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Rotchild M, Shelef G, Sade S, Shoham-Vardi I, Weintraub AY. Obesity is not an independent risk factor for peri- and post-operative complications following mid-urethral sling (MUS) surgeries for the treatment of stress urinary incontinence (SUI). Arch Gynecol Obstet 2024; 309:1119-1125. [PMID: 37695373 DOI: 10.1007/s00404-023-07210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To inquire whether obesity is a risk factor of peri- and post-operative complications following Mid-urethral sling (MUS) surgeries for SUI repair using the Clavien-Dindo classification system (CDcs). METHODS This retrospective cohort included 304 women who undergone a MUS in a 1000 beds tertiary University medical center between the years 2012-2018. Univariate analysis was conducted to compare clinical and operative traits by BMI group and to examine associations of obesity and complications rates and severity according to the CDcs. Multivariate analysis was conducted to assess the risk for post-operative complications and adjust to potential confounders. RESULTS The study group included 106 (34.9%) women with BMI 30 or higher and the comparison group included 198 (65.1%) women with BMI lower than 30. In the study group we found a significantly higher prevalence of hypertension (P = 0.019), previous abdominal surgeries (P = 0.012) including cesarean section (P = 0.025), previous pelvic floor surgeries (P = 0.005) and pelvic organ prolapse (P = 0.02). In the control group we found a significantly higher rates of concomitant hysterectomy which performed during the MUS (P = 0.005). Obesity was not associated with increased rates of peri and post-operative complications (P = 0.973). CONCLUSIONS In our study, obesity was not associated with peri- and post-operative complications following MUS.
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Affiliation(s)
- Matan Rotchild
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer Sheva, Israel.
| | - Goni Shelef
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer Sheva, Israel
| | - Shanny Sade
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer Sheva, Israel
| | - Ilana Shoham-Vardi
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Yehuda Weintraub
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer Sheva, Israel
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Bassi S, Pinar U, Di Maria S, Gambachidze D, Manach Q, Chartier-Kastler E. Ambulatory peri-bulbar implantation, revision and replacement of Artificial Urinary Sphincter in neurogenic and non-neurogenic male patients: A preliminary feasibility study over a one-year experience. Prog Urol 2023:S1166-7087(23)00061-1. [PMID: 36925358 DOI: 10.1016/j.purol.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/16/2023] [Accepted: 02/19/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION Our goal was to determine the rate of complications, early revision and removal after full ambulatory implantation of bulbar AUS in men; secondly, to describe satisfaction and short-term continence rate. MATERIAL AND METHODS Between April 2018 and April 2019, 28 consecutive patients underwent AUS implantation in a newly organised ambulatory setting. A prospective database of all included patients was established with comprehensive data collected on medical history, aetiology and severity of SUI, surgical procedures, postoperative complications and patient satisfaction. RESULTS Twenty-eight patients were included (30 consecutive procedures: 22 primary AUS placement, 6 complete revisions, 2 partial revisions), with a mean follow up of 223±220.5 days. Fourteen patients had prior radiotherapy. Readmission rate was 6.7% in the first 30 days after surgery. Both revision and removal rates were 6.7%. Complications were reported in 26.7% of procedures, mainly Clavien-Dindo I. Patient satisfaction of ambulatory surgery organisation and experience was high (87/5% satisfied or very satisfied). Full continence & social continence were achieved for, respectively, 55.6% and 88.9% of procedures. CONCLUSION Ambulatory placement of AUS is safe and can be performed successfully. Larger patient cohorts and randomised trials are crucial to improve knowledge on non-indications for full ambulatory AUS implantation in men. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- S Bassi
- Department of Urology, University of Verona, Piazzale Aristide Stefani, 1, 37126 Verona (VR), Italy; Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - U Pinar
- Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - S Di Maria
- Department of Anaesthesiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - D Gambachidze
- Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Q Manach
- Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - E Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
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Csuka DA, Ha J, Hanna AS, Kim J, Phan W, Ahmed AS, Ghoniem GM. Foreign body granuloma development after calcium hydroxylapatite injection for stress urinary incontinence: A literature review and case report. Arab J Urol 2022; 21:118-125. [PMID: 37234676 PMCID: PMC10208123 DOI: 10.1080/2090598x.2022.2146859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/06/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives To present a case of foreign body granuloma (FBG) development after injection of calcium hydroxylapatite as a urethral bulking agent and to review all documented cases of this phenomenon in the literature. Methods We analyzed a new case of calcium hydroxylapatite-induced FBG. We also conducted a literature review of the PubMed, Embase, CINAHL, and Web of Science databases through March 2022. Reports were included if they contained stress urinary incontinence patients that developed an FBG after calcium hydroxylapatite injection. The cases were reviewed for presenting symptoms, patient demographics, granuloma details, and surgical treatment. Results We screened 250 articles and included six articles between 2006 and 2015 in addition to the present case. The median age of the patients was 65.5 years (range 45-93), and all patients were female. The most common presenting symptoms and the proportion of patients affected were difficulty voiding (4/8), recurrent urinary incontinence (3/8), and dyspareunia (2/8). The median time between the first CaHA injection and discovery of the FBG was 5 months (range 1-50). The median longest dimension of the FBGs was 1.85 cm (range 1.0-3.0). The 8 masses observed were evenly distributed throughout the urethra, with 3 in the bladder neck, 2 in the midurethra, and 3 in the distal urethra. Surgical excision was the predominant management choice, with some variation in technique. Conclusions Severe, persistent lower urinary tract symptoms after calcium hydroxylapatite injection may indicate an FBG, which has been successfully managed with surgical excision.
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Affiliation(s)
- David A. Csuka
- Department of Urology, University of California Irvine, CA, United States
| | - John Ha
- Department of Computational & Systems Biology, University of California Los Angeles, CA, United States
| | - Andrew S. Hanna
- Department of Urology, University of California Irvine, CA, United States
| | - Jisoo Kim
- Department of Urology, University of California Irvine, CA, United States
| | - William Phan
- Department of Psychological and Brain Sciences, University of California Santa Barbara, CA, United States
| | | | - Gamal M. Ghoniem
- Department of Urology, University of California Irvine, CA, United States
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Sarychev S, Witt JH, Wagner C, Oelke M, Schuette A, Liakos N, Karagiotis T, Mendrek M, Kachanov M, Graefen M, Vetterlein MW, Meyer CP, Tian Z, Leyh-Bannurah SR. Impact of obesity on perioperative, functional and oncological outcomes after robotic-assisted radical prostatectomy in a high-volume center. World J Urol 2022; 40:1419-1425. [PMID: 35348869 DOI: 10.1007/s00345-022-03989-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/06/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To compare surgical, oncological and functional outcomes between obese vs. normal-weight prostate cancer (PCa) patients treated with robotic-assisted radical prostatectomy (RARP). MATERIALS AND METHODS We assessed 4555 consecutive RARP patients from a high-volume center 2008-2018. Analyses were restricted to normal-weight vs. obese patients (≥ 30 kg/m2). Multivariable cox regression analyses (MVA) assessed the effect of obesity on biochemical recurrence (BCR), metastatic progression (MP), erectile function and urinary continence recovery. Analyses were repeated after propensity score matching. RESULTS Before matching, higher rates of pathological Gleason Grade group ≥ 4 (14 vs. 18%; p = 0.004) and pT3 stage (33 vs. 35%; p = 0.016) were observed in obese patients, with similar observations for surgery time, blood loss and 30-day wound- and surgical complication rates. For normal-weight vs. obese patients, BCR- and MP-free rates were 86 vs. 85% (p = 0.97) and 97.5 vs.97.8% (p = 0.8) at 48 months. Similarly, rates of erectile function at 36 months and urinary continence at 12 months were 56 vs. 49% (p = 0.012) and 88 vs. 85% (p = 0.003), respectively. Before and after propensity score matching, obesity had no effect on BCR or MP, but a negative effect on erectile function (matched HR 0.87, 95%CI 0.76-0.99; p = 0.029) and urinary continence recovery (matched HR 0.91, 95%CI 0.84-0.98; p = 0.014). CONCLUSIONS Obesity did not represent a risk factor of BCR or MP after RARP despite higher rates of adverse pathological features. However, obesity was associated with higher risk of perioperative morbidity and impaired functional outcomes. Such information is integral for patient counselling. Thus, weight loss before RARP should be encouraged.
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Affiliation(s)
- Sergey Sarychev
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Jorn H Witt
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Christian Wagner
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Matthias Oelke
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Andreas Schuette
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Nikolaos Liakos
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Theodoros Karagiotis
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Mikolaj Mendrek
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Mykyta Kachanov
- Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian P Meyer
- Department of Urology, Herford Hospital, Campus OWL, Ruhr-University Bochum, Herford, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
| | - Sami-Ramzi Leyh-Bannurah
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany.
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Razzaghi M, Asghari-Azghan A, Montazeri S, Razzaghi Z, Mazloomfard MM, Vafaee R. Intravaginal Pulsed Contractile Radiofrequency for Stress Urinary Incontinence Treatment; A Safety Study. J Lasers Med Sci 2022; 12:e56. [PMID: 35155141 DOI: 10.34172/jlms.2021.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 04/17/2021] [Indexed: 11/09/2022]
Abstract
Introduction: Radiofrequency (RF)-based stress urinary incontinence (SUI) treatment, which has quickly attracted attention, is administered in an office setting. This pilot-safety study assessed the efficacy of transvaginal RF treatment in the quality of life (QOL) and frequency of incontinence episodes in women with SUI. Methods: Twenty-eight women suffering from SUI were treated with an intravaginal quadric applicator while a grounding pad was attached in front of their pubes. The first phase is thermic, which will heat up the vaginal wall up to 40°C for 10 minutes. The second step is contraction to stimulate an aerobic exercise of pelvic floor muscles for 20 minutes (pulsed contractile RF at 20-40 watts and 1000-300 kHz with a modulation of 1 to 300 Hz for muscle exercise). It was scheduled for one session per week for 3 sessions. Patients had follow-up visits before and 1, 6 and 12 months following the treatment for one-day voiding diary, Persian version of urinary incontinence QOL questionnaire (I-QOL), Q-tip test, 24 hours-pad test and daily incontinence episodes' number. Results: The patients' mean age, duration of incontinence and median vesical leak point pressure were 41.6±9.6 years, 5.48±6.84 years and 140 cm H2 O respectively. Significant changes were observed in the mean I-QOL total score and the pad test. Also, a notable reduction was observed in the number of daily leakage episodes and the Q-tip test at any follow-up visit (P=0.001). Conclusion: Preliminary results suggest that transvaginal RF is a convenient method of SUI treatment. Significant changes were observed in the mean I-QOL total score and the pad test. Also, a notable reduction was observed in the number of daily leakage episodes.
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Affiliation(s)
- Mohammadreza Razzaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsar Asghari-Azghan
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Montazeri
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Razzaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohsen Mazloomfard
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Vafaee
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Álvarez-García C, Doğanay M. The prevalence of urinary incontinence in female CrossFit practitioners: A systematic review and meta-analysis. ARCH ESP UROL 2022; 75:48-59. [PMID: 35173077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE CrossFit is a popular sportamong women. It has numerous benefits, but it is unclearwhat effects it has on the pelvic floor, since physicalexercise may be a risk factor for urinary incontinence.The aim of this study was to determine theoverall prevalence of urinary incontinence in femaleCrossFit practitioners. METHODS: A systematic review and meta-analysiswere conducted (PROSPERO, 2020: CRD42020199479).We searched cross-sectional studies in databases (Pub-Med, CINAHL, WOS, Scopus, ProQuest) and search engines,from inception to 17 June, 2020. The AdaptedNewcastle-Ottawa Scale for Cross-Sectional Studies wasused to assess the risk of bias. Pooled prevalence wascalculated using random-effects models. Heterogeneitywas investigated by meta-regression and subgroupanalysis. RESULTS A total of 282 records were identified, ofwhich 13 were included in the qualitative and quantitativesynthesises. The prevalence of urinary incontinenceamong female CrossFit practitioners was 32.1%(95% CI = 22.2-43.8%, n = 2187) and of stress urinaryincontinence was 35.8% (95% CI = 19.4-56.4%, n =1323). The prevalence of urinary incontinence was higher among women over 35 years old, with previouspregnancies and vaginal deliveries (P = 0.004). TheCrossFit exercises associated with higher stress urinaryincontinence were rope jumping, double under,weightlifting, and box jumps. Some preventive strategieswere pelvic floor training, using pads, emptyingthe bladder before workouts, and wearing dark pants. CONCLUSIONS: These results show that the prevalenceof urinary incontinence in female CrossFit practitionerswas similar to that found among women whopractice sport.
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Cardot V, Campagne-Loiseau S, Roulette P, Peyrat L, Vidart A, Wagner L, Thuillier C, Klap J, Hurel S, Hermieu JF, Girard F, Even L, Donon L, Charles T, Tibi B, Bosset PO, Berrogain N, Meyer F, Cornu JN, Deffieux X. 2021 opinion from the CUROPF on THE efficacy and safety of mid-urethral slings used in women WITH urinary stress incontinence. Prog Urol 2021; 32:247-257. [PMID: 34920924 DOI: 10.1016/j.purol.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/23/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the usefulness of mid-urethral slings (MUS) in the surgical management of women presenting with urinary stress incontinence (USI) METHOD: A consensus committee of multidisciplinary experts (CUROPF) was convened and focused on PICO questions concerning the efficacy and safety of MUS surgery compared to other procedures and concerning which approach (retropubic (RP) vs transobturator (TO)) should be proposed as a first-line MUS surgery for specific subpopulations (obese; intrinsic sphincteric deficiency (ISD); elderly) RESULTS: As compared to other procedures (urethral bulking agents, traditional slings and open colposuspension), the MUS procedure should be proposed as the first-line surgical therapy (strong agreement). MUS surgery can be associated with complications and proper pre-operative informed consent is mandatory (strong agreement). Mini-slings (SIS/SIMS) should only be proposed in clinical trials (strong agreement). Both RP and TO approaches may be proposed for the insertion of MUS (strong agreement). However, if the woman is willing to accept a moderate increase in per-operative risk, the RP approach should be preferred (strong agreement) since it is associated with higher very long-term cure rates and as it is possible to completely remove the sling surgically if a severe complication occurs. The RP approach should be used for the insertion of MUS in a woman presenting with ISD (strong agreement). Either the RP or TO approach should be used for the insertion of MUS in an obese woman presenting with USI (strong agreement). In very obese women (BMI ≥35-40kg/m2), weight loss should be preferred prior to MUS surgery and bariatric surgery should be discussed (strong agreement) CONCLUSION: The current Opinion provides an appropriate strategy for both the selection of patients and the best therapeutic approach in women presenting with USI.
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Affiliation(s)
- V Cardot
- Clinique de Meudon-Clamart, 3, avenue de Villacoublay, 92360 Meudon, France
| | - S Campagne-Loiseau
- Service de gynécologie obstétrique, CHU Estaing, Clermont Ferrand, 1, place Lucie et Raymond-Aubrac, 63000 Clermont Ferrand, France
| | - P Roulette
- Service d'urologie, CH Cahors, 30, avenue de la voie Romaine, 06000 Nice, France
| | - L Peyrat
- Service d'urologie, Clinique de Turin, 13, rue de Turin, 75008 Paris, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L Wagner
- Servie d'urologie, CHU Carémeau, place du Pr Robert Debré, 30029 Nîmes, France
| | - C Thuillier
- Service d'urologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - J Klap
- Service d'urologie, hôpital Privé Claude Galien, 20, route de Boussy Saint-Antoine, 91480 Quincy sous Sénart, France
| | - S Hurel
- Service d'urologie, hôpital Européen Georges-Pompidou (AP-HP), 20, rue Leblanc, 75015 Paris, France
| | - J F Hermieu
- Service d'urologie, hôpital Bichat (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - F Girard
- Service d'urologie, clinique oudinot fondation Cognacq-Jay, 2 rue Rousselet, 75007 Paris, France
| | - L Even
- Cabinet d'urologie, Espace Santé 3, 521, avenue de Rome, 83500 La Seyne-sur-Mer, France
| | - L Donon
- Service d'urologie, Polyclinique de la Côte Basque Sud, 7, rue Léonce Goyetche, 64500 Saint Jean de Luz, France
| | - T Charles
- Service d'urologie, CHU La Miletrie, 2, rue de la Milétrie, 86021 Poitiers, France
| | - B Tibi
- Service d'urologie, CH Cahors, 30, avenue de la voie Romaine, 06000 Nice, France
| | - P O Bosset
- Service d'urologie, Clinique de Turin, 13, rue de Turin, 75008 Paris, France
| | - N Berrogain
- Service d'URologie, Clinique Ambroise Pare, 387, route de Saint-Simon, 31100 Toulouse, France
| | - F Meyer
- Service d'urologie, hôpital Saint Louis (APHP), 1, avenue Claude Vellefaux, 75010 Paris, France
| | - J-N Cornu
- Service d'urologie, hôpital Charles-Nicolle, université de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - X Deffieux
- Service de gynécologie obstétrique, hôpital Antoine-Béclère (APHP), 157, rue de la Porte de Trivaux, 92140 Clamart, France.
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Broudeur L, Loubersac T, Le Normand L, Karam G, Branchereau J, Rigaud J, Perrouin-Verbe MA. New technique of robot-assisted laparoscopic artificial urinary sphincter implantation in female by a posterior approach with intraoperative cystoscopic monitoring. World J Urol 2021; 39:4221-4226. [PMID: 34050814 DOI: 10.1007/s00345-021-03739-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report the early experience of a modified technique of robot-assisted artificial urinary sphincter (AUS) implantation in female, with a posterior approach to the bladder neck and intraoperative real-time cystoscopic monitoring. METHODS Retrospective monocentric study included all consecutive female who underwent a primary robot-assisted AUS implantation between 2017 and 2019. Real-time intraoperative cystoscopic monitoring was carried out to check the correct level of the dissection and to avoid any injury during bladder neck dissection. Perioperative and intraoperative data, functional outcomes and complications were assessed. Continence was defined as 0 to 1 pad per day. RESULTS Twenty-four patients were included, the median age was 66 years, 23/24 (96%) had previous SUI or prolapse surgery. Two conversions to open surgery and 2 modifications of the surgical technique with anterior dissection of the bladder neck were required due to major vesicovaginal adhesions. Overall, 20 patients underwent the robotic posterior approach. Eleven intraoperative complications in 10 patients (50%) occurred, including 7 bladder injuries 4 vaginal injuries, without the need to stop the procedure. The median hospital stay was 3 days (2-7). One AUS was removed at 1 year due to vaginal erosion. At last follow-up (median 26 months (22-36)), 95% of the devices were in place and activated and the continence rate was 84%. CONCLUSIONS Early functional results of robot-assisted AUS implantation with a posterior approach to the bladder neck and intraoperative cystoscopic monitoring are promising despite the high rate of intraoperative complications due to previous surgeries. Further evaluation of this technique is required.
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Affiliation(s)
- L Broudeur
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France.
| | - T Loubersac
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - L Le Normand
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - G Karam
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - J Branchereau
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - J Rigaud
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - M A Perrouin-Verbe
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
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9
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Sandwith E, Robert M. Rug-pee study: the prevalence of urinary incontinence among female university rugby players. Int Urogynecol J 2020; 32:281-285. [PMID: 32857177 DOI: 10.1007/s00192-020-04510-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The goal of this study was to determine the prevalence of urinary incontinence among female university varsity rugby players. Secondary objectives were to understand when the incontinence occurred and to assess the degree of bother experienced. It is postulated that female rugby players may have higher rates of urinary incontinence due to the high-impact activities involved in training and competitions. METHODS Data was collected via a self-administered, anonymous questionnaire. RESULTS A total of 95 athletes were included in the survey results. Urinary incontinence was experienced by 51 of the 95 (54%) players. Of the 51 athletes who reported leaking urine, 90% leaked urine when competing in a rugby game and 88% of players leaked when being tackled or hit. Despite the high prevalence of urinary incontinence, most players reported they were not bothered or only slightly bothered by their urinary leaking. Several of the players (18%) were interested in receiving treatment for their urinary incontinence. CONCLUSION The prevalence of urinary incontinence among varsity female rugby players is 54%, which is consistent with rates among other high-impact sports. Surprisingly, the majority of these women are not bothered by their incontinence and most are not interested in treatment for this condition at this time.
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Affiliation(s)
- Emily Sandwith
- Cumming School of Medicine, University of Calgary, 4th floor, North Tower 1403 29th Street NW, Calgary, Alberta, T2N 2T9, Canada.
| | - Magali Robert
- Cumming School of Medicine, University of Calgary, 4th floor, North Tower 1403 29th Street NW, Calgary, Alberta, T2N 2T9, Canada
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Khogeer A, Thuillier C, Descotes JL, Rambeaud JJ, Long JA, Fiard G. Evolution of patients with and without preoperative stress urinary incontinence after surgical cystocele repair by mesh implantation using a vaginal approach. Prog Urol 2020; 30:610-7. [PMID: 32536586 DOI: 10.1016/j.purol.2020.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION To review the short-term evolution of stress urinary incontinence (SUI) after Uphold™ LITE mesh implantation for genital prolapse repair. MATERIAL AND METHODS Retrospective, descriptive, single centre study of women undergoing genital prolapse surgery with Uphold™ LITE mesh insertion between July 2016 and April 2019. Pre-, peri- and 1-year postoperative follow-up data were collected. RESULTS Thirty-six women were included (mean age: 72±7years). Most patients (75%) had grade III cystocele and three (8.3%) had recurrent prolapse. Mean operative time was 41±12min. During surgery, no visceral injury or haemorrhagic complications were noted but there were three intraoperative bladder injuries (8.3%). Twelve patients (33.3%) had preoperative SUI, half of which (n=6; 50%) responded to prolapse repair. De novo SUI was noted in 6/24 (25%) patients. The risk of having persistent postoperative SUI was 50% in patients with preoperative SUI, and the risk of developing de novo postoperative SUI was 25% in patients without preoperative SUI. Thus, patients with preoperative SUI were twice as likely to have persistent postoperative SUI as those without preoperative SUI (RR=2.0 [95% CI: 0.8175-4.8928]; P=0.128). Five patients with de novo SUI and three patients with persistent postoperative SUI were subsequently treated with insertion of a mid-urethral sling (MUS). The other patients improved with physiotherapy. CONCLUSION Risk of persistent SUI after implantation of an Uphold™ LITE mesh is higher in patients with preoperative SUI. Surgical correction with a MUS can be offered in cases of de novo SUI before or after physiotherapy. LEVEL OF EVIDENCE 4.
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11
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Koenig I, Eichelberger P, Luginbuehl H, Kuhn A, Lehmann C, Taeymans J, Radlinger L. Activation patterns of pelvic floor muscles in women with incontinence while running: a randomized controlled trial. Int Urogynecol J 2020; 32:335-343. [PMID: 32472161 DOI: 10.1007/s00192-020-04334-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/05/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Running is known to cause urinary leakage in women with stress urinary incontinence (SUI). Task-specific fiber-type recruitment while running can be estimated using wavelets. The aim of this study was to compare the effect of a new physiotherapy program including involuntary, reflexive training with a standard physiotherapy program on pelvic floor muscle (PFM) activation patterns and fiber-type recruitment behavior while running. METHODS In this triple-blinded randomized controlled trial, women with SUI were randomly allocated to the control group (CON), which performed a standard physiotherapy program, or the experimental group (EXP), which received additional involuntary, reflexive training. PFM electromyography (EMG) was recorded during 10 s at three running speeds and analyzed using Morse wavelets. The relative distribution of power (%) over the frequencies from 20 to 200 Hz was extracted and analyzed within six-time intervals of 30 ms. Statistical nonparametric mapping was performed to identify power spectra differences. RESULTS Thirty-nine (CON) and 38 (EXP) women were included. The power spectra showed no statistically significant group differences. The time intervals from 30 ms before to 30 ms after initial contact showed significantly lower intensities than the intervals from 30 to 150 ms after initial contact in the lowest and higher intensities in the highest frequencies for all running speeds and both groups. CONCLUSIONS Power spectra shifts toward higher frequency bands in the pre-initial contact phase could indicate a feed-forward anticipation and a muscle tuning for the expected impact of initial contact event in order to maintain continence.
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Affiliation(s)
- Irene Koenig
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Murtenstrasse 10, 3008, Bern, Switzerland.
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Patric Eichelberger
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Helena Luginbuehl
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Annette Kuhn
- University Hospital and University of Bern, University Clinic of Gynecology, Bern, Switzerland
| | - Corinne Lehmann
- Department of Physiotherapy, University Hospital Bern, Bern, Switzerland
| | - Jan Taeymans
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Murtenstrasse 10, 3008, Bern, Switzerland
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lorenz Radlinger
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Murtenstrasse 10, 3008, Bern, Switzerland
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Chen CCG, Avondstondt AM, Khatry SK, Singh M, Klasen EM, LeClerq SC, Katz J, Tielsch JM, Mullany LC. Prevalence of symptomatic urinary incontinence and pelvic organ prolapse among women in rural Nepal. Int Urogynecol J 2019; 31:1851-1858. [PMID: 31813031 DOI: 10.1007/s00192-019-04129-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Although pelvic floor disorders (PFDs) are a significant public health issue in higher income countries, less is known about these disorders and associated risk factors in low income countries. We aimed to determine prevalence and associated risk factors for stress urinary incontinence (SUI), urge urinary incontinence (UUI), and pelvic organ prolapse (POP) in reproductive age women in Sarlahi District in rural Nepal. METHODS We conducted a community-based cross-sectional survey of parous, reproductive age women in rural Nepal and screened for pelvic floor disorders using validated screening questions for PFDs. Overall frequency of self-reported symptoms for SUI, UUI, and POP was estimated and compared across demographic and pregnancy history information. RESULTS Of 14,469 women available for analysis, the mean (SD, range) age was 33.5 (8.2, 13-52) years, and median (range) number of pregnancies was 4 (1-15). The prevalence of SUI was 24.1% (95% CI: 23.3-24.8), of UUI was 13.5% (95% CI: 13.0-14.1), and of POP was 8.0% (95% CI: 7.5-8.4). Bivariate analysis identified the risk of PFD increased incrementally with age and number of vaginal deliveries; these covariates were highly correlated. Multivariable logistic regression revealed age, vaginal deliveries, and previous pelvic surgeries were independently associated with PFD. CONCLUSIONS PFDs are common in a community of parous, reproductive age women in rural Nepal. Risk factors for these conditions are similar to risk factors found in higher income countries.
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Affiliation(s)
- Chi Chiung Grace Chen
- Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.
| | - Andrea M Avondstondt
- Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Subarna K Khatry
- Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal
| | - Meeta Singh
- Department of Obstetrics and Gynecology, Institute of Medicine, Kathmandu, Nepal
| | - Elizabeth M Klasen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Steven C LeClerq
- Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - James M Tielsch
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Pereira E Silva R, Gomes Olival V, Ponte C, Palma Dos Reis J, Colaço J, Grilo I, Nunes F. Overactive Bladder Symptoms after Transobturator Sling Surgery for Pure Stress Urinary Incontinence: A Cross-Sectional Comparative Study. Urol Int 2018; 100:428-433. [PMID: 29649817 DOI: 10.1159/000488204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/06/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Transobturator tape (TOT) surgery has been associated with increased overactive bladder (OAB) although much controversy exists. METHODS In a cross-sectional study, women who underwent TOT surgery for pure stress incontinence (MonarcTM) answered the 6 questions of the symptom bother (SB) subscale of the OAB questionnaire - short form (OABq-SF) and an additional question regarding whether symptoms began after surgery. Women with SB score over the 4th quartile (≥30/100) were reassessed after a longer follow-up. Patients from primary care were recruited as controls. RESULTS We recruited 213 patients (135 in the TOT group and 78 age-adjusted controls). The mean age of operated patients was 58.7 ± 10.1 years with a mean follow-up of 25.9 ± 13.2 months. OABq-SF SB scores did not differ between the TOT group and controls (respectively, 18.5 ± 30 and 15.5 ± 6.7, p = 0.202). A total of 48% patients reported no relationship between symptoms and surgery. Highly symptomatic operated patients were reassessed after a longer follow-up (46.3 ± 10.6 months). The mean score in the second follow-up (n = 25) was not statistically different from the first assessment (46.4 ± 22.7 and 58.1 ± 19.8, p = 0.059). CONCLUSIONS Women who underwent TOT surgery did not show increased OAB SB scores when compared to controls. Our study suggests that OAB symptoms may thus be present but overlooked during initial clinical assessment.
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Affiliation(s)
| | - Vanessa Gomes Olival
- Department of Gynecology and Obstetrics, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Carolina Ponte
- Department of Urology, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | | | - João Colaço
- Department of Gynecology and Obstetrics, Hospital de Cascais, Cascais, Portugal
| | - Isabel Grilo
- Department of Gynecology and Obstetrics, Hospital de Cascais, Cascais, Portugal
| | - Filomena Nunes
- Department of Gynecology and Obstetrics, Hospital de Cascais, Cascais, Portugal
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Celik F, Pektas MK, Kose M, Arioz DT, Yesildager E, Yilmazer M. Two-Year Follow-Up Results of Transobturator Tape Procedure with and without Concomitant Vaginal Surgery. Urol Int 2018; 100:402-408. [PMID: 29627828 DOI: 10.1159/000488465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/15/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aims to evaluate the subjective and objective outcomes of the transobturator tape (TOT) procedure performed to treat stress urinary incontinence and to determine the efficacy and safety of the TOT procedure when used along with vaginal surgery. METHODS This is a prospective review of 24 women who had the TOT procedure done only due to stress incontinence; 22 women who underwent concomitant TOT and pelvic floor repair; and 20 women who received concurrent TOT, transvaginal hysterectomy, and sacrospinous ligament fixation. RESULTS When compared to the patients who had TOT with pelvic floor repair, the patients who underwent TOT with hysterectomy declared to have more dyspareunia (p = 0.008) and they were found to have significantly higher post-void residual volume (p = 0.014). When compared to the patients who had only TOT, the patients who underwent TOT with hysterectomy claimed to have more pelvic pain (p = 0.012) and significantly higher post-void residual volume (p = 0.020). CONCLUSION The TOT procedure results in moderately high objective cure rates, and concurrent application of pelvic floor repair or transvaginal hysterectomy does not affect these rates. The relatively higher incidences for voiding problems and pelvic pain in women who underwent TOT, hysterectomy, and sacropinous fixation simultaneously suggest that the extent of surgery directly correlates with the severity of postoperative complications.
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Affiliation(s)
- Fatih Celik
- Department of Obstetrics and Gynecology, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Mine Kanat Pektas
- Department of Obstetrics and Gynecology, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Mesut Kose
- Department of Obstetrics and Gynecology, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Dagistan Tolga Arioz
- Department of Obstetrics and Gynecology, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | | | - Mehmet Yilmazer
- Department of Obstetrics and Gynecology, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
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Weintraub AY, Reuven Y, Paz-Levy D, Yohay Z, Idan I, Elharar D, Glinter H, Tzur T, Yohay D. Prevalence and risk factors for urinary tract infection up to one year following midurethral sling incontinence surgery. Eur J Obstet Gynecol Reprod Biol 2018; 222:146-150. [PMID: 29408746 DOI: 10.1016/j.ejogrb.2018.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/22/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the prevalence and risk factors of urinary tract infection (UTI) one year following sub-midurethral sling (SMUS) incontinence surgery in a university affiliated medical center in southern Israel. METHODS A retrospective cohort study was conducted to identify and characterize patients who suffered UTI within a year following SMUS surgery. The study population comprised of all patients who underwent a SMUS surgery between the years 2014 and 2015. Demographic and clinical data were retrieved from the patients' medical records, and a comparison between patients with and without a positive urine culture was performed. RESULTS During the study period, there were 178 SMUS surgeries. Urine culture positive UTI was noted in 21% (38 patients) within the first year following surgery. The mean age and BMI of patients complicated with UTI was 64.8 and 29.1, respectively. The most common pathogen found in urine culture was E. coli that accounted for 55% of all UTIs. When comparing patients with and without UTI, no significant difference was noted in the pre- and intra-operative characteristics. However, duration of hospitalization and readmissions in the first year following surgery, were significantly associated with the risk of UTI (p < 0.026 and p < 0.003, respectively). CONCLUSIONS Approximately one in every five women undergoing a SMUS operation in our population will suffer from UTI within a year from surgery. A significant association was found between the duration of hospitalization and readmissions in the first postoperative year and suffering from UTI.
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Affiliation(s)
- Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel.
| | - Yonatan Reuven
- Siaal Research Center for Family Medicine and Primary Care, Division of Community Health, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Dorit Paz-Levy
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Inbal Idan
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Debi Elharar
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Hannah Glinter
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Tamar Tzur
- Department of Obstetrics and Gynecology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
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Brennand E, Ruiz-Mirazo E, Tang S, Kim-Fine S; Calgary Women’s Pelvic Health Research Group. Urinary leakage during exercise: problematic activities, adaptive behaviors, and interest in treatment for physically active Canadian women. Int Urogynecol J 2018; 29:497-503. [PMID: 28685262 DOI: 10.1007/s00192-017-3409-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urine loss during recreational exercise is problematic. We aimed to characterize which activities are most frequently reported as causing leakage for women, adaptive management mechanisms, and awareness and interest in treatment in a cohort of physically active women. METHODS We administered an anonymous questionnaire to 59 physically active women in Canada. Surveys were completed electronically or on paper. Demographic information was obtained. Questions about which specific activities caused leakage, adaptive behaviors to deal with urinary loss, and degree of bother were addressed, and knowledge and interest in therapies for leakage were queried. RESULTS Activities most likely to cause leakage were skipping, trampoline, jumping jacks, and running/jogging. To decrease leakage, 93.2% voided immediately before exercise, 62.7% reported voiding breaks, and some reported fluid restriction (37.3%). Leakage impacted activity level for 50% of women. Most often, activity intensity was decreased (90.3%) or specific activities avoided (80.7%). Pad use during exercise was common (49.2%). Interest in receiving treatment for urinary incontinence (UI) was high (88.1%) despite a large proportion (35.6%) not knowing of available treatments. Interest was highest for pelvic floor physiotherapy (84.6%), although interest in both pessary and surgical management (63.5% each) was significant. CONCLUSIONS Women experiencing UI during exercise report high-impact activities as most frequently causing loss. Adaptive behaviors are common. Physically active women are interested in treatment, and the high interest in pelvic physiotherapy presents a unique opportunity to link pelvic exercise with recreational exercise to meet both cardiovascular and continence needs in the physically active patient population.
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van Koeveringe GA, De Wachter S, Zuckerman JM, Tommaselli G, de Wildt MJ, Everaert KCM, Michielsen DPJ, Wyndaele JJ. Minimal Device Encrustation on Vesair Intravesical Balloons in the Treatment of Stress Urinary Incontinence: Analysis of Balloons Removed from Women in the SOLECT Trial. Adv Ther 2017; 34:1686-1694. [PMID: 28597355 PMCID: PMC5504215 DOI: 10.1007/s12325-017-0570-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Indexed: 01/10/2023]
Abstract
Introduction Encrustation of urinary biomaterials is common; however, the incidence of surface deposition on the Vesair® intravesical pressure-attenuation balloon has not been previously reported. The purpose of this analysis is to determine the incidence and potential risk factors for encrustation of the Vesair intravesical balloon. Methods The SOLECT trial is a prospective randomized controlled trial conducted at several European centers to evaluate the safety and efficacy of the Vesair balloon for the treatment of female stress urinary incontinence (SUI). Women included in the study demonstrated SUI symptoms for more than 12 months without complicating factors, such as history of recurrent urinary tract infections or nephrolithiasis. All balloons removed from women enrolled in the SOLECT trial were analyzed for surface characteristics and encrustation. Surface deposition severity was quantified and composition analyzed with infrared spectroscopy and scanning electron microscopy. Incidence of surface deposition was tabulated and risk factors analyzed. Results One hundred and five balloons removed from 75 women were included in this analysis. Measurable stone deposition of less than 1.5 mm was found on four balloons (3.8%), surface granules were noted on 42 (40.0%), surface film on 11 (10.5%), and both granules and film on two (1.9%). Analysis identified calcium oxalate both in measurable encrustation deposits as well as those with surface granulation. Pooled analysis found that dwell time was a risk factor for calcium deposition. Conclusion The rate of encrustation on the Vesair intravesical balloon is low and does not appear to increase the rate of adverse outcomes or reduce clinical efficacy. Funding Solace Therapeutics, Inc.
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Affiliation(s)
| | - Stefan De Wachter
- University Hospital Antwerpen, University of Antwerp-Urology, Antwerp, Belgium
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Swenson CW, Kolenic GE, Trowbridge ER, Berger MB, Lewicky-Gaupp C, Margulies RU, Morgan DM, Fenner DE, DeLancey JO. Obesity and stress urinary incontinence in women: compromised continence mechanism or excess bladder pressure during cough? Int Urogynecol J 2017; 28:1377-1385. [PMID: 28150033 DOI: 10.1007/s00192-017-3279-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/16/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We compared two hypotheses as to why obesity is associated with stress urinary incontinence (SUI): (1) obesity increases demand on the continence system (e.g. higher cough pressure) and (2) obesity compromises urethral function and urethrovaginal support. METHODS A secondary analysis was performed using data from a case-control study of SUI in women. Measurements of urethrovaginal support (POP-Q point Aa, urethral axis), urethral function (maximal urethral closure pressure, MUCP), and measures of continence system demand (intravesical pressures at rest and during maximal cough) were analyzed. Cases and controls were divided into three body mass index (BMI) groups: normal (18.5-24.9 kg/m2); overweight (25.0-29.9 kg/m2); and obese (≥30 kg/m2). Logistic regression models where created to investigate variables related to SUI for each BMI group. Structural equation modeling was used to test the direct and indirect relationships among BMI, SUI, maximal cough pressure, MUCP, and POP-Q point Aa. RESULTS The study included 108 continent controls and 103 women with SUI. MUCP was the factor most strongly associated with SUI in all BMI groups. Maximal cough pressure was significantly associated with SUI in obese women (OR 3.191, 95% CI 1.326, 7.683; p < 0.01), but not in normal weight or overweight women. Path model analysis showed a significant relationship between BMI and SUI through maximal cough pressure (indirect effect, p = 0.038), but not through MUCP (indirect effect, p = 0.243) or POP-Q point Aa (indirect effect, p = 0.410). CONCLUSIONS Our results support the first hypothesis that obesity is associated with SUI because of increased intravesical pressure, which therefore increases demand on the continence mechanism.
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Affiliation(s)
- Carolyn W Swenson
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA.
| | - Giselle E Kolenic
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | | | - Mitchell B Berger
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | | | | | - Daniel M Morgan
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | - Dee E Fenner
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | - John O DeLancey
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
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García Mejido JA, Valdivieso Mejias P, Fernández Palacín A, Bonomi Barby MJ, De la Fuente Vaquero P, Sainz Bueno JA. Evaluation of isolated urinary stress incontinence according to the type of levator ani muscle lesion using 3/4D transperineal ultrasound 36 months post-partum. Int Urogynecol J 2016; 28:1019-1026. [PMID: 27872979 DOI: 10.1007/s00192-016-3208-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/06/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Vaginal delivery can lead to pelvic floor disorders. Many authors have described pelvic floor injuries that can predict future defects such as urinary incontinence and pelvic organ prolapse. We propose the assessment of urinary stress incontinence and its association with levator ani muscle (LAM) microtrauma (>20% in the levator hiatus area during Valsalva) and macrotraumas (avulsion) identified by 3/4D transperineal ultrasound (3D-TpUS) 36 months post-partum. MATERIALS AND METHODS This was a prospective observational study including 168 nulliparous women. All patients included were nulliparous with singleton gestation in cephalic presentation, at ≥37 weeks and were recruited on the first day after delivery. Thirty-six months after delivery, 3D-TpUS was carried out to identify LAM lesions (macro or micro). Clinical assessment of urinary stress incontinence (USI) was based on the ICIQ-UI-SF test; a simple stress test and urodynamic test were carried out in the same visit. RESULTS A total of 105 nulliparous women were studied (51 spontaneous deliveries [SpD] and 54 vacuum-assisted deliveries [VD]). Microtraumas were identified in 35.3% of SpD and 20.4% of VD. Macrotraumas (avulsion) were identified in 9.8% of SpD and 35.2% of VD (p = 0.006). No differences were found in USI between study groups or in relation to the identification of LAM defects (19.2% in the no lesion group, 25% in the macrotrauma and 13.8% in the microtrauma groups; p = not significant). Nor were significant differences found in the results from the different study groups in the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) test (12.7±2.2 in the no lesion group, 12.5±4.2 in the macrotrauma and 13.25±4.8 in the microtrauma groups; p = NS). CONCLUSION No difference was observed in USI between patients with and without LAM lesions (microtrauma or macrotrauma) 36 months post-delivery.
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Affiliation(s)
| | | | | | | | | | - José Antonio Sainz Bueno
- Obstetrica y Ginecología, Hospital Universitario de Valme, Sevilla, CP: 41014, Spain. .,Universidad de Sevilla, Sevilla, Andalucía, Spain.
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Tutolo M, De Ridder D, Van der Aa F. Single incision slings: Are they ready for real life? World J Obstet Gynecol 2016; 5:197-209. [DOI: 10.5317/wjog.v5.i2.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/23/2015] [Accepted: 01/22/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To review of the efficacy and safety outcomes of different single incision slings (SIS) systems, also in comparison with traditional slings.
METHODS: A literature search was conducted in PubMed/MEDLINE database. The research was restricted to randomized and/or prospective trials and retrospective studies, published after 2006, with at least 20 patients with non-neurogenic stress urinary incontinence (SUI). The studies had to assess efficacy and/or safety of the SIS with a minimum follow-up of 12 mo. All the paper assessing the performance of tension free vaginal tape secur were excluded from this review. The final selection included 19 papers fulfilling the aforementioned criteria. Two authors independently reviewed the selected papers.
RESULTS: Four different SIS systems were analysed: Ajust®, Ophira®, Altis® and MiniArc®. The average objective cure rate was 88%. Overall no statistically significant differences were found between SIS and traditional mid-urethral slings (MUS) in terms of objective cure (all P > 0.005). Only one paper showed a statistically lower success rate in MiniArc®vs Advantage® slings (40% vs 90%) and higher rates of failure in the SIS group. Since there was a great variability in terms of tests performed, it was not possible to compare subjective cure between studies. The vast part of the studies showed no major complications after SIS surgery. We also observed very low reported pain rates in SIS patients. The RCTs on Ajust® and MiniArc®, showed better outcomes in terms of post-operative pain compared to MUS. None of the patients reported long- term pain complains.
CONCLUSION: SIS showed similar efficacy to that of traditional slings but lower short-term pain, complication and failure rates.
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Forzini T, Viart L, Alezra E, Saint F. [Erosive complications of mid urethral slings (MUS): 10 years of surgical experience]. Prog Urol 2015; 25:240-8. [PMID: 25617074 DOI: 10.1016/j.purol.2014.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 12/07/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Evaluation of the diagnostic and therapeutic management of erosive complications after mid urethral sling (MUS) procedure: vaginal erosions (VE), bladder (BE) and urethral (UE). METHODS Retrospective monocentric study concerning cohort of patients undergoing surgery from January 2002 to January 2013 supported for erosive complications of MSU: TVT (Tension-free Vaginal Tape) or TOT (Trans-Obturateur Tape). RESULTS Sixteen patients were diagnosed for erosive complications: 7 VE, 6 BE and 3 UE. Dyspareunia and vaginal discharge were observed in 86% patients (n=6/7) with VE. Conservative treatment by vaginal approach was systematically performed in cases of vaginal erosion. After removal of material, 100% dyspareunia were corrected. Postoperative continence was maintained in 57% of patients (n=4/7). Urinary infection was the main symptom of patients with BE. Severe dysuria was present in 66% of patients with a UE (n=2/3). First-line therapy by endoscopic treatment was performed in 77% of patients (n=7/9) with a BE or UE. A second surgery was required in 42% of patients treated with endoscopic first-line therapy (n=3/7) because of a new exposure of MUS. Three of nine patients recurred their incontinence after first-line therapy (33%). CONCLUSION The removal of device exposed vaginally in case VE systematically corrected symptoms with about 60% of continence. In case of BE or UE, endoscopic treatment in first-line therapy was rarely definitive (42%) and recurrence of incontinence appeared in 30% cases.
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Affiliation(s)
- T Forzini
- Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France; Laboratoire de recherche HeRVI (EA 3801), CURS-CHU Amiens-Picardie, 150, avenue de la Croix-Jourdain, 80480 Salouël, France.
| | - L Viart
- Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France; Laboratoire d'anatomie et d'organogénèse, UFR de médecine d'Amiens, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - E Alezra
- Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France
| | - F Saint
- Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France; Laboratoire de recherche HeRVI (EA 3801), CURS-CHU Amiens-Picardie, 150, avenue de la Croix-Jourdain, 80480 Salouël, France
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Biardeau X, Rizk J, Marcelli F, Flamand V. Robot-assisted laparoscopic approach for artificial urinary sphincter implantation in 11 women with urinary stress incontinence: surgical technique and initial experience. Eur Urol 2015; 67:937-42. [PMID: 25582931 DOI: 10.1016/j.eururo.2014.12.041] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/29/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Artificial urinary sphincter (AUS) implantation is recommended for women suffering urinary stress incontinence. Robot-assisted laparoscopy allows improved dexterity and visibility compared to traditional laparoscopy, potentially providing significant advantages for deep pelvic surgery. OBJECTIVE To report our surgical technique and initial experience in transperitoneal robot-assisted laparoscopic AUS implantation in women with urinary stress incontinence. DESIGN, SETTING, AND PARTICIPANTS Eleven eligible patients with AUS implantation or revision using robot-assisted laparoscopy for urinary stress incontinence were included between January 2012 and February 2014 at Department of Urology, Lille University Hospital. SURGICAL TECHNIQUE Procedures were performed with the assistance of a four-arm da Vinci robot. The urethrovaginal space was dissected after transperitoneal access to the Retzius space. An 11-mm port placed in the right iliac fossa allowed introduction of the AUS device. The cuff and balloon tubes were externalised via a 5-mm suprapubic incision. The peritoneum was finally sutured. MEASUREMENTS Clinical data were prospectively collected before, during, and after the procedure. Results were classified as complete continence (no leakage and no pad usage), social continence (leakage and/or pad usage with no impact on social life), or failure (leakage and/or pad usage impacting social life). RESULTS AND LIMITATIONS After mean follow-up of 17.6 mo (interquartile range 10.8-26 mo), eight patients (72.7%) had a successful AUS implantation, of whom seven (87.5%) reported complete continence and one had social continence. Two vaginal injuries and two bladder injuries occurred intraoperatively. Two patients experienced early minor postoperative complications and two had a major postoperative complication. CONCLUSIONS Robot-assisted laparoscopic AUS implantation is a feasible procedure. Further studies will better assess the place of robot-assisted laparoscopy in AUS implantation. PATIENT SUMMARY We investigated the treatment of 11 patients with stress urinary incontinence using robot-assisted implantation of an artificial urinary sphincter (AUS). The results show that the procedure is feasible procedure, and future studies will to help assess the place of robot-assisted laparoscopy in AUS implantation.
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Affiliation(s)
- Xavier Biardeau
- Department of Urology, Lille University Hospital, Lille Nord de France University, Lille, France.
| | - Jérôme Rizk
- Department of Urology, Lille University Hospital, Lille Nord de France University, Lille, France
| | - François Marcelli
- Department of Urology, Lille University Hospital, Lille Nord de France University, Lille, France
| | - Vincent Flamand
- Department of Urology, Lille University Hospital, Lille Nord de France University, Lille, France
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Kim S, Bae J, Cho M, Lee K, Lee H, Jun T. Effect of preoperative flow rate on postoperative retention and voiding difficulty after transobturator tape operation. Korean J Urol 2014; 55:190-5. [PMID: 24648874 PMCID: PMC3956948 DOI: 10.4111/kju.2014.55.3.190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 10/18/2013] [Indexed: 11/24/2022] Open
Abstract
Purpose Controversy exists over the preoperative risk factors for postoperative urinary retention after the midurethral sling procedure for stress urinary incontinence (SUI). We intended to analyze the effect of preoperative flow rate on postoperative urinary retention after the transobturator tape (TOT) operation. Materials and Methods A total of 322 patients who underwent TOT from June 2006 to May 2012 were included in this retrospective study. All patients were preoperatively investigated for urinary symptoms and underwent preoperative urodynamic studies including urine flow rate. Postoperative urinary retention, voiding difficulty, and uroflowmetry were checked. Urinary retention was defined as the need for additional catheterization longer than 1 day. Patients were divided by preoperative peak flow rate (Qmax) of 15 mL/s (low Qmax group and normal Qmax group). Results There were 3 cases of postoperative urinary retention (0.9%) and 52 cases of voiding difficulty (16.1%). The low Qmax group included 40 patients (12.4%) and the normal Qmax group included 282 patients (87.5%). Between the two groups, there were no significant differences in age, previous pelvic surgery history, or past medical history. The low Qmax group had higher scores for voided volume and detrusor pressure at Qmax. However, there was no significant difference in postoperative voiding difficulty between the two groups. Furthermore, three patients who experienced postoperative retention showed high flow rates preoperatively. Conclusions Our results suggest that voiding difficulty in the group with low preoperative flow was tolerable and the treatment success rate was comparable to that in patients in the normal flow group. According to our analysis, patients with a low flow rate preoperatively can be safely treated with TOT for SUI.
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Affiliation(s)
- Sungjune Kim
- Department of Urology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Jungbum Bae
- Department of Urology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Minchul Cho
- Department of Urology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Kwangsoo Lee
- Department of Urology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Haewon Lee
- Department of Urology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Taeyong Jun
- Department of Urology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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Cho MK, Kim CH, Kang WD, Kim JW, Kim SM, Kim YH. Complications Following Outside-in and Inside-out Transobturator-Tape Procedures with Concomitant Gynecologic Operations. Chonnam Med J 2011; 47:165-9. [PMID: 22247917 PMCID: PMC3252505 DOI: 10.4068/cmj.2011.47.3.165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 11/30/2011] [Indexed: 11/06/2022] Open
Abstract
This study was undertaken to compare the complications of outside-in transobturator tape procedures (TOT) and inside-out transobturator tape procedures (TVT-O) with concomitant gynecologic surgery for the treatment of female stress urinary incontinence (SUI). A retrospective review of 206 consecutive patients who underwent either TOT or TVT-O with concomitant gynecologic operations between March 2008 and February 2011 was conducted. The incidence of perioperative complications was compared. For statistical analysis, chi-squared tests were used. There were no reports of intraoperative complications such as vaginal injury or bladder perforation. Postoperative complications were noted in 23 procedures (11.2%). These included 6 cases of urinary retention (2.9%), 2 cases of vulva hematoma (1.0%), 7 cases of urinary tract infection (3.4%), 4 cases of de novo urgency (2.9%), and 4 cases of vaginal erosion (2.9%). There were no significant differences in complication rates between the two groups. Our results suggest that inside-out and outside-in procedures are simple and safe techniques that may have a low rate of complications when used with a concomitant gynecologic operation.
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Affiliation(s)
- Moon Kyoung Cho
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea
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Shin YS, Cha JS, Cheon MW, Kim YG, Kim MK. Efficacy and safety of the TVT-SECUR® and impact on quality of life in women with stress urinary incontinence: a 2-year follow-up. Korean J Urol 2011; 52:335-9. [PMID: 21687393 PMCID: PMC3106166 DOI: 10.4111/kju.2011.52.5.335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 04/25/2011] [Indexed: 11/18/2022] Open
Abstract
PURPOSE As recently reported, the short-term results of the tension-free vaginal tape SECUR® (TVT-S) procedure seem to be similar to those of the conventional transobturator tape (TOT) procedure. However, results of efficacy and satisfaction with TVT-S are insufficient in patients with more than 1 year of follow-up. Therefore, we evaluated the results of the TVT-S procedure in women with stress urinary incontinence (SUI) during 2 years. MATERIALS AND METHODS We evaluated 51 patients with clinical and urodynamic diagnoses of SUI who underwent the TVT-S procedure from March 2008 to February 2009. Preoperative evaluation included a history, cough stress test with full bladder, urodynamic study, and incontinence quality of life (I-QoL) questionnaire. Following the postoperative period, urinary incontinence status was examined through a physical examination and the I-QoL questionnaire was completed in an outpatient setting or by telephone. RESULTS Data from 2 years of follow-up were available for 46 of 51 patients. The cure rate was 80.4% at 1 month after TVT-S and 76.0% at 2 years after TVT-S. The cure or improvement rate was 93.5% at 1 month after TVT-S and 86.8% at 2 years after TVT-S. The mean total I-QoL score increased by 42 points at 1 month after TVT-S (p<0.026) and by 32 points at 2 years after TVT-S (p<0.013). Most patients reported significant improvements in quality of life. At the 2-year follow-up, there were no significant complications related to TVT-S. CONCLUSIONS The results of this study suggest that TVT-S is an efficient and safe procedure for the improvement of both the quality of life of the patients and the SUI itself.
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Affiliation(s)
- Yu Seob Shin
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
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Kim SJ, Choi HW, Cho HJ, Hwang TK, Kim JC. The influence of preoperative bladder outlet obstruction on continence and satisfaction in patients with stress urinary incontinence after midurethral sling. Int Neurourol J 2010; 14:267-71. [PMID: 21253340 DOI: 10.5213/inj.2010.14.4.267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 12/23/2010] [Indexed: 11/08/2022] Open
Abstract
PURPOSE We studied the influence of preoperative bladder outlet obstruction (BOO) on postoperative continence rates and patient satisfaction after the midurethral sling procedure. METHODS A total of 159 women who underwent the midurethral sling procedure were evaluated. Using the Blaivas-Groutz nomogram, we assigned the patients were assigned to Group I (n=37, no obstruction), Group II (n=89, mild obstruction), or Group III (n=33, moderate to severe obstruction). Continence rates, patient satisfaction, urinary sensation scale and uroflowmetry were evaluated postoperatively. RESULTS There were no significant differences in continence rates, satisfaction, or postoperative maximal flow rate between the 3 groups. Postoperative urgency was improved after surgery in Groups I and II (P<0.05) but not in Group III. CONCLUSIONS BOO does not seem to be a risk factor for failure after the midurethral sling procedure. However, BOO may be considered as a potential factor for persistent storage symptoms after the midurethral sling.
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Kim YW, Kim SM, Kim WT, Kim YJ, Yun SJ, Lee SC, Kim WJ. Acute and serious myositis with abscess in thigh muscle after transobturator tape implantation. Int Neurourol J 2010; 14:182-5. [PMID: 21179337 DOI: 10.5213/inj.2010.14.3.182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Accepted: 10/25/2010] [Indexed: 11/08/2022] Open
Abstract
The complications of transobturator tape (TOT) were known as lower urinary tract injury, postoperative urinary retention, urge incontinence, vaginal erosion, and etc. A 63-year-old woman presented with new onset of severe pain, heating, and swelling of the left thigh and perineum. She had undergone TOT implantation for stress urinary incontinence (SUI) 4 days previously in an outside clinic. Painful left thigh swelling and skin erythema were noted on the physical examination. A computed tomography (CT) scan showed multiple, large left medial thigh and obturator abscesses. Removal of the implanted tape and abscess drainage were performed immediately and two additional operations were needed for proper abscess drainage. We believe this case to be one of the most serious complications to occur since the introduction of the TOT procedure. Here we report this case and discuss its initial management along with a review of the literature.
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Jeong MY, Kim SJ, Kim HS, Koh JS, Kim JC. Comparison of Efficacy and Satisfaction between the TVT-SECUR® and MONARC® Procedures for the Treatment of Female Stress Urinary Incontinence. Korean J Urol 2010; 51:767-71. [PMID: 21165197 PMCID: PMC2991574 DOI: 10.4111/kju.2010.51.11.767] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 10/01/2010] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The tension-free vaginal tape SECUR® (TVT-S) is a new, minimally invasive sling procedure for treating female stress urinary incontinence (SUI). However, results of comparisons of the TVT-S with the transobturator tape (TOT) sling are lacking. Therefore, we investigated outcome and satisfaction of the TVT-S procedure compared with the TOT procedure. MATERIALS AND METHODS We included 64 patients with SUI who underwent the TVT-S (n=31) or TOT (MONARC®, n=33) procedure and were followed up for more than 1 year. The preoperative evaluation included history taking, pelvic examination, consecutive 3-day voiding diary, and urodynamic study including Valsalva leak point pressure. Postoperatively, continence status and subjective patient satisfaction were evaluated. Cure was defined as the absence of any episodes of involuntary urine leakage during stressful activities and a stress cough test. RESULTS The TVT-S group (71.0%) showed a slightly lower cure rate than did the MONARC group (84.8%); however, there was no significant difference between the 2 groups (p=0.179). Nine of the patients who underwent the TVT-S showed incontinence postoperatively. Among them, the H approach was used in 7 patients and the U approach was done in 2 patients. Following TVT-S and MONARC, the patients' reported satisfaction was 80.6% and 78.8%, respectively. Patient satisfaction did not differ significantly between the two groups (p=0.854). CONCLUSIONS Our results showed that the TVT-S and MONARC procedures may be comparable in terms of cure rate and patient satisfaction after more than 1 year of follow-up.
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Affiliation(s)
- Moo Youl Jeong
- Department of Urology, The Catholic University of Korea, School of Medicine, Seoul, Korea
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Kim S, Son JH, Kim HS, Ko JS, Kim JC. Tape Shortening for Recurrent Stress Urinary Incontinence After Transobturator Tape Sling: 3-Year Follow-up Results. Int Neurourol J 2010; 14:164-9. [PMID: 21179334 DOI: 10.5213/inj.2010.14.3.164] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 10/27/2010] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Recently, as the number of transobturator tape (TOT) procedures has increased, recurrence after this procedure has been frequently reported. However, there are no standard guidelines for treatment. We describe our experience with shortening the previously implanted tape in patients with recurrent stress urinary incontinence after the TOT procedure. MATERIALS AND METHODS We enrolled 10 women who underwent shortening of the previously implanted tape and were followed up for 3 years. Shortening of the previously implanted tape was done by a figure-eight suture with 1-0 Prolene. One year after TOT shortening, we investigated continence status, patient satisfaction by means of a questionnaire, maximal flow rate (Qmax), and postvoid residual urine volume. Three years after TOT shortening, we evaluated continence status and patient satisfaction. RESULTS The mean period of TOT shortening was 4.2 months (range, 1-12 months) after the TOT procedure. One year after TOT shortening, 7 patients showed complete dryness, 2 patients showed improvement, and 1 patient reported failure. Eight patients were very satisfied or satisfied with the 1-year result after TOT shortening. The mean preoperative and postoperative Qmax were 23.8 and 26.7ml/s, respectively, and there was no significant difference. Three years after TOT shortening, 6 patients showed complete dryness, 2 patients showed improvement, and 2 patients reported failure. Among them,1 had failed from 1 year after TOT shortening and the other had shown 1 year of complete dryness. Eight patients were very satisfied or satisfied and 2 patients were dissatisfied with the 3-year result after TOT shortening. CONCLUSION Most of the patients who underwent TOT shortening reported satisfaction as well as improvement of incontinence after a 3-year follow up. Therefore, we suggest that TOT shortening may be recommended primarily in patients with recurrent stress urinary incontinence after the TOT sling procedure.
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Alinsod R. Recent advances in tape slings for female urinary stress incontinence. Rev Obstet Gynecol 2009; 2:46-50. [PMID: 19399294 PMCID: PMC2673002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Sling therapy is the enhanced surgical support of the urethra. In this article, the history of the use of slings for the surgical treatment of female urinary stress incontinence is reviewed, and the usual surgical routes for retropubic (transvaginal) or transobturator tape passage are described. The latest innovation in sling therapy is the use of minislings, which are short tape mesh implants inserted through a single vaginal incision; these slings may be placed in an office setting. Outcomes data are either lacking or suggest a considerable decrement of effectiveness of unstabilized minislings over full-length slings; however, the short-term efficacy of a stabilized, adjustable minisling is 97%. These results suggest benchmark effectiveness associated with full-length slings in a less invasive device that also has the capability of short-term adjustability.
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