1
|
Yao J, Tse V. Twenty-Five Years of the Midurethral Sling: Lessons Learned. Int Neurourol J 2022; 26:102-110. [PMID: 35793988 PMCID: PMC9260325 DOI: 10.5213/inj.2142086.043] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 11/11/2022] Open
Abstract
Midurethral slings (MUS) are widely accepted for the surgical treatment of stress urinary incontinence (SUI) in cases where conservative treatment has failed. They have been shown to be a safe and effective surgical treatment for the management of SUI. However, there have recently been growing concerns regarding the safety profile of mesh procedures, generating international debate and leading to national inquiries into the effectiveness and safety of mesh implants. A multitude of clinical, technical, manufacturer-related, and other health jurisdictional factors are involved in the outcomes of MUS. Appropriate patient selection and informed consent to all treatment options, with proper guidance from healthcare providers, are critical for empowering women to choose an appropriate treatment option based on a personalized decision.
Collapse
Affiliation(s)
- Jinna Yao
- Department of Surgery, Macquarie University Hospital, Sydney, Australia
| | - Vincent Tse
- Department of Surgery, Macquarie University Hospital, Sydney, Australia
- Concord Repatriation General Hospital, Sydney, Australia
- School of Medicine, University of Sydney, Sydney, Australia
| |
Collapse
|
2
|
Ruffolo AF, Bonavina G, Serati M, Casiraghi A, Degliuomini R, Parma M, Porcari I, Candiani M, Salvatore S. Single-incision mini-sling and trans-obturator sling for stress urinary incontinence: A 5-year comparison. Eur J Obstet Gynecol Reprod Biol 2022; 270:90-94. [PMID: 35033931 DOI: 10.1016/j.ejogrb.2022.01.005] [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: 09/09/2021] [Revised: 11/28/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of our study was to compare objective and subjective outcomes in women with stress urinary incontinence (SUI) submitted to either trans-obturator sling (TVT-ABBREVO®) or single incision mini-sling (SIMS-ALTIS®) at 5-year follow up. STUDY DESIGN A monocentric, retrospective study including women with isolated SUI and with concomitant proved urodynamic stress incontinence (USI), treated with an TVT-ABBREVO® or SIMS-ALTIS®. At 60-month follow up each woman was assessed subjectively, with two validated questionnaires (UDI-6 and ICQI-SF), and objectively with a cough stress test. Adverse events were collected. RESULTS Forty-two patients were evaluated in the ABBREVO® group and 58 in the ALTIS® group. No significant difference was found in subjective (88.1% vs 89.7%, p = 0.806) and objective (81.0% vs 86.2%, p = 0.479) cure rates between the two groups. Subjectively, improvement in urinary distress after surgery resulted statistically significant in both groups compared to baseline (p < 0.001). Long-term post-operative complications rate (i.e. de novo OAB and sling exposure) was similar in the two groups. They were, in fact, mainly classified as Dindo II grade and conservatively managed (i.e. antimuscarinics or β3 agonists for de novo OAB). CONCLUSION This comparative study did not reveal significant difference between single-incision (ALTIS®) and trans-obturator (TVT-ABBREVO®) slings in terms of efficacy and morbidity at 5-year follow up.
Collapse
Affiliation(s)
- Alessandro F Ruffolo
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy.
| | - Giulia Bonavina
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Insubria University of Varese, Italy
| | - Arianna Casiraghi
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy
| | - Rebecca Degliuomini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy
| | - Marta Parma
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy
| | - Irene Porcari
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy; Department of Obstetrics and Gynecology, Insubria University of Varese, Italy; Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, University Vita and Salute, Milan, Italy
| |
Collapse
|
3
|
Lo TS, Ng KL, Lin YH, Hsieh WC, Huang TX, Shen YH. De novo detrusor overactivity and urgency after mid-urethral slings for urodynamic stress incontinence. Int Urogynecol J 2021; 32:2737-2745. [PMID: 34292341 DOI: 10.1007/s00192-021-04911-x] [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: 04/13/2021] [Accepted: 05/29/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to identify incidence and risk factors of de novo urgency and detrusor overactivity (DO) following mid-urethral slings (MUS) in patients with urodynamic stress incontinence (USI) without urgency. METHODS A total of 688 women between January 2004 and July 2017 were reviewed retrospectively. De novo urgency was established with a positive response to question 2 on the Urogenital Distress Inventory-6 questionnaire (UDI-6). Objective cure of USI is no involuntary urine leakage during filling cystometry and pad test < 2 g. Subjective cure of stress urinary incontinence (SUI) is defined as a negative response to question 3 on UDI-6. Multivariate logistic regression was used to identify risk factors for failure. RESULTS Forty-four out of 688 women (6.4%) developed de novo urgency, with 16 out of 688 (2.3%) demonstrating de novo DO. Subjective cure for women with de novo urgency was significantly lower at 35 out of 44 (79.5%) compared with 556 out of 644 (86.3%) in those with no urgency (p < 0.001). Objective cure for women with de novo DO was significantly lower at 8 out of 16 (50%) compared with 599 out of 672 (89.1%) in those with detrusor stability (p < 0.001). Quality of life improved for all. Age ≥ 66 (OR, 1.23; 1.07), increased bladder sensation (OR, 4.18; 3.80), lower bladder capacity (OR, 5.28; 4.97), lower maximum urethral closure pressure (OR, 2.32; 5.20), and pad test > 100 g (OR, 1.08; 1.15) were independent risk factors for de novo urgency and DO. Diabetes (OR, 1.32) was an independent predictor of de novo urgency. CONCLUSION Cure is significantly reduced in women who report symptoms of de novo urgency or demonstrate DO after MUS at 1 year. Independent risk factors include age ≥ 66, increased bladder sensation, lower bladder capacity, lower maximum urethral closure pressure, greater pad loss, and diabetes.
Collapse
Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China. .,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China. .,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Medical Center, Taipei, Taiwan, Republic of China. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
| | - Kai Lyn Ng
- Department of Obstetrics & Gynaecology, National University Hospital of Singapore, Singapore, Singapore
| | - Yi-Hao Lin
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China.,School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Wu-Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China.,School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Ting-Xuan Huang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China
| | - Yu-Hua Shen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China
| |
Collapse
|
4
|
Abrams P, Constable LD, Cooper D, MacLennan G, Drake MJ, Harding C, Mundy A, McCormack K, McDonald A, Norrie J, Ramsay C, Smith R, Cotterill N, Kilonzo M, Glazener C. Outcomes of a Noninferiority Randomised Controlled Trial of Surgery for Men with Urodynamic Stress Incontinence After Prostate Surgery (MASTER). Eur Urol 2021; 79:812-823. [PMID: 33551297 PMCID: PMC8175331 DOI: 10.1016/j.eururo.2021.01.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/17/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is common after radical prostatectomy and likely to persist despite conservative treatment. The sling is an emerging operation for persistent SUI, but randomised controlled trial (RCT) comparison with the established artificial urinary sphincter (AUS) is lacking. OBJECTIVE To compare the outcomes of surgery in men with bothersome urodynamic SUI after prostate surgery. DESIGN, SETTING, AND PARTICIPANTS A noninferiority RCT was conducted among men with bothersome urodynamic SUI from 27 UK centres. Blinding was not possible due the surgeries. INTERVENTION Participants were randomly assigned (1:1) to the male transobturator sling (n = 190) or the AUS (n = 190) group. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was patient-reported SUI 12 mo after randomisation, collected from postal questionnaire using a composite outcome from two items in validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire (ICIQ-UI SF). Noninferiority margin was 15%, thought to be of acceptable lower effectiveness, in return for reduced adverse events (AEs) and easier operation, for the sling. Secondary outcomes were operative and postoperative details, patient-reported measures, and AEs, up to 12 mo after surgery. RESULTS AND LIMITATIONS A total of 380 participants were included. At 12 mo after randomisation, incontinence rates were 134/154 (87.0%) for male sling versus 133/158 (84.2%) for AUS (difference 3.6% [95% confidence interval {CI} -11.6 to 4.6], pNI = 0.003), showing noninferiority. Incontinence symptoms (ICIQ-UI SF) reduced from scores of 16.1 and 16.4 at baseline to 8.7 and 7.5 for male sling and AUS, respectively (mean difference 1.4 [95% CI 0.2-2.6], p = 0.02). Serious AEs (SAEs) were few: n = 6 and n = 13 for male sling and AUS (one man had three SAEs), respectively. Quality of life scores improved, and satisfaction was high in both groups. All other secondary outcomes that show statistically significant differences favour the AUS. CONCLUSIONS Using a strict definition, urinary incontinence rates remained high, with no evidence of difference between male sling and AUS. Symptoms and quality of life improved significantly in both groups, and men were generally satisfied with both procedures. Overall, secondary and post hoc analyses were in favour of AUS. PATIENT SUMMARY Urinary incontinence after prostatectomy has considerable effect on men's quality of life. MASTER shows that if surgery is needed, both surgical options result in fewer symptoms and high satisfaction, despite most men not being completely dry. However, most other results indicate that men having an artificial urinary sphincter have better outcomes than those who have a sling.
Collapse
Affiliation(s)
- Paul Abrams
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Lynda D Constable
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK.
| | - David Cooper
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Chris Harding
- Department of Urology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Anthony Mundy
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kirsty McCormack
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - Alison McDonald
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Craig Ramsay
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - Rebecca Smith
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Nikki Cotterill
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; Faculty of Health and Applied Science, University of West of England, Bristol, UK
| | - Mary Kilonzo
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Cathryn Glazener
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| |
Collapse
|
5
|
Dietz HP, Subramaniam N. Is coital incontinence a manifestation of urodynamic stress incontinence or detrusor overactivity? Int Urogynecol J 2021; 33:1175-1178. [PMID: 33938964 DOI: 10.1007/s00192-021-04809-8] [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: 01/31/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Coital incontinence (CI) is an underreported symptom among sexually active women. It has been assumed that incontinence at penetration (CIAP) is due to urodynamic stress incontinence (USI), while coital incontinence at orgasm (CIAO) is thought to be due to detrusor overactivity (DO). METHODS To evaluate demographic and urodynamic findings associated with coital incontinence (CI) and to confirm the hypotheses 'CIAP is associated with USI' and 'CIAO is associated with DO we performed a retrospective study of 661 sexually active women attending a tertiary clinic between January 2017 and December 2019 for pelvic floor dysfunction. All patients filled in a standardized questionnaire and had a clinical examination and multichannel urodynamic testing. Women were asked if they experienced urine leakage during intercourse and the timing of such leakage. RESULTS Of 661 sexually active women, one third (n = 220) reported coital incontinence. While 121 (18%) women experienced CIAP, 172 (26%) had CIAO and 76 (11.5%) suffered both. For women with pure USI, the prevalence of CIAP (61.7%) and CIAO (69.5%) was significantly higher than for women with pure DO, where only 12.3% had CIAP and 8.6% had CIAO. Factors significantly associated with CI were body mass index, mid-urethral closure pressure (MUCP) and abdominal leak point pressure (ALPP). When only women with pure USI or DO were included, USI remained associated with CI while DO was not. CONCLUSIONS CI is clearly associated with SUI and USI and is likely to share etio-pathogenetic mechanisms. CI seems to be a manifestation of USI, even when it occurs during orgasm.
Collapse
Affiliation(s)
- Hans Peter Dietz
- University of Sydney, Penrith, Australia. .,, 193 Burns Rd, Springwood, NSW 2777, Australia.
| | | |
Collapse
|
6
|
Athanasiou S, Zacharakis D, Kalantzis C, Protopapas A, Chatzipapas I, Grigoriadis T. Women living with a midurethral sling in their 80s: long-term outcomes. Int Urogynecol J 2019; 31:2669-2674. [PMID: 31828402 DOI: 10.1007/s00192-019-04174-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/17/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Surgical outcomes of elderly women who have been treated using midurethral slings could be influenced by confounding factors, such as age-related comorbidities. Aim of this study is to assess elderly patients (>75 years) who underwent a transobturator sling procedure with a follow-up of at least 13 years. METHODS This is a prospective follow-up observational study including elderly women of current age ≥ 75 years old who underwent TVT-O placement at least 13 years prior to the study period. Main outcome measures were the objective and subjective cure rates at the follow-up visit. Secondary outcome measures included: patient-reported success rate, de novo urgency symptoms rate, evaluation of other subjective parameters related to the lower urinary tract function, and assessment of the health-related quality of life. RESULTS Seventy-two out of 85 women (84.7%) meeting the inclusion and exclusion criteria were assessed at the follow-up visit. The mean follow-up period was 13.7 years (SD = 0.8). The overall objective and subjective cure rates were 80.5% (58 out of 72) and 84.7% (61 out of 72) respectively, whereas 9.7% of the patients (7 out of 72) reported being subjectively improved. The patient-reported success rate was 91.7% (66 out of 72). De novo urgency rate was 23.7% (9 out of 38), whereas 26.5% of the patients (9 out of 34) reported aggravation of preexisting urgency. CONCLUSIONS In women of advanced age, the TVT-O procedure is a highly effective and long-lasting treatment. The safety profile of the TVT-O was not influenced by geriatric conditions, whereas the long-term presence of a polypropylene sling did not appear to trigger the onset of medical disorders.
Collapse
Affiliation(s)
- Stavros Athanasiou
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece.
| | - Dimitrios Zacharakis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| | - Christos Kalantzis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| | - Athanasios Protopapas
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| | - Ioannis Chatzipapas
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| | - Themos Grigoriadis
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens "Alexandra" Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece
| |
Collapse
|
7
|
Lo TS, Shailaja N, Tan YL, Wu MP, Chua S, Roy KW. Outcomes and failure risks in mid-urethral sling insertion in elderly and old age with urodynamic stress incontinence. Int Urogynecol J. 2020;31:717-726. [PMID: 31832716 DOI: 10.1007/s00192-019-04171-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/25/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To study the surgical outcomes and risk factors for failure of three types of mid urethral slings(MUS) surgeries in elderly and old age women with urodynamic stress incontinence(USI). METHODS Three different types of MUS surgeries [single incision sling(SIS), trans-obturator tape(TOT), retro-public mid-urethral sling-tension-free vagina tape (TVT)]were performed among three age groups of women (young <64 yr, elderly 65-74 yr and old >75 yr) with USI. They were followed up for 1 year. RESULTS Complete postoperative data was available for 688 women. After 1 year, overall objective cure rate was 88.2% and subjective cure rate was 85.9%. Among the young, elderly, and old age women objective cure rates were 91.0%, 80.6%, 66.7% and subjective cure rates were 89.2%, 77.6%, 58.3% respectively. Urodynamic parameters demonstrated flow rate, higher post-void bladder residual, smaller cystometric capacity, and lower maximum urethral closure pressure were significantly lower among old and elderly group. Subjectively, urinary distress inventory-6 (UDI-6) and incontinence impact questionnaire-7(IIQ-7) improved significantly in all groups with significant changes from baseline only in older women. Intrinsic sphincter deficiency(ISD) was found to be significantly associated with failure in older women. Other preoperative comorbidities were equally distributed among all the three age groups. The operative time, perioperative complications, and length of hospital stay showed no difference between the study groups. CONCLUSIONS MUS surgery is safe for the young and aging patients with USI and demostrated significant improvement in its outcomes, but objective and subjective cure rates decreases with age. ISD was also found to be significantly associated with failure.
Collapse
|
8
|
Fouad R, El-Faissal YM, Hashem AT, Gad Allah SH. Uroflowmetric changes, success rate and complications following Tension-free Vaginal Tape Obturator (TVT-O) operation in obese females. Eur J Obstet Gynecol Reprod Biol 2017; 214:6-10. [PMID: 28453959 DOI: 10.1016/j.ejogrb.2017.04.038] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 02/11/2017] [Accepted: 04/20/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the outcome of Tension-free Vaginal Tape Obturator (TVT-O) operation in the treatment of urodynamic stress incontinence (USI) in obese females, with respect to uroflowmetric changes, success rate and postoperative complications. METHODS This prospective observational study included 26 patients with USI at the Obstetrics & Gynecology department-Cairo University hospital during the year 2015. The participants had body mass index (BMI)≥30. Patients underwent TVT-O operation. Follow up of the patients was performed by cough test and uroflowmetry after one week, one month, three months and six months. Postoperative complications such as groin pain, sense of incomplete emptying, need to strain to complete micturition and urinary tract infection were recorded. Comparisons between groups were done using Chi square, Phi-Cramer test for categorical variables. RESULTS The mean age for the subjects was 43.58±9.01years. The mean BMI was 33.4±2.1. The success rate of TVT-O operation was 21 out of 26 patients (≈81%). Normal maximum flow rate was in 88% of patients at week one and was normal in 100% of patients at months three and six (p=0.101 & 0.101). Postoperative groin pain was the main complaint during the first week after operation and decreased significantly from week one to the 1st month postoperative (84.62% & 65.38%, P=0.041). CONCLUSION TVT-O operation showed a high success rate in treatment of USI in obese patients without affecting the voiding function of the bladder as proven by the uroflowmetry. The main postoperative complaint was the groin pain which significantly improved after one month.
Collapse
Affiliation(s)
- Reham Fouad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Yahia M El-Faissal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed T Hashem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sherine H Gad Allah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
9
|
Chughtai B, Laor L, Dunphy C, Lee R, Te A, Kaplan S. Diagnosis, Evaluation, and Treatment of Mixed Urinary Incontinence in Women. Rev Urol 2016; 17:78-83. [PMID: 27222643 DOI: 10.3909/riu0653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mixed urinary incontinence (MUI) is a common clinical problem in the community and hospital setting. The broad definition of the term makes it difficult to diagnose, as well as determine effective treatment strategies. There are no current guidelines recommended for physicians. The estimated prevalence of this condition is approximately 30% in all women with incontinence. It has also been suggested that patients with MUI report more bothersome symptoms than either stress or urge incontinence; approximately 32% of 40- to 64-year-olds with MUI report symptoms of depression. The authors examine the diagnosis, evaluation, and treatment of patients with MUI.
Collapse
Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Leanna Laor
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Claire Dunphy
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Richard Lee
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Alexis Te
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Steven Kaplan
- Department of Urology, Weill Cornell Medical College, New York, NY
| |
Collapse
|
10
|
Lo TS, Jaili S, Tan YL, Wu PY. Five-year follow-up study of Monarc transobturator tape for surgical treatment of primary stress urinary incontinence. Int Urogynecol J 2016; 27:1653-9. [PMID: 27085545 DOI: 10.1007/s00192-016-3019-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 03/24/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We hypothesized that transobturator tape (TOT) is safe and efficacious for the treatment of urodynamic stress incontinence in the long term. METHODS We conducted a prospective study of patients with confirmed urodynamic stress incontinence (USI) who underwent a MonarcTM TOT procedure in a tertiary center between February 2006 and March 2009 without other concurrent surgical procedures. Urodynamics were conducted at 1 and 3 years postoperatively. Subjective evaluation included Incontinence Impact Questionnaire (IIQ-7), Urinary Distress Inventory Questionnaire (UDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Objective cure was defined as no urinary leakage demonstrable on provocative filling cystometry and/ or 1-h pad test of <2 g. Subjective cure was based on a negative response to question 3 in UDI-6. Paired-samples t test, chi-square, and Fisher exact tests were applied; p < 0.05 was considered significant. The log-rank tests were used to compare event-free survival. RESULTS Sixty patients were enrolled, and 56 were evaluated at 5 years postoperatively. The majority were middle aged, postmenopausal, and overweight. Mean operating time was 31.1 ± 8.9 min, intraoperative complications were minor, and median period of follow-up was 80.3 ± 9.6 months. At 5 years of follow-up, objective and subjective cure rates were 89.3 % and 87.5 %, respectively. No mesh-related complications were seen. One patient needed a repeat midurethral sling procedure, and one patient each had bladder and bowel cancer. CONCLUSION Monarc TOT was safe and retained its high cure rate in the short- and long-term treatment of stress urinary incontinence.
Collapse
|
11
|
Grigoriadis T, Giannoulis G, Zacharakis D, Protopapas A, Cardozo L, Athanasiou S. The "1-3-5 cough test": comparing the severity of urodynamic stress incontinence with severity measures of subjective perception of stress urinary incontinence. Int Urogynecol J 2016; 27:419-25. [PMID: 26239956 DOI: 10.1007/s00192-015-2808-4] [Citation(s) in RCA: 7] [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: 05/10/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of the study was to examine whether a test performed during urodynamics, the "1-3-5 cough test", could determine the severity of urodynamic stress incontinence (USI). METHODS We included women referred for urodynamics who were diagnosed with USI. The "1-3-5 cough test" was performed to grade the severity of USI at the completion of filling cystometry. A diagnosis of "severe", "moderate" or "mild" USI was given if urine leakage was observed after one, three or five consecutive coughs respectively. We examined the associations between grades of USI severity and measures of subjective perception of stress urinary incontinence (SUI): International Consultation of Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptom (ICIQ-FLUTS), King's Health Questionnaire (KHQ), Urinary Distress Inventory-6 (UDI-6), Urinary Impact Questionnaire-7 (UIQ-7). RESULTS A total of 1,181 patients completed the ICIQ-FLUTS and KHQ and 612 completed the UDI-6 and UIQ-7 questionnaires. There was a statistically significant association of higher grades of USI severity with higher scores of the incontinence domain of the ICIQ-FLUTS. The scores of the UDI-6, UIQ-7 and of all KHQ domains (with the exception of general health perception and personal relationships) had statistically significant larger mean values for higher USI severity grade. Groups of higher USI severity had statistically significant associations with higher scores of most of the subjective measures of SUI. CONCLUSIONS Severity of USI, as defined by the "1-3-5 cough test", was associated with the severity of subjective measures of SUI. This test may be a useful tool for the objective interpretation of patients with SUI who undergo urodynamics.
Collapse
|
12
|
Dwivedi R, Kapoor DS, Dix S. Does previous pelvic surgery hasten the onset of clinically bothersome urodynamic stress incontinence? Eur J Obstet Gynecol Reprod Biol 2013; 172:124-6. [PMID: 24209994 DOI: 10.1016/j.ejogrb.2013.09.046] [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: 01/19/2013] [Revised: 07/31/2013] [Accepted: 09/27/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To study the impact of previous pelvic surgery on the onset of clinically bothersome urodynamic stress incontinence (USI). STUDY DESIGN Retrospective case-cohort study at a District General Hospital of 305 women undergoing surgery for urodynamic stress incontinence: case note and computer records review of patients undergoing USI surgery. The main outcome measures were age at index USI surgery, and duration from previous pelvic surgery to index surgery. RESULTS 305 women were included, of whom 118 had previous pelvic surgery including abdominal hysterectomy (TAH) (n=74), vaginal hysterectomy (n=23), anterior colporrhaphy (n=27) and posterior colporrhaphy (n=25). The mean age in the previous surgery group was 62.4 years (95% CI 60.2-64.6, range 32-87) and 53.2 years in the no previous surgery group (95% CI 51.4-55, range 30-88). There were no differences in the mean BMI (28.4 vs. 27.5), or mean parity (2.4 vs. 2.5). The median duration from previous surgery to the index USI surgery was 222 months (abdominal hysterectomy), 96 months (vaginal hysterectomy), 78 months (anterior colporrhaphy), and 72 months (posterior colporrhaphy). CONCLUSION Previous pelvic surgery does not seem to accelerate the onset of USI, as women without previous pelvic surgery presented at a significantly earlier age (53.2 years) with clinically bothersome USI than those who had previous surgery (62.4 years). Posterior colporrhaphy had the shortest interval to index USI surgery amongst previous operations.
Collapse
Affiliation(s)
- Rachana Dwivedi
- Department of Gynaecology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, United Kingdom; Department of Urogynaecology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, United Kingdom
| | - Dharmesh S Kapoor
- Department of Gynaecology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, United Kingdom; Department of Urogynaecology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, United Kingdom.
| | - Sarah Dix
- Department of Gynaecology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, United Kingdom; Department of Urogynaecology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, United Kingdom
| |
Collapse
|
13
|
Agur W, Riad M, Secco S, Litman H, Madhuvrata P, Novara G, Abdel-Fattah M. Surgical treatment of recurrent stress urinary incontinence in women: a systematic review and meta-analysis of randomised controlled trials. Eur Urol 2013; 64:323-36. [PMID: 23680414 DOI: 10.1016/j.eururo.2013.04.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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: 02/19/2013] [Accepted: 04/16/2013] [Indexed: 12/12/2022]
Abstract
CONTEXT Recurrent stress urinary incontinence (R-SUI) represents a management dilemma; however, only a limited number of randomised controlled trials (RCTs) have assessed the various surgical procedures used for its treatment. OBJECTIVE To assess the effectiveness and complications of various surgical procedures for the treatment of female R-SUI. EVIDENCE ACQUISITION A prospective peer-reviewed protocol was prepared a priori. A systematic literature review of all published RCTs comparing surgical procedures for treatment of R-SUI was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Data were analysed using RevMan 5. EVIDENCE SYNTHESIS We conducted a literature search from 1945 to February 2013. Data were available for a total of 350 women in 10 RCTs with a mean follow-up of 18.1 mo. Meta-analysis was possible for the comparison of retropubic tension-free vaginal tape (RP-TVT) versus transobturator tension-free vaginal tape (TO-TVT) in five RCTs (n = 135). There was no statistically significant difference between RP-TVT and TO-TVT in the patient-reported improvement (odds ratio [OR]: 0.84, 95% confidence interval [CI], 0.41-1.69) or objective cure/improvement (OR: 1.75; 95% CI, 0.86-3.54). One RCT showed a trend towards a higher rate of patient-reported and objective cure/improvement with the inside-out TO-TVT compared with the outside-in; however, it was not statistically significant (OR: 3.00; 95% CI, 0.85-10.57, and OR: 3.32; 95% CI, 0.96-11.41, respectively). There was no significant difference between Burch colposuspension and RP-TVT (one RCT) in patient-reported improvement (OR: 0.33; 95% CI, 0.01-8.57) or objective cure/improvement (OR: 0.52; 95% CI, 0.13-2.05). CONCLUSIONS This meta-analysis shows no evidence of a significant difference in patient-reported and objective cure/improvement rates between RP-TVT and TO-TVT in the surgical treatment of women with R-SUI. However, due to the relatively low number of patients, the analysis might be underpowered. This review highlights the poor level of evidence in this field and the need for well-designed clinical trials to address this important clinical dilemma.
Collapse
Affiliation(s)
- Wael Agur
- NHS Ayrshire & Arran, NHS Research Scotland, Kilmarnock, UK.
| | | | | | | | | | | | | |
Collapse
|