Burch Colposuspension Research Articles

Instruments Used for the Assessment of SUI Severity in Urogynecologic Surgical Trials: A Scoping Review.

Various instruments are used to evaluate the severity of stress urinary incontinence (SUI) in clinical trials for SUI surgery. We conducted a scoping review with the primary aim of investigating the use of such instruments. A comprehensive search in PubMed/MEDLINE, Cochrane Library, ClinicalTrials.gov, and WHO ICTRP was carried out. Inclusion criteria were studies including patients undergoing surgical intervention for SUI with assessment of SUI severity performed pre- and post-operatively. Exclusion criteria were nonprospective studies, nonrandomized studies, studies not in the English language, and the absence of reporting the methods of SUI severity evaluation in the study. In total, 8,886 articles were identified, yielding 100 papers for data extraction. The most frequent interventions were mid-urethral slings (85 studies), Burch colposuspension (10 studies), and the use of bulking agents (3 studies). The most frequently used instruments for objective evaluation of SUI were urodynamics (90 studies), nonvalidated cough stress test (83 studies), and 1-h pad test (28 studies). The most frequently used instruments for subjective evaluation were bladder diary (37 studies), Incontinence Impact Questionnaire-7 (26 studies), and Urinary Distress Inventory-6 (23 studies). There were three studies reporting results according to the severity of pre- and post-operative SUI. There is significant heterogeneity regarding the instruments used to evaluate the severity of SUI in surgical trials for female incontinence. There is a paucity of data regarding results according to the pre-operative severity of SUI. Hence, commonly agreed standardized methods for the assessment of SUI severity are needed to improve comparability between clinical trials for SUI surgery.

187 - Extraperitoneal laparoscopic Burch colposuspension after suburethral mesh failure in female stress urinary incontinence

187 - Extraperitoneal laparoscopic Burch colposuspension after suburethral mesh failure in female stress urinary incontinence

Role of Preoperative and Postoperative Endovaginal Ultrasound and 24 h Pad Test in Evaluation of Efficacy of Various Treatment Modalities for Stress Urinary Incontinence

ABSTRACT Background: Stress urinary incontinence (SUI) is a common problem affecting the quality of life of women. Materials and Methods: It is a prospective study conducted over 40 women of SUI by endovaginal ultrasound on rest and Valsalva preoperatively and 6 months postoperatively for levator hiatus (LH), pubovisceral thickness, urethral length, and bladder neck (BN) position. A 24 h pad test was also performed on all women at the same time for grading of SUI. Treatment given was medical in 4 (10%), Burch colposuspension in 18 (45%), and tension-free obturator tape in 18 (45%). Results: The mean age, parity, and body mass index in the study were 41.60 years, 2.73, and 24.2 kg/m2, respectively. All 40 (100%) patients had SUI with a mean duration of symptoms being 4.04 years. On 24 h pad test, mild SUI was in 4 (10%), moderate SUI in 33 (82.5%), and severe SUI in 3 (7.5%) with mean preoperative 24 h pad test being 36.69 g which significantly reduced to 9.79 g postoperatively (P = 0.001). There was significant change in LH and pubovisceral thickness with treatment of SUI. Overall urethral length increased but there was significant decrease in urethral length on Valsalva after the treatment (0.40 cm vs. 0.28 cm, P = 0.04) and significant reduction in BN descent after Valsalva after treatment (0.41 cm vs. 0.27 cm, P = 0.001). Conclusion: Endovaginal ultrasound and 24 h pad test are the useful diagnostic modalities for SUI diagnosis and to see the impact of treatment.

Randomized Trial of Single-Incision Midurethral Sling and Laparoscopic Burch Colposuspension: Postoperative Surgical Outcomes and Complications

Various retropubic and midurethral sling techniques have shown high cure rates in the treatment of stress urinary incontinence (SUI). This study aimed to compare single-incision midurethral sling (SIMS) and laparoscopic Burch colposuspension (LBC) procedures in patients with SUI in terms of the effectiveness, patient satisfaction, surgical complications and results. This is a prospective randomized study. A university tertiary hospital. Forty patients with clinically and/or urodynamically proven SUI who agreed to surgical treatment were randomized to the SIMS and LBC groups and included in the study. Patients were treated with SIMS and LBC operations. Demographic characteristics of patients, physical and pelvic examination, preoperative and postoperative clinical findings, Kings Health Questionnaire form, Female Sexual Function Index and Prolapse Quality of Life Questionnaire form, postoperative day 1 visual analog scale score, and postoperative complications were recorded. Objective and subjective success rates were recorded by re-evaluating the patients in the first and sixth months of the operation. Objective success was defined as having a negative stress test and subjective success was defined as the absence of stress-induced urine leakage after surgery in a validated questionnaire. The primary result of our study was considered to be objective success, whereas the secondary result was subjective success and life quality tests. Twenty patients each in the SIMS group and the LBC group were included in the study. No significant difference was found in objective success (90% vs 85%, p = .633) or subjective success (85% vs 75%, p = .695) between the 2 groups at 6-month follow-up. A significant improvement in life quality was observed in the postoperative period for both groups; however, the difference between the groups was not significant. There was an improvement in sexual function in both groups. Nonetheless, although this improvement was significant in the SIMS group, it was not significant in the LBC group. In addition, surgery time, catheterization time, and hospitalization time were shorter in the SIMS group than in the LBC group. The visual analog scale score on postoperative day 1 was lower in the SIMS group. Groups were not different in terms of preoperative and postoperative complications. This preliminary study is the first randomized study that compares the LBC and SIMS procedures in the literature. It shows that SIMS and LBC procedures have not different objective and subjective success rates in the short term. It was also observed that they increase both sexual and life quality results in a positive and similar way.

Managing female stress urinary incontinence in a post mesh era: What to do and when to refer.

Urinary incontinence is a common presentation in general practice and can significantly affect a patient's quality of life. Stress urinary incontinence (SUI) is defined by the International Continence Society as 'the complaint of any involuntary loss of urine on effort or physical exertion (egsporting activities), or on sneezing or coughing'. There is a key role for primary care providers in the assessment and management of female SUI. To highlight the key diagnostic and management principles of female SUIingeneral practice and discuss management options. SUI can usually be diagnosed based upon clinical history and targeted physical examination. Pelvic floor physiotherapy and lifestyle interventions, including weight modification and management of co-morbidities, are important first-line therapies. Surgical options for both persistent or complex SUI include urethral bulking agents, Burch colposuspension and pubovaginal fascial slings. Synthetic (mesh) mid-urethral slings remain a viable surgical option for women suffering SUI.

Tethered vagina syndrome: massive urine loss caused by bladder neck scarring cured by skin graft.

The bladder neck area of the vagina is known as the "zone of critical elasticity" (ZCE). Adequate vaginal elasticity at ZCE is required for the oppositely-acting muscles to independently close the distal urethra and bladder neck. Scarring at ZCE "tethers" the more powerful posterior muscles to the anterior muscles and the bladder neck is forcibly pulled open, resulting in massive urine loss. This condition is known as "tethered vagina syndrome" (TVS). In developed countries, the main cause of TVS is iatrogenic. Vaginal repairs, vaginal mesh, may cause scarring at ZCE and this directly links the oppositely-acting muscle forces. Over-elevated Burch colposuspensions may stretch the ZCE to the point where its elasticity is lost so the muscles can no longer function independently. The treatment is to dissect the vagina clear of the scarring and to insert a skin graft to the bladder neck to restore ZCE elasticity. In developing countries, extensive trauma to the vagina and bladder from obstructed childbirth can cause obstetric fistulas. In up to 40-50% of these women, there is ongoing massive urine loss after the fistula has been successfully closed. Performing a prophylactical skin graft during fistula closure if there is vaginal tissue deficit is proving to be revolutionary. In women with Goh type 4 fistula (n=45), 46% were cured (full dryness) against an expected 19%. The same operation can produce equally dramatic cures in women who continue to leak urine after successful fistula repair.

Evaluating Patient Preferences and Clinical Outcomes for Modified Laparoscopic Burch Colposuspension and Transobturator Tape Procedures in Stress Urinary Incontinence Treatment.

This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two prominent surgical techniques for treating Stress Urinary Incontinence (SUI): the modified laparoscopic Burch colposuspension and the transobturator tape (TOT) procedure. A prospective cohort study was conducted on 145 patients who recieved surgical treatment for SUI, of which 71 patients (49%) underwent the modified laparoscopic Burch procedure, while 74 patients (51%) received the TOT procedure. Data on clinical characteristics, treatment success rates, and postoperative outcomes were collected and analyzed to understand patient preferences and real-world clinical effectiveness. This study revealed notable differences in patient demographics and clinical characteristics between the two groups. At the 2-year follow-up, a success rate of 100% was reported in the modified laparoscopic Burch group and 86.48% in the TOT group. A total of 99 patients (68.28%) were considered cured postoperatively, with 47 (66.20%) in the modified laparoscopic Burch group and 52 (70.27%) in the TOT group (p = 0.598). A significant difference was found in the incidence of dyspareunia, with six cases (8.10%) reported in the TOT group, compared to none reported in the modified laparoscopic Burch group (p = 0.028). The median operation time was significantly shorter in the TOT group, namely 15 min, compared to the modified laparoscopic Burch group, which had a median equal to 27 min (p < 0.001). Despite these differences, patient preference for either surgical technique was observed, along with similar success rates and varied postoperative outcomes. The findings provide a comprehensive overview of patient preferences and factual clinical outcomes for the two surgical techniques in SUI treatment. This study contributes to understanding the factors influencing patient choice and offers valuable insights into the real-world application of these techniques, enhancing patient-centered care in SUI management.

Comparative study of two techniques of laparoscopic burch colposuspension using sutures versus mesh in women with genuine stress urinary incontinence

ABSTRACT Background To compare the effectiveness and safety of laparoscopic colposuspension using sutures (LCS) versus mesh and staples (LCM) in the treatment of female stress urinary incontinence. Methods This randomized study was conducted over a total of 80 women with genuine stress urinary incontinence between January 2020 and April 2022. Women were randomly assigned to the LCS group (n = 40) or the LCM group (n = 40). They underwent objective evaluations, including a standardized stress test, a 24-hour pad test, and a frequency-volume chart. Subjective assessments were made using a quality-of-life questionnaire. Results The LCS group exhibited superior outcomes in PAD test improvement (from 147 [31–304] to 3 [0–300] at 1 year, p < 0.001), stress test scores (from 82 [11–153] to 1 [0–124] at 1 year, p < 0.001), and mean micturated volume (increase from 294 ± 65 to 321 ± 57 at 1 year, p = 0.037) compared to the LCM group. Urodynamic findings revealed a higher Maximum Urethral Closure Pressure in the LCS group (33.1 ± 6.9) versus the LCM group (28.3 ± 6.4, p = 0.002). Quality of life improvements were significantly better in the LCS group across various domains. However, the LCM group benefitted from shorter surgery duration, hospital stays, and bladder drainage duration. Conclusion LCS demonstrates significant advantages over LCM in treating female stress urinary incontinence, particularly in cure rates and quality of life improvements. Despite the operational benefits of LCM in terms of reduced surgery and recovery times, LCS offers superior therapeutic outcomes.

Examining the Role of Frailty on Treatment Patterns and Complications Among Older Women Undergoing Procedure-Based Treatment for Urinary Incontinence.

Aging beyond 65 years is associated with increased prevalence of urinary incontinence (UI), frailty, and increased complication rate with UI treatments. To investigate this relationship, we examined frailty as a predictor of procedure-based UI treatment patterns and urologic complications in Medicare-eligible women. We identified women undergoing procedures for UI between 2011 and 2018 in the 5% limited Medicare data set. A claims-based frailty index (CFI) using data from the 12 months prior to the index procedure defined frailty (CFI ≥0.25). Urologic complications were assessed during the 12 months following the index procedure. We used unadjusted logistic regression models to calculate odds of having a specific type of UI procedure based on frailty status. Odds of postprocedure urologic complications were examined with logistic regression adjusted for age and race. We identified 21783 women who underwent a procedure-based intervention for UI, of whom 3826 (17.5%) were frail. Frail women with stress UI were 2.6 times more likely to receive periurethral bulking (95% confidence interval [CI] 2.26-2.95), compared to nonfrail. Conversely, frailty was associated with lower odds of receiving a Sling or Burch colposuspension. Among women with urgency UI or overactive bladder, compared to nonfrail, frailty was associated with higher odds of both sacral neuromodulation (odds ratio [OR] = 1.21, 95% CI: 1.11-1.33) and intravesical Botox (OR = 1.16, 95% CI: 1.06-1.28), but lower odds of receiving posterior tibial nerve stimulation. Frailty was associated with higher odds of postprocedure urologic complications (OR = 1.64, 95% CI: 1.47-1.81). Frailty status may influence treatment choice for treatment of stress or urgency UI symptoms and increase the odds of postprocedural complications in older women.

Long-term outcomes of surgical interventions for stress urinary incontinence: a systematic review and network meta-analysis.

Stress urinary incontinence is common among women, and surgical interventions have significantly improved patients' symptoms. The long-term effectiveness of these surgeries is increasingly drawing attention, yet it remains sparsely documented in the literature. To compare the long-term effectiveness and safety of retropubic tension-free vaginal tape (TVT-RP), tension-free vaginal tape-obturator (TVT-O), transobturator tape (TOT), single-incision sling (SIS), Burch colposuspension, and pubovaginal sling (PVS). A comprehensive and systematic literature review was conducted in PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, and clinicaltrials.gov from inception to May 2023. Selected trials were evaluated for potential bias using the Cochrane tool. Treatment modalities were compared using network meta-analysis to assess objective success rate, subjective success rate, and complications as outcomes. A total of 37 studies involving 5720 patients were included. No significant statistical differences were found among the interventions regarding objective success rate. PVS had the highest surface under the cumulative ranking curve SUCRA value (93.1). For subjective success rate, TVT-RP, TVT-O, and PVS demonstrated superiority over SIS, with PVS having the highest SUCRA value (80.1). SIS had lower overall complication and pain rates compared to other methods, with statistical significance. There were no differences in reoperation rate, exposure rate, and urinary tract infection occurrence among the surgical approaches. In terms of long-term effectiveness and safety, TVT-RP and TVT-O appear to be the preferred options for patients opting for synthetic slings, while for patients seeking nonsynthetic slings, PVS may represent the optimal choice.

Sunt meşele necesare în tratamentul incontinenţei urinare de efort la femei?

Introduction. Stress urinary incontinence (SUI) impacts over 20% of women, and its prevalence is increasing with the aging of population. This review assesses mesh surgery for SUI treatment by analyzing midurethral slings, retropubic urethropexy, bulking agents and artificial sphincters. Methodology. We searched the PubMed database from 1995 to 2023 inclusive, and 31 studies met our inclusion criteria, focusing on women aged 20-70 years old with SUI, excluding nervous system diseases affecting the function of the bladder. Results. Minimally invasive midurethral slings – particularly transvaginal tension-free tape (TVT) and transobturator tension-free vaginal tape (TOT) – have become the standard of care, endorsed by the Food and Drug Administration (FDA) in 2011. TVT offers reduced hospital stays and shorter operating times, with risks including bladder perforation and infections. TOT, while minimizing bladder perforation risks, may increase groin pain. Mini-slings and autologous fascial slings show varying success; the latter has higher success but more complications than Burch colposuspension. Retropubic urethropexy is effective on the long term, but with longer recovery and more complications. Conclusions. Mesh-based midurethral slings (MUS) are pivotal in SUI treatment, providing high short-term success and enhanced quality of life. Effective SUI management requires individualized treatment, with a fine balance between benefits and risks. With emerging regenerative medicine, the future of SUI treatment is promising. Until then, MUS remains a key modality, necessitating careful patient selection and ongoing research to refine the surgical outcomes and improve the quality of life for SUI patients.

Comparison of laparoscopic versus open Burch colposuspension techniques for female stress or mixed urinary incontinence: a ten-year experience in a tertiary center

Aims: To evaluate postoperative course, efficacy, and complication rates of Open Burch Colposuspension and Laparoscopic Burch Colposuspension techniques in stress or mixed urinary incontinence at a single training and research hospital for the last ten years in İstanbul, Turkey.&#x0D; Methods: A retrospective cohort study was conducted in all Burch Colposuspension cases performed between January 2011 and May 2022 in the Department of Gynecology and Obstetrics of İstanbul Kanuni Sultan Süleyman Training and Resaerch Hospital. All patients’ data were reviewed from the electronic medical records and analyzed who underwent Burch colposuspension surgery either with an open or laparoscopic approach. The primary outcome was a surgical success, whereas secondary outcomes were perioperative and postoperative data, including surgical type, operating time, duration of hospital stay, estimated blood loss, complications, subjective cure, and additional interventional procedure types. &#x0D; Results: The demographic and clinical characteristics among the groups have no significant difference (p &gt;0.05). The major complication rate postoperatively was considerably higher in the OC group (p

Google searches for stress urinary incontinence treatment options: a worldwide trend analysis in the synthetic mesh controversy era.

To analyze trends in worldwide public interest in the treatment options for stress urinary incontinence around the latest FDA 2019 ban on vaginal mesh for prolapse. We used the web-based tool Google Trends to analyse online searches related to the following terms: 'pelvic floor muscle exercises', 'continence pessary', 'pubovaginal slings', 'Burch colposuspension', 'midurethral slings', 'injectable bulking agents'. Data were expressed as relative search volume on a scale of 0-100. Comparisons of annual relative search volume and average annual percentage change, were analyzed to assess loss or gain of interest. Finally, we assessed the impact of the last FDA alert. The mean annual relative search volume for midurethral slings was 20% in 2006 and significantly decreased until 8% in 2022 (p < 0.01). A regular decrease interest was recorded for autologous surgeries but a regain of interest for pubovaginal slings was registered since 2020 (+ 2.8%; p < 0.01). Conversely, a steep interest was noted for injectable bulking agents (average annual percentage change: + 4.4%; p < 0.01) and conservative therapies (p < 0.01). When trends were compared before and after the FDA 2019 alert, a lower research volume was found for midurethral slings, while a higher research volume was observed all others treatments (all p < 0.05). The online public researches about midurethral slings have considerably decreased following warnings on the use of transvaginal mesh. There seems to be a growing interest in conservative measures, bulking agents, and recently pubovaginal slings.

Predictors of Surgical Failure of Open Burch Colposuspension Versus Retropubic Midurethral Sling for Stress Urinary Incontinence

To identify and compare long-term predictors for 'surgical failures' in matched groups of Midurethral sling (MUS) and Burch colposuspension (BC). A secondary analysis of patients with urodynamic stress incontinence who were treated either by open BC or retropubic MUS. The study had a cohort of 1344 women with a ratio of 1:3 (BC: MUS). We defined surgical success or failure by combining Patient Reported Outcome Measures and the need for repeat surgery. Risk factors for failure identified by multivariate analysis. Of the 1344 women included, 336 had BC, and 1008 had MUS. Patients were followed-up for 13.1 and 10.1 years, and the rate of failure was 22% and 20%, for BC and MUS, respectively (P=0.35). Significant predictors for MUS failure were Body mass index (BMI)>30, preoperative anticholinergic medication use, smoking, diabetes, and previous surgery for incontinence (Hazard ratio 3.6, 2.6, 2.5, 1.8, 2.3, respectively). BMI>25, preoperative use of anticholinergic medication, age>60, previous surgery for incontinence, and loss of follow-up>5 years (Hazard ratio: 3.2, 2.8, 2.6, 2.5, 2.1, respectively), were significant predictors of BC failure. This study shows similar predictors for surgical failure for BC and MUS, with high BMI, mixed urinary incontinence, and previous continence procedures being the most important.

V12-10 COMPLETE BLADDER PROLAPSE THROUGH THE URETHRA: ROBOTIC-ASSISTED LAPAROSCOPIC BURCH COLPOSUSPENSION AND BLADDER NECK RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023V12-10 COMPLETE BLADDER PROLAPSE THROUGH THE URETHRA: ROBOTIC-ASSISTED LAPAROSCOPIC BURCH COLPOSUSPENSION AND BLADDER NECK RECONSTRUCTION Connie Wang, Rainjade Chung, Miyad Movassaghi, and Doreen Chung Connie WangConnie Wang More articles by this author , Rainjade ChungRainjade Chung More articles by this author , Miyad MovassaghiMiyad Movassaghi More articles by this author , and Doreen ChungDoreen Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003347.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present a unique case report of complete bladder prolapse through the urethra. We additionally demonstrate the surgical technique of robotic-assisted Burch Colposuspension and bladder neck reconstruction to address multiple urologic problems for a patient who was not a candidate for a mid-urethral sling, and who required concomitant pelvic organ prolapse repair. METHODS: The patient’s initial presentation of bladder prolapse through the urethra was repaired with manual reduction, urethroplasty, bladder neck closure, and cystorrhaphy. Her subsequent Burch Colpopsuspension was performed robotically. The Da Vinci Xi robot was used with a 5-port configuration, including an assistant port. Surgical steps described in this video include dissection of vagina off bladder, apical uterosacral ligament suspension, dropping the bladder, bladder neck reconstruction, Burch Colposuspension, paravaginal repair, and new suprapubic tube placement. RESULTS: A successful treatment of a freely mobile, prolapsing bladder and near absent urethra causing severe urinary incontinence is achieved. The patient remains continent and her bladder remains well reduced post-operatively. CONCLUSIONS: Robotic-assisted laparoscopic Burch Colposuspension represents a minimally-invasive, effective option for patients who present with multiple different urologic issues, including pelvic organ prolapse and stress urinary incontinence. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1067 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Connie Wang More articles by this author Rainjade Chung More articles by this author Miyad Movassaghi More articles by this author Doreen Chung More articles by this author Expand All Advertisement PDF downloadLoading ...

MP26-01 BENIGN PELVIC SURGERY WITH HUGO ® RAS SYSTEM: OUR EXPERIENCE IN A TERTIARY REFERRAL ROBOTIC CENTER

You have accessJournal of UrologyCME1 Apr 2023MP26-01 BENIGN PELVIC SURGERY WITH HUGO® RAS SYSTEM: OUR EXPERIENCE IN A TERTIARY REFERRAL ROBOTIC CENTER Eleonora Balestrazzi, Angelo Mottaran, Carlo Andrea Bravi, Luigi Nocera, Marco Paciotti, Adele Piro, Maria Peraire Lores, Luca Sarchi, Federico Piramide, Ruben De Groote, Geert De Naeyer, and Alexandre Mottrie Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Angelo MottaranAngelo Mottaran More articles by this author , Carlo Andrea BraviCarlo Andrea Bravi More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Adele PiroAdele Piro More articles by this author , Maria Peraire LoresMaria Peraire Lores More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Federico PiramideFederico Piramide More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urologic surgery for benign pelvic conditions – such as female urinary stress incontinence secondary to a pelvic organ prolapse and male benign prostatic iperplasia – can be performed using robotic and laparoscopic approaches. However, the robotic approach is still limited by platforms availability and their cost. Recently, new robotic platforms such as Hugo® Robotic Assisted Surgery (RAS) System were introduced into the market. The aim of our study was to assess the safety and technical feasibility of surgery for benign urological conditions with Hugo® RAS System. METHODS: We analysed data of 23 patients who underwent surgery for urological pelvic benign conditions at OLV Hospital (Aalst, Belgium). All surgeries were performed with HUGO™ RAS System between February and October 2022. We collected data about patient’s characteristics, operative time, intra- and post-operative complications, postoperative outcomes, clashing of instruments or technical errors of the system. RESULTS: Overall, 9 men underwent robot-assisted simple prostatectomy (RASP), 12 women robot-assisted sacropexy (RSC), 1 woman underwent robot-assisted diverticulectomy and 1 underwent robot-assisted Burch colposuspension. All procedures were completed, with no need for conversion or for placement of additional ports. No intraoperative complications and no one of the patients needed blood transfusion. One robotic monopolar curved shears had to be replaced during RASP, however no further instrument clashing or technical errors of the system occurred. Median (interquartile range [IQR]) console time for RASP was 120 (IQR: 100, 145) minutes and for RSC was 100 (IQR: 80, 100). The console time for the diverticulectomy and for the Burch colposuspension was 95 minutes and 100 minutes, respectively. Median length of stay was 4 (IQR: 3,5, 4,5) and 3 (IQR: 2, 4) days for RASP and RSC, respectively; length of stay for diverticulectomy and Burch colposuspension was 2 and 4 days, respectively. For all surgeries, vescical catheter was removed on the first operative day. Only one patient of the RASP group experienced a post-operative complication – an asymptomatic pelvic hematoma – that was conservatively treated. CONCLUSIONS: The use of HUGO® RAS system for the treatment of benign urological conditions, both in male and female patients, is safe and feasible. Awaiting further evidence on clinical outcomes, the introduction of this novel platform into the market can decrease the costs of robotic technology and thus increasing the availability of robotic surgery also for benign conditions in urology. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e352 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eleonora Balestrazzi More articles by this author Angelo Mottaran More articles by this author Carlo Andrea Bravi More articles by this author Luigi Nocera More articles by this author Marco Paciotti More articles by this author Adele Piro More articles by this author Maria Peraire Lores More articles by this author Luca Sarchi More articles by this author Federico Piramide More articles by this author Ruben De Groote More articles by this author Geert De Naeyer More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...

Autologous fascial slings – efficacy and future challenges. An analytic review

Stress urinary incontinence (SUI) consists a clinical entity affecting approximately 1/3 of women worldwide. Therefore, management and therapeutic mapping should be planned assiduously. Surgical treatment for SUI has been an optimal surgical intervention for over 50 years, beginning from Burch colposuspension and Kelly’s plication, to midurethral slings, tension free vaginal tapes, trans obturator tapes and autologous fascial slings. Even though synthetic midurethral slings represented the most common surgical approach since the mid 90’s, due to their minimally invasive character, nowadays, lots of concerns have been raised among medical community concerning their serious long-term complications such as, mesh erosion, vaginal extrusion, urethral erosion and injury, groin, thigh or pelvic pain, recurrent infections and dyspareunia. These complications forced FDA (Food and Drug Administration) to issue a warning against their use, leading the implementation concerning autologous facial slings come back in to the surface. Despite the fact that the use of autologous fascial slings depicts a more invasive and challenging approach to treat SUI, there are notably more benefits regarding postoperative outcome, as well as decreased rate of potential complications when compared to TVT (Tension-free Vaginal Tape) and TOT (Trans Obturator Tape). Although, more trials and data must be conducted in order to be considered as main approach. Aim of this analytic review consists efficacy’s depiction of the autologous fascial slings according to recent bibliography and the role they could play in the near future concerning optimal therapeutic strategy of SUI.

Minimally invasive burch colposuspension to reduce de novo stress incontinence: the micro randomized trial

Minimally invasive burch colposuspension to reduce de novo stress incontinence: the micro randomized trial

Compare using sutures versus mesh during laparoscopic Burch colposuspension in patints with stress urinary incontinence

Compare using sutures versus mesh during laparoscopic Burch colposuspension in patints with stress urinary incontinence

Robotic Burch colposuspension: anatomical and technical considerations.

Up to 13.6% of women will undergo surgical treatment for stress urinary incontinence during their lifetime. Midurethral slings are the mainstay of stress incontinence treatment; however, diversity of surgical options is needed to serve the large number of patients desiring treatment. The Burch colposuspension remains a viable treatment option for appropriately selected patients. Currently, information on procedural standardization and tools for surgical training on robot-assisted colposuspension is limited. We describe a stepwise robotic approach aimed at enhancing procedural reproducibility, while decreasing risks of intraoperative injury and postoperative complications. We analyze perioperative outcomes of our technique in a retrospective cohort of patients who underwent robot-assisted colposuspension at our institution. Seven key procedural steps are defined to optimize safe dissection in the retropubic space and to reduce the potential for surgical complications. These include methods of avoiding bladder, urethral, and neurovascular injury, as well as enhancing adequate suture fixation that prevents urethral obstruction and adverse postoperative urinary and pain-related symptoms. Surgical outcomes for 20 patients are reported and reveal low rates of perioperative complications. Robot-assisted colposuspension requires thorough knowledge of the retropubic space and the application of standardized techniques may reduce the risk of injury and optimize procedure efficiency and reproducibility.