Concomitant Pelvic Prolapse Repair Research Articles

Mid‐urethral synthetic slings in the treatment of urodynamic female stress urinary incontinence without concomitant pelvic prolapse repair: 4‐year health‐related quality of life outcomes

To report 4-year health-related quality of life (HRQL) outcome data after retropubic mid-urethral synthetic sling (MUS) surgery without concomitant prolapse repair for treating female stress urinary incontinence (SUI) in a single institution. The data were prospectively collected, which yielded 21 consecutive patients with a mean (range) age of 67.6 (41-81) years who underwent retropubic MUS with > or = 4 years follow-up. Before surgery, all patients underwent history, examination, pad usage, and multichannel fluoroscopic urodynamics according to International Continence Society standards. In all, 19 patients had urethral hypermobility with an abdominal leak-point pressure (ALPP) of >90 cmH(2)O and two had intrinsic sphincter deficiency with an ALPP of <60 cmH(2)O. The MUS were all placed under no tension. All patients were cystoscoped with both 30 and 70 degrees lens at the end of the procedure with a fully distended bladder to exclude bladder or urethral injury. The validated Kings Health Questionnaire (KHQ) was used both before and after surgery to assess HRQL measures. All patients were assessed at 3 months, and then at least three times thereafter. The paired Student's t-test was used on the mean KHQ scores before and after MUS surgery (4 years follow-up). There were statistically significant improvements in all nine domains on the KHQ between preoperative and 3 months after MUS surgery (P < 0.01), with the most significant being in 'General Health Perceptions', 'Incontinence Impact', 'Physical Limitations', and 'Role Limitations'. Improvement in HRQL persisted up to 4 years in all domains. Bladder perforation occurred in two patients with uneventful resolution. Two patients required very short-term catheterization (<5 days). In the present series, there was no sling revision, division, infection or erosion. No patients developed de novo urgency or urge UI after MUS surgery. The pad-free rate in the present series was 85.7%. In our institution, HRQL improvement at 3 months after retropubic MUS surgery predicts persistence of improvement at 4 years. This is useful clinically in counselling our patients for treatment efficacy. Tension-free placement is associated with minimal risk of postoperative retention or de novo overactive bladder. Although patient numbers are modest, these data contribute to the scarce longer term (> or =4 years) HRQL data on the MUS, which is a safe and durable procedure with a minimal complication profile.

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures. A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: significant response (> or =80% improvement), moderate response (> or =50% and <80% improvement), and poor response (<50% response). Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal fistula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow-up was 7.2 months. Twenty-two women (88%) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50% improvement in clinical symptoms at last follow-up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 (P < 0.001). There were no significant differences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters. Sacral neuromodulation appears to be an effective therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow-up are needed to assess the durability of this therapeutic modality.