Mid-urethral sling operations for stress urinary incontinence in women.

Mid-urethral sling operations have been the most extensively researched surgical treatment for stress urinary incontinence (SUI) in women and have a good safety profile. Irrespective of the routes traversed, they are highly effective in the short and medium term, and accruing evidence demonstrates their effectiveness in the long term. This review illustrates their positive impact on improving the quality of life of women with SUI. With the exception of groin pain, fewer adverse events occur with employment of a transobturator approach. When comparing transobturator techniques of a medial-to-lateral versus a lateral-to-medial insertion, there is no evidence to support the use of one approach over the other. However, a bottom-to-top route was more effective than top-to-bottom route for retropubic tapes.A salient point illustrated throughout this review is the need for reporting of longer-term outcome data from the numerous existing trials. This would substantially increase the evidence base and provide clarification regarding uncertainties about long-term effectiveness and adverse event profile.

Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline

Complications of Mid Urethral Slings: Important Outcomes for Future Clinical Trials

Collagen Injection for Female Urinary Incontinence After Urethral or Periurethral Surgery

This study investigated the relationship between abdominal obesity and stress urinary incontinence in Korean women. Women aged 30 and over, who visited the Department of Family Medicine of Asan Medical Center were recruited to participate in this study. Anthropometric measurements including body mass index (BMI) and waist circumference were taken, and associated factors of stress urinary incontinence was assessed by questionnaire. Stress urinary incontinence was significantly associated with physical work, vaginal delivery, and high waist circumference. In comparison with women in the lowest quartile of waist circumference, the odds ratios (OR) for stress urinary incontinence in women in the second, third, and fourth quartiles were increased significantly (1.79, 95% CI 1.07-2.98; 3.50, 95% CI 2.02-6.07; and 6.07, 95% CI 3.23-11.40, respectively). Our results indicate that high waist circumference may be a risk factor associated with stress urinary incontinence in women.

BackgroundINVESTIGATE-I (INVasive Evaluation before Surgical Treatment of Incontinence Gives Added Therapeutic Effect?) was a mixed methods study to assess the feasibility of a future randomised controlled trial of invasive urodynamic testing (IUT) prior to surgery for stress urinary incontinence (SUI) in women. Here we report one of the study’s five components, with the specific objectives of (i) exploring the cost-effectiveness of IUT compared with clinical assessment plus non-invasive tests (henceforth described as ‘IUT’ and ‘no IUT’ respectively) in women with SUI or stress-predominant mixed urinary incontinence (MUI) prior to surgery, and (ii) determining the expected net gain (ENG) from additional research.MethodsStudy participants were women with SUI or stress-predominant MUI who had failed to respond to conservative treatments recruited from seven UK urogynaecology and female urology units. They were randomised to receive either ‘IUT’ or ‘no IUT’ before undergoing further treatment. Data from 218 women were used in the economic analysis. Cost utility, net benefit and value of information (VoI) analyses were performed within a randomised controlled pilot trial. Costs and quality-adjusted life years (QALYs) were estimated over 6 months to determine the incremental cost per QALY of ‘IUT’ compared to ‘no IUT’. Net monetary benefit informed the VoI analysis. The VoI estimated the ENG and optimal sample size for a future definitive trial.ResultsAt 6 months, the mean difference in total average cost was £138 (p = 0.071) in favour of ‘IUT’; there was no difference in QALYs estimated from the SF-12 (difference 0.004; p = 0.425) and EQ-5D-3L (difference − 0.004; p = 0.725); therefore, the probability of IUT being cost-effective remains uncertain. The estimated ENG was positive for further research to address this uncertainty with an optimal sample size of 404 women.ConclusionsThis is the largest economic evaluation of IUT. On average, up to 6 months after treatment, ‘IUT’ may be cost-saving compared to ‘no IUT’ because of the reduction in surgery following invasive investigation. However, uncertainty remains over the probability of ‘IUT’ being considered cost-effective, especially in the longer term. The VoI analysis indicated that further research would be of value.Trial registrationISRCTN. ISRCTN71327395. Registered 7 June 2010.

Stress urinary incontinence (SUI) affects many women worldwide in every age group. Involuntary leakage of urine during abdominal pressure increase significantly reduces the quality of life. The choice of treatment depends on the patient's expectations, the doctor's experience and the severity of symptoms. Aim of the study: The aim of this study is to discuss the therapeutic methods of stress urinary incontinence (SUI). Material and method: The work was based on a review of the available literature in the PubMed, Google and Google Scholar databases using the following keywords: stress urinary incontinence; SUI; urinary incontinence in women; Surgical treatment; TOT; TVT. Results and conclusions: We use conservative and surgical methods in the treatment of stress urinary incontinence. Conservative treatments such as physiotherapy, pharmacotherapy, and behavioral therapy are first-line treatments. In the case of severe symptoms of stress urinary incontinence, surgical treatment is used. The most common method is the Burch operation and TVT and TOT sling operations. Treatment of stress urinary incontinence (SUI) in women requires an approach that takes into account the patient's goals, severity of symptoms, desired effect, physician experience and complications, therefore there is no single effective management.

The efficiency of surgical treatment of stress urinary incontinence (SUI) in women is 77-85%, and in nearly 15% of cases repeated procedures are required. To present the experience of our center in the treatment of recurrent SUI in women and to evaluate the efficiency of repeated interventions. The retrospective study included women with recurrent SUI. They underwent to mid-urethral sling procedure or Burch colposuspension. The preoperative data, objective assessment of urinary incontinence and previous interventions were analyzed. Postoperatively, the presence of SUI, the degree of urinary incontinence and the quality of life were assessed. Data on additional surgical procedures was collected at a follow-up visit. A total of 179 patients underwent correction of SUI. Data on 10 patients with recurrent SUI were included. The age of the women was from 32 to 74 years (median 65 years, IQR 28), and one of them had a hysterectomy. Before our interventions, 9 patients underwent a single surgical procedure for SUI and one had previously had three interventions in other clinics. In general, there were 12 previous operations, including urethropexy with tension-free vaginal tape-obturator (TVT-O) (7/12), urethropexy with tension-free vaginal tape (TVT) (1/12), laparoscopic Burch colposuspension (1/12) and urethropexy with a synthetic loop with unspecified approach (3/12). At the time of the first examination, the women used 2-6 pads per day. The following types of treatment were performed in our center: 5 patients underwent retropubic urethropexy with tension-free vaginal tape (TVT) and 4 patients had laparoscopic Burch colposuspension. In addition, 2 simultaneous laparoscopic revision of the Retzius space and TVT under laparoscopic guidance were performed as well as one simultaneous open Burch colposuspension and TVT. The median follow-up after surgery was 6 months. In two out of 10 patients (after primary TVT and TVT-O), laparoscopic Burch colposuspension was not effective. A recurrence of SUI was detected in the postoperative period. Then, the patients underwent revision of the Retzius space and TVT under laparoscopic guidance and open Burch colposuspension and TVT, respectively. Postoperatively, urinary continence was restored. Complete urinary continence (0 pads per day) was achieved in 50% of cases (6 out of 12 procedures). In three women (25%) mild SUI remained (2-4 points on the ICIQ-SF, 1 safety pad per day); at the same time, they noted a significant improvement in their quality of life. Thus, repeated interventions were effective in 75% of cases (9 out of 12). According to the evaluation of urination disorders (UDI-6), five patients had minor symptoms (1-3 points). Most of them complained of frequent urination that did not affect the quality of life. The efficiency of surgical treatment of recurrent SUI was 75%. The most often subsequent procedures were TVT and Burch colposuspension, as well as their combinations.

To assess the efficacy of physical therapies for first-line use in the treatment and prevention of stress urinary incontinence (SUI) in women, using a systematic review of randomized clinical trials (RCTs). A computer-aided and manual search for published RCTs investigating treatment and prevention of SUI using physical therapies, e.g. pelvic floor muscle (PFM) exercises, with or without other treatment modalities, were carried out. The methodological quality of the included trials was assessed using criteria based on generally accepted principles of interventional research. Twenty-four RCTs (22 treatment and two prevention) were identified; the methodological quality of the studies included was moderate and 11 RCTs were of sufficient quality to be included in further analysis. Based on levels-of-evidence criteria, there is strong evidence to suggest that PFM exercises are effective in reducing the symptoms of SUI. There is limited evidence for the efficacy of high-intensity vs a low-intensity regimen of PFM exercises. Despite significant effects of biofeedback after testing as an adjunct to PFM exercises, there is no evidence that PFM exercises with biofeedback are more effective than PFM exercises alone. There is little consistency (of stimulation types and parameters) in the studies of electrical stimulation, but when the results are combined there is strong evidence to suggest that electrostimulation is superior to sham electrostimulation, and limited evidence that there is no difference between electrostimulation and other physical therapies. In the prevention of SUI the efficacy of PFM exercises, with or without other adjuncts, is uncertain.

The new etiology and surgical therapy of stress urinary incontinence in women

Background:Assessment of the success rates and complications of inside-out technique of Trans-Vaginal Tape (Obturator) (TVT-O) for treatment of stress urinary incontinence (SUI) in women with utero-vaginal prolapse.Materials and Methods:A total of 30 consenting subjects with SUI and utero-vaginal prolapse were subjected to TVT-O surgery. These subjects were closely monitored for complications and success rate of surgery up to 1 year of surgery.Results:Urinary tract infection (16.67%) was the most common early post-operative complication. Groin pain (23%) was the most common late post-operative complication while denovo urgency developed in 3 (11.54%) subjects. Majority (88.46%) of subjects had total improvement at 3month follow-up while 100% subjects had total improvement at 12 month follow-up with a “definitely improved quality-of-life.”Conclusion:The TVT-O (inside-out) appears to have performed favorably as a safe and effective surgery for SUI associated with utero-vaginal prolapse.

Autologous Muscle Derived Cells for Treatment of Stress Urinary Incontinence in Women

Duloxetine for the treatment of stress urinary incontinence in women: An integrated analysis of safety

Background. The article presents the results of applying the method of high-intensity focused electromagnetic therapy in the complex treatment of stress urinary incontinence in women.
 Aim. To study and scientifically use the method of high-intensity focused electromagnetic therapy in the complex treatment of stress urinary incontinence in women. Research Objective: To study the effect of high-intensity focused electromagnetic therapy on the manifestations of urinary incontinence by assessing the ability of urinary retention (by the number of absorbent pads used) and quality of life according to the questionnaire of the International Council of Urinary Incontinence (ICIQ-SF) in women with stress urinary incontinence.
 Methods. The study included 40 women whose average age was 53.6 4.8 years with stress incontinence; the disease duration was 5.6 1.1 years, which were divided into 2 groups comparable by clinical and functional characteristics, the main 20 patients who underwent a course of WIFEM therapy, consisting of 67 procedures, which were carried out 23 once a week, the duration of each procedure was 28 minutes and the control ― 20 patients who underwent a course of exercises according to Kegel, daily, for a course of
 20 lessons.
 Results. As a result of the study, it was shown that high-intensity focused electromagnetic therapy has a pronounced myostimulating effect on the pelvic floor muscles in women with stress urinary incontinence, which helps to strengthen control over urinary retention, a significant reduction and even complete disappearance of symptoms of urinary incontinence, and an increase in the psycho-emotional background and quality of life in general, as evidenced by a test to determine the amount of absorbent pads used and questionnaire data and for urinary incontinence (ICIQ-SF).
 Conclusion. High-intensity focused electromagnetic therapy has a pronounced myostimulating effect on the pelvic floor muscles in women with stress urinary incontinence, which contributes to increased control over urinary retention, a significant decrease or even complete disappearance of symptoms of incontinence, as well as an increase in psycho-emotional background and quality of life in general.

The aim of our study was to evaluate the efficiency and safety of synthetic mid-urethral slings (sMUS) for the treatment of stress urinary incontinence (SUI) in women with neurogenic lower urinary tract dysfunction (NLUTD). A systematic review was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MEDLINE, Embase and Cochrane controlled trials databases were systematically searched from January 1995 to April 2021. Studies including adult women with NLUTD who had a sMUS for SUI were considered for inclusion. Primary outcome was success of the surgery according to study criteria. Secondary outcomes were complications, especially de novo urgency, urinary retention, tape exposure and revision for complications. A total of 752 abstracts were screened and 9 studies were included, representing 298 patients. The mean age was 52years and median follow-up was 41.3months. sMUS insertion was successful in 237 patients (79.5%). The median rate of de novo urgency was 15.7% (range 8.3-30%). In patients with spontaneous voiding, the median rate of retention was 19.3% (range 0-46.7%) and 21 out of 26 patients required intermittent self-catheterisation. Four cases of tape exposure were reported, and 8 patients underwent a revision for complications. This review suggests that sMUS might offer interesting success rates and acceptable morbidity and could be considered for the treatment of SUI in women with NLUTD. Further studies are required to define which patients would be more likely to benefit from this intervention, as well as its place among the other surgical treatments for SUI.