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The impact of overweight in the efficiency and complications of midurethral sling in patients with stress urinary incontinence: a systematic review and meta-analysis. Int Urol Nephrol 2018; 50:1597-1606. [PMID: 30008144 DOI: 10.1007/s11255-018-1928-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/29/2018] [Indexed: 02/05/2023]
Abstract
AIMS To compare the efficiency and complications of normal weight and overweight women with stress urinary incontinence (SUI) after surgery. METHODS We searched the PubMed, Embase, and Cochrane Library Databases to identify all compared results, including those involving the terms normal weight, overweight, body mass index (BMI), and SUI. After treatment with surgery, the efficiency (subjective cure rate, objective cure rate, UDI-6, and IIQ-7) and complications were compared between the normal weight and overweight groups. RESULTS The study inclusion criteria were met by 20 studies involving 3829 patients. The data synthesized from these studies indicated that the subjective and objective cure rates in the normal weight group were significantly more effective than those in the overweight group (RR 1.07; 95% CI 1.04-1.10; P < 0.00001; RR 1.24; 95% CI 1.18-1.30; P < 0.00001), while the IIQ-7 and UDI-6 were no different between the two groups (MD 0.07; 95% CI - 1.44 to 1.58; P = 0.93; MD 0.18; 95% CI - 1.24 to 1.60; P = 0.81). For the data of complications, only the urgency was more in the overweight group (RR 0.68, 95% CI 0.55-0.84, P = 0.0003). CONCLUSIONS The objective success rate and subjective success rate of the surgery were higher in normal weight patients than those in overweight patients. Also, the side effects between the two groups were not significantly different.
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Aragón IM, Imbroda BH, Lara MF. Cell Therapy Clinical Trials for Stress Urinary Incontinence: Current Status and Perspectives. Int J Med Sci 2018; 15:195-204. [PMID: 29483809 PMCID: PMC5820847 DOI: 10.7150/ijms.22130] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/22/2017] [Indexed: 12/11/2022] Open
Abstract
Stress urinary incontinence (SUI) affects 200 million people worldwide. Standard therapies often provide symptomatic relief, but without targeting the underlying etiology, and show tremendous patient-to-patient variability, limited success and complications associated with the procedures. We review in this article the latest clinical trials performed to treat SUI using cell-based therapies. These therapies, despite typically including only a small number of patients and short term evaluation of results, have proven to be feasible and safe. However, there is not yet a consensus for the best cell source to be used to treat SUI and not all patients may be suitable for these therapies. Therefore, more clinical trials should be promoted recruiting large number of patients and evaluating long term results.
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Affiliation(s)
- Isabel María Aragón
- Department of Urology, Virgen de la Victoria University Hospital, Campus Universitario de Teatinos, Málaga, Spain
| | - Bernardo Herrera Imbroda
- Department of Urology, Virgen de la Victoria University Hospital, Campus Universitario de Teatinos, Málaga, Spain
| | - María Fernanda Lara
- Department of Urology, Virgen de la Victoria University Hospital, Campus Universitario de Teatinos, Málaga, Spain
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Abstract
PURPOSE OF REVIEW To review and summarize the current literature of the implications of obesity on nononcological urological surgery. We conducted a comprehensive search of the current literature with emphasis on the published literature in the last 18 months. RECENT FINDINGS Over time, obese patients have become a more common encounter in clinical practice. Obesity represents a considerable operative challenge and has been linked to a higher rate of postoperative complications. Data regarding surgery for incontinence are inconsistent. Nevertheless, the success rates in obese women are high, and complication rates are relatively low with comparable results to nonobese women. In renal surgery, percutaneous nephrolithotomy and minipercutaneous nephrolithotomy are feasible, well tolerated, and effective even in obese patients. However, certain precautions and availability of proper instruments are necessary. SUMMARY Although randomized clinical data are lacking and the results of many studies are inconsistent, evidence supports the feasibility and safety of different nononcological urological interventions in obese patients. Moreover, the success rates and the overall complication rates seem to be comparable to nonobese patients with some exceptions.
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Pomian A, Lisik W, Kosieradzki M, Barcz E. Obesity and Pelvic Floor Disorders: A Review of the Literature. Med Sci Monit 2016; 22:1880-6. [PMID: 27255341 PMCID: PMC4907402 DOI: 10.12659/msm.896331] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Overweight and obesity are becoming a worldwide health problem associated with numerous co-morbidities. National costs of obesity and pelvic flor disorders have been rising since the 1950s across the world. Obesity is thought to have a very strong effect on pelvic floor disorders, and, considering the high prevalence of both problems worldwide, it is of utmost importance to evaluate the association between these pathologies as well as the impact of obesity on treatment efficacy. This review is based on a selection of reports in the literature (PubMed search), including guidelines and Cochrane reviews. Obesity seems to be a well-documented risk factor for lower urinary tract symptoms (LUTS) and is a predictor of exacerbation of stress urinary incontinence (SUI) and overactive bladder (OAB). Weight loss is also associated with improvement or resolution of SUI and OAB. In the case of pelvic organ prolapse (POP), weight loss is associated with improvement in quality of life. Although obesity is associated with POP in general, the exact role of obesity in symptomatic POP remains uncertain. While outcomes of anti-incontinence surgery among obese women are similar to those in non-obese women, postoperative urge incontinence is more likely to occur. It seems that obesity is not a risk factor for postoperative complications or short-term efficacy of POP surgical treatment. Long-term effects are still uncertain. Obesity is a strong risk factor for LUTS, but in most cases it does not affect efficacy of operative treatment. It may be associated with some post-operative complications. Weight loss in many cases allows avoiding surgical intervention.
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Affiliation(s)
- Andrzej Pomian
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Lisik
- Deparment of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kosieradzki
- Deparment of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, China (mainland)
| | - Ewa Barcz
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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Efficacy and safety of the trans-obturator TVT-Abbrevo device in normal weight compared to overweight patients affected by stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2015; 197:116-9. [PMID: 26722996 DOI: 10.1016/j.ejogrb.2015.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/04/2015] [Accepted: 11/17/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate if TVT-Abbrevo has similar outcomes in normal weight and overweight patients. STUDY DESIGN Retrospective evaluation of 205 (105 normal weight women and 100 overweight women with BMI ≥ 25 kg/m(2)) undergone TVT-Abbrevo positioning with 12 month follow-up. Primary outcomes were objective cure rate (defined as no leakage during CST) and subjective cure rate ("very much improved"/"much improved" at PGI-I), secondary outcomes were intra-operative and post-operative complications. RESULTS Objective cure rates in the normal and overweight groups were 96.2% and 94%, respectively (p=.47). Subjective cure rates in the normal and overweight groups were 90.5% and 88%, respectively (p=.57). ICIQ-SF, I-QoL and PGI-S scores significantly improved in both groups with no differences between the two groups. No serious intra- or post-operative complications were observed. No differences were observed in pain VAS scores and number of analgesic vials administered. CONCLUSIONS TVT-Abbrevo seems to have similar efficacy and safety in normal weight and overweight women. More studies are needed to assess the efficacy of this device in frankly obese women and long-term outcomes.
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Yonguc T, Aydogdu O, Bozkurt IH, Degirmenci T, Gunlusoy B, Sen V, Yarimoglu S. Do severe obese patients with stress urinary incontinence benefit from transobturator tape procedure? 3-year surgical outcome. Can Urol Assoc J 2015; 9:E546-50. [PMID: 26609331 DOI: 10.5489/cuaj.2770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We evaluate the impact of severe obesity on surgical outcomes of the transobturator tape (TOT) procedure in patients with stress urinary incontinence (SUI). METHODS In total, 32 women with severe obesity (body mass index [BMI] >35 kg/m(2)) were included in the study. All patients were preoperatively evaluated with history, pelvic examination, ultrasonography, and cough stress test. All patients completed the International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) preoperatively and at the postoperative follow-up. Cure of incontinence was defined as being completely dry after surgery. Cure was assessed subjectively and objectively. Subjective improvement defined as an International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) score ≤12 and satisfaction with surgery. Failure was defined as having no change or worsening of urinary incontinence after surgery. Postoperative patient satisfaction was assessed using a visual analog scale. RESULTS The mean follow-up time and mean BMI were 40.9 ± 20.9 months and 38 ± 3 kg/m(2), respectively. According to preoperative ICIQ-SF questionnaire scores, 20 patients (62.5%) had severe and 12 patients (37.5 %) had very severe urinary incontinence symptoms. No patient had slight or moderate symptoms. None of the patients experienced worsening symptoms after surgery. Objective cure, subjective cure, subjective improvement and patient satisfaction rates were 81.2%, 46.8%, 37.5%, and 84.3% respectively. Our overall complication rate was 9.3%. None of the patients experienced intraoperative complications. CONCLUSION In experienced hands, TOT is an effective and safe procedure to treat SUI, with minimal complications in severe obese women.
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Affiliation(s)
- Tarik Yonguc
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Ozgu Aydogdu
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | | | - Tansu Degirmenci
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Bulent Gunlusoy
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Volkan Sen
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Serkan Yarimoglu
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
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Pereira I, Valentim-Lourenço A, Castro C, Martins I, Henriques A, Ribeirinho AL. Incontinence surgery in obese women: comparative analysis of short- and long-term outcomes with a transobturator sling. Int Urogynecol J 2015; 27:247-53. [PMID: 26318611 DOI: 10.1007/s00192-015-2820-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/02/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Midurethral slings (MUS) are still discussed in complex incontinence situations, such as obesity, lacking sustained efficacy validation in this particular sub-population. We hypothesized that the outcomes of a transobturator MUS, such as TVT-O, do not differ according to body mass index (BMI) over a 4-year period. METHODS We conducted a retrospective analysis of 281 women who underwent TVT-O at our institution, between 2004 and 2012. Patients were stratified into obese (BMI ≥ 30 kg/m(2)) or non-obese (BMI < 30 kg/m(2)). We compared preoperative and postoperative parameters, including objective cure (negative stress test), complications, and quality of life scores. Data were collected at 0, 6, 12, 24, and 48 months. We used Fisher's exact test for categorical variables and Student's t test or the Mann-Whitney U test for continuous variables. RESULTS Baseline characteristics of the obese (n = 122) and non-obese groups (n = 159) were similar. We found no significant differences between groups in terms of objective cure rates at all follow-up evaluations, with 95.8 % and 95 % at 48 months in the non-obese and obese groups respectively. There were no significant differences in the cumulative complication rates of both groups. Quality of life assessment also showed no significant differences between groups at all follow-up visits. At 48 months our follow-up rate was 59 % (n = 96) and 60.4 % (n = 72) in the non-obese and obese group respectively (p = 0.9). CONCLUSIONS The TVT-O procedure is effective and safe in the long term for stress incontinence treatment, regardless of BMI.
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Affiliation(s)
- Inês Pereira
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hospital de Santa Maria, Lisbon, Portugal. .,, Rua do Ebro N1 4°C, 1990-526, Lisboa, Portugal.
| | | | - Catarina Castro
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hospital de Santa Maria, Lisbon, Portugal
| | - Inês Martins
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hospital de Santa Maria, Lisbon, Portugal
| | - Alexandra Henriques
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hospital de Santa Maria, Lisbon, Portugal
| | - Ana Luísa Ribeirinho
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hospital de Santa Maria, Lisbon, Portugal
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Yonguc T, Degirmenci T, Bozkurt IH, Aydogdu O, Gunlusoy B, Sen V, Polat S. Effectiveness of Transobturator Tape Procedure in Obese and Severely Obese Women: 3-Year Follow-up. Urology 2015. [PMID: 26199159 DOI: 10.1016/j.urology.2015.03.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of transobturator tape (TOT) for the treatment of stress urinary incontinence in severely obese and obese women. METHODS We retrospectively reviewed the women who underwent a TOT procedure at 2 institutions between March 2005 and March 2013. The patients were divided into 3 groups according to the World Health Organization body mass index (BMI) values: normal weight group (BMI <25 kg/m(2); group 1), obese group (BMI = 30-34 kg/m(2); group 2), and severely obese group (BMI ≥35 kg/m(2); group 3). Overweight women (BMI = 25-29 kg/m(2)) were omitted. Patients filled in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) preoperatively and at the postoperative follow-up visits. The severity of urinary incontinence was classified by ICIQ-SF: slight (1-5), moderate (6-12), severe (13-18), and very severe (19-21). Patient satisfaction was assessed using a visual analog scale. Subjective improvement was defined as an ICIQ-SF score ≤12 and satisfaction with surgery (visual analog scale score ≥80). RESULTS A total 470 women met the requirements for inclusion. There were 153 women in group 1, 72 women in group 2, and 32 women in group 3. Mean follow-up period was at least 12 months in all the groups. The difference between the groups according to mean operative time was significant (P <.001). The objective cure, subjective success (cured and improved), patient satisfaction rates, and complications were similar between the groups. CONCLUSION Obesity and severe obesity do not seem to be risk factors for the failure of TOT procedure. However, postoperative urgency urinary incontinence rate was higher in severely obese women, and more women showed improvement instead of cure among severely obese women.
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Affiliation(s)
- Tarik Yonguc
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
| | - Tansu Degirmenci
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | | | - Ozgu Aydogdu
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Bulent Gunlusoy
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Volkan Sen
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Salih Polat
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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Jeong SJ, Lee HS, Lee JK, Jeong JW, Lee SC, Kim JH, Hong SK, Byun SS, Lee SE. The long-term influence of body mass index on the success rate of mid-urethral sling surgery among women with stress urinary incontinence or stress-predominant mixed incontinence: comparisons between retropubic and transobturator approaches. PLoS One 2014; 9:e113517. [PMID: 25415490 PMCID: PMC4240655 DOI: 10.1371/journal.pone.0113517] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 10/29/2014] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Mid-urethral sling (MUS) surgery for the treatment of urinary incontinence has been widespread since the introduction of tension-free vaginal tape in the mid-1990s. The majority of studies with short-term follow-up <2 years found no differences in the surgical outcomes according to body mass index (BMI). However, considering the chronic influence of obesity on pelvic floor musculature, it is cautiously speculated that higher BMI could increase stress on pelvic floor and sub-urethral tape, possibly decreasing the long-term success rate in the obese population. We aimed to compare the long-term effects of BMI on the outcomes of MUS between women with retropubic and transobturator approaches. METHODS We performed a retrospective analysis on 243 consecutive women who received MUS and were followed up for ≥36 months. The influence of BMI on the success rates was separately estimated and the factors for treatment failure were examined using logistic regression in either approach. RESULTS The mean follow-up was 58.4 months, and 30.5% were normal weight, 51.0% overweight, and 18.5% obese. Patients received either the retropubic (30.5%) or transobturator (69.5%) approach. The success rates (%) under the transobturator approach differed according to the BMI groups (94.3, 88.6, and 78.6, respectively; P = 0.037) while those under the retropubic approach were not different according to the BMI groups. However, in multivariate models, only the presence of preoperative mixed urinary incontinence (MUI) was proven to be the risk factor for treatment failure in the transobturator approach (OR 6.39, P = 0.003). The percent of subjects with MUI was higher in obese women than in non-obese women with the transobturator approach. CONCLUSIONS BMI was not independently associated with failures in either approach. Higher success rates in women with lower BMI in the transobturator approach were attributed to the lower percent of preoperative MUI in those with lower BMI.
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Affiliation(s)
- Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Han Sol Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Keun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Woo Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Cheol Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Hyun Kim
- Department of Urology, Kangwon National University Hospital, Chuncheon, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
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Dursun M, Otunctemur A, Ozbek E, Sahin S, Besiroglu H, Koklu I. Stress urinary incontinence and visceral adipose index: a new risk parameter. Int Urol Nephrol 2014; 46:2297-300. [DOI: 10.1007/s11255-014-0832-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/29/2014] [Indexed: 11/24/2022]
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Frohme C, Ludt F, Varga Z, Olbert PJ, Hofmann R, Hegele A. TOT approach in stress urinary incontinence (SUI) - outcome in obese female. BMC Urol 2014; 14:20. [PMID: 24552585 PMCID: PMC3936697 DOI: 10.1186/1471-2490-14-20] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 02/15/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Only limited data are available on the outcome of tension-free obturator tape (TOT) procedures in overweight and obese women. We would like to verify the objective and subjective outcomes of TOT in women with a higher body mass index (BMI). METHODS We evaluated the records of 116 patients who had undergone TOT, stratifying by BMI into normal weight (n = 31), overweight (n = 56), and obese (n = 29) groups. We compared pre- and postoperative evaluations, including subjective and objective outcome of TOT, complications, and quality of life assessed by validated questionnaires (ICIQ-SF and KHQ). RESULTS The median follow-up was 21 months. There were no significant differences between different groups in terms of objective cure rate and subjective success, quality of life scores and postoperative complications. CONCLUSIONS Our data demonstrate that TOT procedure is safe and effective. BMI did not influence the outcome of TOT procedures at a median of 21 months after surgery and represents no contraindication for continence surgery. The success of the outcome of TOT procedure in females and the occurrence of complications are not negatively affected by obesity.
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Affiliation(s)
- Carsten Frohme
- Department of Urology and Pediatric Urology, University hospital Marburg, Philipps University, Marburg, Germany.
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12
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Kaufman MR. Management of Stress Urinary Incontinence in the Neobladder Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0207-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Osborn DJ, Strain M, Gomelsky A, Rothschild J, Dmochowski R. Obesity and Female Stress Urinary Incontinence. Urology 2013; 82:759-63. [DOI: 10.1016/j.urology.2013.06.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 06/10/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
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