher's exact, and multivariate linear regression models. RESULTS A total of 231 women with a mean age of 77.7 years (± 6.0 years SD) met the inclusion criteria. One hundred and thirty-eight women underwent colpocleisis alone, whereas 93 women had colpocleisis with MUS. Preoperative retention rates were high (44.9% vs 34.4%, for colpocleisis alone versus with MUS, p = 0.114). Postoperative retention rates were lower and similar between the groups (10.1% vs 11.8%, for colpocleisis alone vs with MUS, p = 0.69). Linear regression models showed the adjusted odds ratio for postoperative urinary retention in patients with concomitant MUS was 1.68 (95% confidence interval: 0.64-4.41) compared with patients with colpocleisis alone and this did not reach statistical significance (p = 0.292). Fortunately, after colpocleisis, women had high rates of resolution of retention, regardless of MUS (80.3% vs 90.6% for colpocleisis alone vs with MUS; p = 0.20). Few women required reoperation for retention (3.1%). CONCLUSIONS Placement of an MUS at the time of colpocleisis is a safe and effective therapy. This appears to be unaffected by preoperative urinary retention status.
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21
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Yasa C, Gungor Ugurlucan F, Dural O, Yalcın O. External validation of a model predicting de novo stress urinary incontinence after pelvic organ prolapse surgery. Neurourol Urodyn 2021; 40:688-694. [PMID: 33492730 DOI: 10.1002/nau.24608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 11/07/2022]
Abstract
AIMS De novo stress urinary incontinence (SUI) may develop after surgical correction of advanced pelvic organ prolapse (POP) in otherwise continent women. Prediction of which women with POP will develop SUI after the prolapse is corrected is difficult. We aimed to externally validate a previously described prediction model for de novo SUI after performing vaginal surgery for POP and to assess its clinical performance when used as a diagnostic test. METHODS This retrospective cohort study included all continent women with ≥ stage 2 POP according to the POP-Quantification System who underwent reconstructive surgery for symptomatic POP. Surgical correction for prolapse of the anterior and/or apical compartment was performed using native tissue or vaginal mesh repair. Seven parameters of the prediction model including age at surgery, number of vaginal births, body mass index, preoperative stress test, previous continence procedure history, urine leakage associated with a feeling of urgency, and diagnosis of diabetes for each patient was provided from the medical records, and the predicted probability of de novo SUI after POP surgery was calculated. The primary outcome used to validate the prediction model was the presence of SUI 1 year after surgery. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive accuracy. A cut-off point of ≥ 50% was used to evaluate its clinical performance as a diagnostic test. RESULTS Two hundred twenty-five women were suitable for analysis. The rate of de novo SUI was 5.3%. The predictive accuracy of the model in our population using the area under the ROC curve was 0.56 (95% confidence interval = 0.35-0.77). Its performance as a diagnostic test was poor (positive likelihood ratio = 1.20 and negative likelihood ratio = 0.89). CONCLUSIONS Our clinical validation of this model showed that it did not have good clinical performance. We need future prospective studies to identify and incorporate additional markers of de novo SUI to improve the prediction capacity.
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Affiliation(s)
- Cenk Yasa
- Department of Obstetrics and Gynecology, School of Medicine, Istanbul University, Istanbul, Turkey
| | - Funda Gungor Ugurlucan
- Department of Obstetrics and Gynecology, School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozlem Dural
- Department of Obstetrics and Gynecology, School of Medicine, Istanbul University, Istanbul, Turkey
| | - Onay Yalcın
- Department of Obstetrics and Gynecology, School of Medicine, Istanbul University, Istanbul, Turkey
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Moosavi SY, Samad-Soltani T, Hajebrahimi S, Sadeghi-Ghyassi F, Pashazadeh F, Abolhasanpour N. Determining the risk factors and characteristics of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery: A systematic review. Turk J Urol 2020; 46:427-435. [PMID: 32976089 DOI: 10.5152/tud.2020.20291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Stress urinary incontinence (SUI) is a common problem in women that affects their quality of life. According to the current evidence, 15%-50% of severe pelvic organ prolapse (POP) surgeries lead to de novo urinary incontinence (UI). This study aimed at determining the risk factors and characteristics of de novo SUI after POP surgeries in a systematic review. MATERIAL AND METHODS We conducted a systematic search of articles in English related to the risk of UI after POP surgery published until December 2019 in the selected bibliographic databases, including PubMed, EMBASE, Scopus, Cochrane Library, and ProQuest. RESULTS The initial search resulted in 2,363 studies, and after reviewing the titles and abstracts, 146 studies were identified. Moreover, 2 independent reviewers, using the Joanna Briggs Institute checklists, evaluated the risk of biases in the selected studies. Finally, 40 studies met the inclusion criteria. The most important predictors of UI after POP surgery were positive pessary testing, age >50 years, and maximum urethral closure pressure (MUCP) <60 cmH2O. CONCLUSION Positive pessary testing, older age, and low MUCP were the most important risk factors for de novo incontinence after POP surgeries.
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Affiliation(s)
- Seyyde Yalda Moosavi
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taha Samad-Soltani
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.,Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Sadeghi-Ghyassi
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Pashazadeh
- Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasrin Abolhasanpour
- Research Center for Evidence-Based Medicine: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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Balancing the possibility of needing a future incontinence procedure versus a future urethral sling revision surgery: a tradeoff analysis for continent women undergoing pelvic organ prolapse surgery. Int Urogynecol J 2020; 31:1141-1150. [PMID: 32125489 DOI: 10.1007/s00192-020-04226-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/14/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Although urinary incontinence surgery has potential benefits such as preventing de novo stress urinary incontinence in women undergoing pelvic organ prolapse (POP) surgery, it comes with the potential cost of overtreatment and complications. We compared future surgery rates in a population cohort of women undergoing vaginal pelvic organ prolapse surgery. METHODS All women undergoing POP repair in California from 2005 to 2011 were identified from the Office of Statewide Health Planning and Development databases. Rates of repeat surgery in those with and without concomitant urethral sling procedures were compared. To control for confounding effects, multivariate mixed effects logistic regression models were constructed to compare each woman's individualized risk of undergoing either sling revision surgery or future incontinence surgery. RESULTS In the cohort, 38,456 underwent a sling procedure at the time of POP repair and 42,858 did not. The future surgery rate was higher for sling-related complications in the POP + sling cohort compared with future incontinence surgery in the POP alone cohort (3.5% versus 3.0% respectively, p < 0.001). The difference persisted in multivariate modeling, where most women (60%) are at a higher risk of requiring sling revision surgery compared with needing a future primary incontinence procedure (40%). CONCLUSIONS Women who undergo vaginal prolapse repair without an incontinence procedure are at a low risk of future incontinence surgery. Women without urinary incontinence who are considering vaginal POP surgery should be informed of the risks and benefits of including a sling procedure.
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Does Previous Pelvic Organ Prolapse Surgery Influence the Effectiveness of the Sub-Urethral Sling Procedure? J Clin Med 2020; 9:jcm9030653. [PMID: 32121239 PMCID: PMC7141339 DOI: 10.3390/jcm9030653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 02/24/2020] [Indexed: 02/02/2023] Open
Abstract
Pelvic organ prolapse (POP) often co-occurs with stress urinary incontinence. There is no consensus on whether prolapse repair and anti-incontinence surgery should be performed concomitantly or separately, in a two-step manner. The present study evaluated the effects of the tension-free vaginal tape (TVT) procedure in patients who had previously undergone pelvic floor repair (study group), compared to women who underwent TVT insertion only (control group). The study group comprised 84 patients who underwent the TVT procedure but had previously also undergone surgical POP repair. The control group consisted of 250 women in whom the TVT was inserted. The primary objective was to compare the objective cure rate and the secondary objective was to compare the subjective cure rate in both groups. Negative pad test was achieved in over 91% in both groups. Objective and subjective cure rates were compared, as well as complication rates. Significant improvement was observed in the postoperative 1-h pad test in all patients. In all patients, we observed significant improvement in the quality of life, with no differences between the groups. No differences were found in the occurrence of postoperative urinary retention, urgency and frequency of daytime micturition, or vaginal erosion between the groups. The current results demonstrate that the two-step approach to pelvic reconstruction and anti-incontinence surgery is as safe and effective as primary TVT implantation.
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Bentaleb J, Larouche M. Innovative use of artificial intelligence in urogynecology. Int Urogynecol J 2020; 31:1287-1288. [PMID: 32055869 DOI: 10.1007/s00192-020-04243-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Jouhayna Bentaleb
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
| | - Maryse Larouche
- St. Mary's Research Centre, Montreal, QC, Canada.
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada.
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Yin Y, Xia Z, Feng X, Luan M, Qin M. Three-Dimensional Transperineal Ultrasonography for Diagnosis of Female Occult Stress Urinary Incontinence. Med Sci Monit 2019; 25:8078-8083. [PMID: 31657360 PMCID: PMC6836640 DOI: 10.12659/msm.917086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background We evaluated the utility of three-dimensional transperineal ultrasonography in detecting occult stress urinary incontinence in women undergoing anterior pelvic floor reconstruction surgery for severe cystocele. Material/Methods We enrolled 207 women with stage III–IV cystocele without urinary stress incontinence. One week before the operation, the patients underwent pelvic floor ultrasonography. We measured the vertical distance between the bladder neck and posterior margin of the pubic symphysis, the posterior vesicourethral angle, the urethral rotation angle, the formation of funnel shape, the hiatus area, and the length of the urethra and the funnel shape. Postoperatively, the patients were evaluated for symptoms of stress urinary incontinence and with the 20-minute pad test. Results The posterior vesicourethral angle with Valsalva maneuver, the difference in the posterior vesicourethral angle between the resting state and with the Valsalva state, and the angle of the proximal urethra were larger in the incontinence-positive group than in the incontinence-negative group (P<0.05). Funnel shape urethra was longer in the incontinence-positive group than in the incontinence-negative group (P<0.05). The cutoff value was 137.5° for the posterior vesicourethral angle with Valsalva maneuver, 39.5° for the difference in the posterior vesicourethral angle, 44.5° for the angle of the proximal urethra, and 0.35 cm for the length of the funnel shape. Multivariate analysis revealed that the difference between the posterior vesicourethral angle in the resting state and with Valsalva, the angle of the proximal urethra, and the length of funnel shape were strongly correlated with occult stress urinary incontinence. Conclusions Ultrasonography is an effective method for identifying occult stress urinary incontinence.
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Affiliation(s)
- Yitong Yin
- Department of Obstetrics and Gynecology, Pelvic Floor Disease Diagnosis and Treatment Center, China Medical University Affiliated Shengjing Hospital, Shenyang, Liaoning, China (mainland)
| | - Zhijun Xia
- Department of Obstetrics and Gynecology, Pelvic Floor Disease Diagnosis and Treatment Center, China Medical University Affiliated Shengjing Hospital, Shenyang, Liaoning, China (mainland)
| | - Xiaoyu Feng
- Department of Ultrasound, China Medical University Affiliated Shengjing Hospital, Shenyang, Liaoning, China (mainland)
| | - Meng Luan
- Department of Obstetrics and Gynecology, Pelvic Floor Disease Diagnosis and Treatment Center, China Medical University Affiliated Shengjing Hospital, Shenyang, Liaoning, China (mainland)
| | - Meiying Qin
- Department of Obstetrics and Gynecology, Pelvic Floor Disease Diagnosis and Treatment Center, China Medical University Affiliated Shengjing Hospital, Shenyang, Liaoning, China (mainland)
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Harris EP, MacDonald DB, Boland L, Boet S, Lalu MM, McIsaac DI. Personalized perioperative medicine: a scoping review of personalized assessment and communication of risk before surgery. Can J Anaesth 2019; 66:1026-1037. [DOI: 10.1007/s12630-019-01432-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 01/14/2023] Open
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Validation of a Model Predicting De Novo Stress Urinary Incontinence in Women Undergoing Pelvic Organ Prolapse Surgery. Obstet Gynecol 2019; 133:683-690. [DOI: 10.1097/aog.0000000000003158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this paper is to review (1) the epidemiology and pathophysiology of pelvic organ prolapse (POP) and occult stress urinary incontinence (SUI), (2) examine the data on combined operative management of POP and occult SUI, (3) discuss the approaches to clinical decision making, and (4) present future therapies. RECENT FINDINGS Prospective data on many approaches to concomitant treatment of prolapse and occult stress urinary incontinence, such as minimally invasive sacrocolpopexy and midurethral sling, or older approaches that have regained favor among patients and clinicians wishing to avoid synthetic mesh, such as native tissue prolapse repair and pubovaginal sling, are limited. Safe durable treatments with absorbable graft materials that promote a beneficial host response are intriguing but may be far from clinical implementation. Stem cell therapy for the treatment of stress urinary incontinence has demonstrated benefit in phase I/II trials but has not been studied in the setting of concomitant treatment of occult SUI with POP surgery and remains in the preclinical phase for the treatment of POP. A personalized approach to concomitant SUI surgery that incorporates individual risk assessment as well as informed patient preferences likely optimizes the risk/benefit ratio and patient satisfaction. Novel therapies, including graft materials and cellular therapies that stimulate a regenerative response, may improve or maintain continence outcomes while mitigating risk and alter the approach to both POP and SUI surgery.
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Affiliation(s)
- Joshua A Cohn
- Department of Urology, Einstein Healthcare Network, 50 E. Township Line Road, Suite 202, Elkins Park, Philadelphia, PA, 19027, USA. .,Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Ariana L Smith
- University of Pennsylvania Health System and Perelman School of Medicine, Philadelphia, PA, USA
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van der Ploeg JM, Steyerberg EW, Zwolsman SE, van der Vaart CH, Roovers JPWR. Stress urinary incontinence after vaginal prolapse repair: development and internal validation of a prediction model with and without the stress test. Neurourol Urodyn 2019; 38:1086-1092. [PMID: 30843271 DOI: 10.1002/nau.23958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/23/2018] [Accepted: 02/11/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop a prediction model for stress urinary incontinence (SUI) after vaginal prolapse repair (postoperative stress urinary incontinence [POSUI]) and assess the value of a preoperative stress test. PATIENTS AND METHODS Secondary analysis of two trials in which women were randomised for prolapse repair with or without a midurethral sling (MUS). The trials included women with (CUPIDO-1, n = 134) and without (CUPIDO-2, n = 225) coexisting SUI. POSUI was defined as bothersome SUI one year after surgery and/or treatment of SUI in the first postoperative year. Logistic regression analysis was used to define a reference model, which was extended with the preoperative stress test. The stress test was performed with and without reduction of the prolapse. Missing values were imputed 20 times, with bootstrap resampling for internal validation of discriminatory ability. RESULTS Three hundred fifty-six women could be included. POSUI occurred in 17% of the women (n = 61). The reference model included age (<55 years), point Ba of the pelvic organ prolapse quantification system (<-1), vaginal parity (≤3), subjective urinary incontinence, and MUS. The stress test had an odds ratio of 2.4 (95% confidence interval [CI], 1.2-4.6) in the extended model, which increased the optimism-corrected area under the receiver-operating curve from 0.74 to 0.76. The stress test was especially valuable in women with a 10% to 30% POSUI risk, where a stress test substantially impacted the POSUI risk. In more than 50% of the women, the stress test had no additional value in predicting POSUI. CONCLUSION A preoperative stress test is not valuable for women at low risk of SUI after vaginal prolapse repair.
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Affiliation(s)
| | - Ewout W Steyerberg
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sandra E Zwolsman
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - C Huub van der Vaart
- Department of Gynaecology and Reproductive Medicine, University Medical Centre Utrecht, The Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Sierra T, Sullivan G, Leung K, Flynn M. The negative predictive value of preoperative urodynamics for stress urinary incontinence following prolapse surgery. Int Urogynecol J 2019; 30:1119-1124. [PMID: 30643978 DOI: 10.1007/s00192-018-03864-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is no consensus for the evaluation of stress urinary incontinence (SUI) in patients planning pelvic organ prolapse (POP) surgery. We sought to determine the negative predictive value (NPV) of prolapse reduction during preoperative urodynamics (UDS) for postoperative SUI. METHODS We performed a retrospective study of 322 women with preoperative UDS and subsequent POP surgery. Abstracted data included demographics, prolapse stage, prior prolapse or incontinence surgery, preoperative SUI complaint, prolapse reduction method, and length of follow-up. Any woman who reported SUI symptoms within 6 months from surgery was considered a diagnostic UDS failure. The NPV was calculated by dividing the number of patients who did not demonstrate SUI on UDS and had no postoperative SUI by the number of patients who did not demonstrate SUI on UDS. RESULTS Patient characteristics (age, race, parity, prolapse stage, prior surgery, and length of follow-up) were similar among those who had urodynamic-proven SUI and those who did not. The NPV of preoperative UDS for postoperative SUI in patients undergoing any POP repair was 97.9.0% [95% confidence interval (CI) 92.7-99.7%]. The NPV remained high in the subset of patients who underwent an apical suspension-98.6% (95% CI 92.7-100.0%)-as well as those without a preoperative SUI complaint-98.6% (95% CI 92.3-100.0%). In most patients (72.9%), a ring pessary with support combined with intraprocedural manipulation allowed for reliable stress testing. CONCLUSIONS Our study supports using preoperative UDS as a screening tool to avoid unnecessary concomitant continence procedures. Further studies are needed to individualize patient preoperative assessment and surgical counseling.
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Affiliation(s)
- Tania Sierra
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA.
| | - Gina Sullivan
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA
| | - Katherine Leung
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA
| | - Michael Flynn
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA
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Rates and Risk Factors for Future Stress Urinary Incontinence Surgery after Pelvic Organ Prolapse Repair in a Large Population-based Cohort in California. Urology 2019; 123:81-86. [DOI: 10.1016/j.urology.2018.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/22/2018] [Accepted: 09/05/2018] [Indexed: 11/21/2022]
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External validation of de novo stress urinary incontinence prediction model after vaginal prolapse surgery. Int Urogynecol J 2018; 30:1719-1723. [PMID: 30443760 DOI: 10.1007/s00192-018-3805-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/19/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) may appear after the correction of pelvic organ prolapse (POP). The aim of this study was to externally validate a described predictive model for de novo SUI and to assess its clinical performance when used as a diagnostic test. METHODS This was a retrospective descriptive study on a cohort of consecutive women treated in our institution. The main outcome used to validate the model was the presence of objective or subjective SUI 1 year after surgery. A receiver operating characteristic curve was generated from our population to evaluate the predictive accuracy and to compare it with the original model. A cutoff point of ≥50% was used to evaluate its clinical performance as a diagnostic test. RESULTS Of the full cohort, 169 women were suitable for analysis. The rate of de novo SUI was 11.8%. The predictive accuracy of the model in our population was similar to the original [area under the curve (AUC) = 0.69; 95% confidence interval (CI) = 0.58-0.80). However, its performance measures when evaluated as a diagnostic test were low: positive likelihood ratio = 2.71 and negative likelihood ratio = 0.86. Only 15 women presented a positive test result. CONCLUSIONS External validation of the model found a global predictive accuracy similar to that of the original model. Despite the study being underpowered to give firm conclusions, the test did not show a good clinical performance when applied to our population with low de novo SUI prevalence. A larger sample size is needed to validate the model conclusively.
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Does the Degree of Cystocele Predict De Novo Stress Urinary Incontinence After Prolapse Repair? Further Analysis of the Colpopexy and Urinary Reduction Efforts Trial. Female Pelvic Med Reconstr Surg 2018; 24:292-294. [DOI: 10.1097/spv.0000000000000487] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jaunarena JH, Kowalik CG, Delpe SD, Kaufman MR, Dmochowski RR, Stuart Reynolds W. Effects of Pelvic Organ Prolapse on the Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Predicting risk of pelvic floor disorders 12 and 20 years after delivery. Am J Obstet Gynecol 2018; 218:222.e1-222.e19. [PMID: 29056536 DOI: 10.1016/j.ajog.2017.10.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/01/2017] [Accepted: 10/12/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Little progress has been made in the prevention of pelvic floor disorders, despite their significant health and economic impact. The identification of women who are at risk remains a key element in targeting prevention and planning health resource allocation strategies. Although events around the time of childbirth are recognized clinically as important predictors, it is difficult to counsel women and to intervene around the time of childbirth because of an inability to convey a patient's risk accurately in the presence of multiple risk factors and the long time lapse, which is often decades, between obstetric events and the onset of pelvic floor disorders later in life. Prediction models and scoring systems have been used in other areas of medicine to identify patients who are at risk for chronic diseases. Models have been developed for use before delivery that predict short-term risk of pelvic floor disorders after childbirth, but no models that predict long-term risk exist. OBJECTIVE The purpose of this study was to use variables that are known before and during childbirth to develop and validate prognostic models that will estimate the risks of these disorders 12 and 20 years after delivery. STUDY DESIGN Obstetric variables were collected from 2 cohorts: (1) women who gave birth in the United Kingdom and New Zealand (n=3763) and (2) women from the Swedish Medical Birth Register (n=4991). Pelvic floor disorders were self-reported 12 years after childbirth in the United Kingdom/New Zealand cohort and 20 years after childbirth in the Swedish Register. The cohorts were split so that data during the first half of the cohort's time period were used to fit prediction models, and validation was performed from the second half (temporal validation). Because there is currently no consensus on how to best define pelvic floor disorders from a patient's perspective, we chose to fit the data for each model using multiple outcome definitions for prolapse, urinary incontinence, fecal incontinence, ≥1 pelvic floor disorder, and ≥2 pelvic floor disorders. Model accuracy was measured in the following manner: (1) by ranking an individual's risk among all subjects in the cohort (discrimination) with the use of a concordance index and (2) by observing whether the predicted probability was too high or low (calibration) at a range of predicted probabilities with the use of visual plots. RESULTS Models were able to discriminate between women who experienced bothersome symptoms or received treatment at 12 and 20 years, respectively, for pelvic organ prolapse (concordance indices, 0.570, 0.627), urinary incontinence (concordance indices, 0.653, 0.689), fecal incontinence (concordance indices, 0.618, 0.676), ≥1 pelvic floor disorders (concordance indices, 0.639, 0.675), and ≥2 pelvic floor disorders (concordance indices, 0.635, 0.619). Route of delivery and family history of each pelvic floor disorder were strong predictors in most models. Urinary incontinence before and during the index pregnancy was a strong predictor for the development of all pelvic floor disorders in most models 12 years after delivery. The 12- and 20-year bothersome symptoms or treatment for prolapse models were accurate when predictions were provided for risk from 0% to approximately 15%. The 12- and 20-year primiparous model began to over predict when risk rates reached 20%. When we predicted bothersome symptoms or treatment for urinary incontinence, the 12-year models were accurate when predictions ranged from approximately 5-60%; the 20-year primiparous models were accurate from 5% and 80%. For bothersome symptoms or treatment for fecal incontinence, the 12- and 20-year models were accurate from 1-15% risk and began to over predict at rates at >15% and 20%, respectively. CONCLUSION Models may provide an opportunity before birth to identify women who are at low risk of the development of pelvic floor disorders and may provide institute prevention strategies such as pelvic floor muscle training, weight control, or elective cesarean section for women who are at higher risk. Models are provided at http://riskcalc.org/UR_CHOICE/.
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Frigerio M, Manodoro S, Palmieri S, Spelzini F, Milani R. Risk factors for stress urinary incontinence after native-tissue vaginal repair of pelvic organ prolapse. Int J Gynaecol Obstet 2018; 141:349-353. [PMID: 29333601 DOI: 10.1002/ijgo.12443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/13/2017] [Accepted: 01/12/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify risk factors for postoperative stress urinary incontinence (POSUI) after native-tissue prolapse repair without a concomitant anti-incontinence procedure. METHODS The present single-center retrospective study included women with genital prolapse who underwent high uterosacral ligament suspension without a concomitant anti-incontinence procedure during 2008-2013. Univariate and multivariate analyses were performed to identify risk factors for POSUI (identified through clinical interview and International Consultation on Incontinence Modular Questionnaire-Short Form [ICIQ-SF] self-administration) at 6 months. RESULTS In total, 87 (20.9%) of 417 women developed POSUI. Preoperative stress urinary incontinence (SUI) and urodynamically diagnosed SUI were significantly associated with POSUI; moreover, women with POSUI had a higher preoperative ICIQ-SF score, a lower opening detrusor pressure, and a lower detrusor pressure at maximum flow than did women without POSUI (P<0.05 for all comparisons). In the multivariate analysis, preoperative SUI (odds ratio 3.11), a detrusor pressure at maximum flow of less than 30 cm H2 O (odds ratio 2.93), and urodynamically diagnosed SUI (odds ratio 2.26) were independent risk factors for POSUI. CONCLUSION Preoperative urodynamic parameters, obtained before prolapse repair surgery, were associated with POSUI and could be useful in providing adequate counseling to facilitate decision making on whether to add a concomitant anti-incontinence procedure.
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Affiliation(s)
- Matteo Frigerio
- ASST Monza, Ospedale San Gerardo, Monza, Italy.,Università degli Studi di Milano-Bicocca, Milan, Italy
| | | | - Stefania Palmieri
- ASST Monza, Ospedale San Gerardo, Monza, Italy.,Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Federico Spelzini
- Università degli Studi di Milano-Bicocca, Milan, Italy.,AUSL Romagna, Ospedale Infermi, Rimini, Italy
| | - Rodolfo Milani
- ASST Monza, Ospedale San Gerardo, Monza, Italy.,Università degli Studi di Milano-Bicocca, Milan, Italy
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Schachar JS, Williams KS, Winkler HA. Robotic-assisted Sacrocolpopexy with versus without Concomitant Midurethral Sling: A 2-year Follow-up of Urinary Symptoms and Quality of Life. J Midlife Health 2018; 9:26-31. [PMID: 29628725 PMCID: PMC5879844 DOI: 10.4103/jmh.jmh_64_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess long-term postoperative urinary incontinence (UI) symptoms and quality of life (QOL) in patients after robotic-assisted sacrocolpopexy (RASC) with or without concomitant midurethral sling (MUS). MATERIALS AND METHODS This is a cross-sectional survey of patients comparing long-term postoperative urinary symptoms and QOL measurements in women who underwent RASC with or without MUS. We included all patients from 2011 to 2014 who had RASC with or without MUS. All patients had preoperative urodynamic testing (UDS). Patients who demonstrated stress UI on UDS underwent MUS at the time of RASC. Urinary symptoms and QOL were assessed through the validated Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) patient questionnaires. RESULTS Sixty-eight patients met inclusion criteria, 46 patients completed follow-up questionnaires, and were included in the final analysis. Average length of time to follow-up from surgery was 24 months (range: 6-36 months). A statistically significant difference in UDI-6 scores between the two groups (RASC vs. RASC + MUS) was observed. Median (25th and 75th percentiles) scores for UDI-6 were 22.92 (8.33 and 32.29, respectively) for the RASC group and 4.17 (0 and 13.54, respectively) for the RASC + MUS group (P = 0.0017). Median scores for IIQ-7 were 0 (0 and 29.73 for the 25th and 75th percentiles, respectively) for the RASC group and 0 (0 and 0, respectively) for the RASC + MUS group (P = 0.1691). CONCLUSION Patients who underwent RASC + MUS scored significantly lower on the UDI-6, indicating fewer urinary distress symptoms. Although not statistically significant, patients in the RASC + MUS group had lower IIQ-7 scores, indicating less negative impact on QOL, compared to the RASC-only group.
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Affiliation(s)
- Jeffrey S. Schachar
- Division of Obstetrics and Gynecology, North Shore University Hospital, Northwell Health System, Great Neck, New York, USA
| | - Kathryn S. Williams
- Division of Urogynecology, Female Pelvic Medicine and Reconstructive Surgery, North Shore University Hospital, Northwell Health System, Great Neck, New York, USA
| | - Harvey A. Winkler
- Division of Urogynecology, Female Pelvic Medicine and Reconstructive Surgery, North Shore University Hospital, Northwell Health System, Great Neck, New York, USA
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van der Ploeg JM, van der Steen A, Zwolsman S, van der Vaart CH, Roovers JPWR. Prolapse surgery with or without incontinence procedure: a systematic review and meta-analysis. BJOG 2017; 125:289-297. [DOI: 10.1111/1471-0528.14943] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 11/27/2022]
Affiliation(s)
- JM van der Ploeg
- Department of Obstetrics and Gynaecology; Martini Hospital; Groningen the Netherlands
| | - A van der Steen
- Department of Obstetrics and Gynaecology; Ziekenhuisgroep Twente; Almelo the Netherlands
| | - S Zwolsman
- Department of Obstetrics and Gynaecology; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
| | - CH van der Vaart
- Department of Gynaecology and Reproductive Medicine; University Medical Centre Utrecht; Utrecht the Netherlands
| | - JPWR Roovers
- Department of Obstetrics and Gynaecology; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
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Khullar V, Anding R, Robinson D, Castro-Diaz D, Dmochowski R, Cardozo L. Under what circumstances should stress incontinence surgery be performed at the same time as prolapse surgery? ICI-RS 2015. Neurourol Urodyn 2017; 36:909-914. [PMID: 28444705 DOI: 10.1002/nau.23245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/06/2017] [Indexed: 11/08/2022]
Abstract
AIMS An International Consultation on Incontinence-Research Society (ICI-RS) Think Tank in 2015 discussed and evaluated the evidence of when stress incontinence surgery should be performed with prolapse surgery and highlighted evidence gaps, with the aim of recommending further clinical and research proposals. METHODS A review of the literature assessing randomized studies where women with vaginal prolapse have been randomized to vaginal prolapse surgery with or without continence surgery were evaluated. The different clinical presentations were also evaluated and their impact on outcome was critically reviewed. RESULTS There are three symptomatic groups of women with vaginal prolapse who are treated. The first group is continent women with vaginal prolapse. The second group has stress urinary incontinence (SUI) and vaginal prolapse. The last group has vaginal prolapse and have been found through testing to have occult SUI. The studies have reported a range of outcomes for each of these groups. There are different outcomes based on the surgical method used to correct the prolapse and also the different continence surgical techniques. There are insufficient studies to allow firm conclusions to be drawn. The economic impact of the different management pathways is also discussed although costs vary according to different national medical funding systems. CONCLUSIONS There is considerable uncertainty about the optimal method of managing women with vaginal prolapse and stress incontinence due to the different surgical techniques available. In particular the group of women with occult SUI are a challenge as the optimal diagnostic method has not yet been defined.
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Affiliation(s)
- Vik Khullar
- Department of Urogynaecology, St Mary's Hospital, London, UK
| | | | - Dudley Robinson
- Department of Urogynaecology, King's College Hospital, London, UK
| | - David Castro-Diaz
- Hospital Universitario de Canarias, Urology Canary Islands, Canary Islands, Spain
| | - Roger Dmochowski
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
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Baeßler K, Aigmüller T, Albrich S, Anthuber C, Finas D, Fink T, Fünfgeld C, Gabriel B, Henscher U, Hetzer FH, Hübner M, Junginger B, Jundt K, Kropshofer S, Kuhn A, Logé L, Nauman G, Peschers U, Pfiffer T, Schwandner O, Strauss A, Tunn R, Viereck V. Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016). Geburtshilfe Frauenheilkd 2016; 76:1287-1301. [PMID: 28042167 PMCID: PMC5193153 DOI: 10.1055/s-0042-119648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 10/22/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022] Open
Abstract
Aims: The aim was to establish an official interdisciplinary guideline, published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). The guideline was developed for use in German-speaking countries. In addition to the Germany Society of Gynecology and Obstetrics, the guideline has also been approved by the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). This is a guideline published and coordinated by the DGGG. The aim is to provide evidence-based recommendations obtained by evaluating the relevant literature for the diagnostic, conservative and surgical treatment of women with female pelvic organ prolapse with or without stress incontinence. Methods: We conducted a systematic review together with a synthesis of data and meta-analyses, where feasible. MEDLINE, Embase, Cinahl, Pedro and the Cochrane Register were searched for relevant articles. Reference lists were hand-searched, as were the abstracts of the Annual Meetings of the International Continence Society and the International Urogynecological Association. We included only abstracts of randomized controlled trials that were presented and discussed in podium sessions. We assessed original data on surgical procedures published since 2008 with a minimum follow-up time of at least 12 months. If the studies included descriptions of perioperative complications, this minimum follow-up period did not apply. Recommendations: The guideline encompasses recommendations for the diagnosis and treatment of female pelvic organ prolapse. Recommendations for anterior, posterior and apical pelvic organ prolapse with or without concomitant stress urinary incontinence, uterine preservation options, and the pros and cons of mesh placements during surgery for pelvic organ prolapse are presented. The recommendations are based on an extensive and systematic review and evaluation of the current literature and include the experiences and specific conditions in Germany, Austria and Switzerland.
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Affiliation(s)
- K. Baeßler
- Beckenbodenzentrum, Charité Universitätsmedizin, Berlin, Germany
| | - T. Aigmüller
- Universitätsklinik für Gynäkologie und Geburtshilfe, Med Uni Graz, Austria
| | - S. Albrich
- Praxis “Frauenärzte Fünf Höfe” München, München, Germany
| | | | - D. Finas
- Evangelisches Krankenhaus Bielefeld EvKB, Bielefeld, Germany
| | - T. Fink
- Sana Klinikum Berlin Lichtenberg, Berlin, Germany
| | | | - B. Gabriel
- St. Josefʼs Hospital Wiesbaden, Wiesbaden, Germany
| | - U. Henscher
- Praxis für Physiotherapie, Hannover, Germany
| | | | - M. Hübner
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - B. Junginger
- Beckenbodenzentrum, Charité Universitätsmedizin, Berlin, Germany
| | - K. Jundt
- Frauenarztpraxis am Pasinger Bahnhof, München, Germany
| | | | - A. Kuhn
- Inselspital Bern, Bern, Switzerland
| | - L. Logé
- Sana Klinikum Hof GmbH, Hof, Germany
| | - G. Nauman
- Helios Klinikum Erfurt, Erfurt, Germany
| | | | - T. Pfiffer
- Asklepios Klinik Hamburg Harburg, Hamburg, Germany
| | | | - A. Strauss
- Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - R. Tunn
- St. Hedwig Krankenhaus, Berlin, Germany
| | - V. Viereck
- Kantonsspital Frauenfeld, Frauenfeld, Switzerland
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Abstract
PURPOSE OF REVIEW Many women choosing to have surgery for pelvic organ prolapse also choose to undergo continence surgery. This review focuses on available evidence that clinicians may use to counsel patients when choosing whether to perform continence surgery and how predictive analytic tools improve this decision-making process. RECENT FINDINGS Midurethral sling, Burch cystourethropexy and bladder neck sling are highly effective for the surgical treatment of stress urinary incontinence. Trials demonstrate that continence surgery may be routinely performed to reduce the risk of postoperative incontinence in women undergoing surgery for pelvic organ prolapse with or without preoperative stress urinary incontinence. Although these procedures are effective and well tolerated on average, media concerns, regulatory warnings and litigation reinforce the need for a balanced discussion regarding efficacy and potential adverse events directed at the individual patient during the preoperative visit. Advances in predictive analytics allow surgeons to quantitate individual risk using algorithms that tailor estimates for the individual patient and facilitate shared understanding of risks and benefits. These models are less prone to cognitive biases and frequently outperform experienced clinicians. SUMMARY This review discusses how predictive analytic tools can be used to improve decisions about continence surgery in the woman planning to undergo prolapse surgery.
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Affiliation(s)
- John E Jelovsek
- Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, United States
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Effect of a New Risk Calculator on Patient Satisfaction With the Decision for Concomitant Midurethral Sling During Prolapse Surgery: A Randomized Controlled Trial. Female Pelvic Med Reconstr Surg 2016; 23:17-22. [PMID: 27682745 DOI: 10.1097/spv.0000000000000339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether use of a new personalized risk calculator increases patient satisfaction with the decision whether or not to have a prophylactic midurethral sling (MUS) during pelvic organ prolapse (POP) surgery. METHODS We performed a randomized controlled trial involving English-speaking women without symptoms of stress urinary incontinence (SUI) with ≥ stage 2 POP who planned to undergo POP surgery with 1 of 4 fellowship-trained urogynecologists at a single academic center. Women with a history of prior POP or incontinence surgery, or who were pregnant, or unable to complete study forms were excluded. Participants were randomly assigned to standard preoperative counseling or preoperative counseling with the use of a validated, online risk calculator for de novo SUI after POP surgery. The primary outcome was patient satisfaction with the decision for prophylactic MUS placement during POP surgery at 3 months postoperative assessed using the Satisfaction with Decision Scale for Pelvic Floor Disorders. RESULTS Sixty-three women were approached for participation. Forty-two agreed to participate, 41 underwent randomization, and 33 had POP surgery and completed 3-month follow-up. Of these 33, 17 were randomized to the risk calculator and 16 to standard counseling. The mean age was 61.2 ± 9.1 years, and 41% (14/33) had a prophylactic MUS. At 3 months postoperative, there was no difference in Satisfaction with Decision Scale for Pelvic Floor Disorders scores between groups (4.67 ± 0.46 [intervention] vs 4.78 ± 0.34 [control]; P = 0.61). CONCLUSIONS Use of the de novo SUI risk calculator did not increase patient satisfaction with the decision regarding MUS placement during POP surgery.
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Tran A, Botros C, Botros SM. Concomitant Incontinence Surgery at the Time of Prolapse Repair. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0159-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Jelovsek JE, Hill AJ, Chagin KM, Kattan MW, Barber MD. Predicting Risk of Urinary Incontinence and Adverse Events After Midurethral Sling Surgery in Women. Obstet Gynecol 2016; 127:330-40. [DOI: 10.1097/aog.0000000000001269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vaginal prolapse repair with or without a midurethral sling in women with genital prolapse and occult stress urinary incontinence: a randomized trial. Int Urogynecol J 2016; 27:1029-38. [DOI: 10.1007/s00192-015-2924-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
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Paxton EW, Inacio MCS, Khatod M, Yue E, Funahashi T, Barber T. Risk calculators predict failures of knee and hip arthroplasties: findings from a large health maintenance organization. Clin Orthop Relat Res 2015; 473:3965-73. [PMID: 26324831 PMCID: PMC4626526 DOI: 10.1007/s11999-015-4506-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 08/05/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Considering the cost and risk associated with revision Total knee arthroplasty (TKAs) and Total hip arthroplasty (THAs), steps to prevent these operations will help patients and reduce healthcare costs. Revision risk calculators for patients may reduce revision surgery by supporting clinical decision-making at the point of care. QUESTIONS/PURPOSES We sought to develop a TKA and THA revision risk calculator using data from a large health-maintenance organization's arthroplasty registry and determine the best set of predictors for the revision risk calculator. METHODS Revision risk calculators for THAs and TKAs were developed using a patient cohort from a total joint replacement registry and data from a large US integrated healthcare system. The cohort included all patients who had primary procedures performed in our healthcare system between April 2001 and July 2008 and were followed until January 2014 (TKAs, n = 41,750; THAs, n = 22,721), During the study period, 9% of patients (TKA = 3066/34,686; THA=1898/20,285) were lost to followup and 7% died (TKA= 2350/41,750; THA=1419/20,285). The outcome of interest was revision surgery and was defined as replacement of any component for any reason within 5 years postoperatively. Candidate predictors for the revision risk calculator were limited to preoperative patient demographics, comorbidities, and procedure diagnoses. Logistic regression models were used to identify predictors and the Hosmer-Lemeshow goodness-of-fit test and c-statistic were used to choose final models for the revision risk calculator. RESULTS The best predictors for the TKA revision risk calculator were age (odds ratio [OR], 0.96; 95% CI, 0.95-0.97; p < 0.001), sex (OR, 0.84; 95% CI, 0.75-0.95; p = 0.004), square-root BMI (OR, 1.05; 95% CI, 0.99-1.11; p = 0.140), diabetes (OR, 1.32; 95% CI, 1.17-1.48; p < 0.001), osteoarthritis (OR, 1.16; 95% CI, 0.84-1.62; p = 0.368), posttraumatic arthritis (OR, 1.66; 95% CI, 1.07-2.56; p = 0.022), and osteonecrosis (OR, 2.54; 95% CI, 1.31-4.92; p = 0.006). The best predictors for the THA revision risk calculator were sex (OR, 1.24; 95% CI, 1.05-1.46; p = 0.010), age (OR, 0.98; 95% CI, 0.98-0.99; p < 0.001), square-root BMI (OR, 1.07; 95% CI, 1.00-1.15; p = 0.066), and osteoarthritis (OR, 0.85; 95% CI, 0.66-1.09; p = 0.190). CONCLUSIONS Study model parameters can be used to create web-based calculators. Surgeons can enter personalized patient data in the risk calculators for identification of risk of revision which can be used for clinical decision making at the point of care. Future prospective studies will be needed to validate these calculators and to refine them with time. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Elizabeth W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA, 92108, USA.
| | - Maria C S Inacio
- Surgical Outcomes and Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA, 92108, USA
| | - Monti Khatod
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, West Los Angeles, CA, USA
| | - Eric Yue
- Department of Orthopaedic Surgery, The Permanente Medical Group, Oakland, CA, USA
| | - Tadashi Funahashi
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, West Los Angeles, CA, USA
| | - Thomas Barber
- Department of Orthopaedic Surgery, The Permanente Medical Group, Oakland, CA, USA
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King AB, Goldman HB. Stress incontinence surgery at the time of prolapse surgery: mandatory or forbidden? World J Urol 2015; 33:1257-62. [PMID: 25991600 DOI: 10.1007/s00345-015-1591-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 05/10/2015] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Concomitant anti-incontinence surgery at the time of prolapse repair has been a long-debated topic. Still today, there remains no clear answer to this question, although in recent years the literature has become more robust with the addition of more randomized controlled trials. The lifetime risk for women of undergoing surgical correction of pelvic organ prolapse is significant, and concomitant anti-incontinence surgery is an important question during surgical planning. MATERIALS AND METHODS This review delves further into the current literature to discuss a possible algorithm for managing the risk of stress incontinence after pelvic organ prolapse repair and examines the support in the literature for the following treatment methods: (1) anti-incontinence surgery for all women undergoing pelvic organ prolapse repair, (2) anti-incontinence surgery for no women undergoing pelvic organ prolapse repair, and (3) anti-incontinence surgery in select women undergoing pelvic organ prolapse repair. CONCLUSIONS While there are data both for and against each of these approaches, after a review of the literature, we recommend anti-incontinence surgery for select women undergoing pelvic organ prolapse repair, including women with a history of symptomatic and occult stress incontinence diagnosed preoperatively.
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Affiliation(s)
- Ashley B King
- Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave. Q10, Cleveland, OH, 44195, USA,
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Lo TS, Bt Karim N, Nawawi EA, Wu PY, Nusee Z. Predictors for de novo stress urinary incontinence following extensive pelvic reconstructive surgery. Int Urogynecol J 2015; 26:1313-9. [PMID: 25862240 DOI: 10.1007/s00192-015-2685-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/11/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to look for possible predictors preoperatively for the development of de novo stress urinary incontinence (SUI) in urodynamically continent women who underwent pelvic reconstructive surgery (PRS). MATERIALS AND METHODS Medical records of 637 continent women who underwent PRS for severe prolapse from January 2005 to December 2013 in our institutions were included in this study. We excluded women who had urodynamic stress incontinence (UDI) either occult or overt, detrusor overactivity, neurogenic bladder-voiding dysfunction, and previous anti-incontinent surgery. Primary outcome measure was the development of de novo SUI at 6 months to 1 year post operation. RESULTS Of women in this study, 11 % developed postoperative de novo SUI at 6 months to 1 year of follow-up. Women older than 66 years were 2.86 times [95 % confidence interval (CI) 1.01-2.53, p = 0.14], diabetes mellitus (DM) 2.18 times (95 % CI 1.63-4.21, p = 0.002), certain type of transvaginal mesh procedure 3.5 times (95 % CI, p < 0.001), maximum urethral closure pressure (MUCP) < 60 mmH20 4.65 times (95 % CI, 2.87-8.64, p < 0.001), and functional urethral length (FUL) < 2 cm 3.48 times (95 % CI, 2.13-5.83, p < 0.001) at greater risk of developing de novo SUI. CONCLUSIONS Continent women with advanced pelvic organ prolapse (POP) > 66 years, with DM or low MUCP and FUL values during preoperative urodynamic evaluation have higher risk of developing de novo SUI; therefore, we suggest counselling such women for concomitant PRS and anti-incontinent surgery.
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Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Keelung, Keelung Medical Centre, 222, Maijin Road, Keelung, Taiwan, 204, Republic of China,
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