Cough Test Research Articles

Transobturator Tape (TOT) in Management of Female Stress Urinary Incontinence

BACKGROUND Transobtorator tape (TOT) is a minimally invasive procedure that gained increased popularity in the surgical field for management of patients with stress urinary incontinence . The use of TOT had significantly simplified the surgical procedure and made it safer. OBJECTIVES To evaluate the safety and efficacy of the TOT procedure in women with SUI PATIENTS AND METHOD Thirty female patient are complaining of urinary incontinence presented at urology department of Ghazi Al-Hariri surgical specialties hospital from January 2012-Oct. 2013 were enrolled in this study. All of our patients are with pure SUI. The procedure was done under spinal anesthesia. TOT require placement of macroporous polypropylene tape at the mid urethra through the obturator membrane with minimal vaginal incision. The patients were followed up before discharge, 1 month and six month using cough test. RESULTS Mean patients age is 48.2 year (range 30-60 year) with a mean parity of 5(range from 3-7 child). The mean operating time is 26.5 minutes (ranging from 20-30 minutes). Intraoperative complications occur in 6 patients (20%), include hemorrhage in 5 patients, hematoma in one patient. The total incidence of postoperative complication was 36%, transient thigh pain occurred in seven patients, two patients got retention, two patients got de novo urgency. The objective cure rate was 93.3% CONCLUSION The TOT procedure is a safe and effective technique for the management of patient complaining of SUI.

A prospective observational cohort study of the Ajust® single incision sling performed under conscious sedation with local infiltration.

To evaluate the adjustable single-incision sling (Ajust®) in the treatment of stress urinary incontinence (SUI), when placed under conscious sedation with local infiltration, using the cough test during surgery. In this multicenter observational study, 90 women who had moderate to severe SUI, were asked to have the Ajust® procedure performed under sedation with local infiltration with levobupivacain. This allowed for a perioperative cough test to adjust the sling to the urethra till continence was reached. The primary outcome of the study was subjective cure of stress incontinence at 1 year follow up. Secondary objectives were objective and subjective improvement, complications during and after the procedure, and postoperative pain scores. These results were compared with the results of a historical control group of 96 patients who received their Ajust® under general or regional (spinal) anesthesia. At 6 weeks and 12 months, there were no statistical significant differences in the results for subjective cure (83.6% and 71.6% sedation group, 88.4% and 77.2% general/regional anesthesia group), objective cure (96% and 86.9% sedation group, 88.1% and 91.8% general/regional anesthesia group), de novo urgency (10.5% and 6.7% sedation group, 7.1% and 24.1% general/regional anesthesia group) and the patients global impression of improvement (96% and 89.2% sedation group, 91.4% and 84.4% general/regional anesthesia group). The performance of a cough test during the placement of an adjustable single-incision sling for the treatment of SUI does not affect the functional outcome, and is therefore not necessary.

MP56-13 MALE STRESS INCONTINENCE GRADING SCALE (MSIGS) CORRELATES STRONGLY WITH 24-HOUR PAD WEIGHTS: EXTERNAL VALIDATION OF STANDING COUGH TEST FOR RAPID OBJECTIVE EVALUATION OF MALE STRESS URINARY CONTINENCE

INTRODUCTION AND OBJECTIVES:We previously proposed the standing cough test (SCT) as a method of providing rapid, objective assessment of incontinence severity via the Male Stress Incontinence Gradi...

Utility and safety of endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound with an echobronchoscope-guided fine needle aspiration in children with mediastinal pathology.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound with an echobronchoscope-guided fine needle aspiration (EUS-B-FNA) are useful modalities in the evaluation of mediastinal pathologies in adults. However, sparse data are available in children. To describe the utility and safety of EBUS-TBNA and EUS-B-FNA in children with mediastinal pathologies of unknown etiology. Chart review. Pediatric Chest and Tuberculosis Clinics, Department of Pediatrics, AIIMS, New Delhi from May 2015 to March 2018. Children <18 years of age with mediastinal pathologies of undefined etiology. Case records of children who underwent EBUS-TBNA and EUS-B-FNA were reviewed. Data on demographic profile, clinical features, laboratory investigations, the technique of EBUS-TBNA/ EUS -B- FNA, complications, and findings were collected. Thirty children (19 males) with mean (SD) age of 9.6 (±3.5) years underwent endobronchial procedures. Median (IQR) weight(kg) and height(cm) were 29(19.5,35) and 134(125,150) respectively. Tuberculosis was the most common preprocedure clinical diagnosis(73.3%), followed by lymphoma(13.3%). Presenting features were fever (80%), cough (53.3%), hepatomegaly (13%), peripheral lymphadenopathy (21.7%), and positive tuberculin skin test (63.3%). Approximately one fourth were on antitubercular therapy without definite evidence of TB. Conscious sedation was used for the procedures: midazolam and fentanyl (n = 22), propofol(n = 8). Transesophageal, transtracheal, and both routes were used in 20(66.6%), 7(23.3%), and 3(10.1%), respectively. Lymph-nodes were sampled in 24 children (subcarinal in 16, right paratracheal in 4 and both in 4). Mean (SD) size of lymph node (in cm) on EBUS was 1.93(±0.5) and median (IQR) number of FNAC needle passes per node were 2(2,4). The diagnosis was confirmed in 11 (36.6%, tuberculosis in 10 by GeneXpert/MGIT/cytopath and lymphoma in one) patients. Only 3.3% had a minor complication. EBUS-TBNA and EUS-B-FNA are helpful in children with undiagnosed mediastinal pathology with fair diagnostic yield and excellent patient safety profile.

Surgical outcome of the transobturator tape procedure for management of female urinary incontinence: A single center experience

Background/Aim. The transobturator tape (TOT) procedure is considered as a gold standard of surgical treatment option for stress urinary incontinence (SUI). The aim of this study was to determine the efficacy of this procedure in the surgical management of SUI by analyzing a single centre short-term results. Methods. From April 2011 until January 2018, 40 patients with predominantly SUI were operated by the standard TOT procedure. A polypropylene tape was placed in the mid-urethra by a percutaneous transobturator approach. The postoperative assessment considered cough tests and post-void residual urine volume at a week following the operation with additional clinical examination and urine culture at one, three and six months. Results. The mean age of the patients was 58 (42?78) years. Predominantly SUI was present in 32 patients (80%) and mixed urine incontinence in 8 patients (20%). At the initial (one week) assessment, the cough test was positive in 3 patients (7.5%), and 4 patients (10%) needed an indwelling urethral catheter because of voiding difficulties. At the second follow-up, 2 (5%) patients still had a positive cough test, 2 patients (5%) had still the need for an indwelling catheter because of significant postvoid residual (PVR) urine volumes and 2 patients (5%) had a positive urine culture. At the three and six months, postoperative assessment. 3 patients (7.5%) still had a positive cough test. After six months 36 patients (90%) were considered as cured, 1 patient (2.5%) improved and 3 patients (7.5%) were classified as a failure. Conclusion. These results concur with the results of the other published short-term studies that analyzed the surgical outcome of the TOT procedure for female urinary incontinence. This allows us to confirm that the transobturator tape technique is a safe, effective and straightforward procedure after adequate training.

Comparison of two retropubic tension-free vaginal tape procedures in women with stress urinary incontinence: a randomized controlled multicenter trial.

Midurethral slings are a well-established treatment option in women suffering stress urinary incontinence. Various different products and methods are used, therefore, the aim of our study was to compare two inside-out retropubic slings (TVT exact® vs. RetroArc®) inserted in two different ways regarding perioperative and mid-term outcomes. In this prospective randomized controlled non-inferiority multicentre trial, primary endpoint was postoperative cure rate, both objective (negative cough test) and subjective (absence of leakage during physical activity using the UDI-6 questionnaire). Secondary endpoints were patients' satisfaction (Likert scale; ICIQ-UI-SF questionnaires). In addition, intra-and postoperative complications were evaluated. The TVT®-group was operated with an empty bladder, a 18 CH catheter was used with a straight inserter as instructed. Patients randomized into the RetroArc®-group were operated without inserter leading to a reduced catheter size (14 CH), bladder was filled (200ml) during the procedure. Of the 303 women, 152 were randomized to the TVT® and 151 to the RetroArc® operation. At 3 months, n = 288 (95.0%) and at 12months n = 229 (75.6%) were assessed. In postoperative objective cure the RetroArc®-procedure was not inferior to TVT® (p = 0.144). In subjective cure, however, the TVT exact® procedure achieved significant better results (TVT® 76.1%, RetroArc® 54.3%, p = 0.002). Perioperative complications were in majority voiding difficulties and lower after the TVT exact®-procedure. Retropubic sling procedures are safe and successful to treat female stress urinary incontinence. However, different materials and techniques result in differences between outcomes also experienced surgeons should be aware of.

Involuntary cough is superior to voluntary cough for identifying stress urinary incontinence.

IntroductionVoluntary cough (VC) and the laryngeal expiration reflex (LER) provoke stress urinary incontinence (SUI). The aim of this article is to analyze the effectiveness of these stimuli on the timing of urinary leaks.Material and methodsUrodynamic testing using pressure catheters was performed on 123 subjects with history of SUI. The LER was triggered using the induced reflex cough test (iRCT). Each subject was tested with VC and LER and leaked with one or both stimuli. The occurrence and timing of leaks were recorded.ResultsThe peak and average intra-abdominal pressures were 16–19% greater for LER compared to VC. Of the 123 subjects, LER caused leak in 118 (96%), VC in 71 (58%) and both in 66 (54%). For LER compared to VC, leak was more likely to occur during or immediately after the first expiratory effort. The electromyogram for VC and LER were similar.ConclusionsThe iRCT reliably initiated the LER and triggered SUI more effectively than VC. During VC, the smooth muscle of the internal urethral sphincter (IUS) starts to contract during inspiration, and constriction of the IUS continues into the expiratory phase; this increased urethral tonicity would lessen the likelihood of SUI. We refer to this as the inspiration closure reflex (ICR). With LER the inspiration would not take place, and the first expiratory effort would be against a non-constricted IUS, making leak more likely. Our findings disprove the pressure transmission theory. The internal and external urethral sphincters may both increase urethral closure pressure and resistance.

Mini-bandelette sous-urétrale versus bandelette transobturatrice : efficacité et morbidité

ObjectiveTo compare the effectiveness of an ALTIS® mini-sling and a conventionnal suburethral sling TVT-ABBREVO® for treatment of female stress urinary incontinence. MethodsA single-center retrospective study included all female patients fitted with a conventional transobturator tape (TVT-ABBREVO®) or mini-sling (ALTIS®), during 2015, in Angers university hospital. The success rate was defined by no urine leakage during a cough test on clinical examination, improved quality of life defined by a PGI-I (Patient Global Impression of Improvement) score of 1 to 3, and no stress urinary incontinence on USP (Urinary Symptom Profile) questionnaire. Morbidity associated with slings and perioperative data were also recorded. ResultsNinety-two patients were included (39 in the ALTIS group and 53 in the ABBREVO group). The average follow-up was 13.55 months. The success rate was not significantly different in ALTIS group for the negative cough test (89.7% vs 94.3% in ABBREVO group, P=0.45), for the absence of urinary leakage reported on the USP questionnaire (87.2% vs 90.6% in ABBREVO group, P=0.61), or for the improvement of the quality of life with a PGI-I score between 1 and 3 (82.1% vs 86.8% in ABBREVO group, P=0.53). On the other hand, more patients were fully satisfied, with a PGI-I quality of life score of 1, in ABBREVO group than in ALTIS group (67.9% compared with 46.2%, P=0.03). Immediate postoperative pain was significantly less intense in ALTIS group than in ABBREVO group (average VAS score of 0.5 comparated with 1.3, P=0.01), but this difference had disappeared one week after surgery. The rates of other complications were similar in both groups. ConclusionThe functional results of the ALTIS and TVT-ABBREVO® slings appear similar in the treatment of female stress urinary incontinence.

Comparison between tension-free vaginal tape and transobturator tape in treating stress urinary incontinence after vaginal mesh surgery

ObjectiveA midurethral sling is the gold standard surgical treatment for stress urinary incontinence (SUI), however a lower success rate has been reported in the treatment of SUI after pelvic organ prolapse surgery. The aim of this study was to compare the success rates, quality of life, and complications with treatment using tension-free vaginal tape (TVT) and transobturator tape (TOT) in these patients. Materials and MethodsWe enrolled patients who had symptomatic SUI after anterior vaginal mesh repair who underwent either TVT or TOT surgery. Successfully cure was defined as the absence of urinary leakage in a stress test during filling cystometry, and a negative cough test. Quality of life was evaluated using the short form of the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). ResultsWe included 50 patients in the TOT group and 37 patients in the TVT group, with a median follow-up of 18.5 months. The TVT group had a significantly higher success rate than the TOT group (88% vs. 60%, p = 0.036), while there was no statistically significant difference in de novo detrusor overactivity (30% vs. 9%, p = 0.090). There was also no significant difference in postoperative quality of life (UDI-6, 5.9 ± 7.9 vs. 5.0 ± 5.9, p = 0.639; IIQ-7, 5.2 ± 12.5 vs. 4.3 ± 9.7, p = 0.766). The TVT group had a longer operative time (p < 0.001) and hospital stay (p = 0.004), however the TOT group required more repeat surgeries for recurrent SUI (p = 0.045). ConclusionRetropubic TVT is a more effective surgical option than TOT in women with SUI after vaginal mesh repair.

Determining Peak Cough Flow Cutoff Values to Predict Aspiration Pneumonia Among Patients With Dysphagia Using the Citric Acid Reflexive Cough Test

ObjectiveTo investigate the clinical usefulness of the peak cough flow generated during the citric acid reflexive cough test (0.28 mol/L) by determining the appropriate cutoff values that could accurately predict aspiration pneumonia within the first 6 months after onset. DesignRetrospective analysis of a prospectively maintained database. SettingUniversity-affiliated hospital. ParticipantsPatients (N=163) with first-ever diagnosed dysphagia attributable to cerebrovascular disease, who had undergone the citric acid reflexive cough test on the same day they underwent the instrumental assessment of swallowing, such as videofluoroscopy or the functional endoscopic swallowing test. InterventionsNot applicable. Main Outcome MeasuresPeak cough flow (L/min) from the citric acid reflexive cough test. ResultsA final 163 patients had full medical records with 6-month follow-up. Receiver operating curve analysis showed that peak cough flow cutoff values set at 59 L/min were significantly associated with aspiration pneumonia (area under the curve [AUC] 95% confidence interval =0.88 [0.83-0.93]). This cutoff value significantly (P<.001) predicted the risk of aspiration pneumonia with an odds ratio of 21.56 (9.62-48.28). A multivariate regression logistic regression analysis model including initial dysphagia severity, low body mass index, and decreased level of cognition showed that inclusion of the peak cough flow from the citric acid reflexive cough test significantly improved the predictive model of aspiration pneumonia within the first 6 months after onset (AUC=0.91 vs 0.79). ConclusionsThose with reflexive cough strength less than 59 L/min may be at high risk of respiratory infections within the first 6 months after dysphagia onset. Objective measurement of reflexive cough strength may help to predict those at risk of aspiration pneumonia.

Urolastic®, a new bulking agent for treatment of stress urinary incontinence: a systematic review and meta-analysis

The aim of the present systematic review and meta-analysis was to assess the effectiveness and safety of injections of the new bulking agent Urolastic® in the treatment of patients with stress urinary incontinence (SUI). A systematic search was carried out to select observational and experimental studies on Urolastic® in female patients with SUI. Three different databases, Pubmed, the Cochrane Central Register of Controlled Trials, and Scopus, were used to retrieve scientific articles published from their inception to 31 January 2018. Eight full texts were evaluated but only five were selected for the qualitative and quantitative analyses. Duration of follow-up after Urolastic® injections was significantly heterogeneous, ranging from 6 to 24months. Secondary injections were needed in 16.7%-35.0% of the treated patients. The pooled proportion of secondary injections was 20% (95% CI: 15%-24%; I2: 0%). Subjective improvement, measured by different means (i.e., patient global impression of improvement PGI-I score) was only assessed by 40% of the selected papers and was > 80% in two cohorts. The objective treatment success was evaluated by four (80.0%) papers and was achieved in all cohorts with a wide proportional range: from 32.7% (i.e., patients without objective SUI symptom cough tests and with a negative pad test) to 67.0%. Its pooled proportion was 57% (95% CI: 38%-75%; I2: 82.3%). Urolastic® showed effectiveness in patients with SUI during a follow-up period of 6-24months.

Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success.

To develop a decision aid in predicting sling success, incorporating the Male Stress Incontinence Grading Scale (MSIGS) into existing treatment algorithms. We reviewed men undergoing first-time transobturator sling for stress urinary incontinence (SUI) from 2007 to 2016 at our institution. Patient demographics, reported pads per day (PPD), and Standing Cough Test (SCT) results graded 0-4, according to MSIGS, were assessed. Treatment failure was defined as subsequent need for >1 PPD or further procedures. Parameters associated with failure were included in multivariable logistic models, compared by area under the receiver-operating characteristic curves. A nomogram was generated from the model with greatest AUC and internally validated. Overall 203 men (median age 67 years, IQR 63-72) were evaluated with median follow-up of 45 months (IQR 11-75 months). A total of 185 men (91%) were status-post radical prostatectomy and 29 (14%) had pelvic radiation history. Median PPD and SCT grade were both two. Eighty men (39%) failed treatment (use of ≥1 PPD or subsequent anti-incontinence procedures) at a median of 9 months. History of radiation (P = 0.03), increasing MSIGS (P < 0.0001) and increasing preoperative PPD (P < 0.0001) were associated with failure on univariate analysis. In a multivariable model with AUC 0.81, MSIGS, and PPD remained associated (P = 0.002 and <0.0001 respectively, and radiation history P = 0.06), and was superior to models incorporating PPD and radiation alone (AUC 0.77, P = 0.02), PPD alone (AUC 0.76, P = 0.02), and a cutpoint of >2 PPD alone (AUC 0.71, P = 0.0001). MSIGS adds prognostic value to PPD in assessing success of transobturator sling for treatment of SUI.

Urethral funneling visualized during pelvic floor sonography - analysis of occurrence among urogynecological patients.

There are different diagnostic methods used in women with urinary incontinence symptoms such as: medical history, voiding diary, cough test, pad test, urodynamic testing. None of them is optimal. The aim of this study is to analyze the correlation between urethral funneling visualized during pelvic floor sonography and symptoms of stress urinary incontinence. We have performed a retrospective analysis of 657 complete datasets of patients who attended our urogynecological clinic for diagnostics. Women with wet overactive bladder were excluded from the analysis. Tests used in our clinic included: standardized interview and questionnaire, clinical exam, cough test. Pelvic floor sonography with a transvaginal probe in women with filled bladder was performed to assess the urethral length and the urethral funneling during maximal Valsalva maneuver. In all patients with clinical SUI symptoms and with a positive cough test the urethral funneling length during Valsalva maneuver was > 50% of urethral length (long urethral funneling). In 83.7% of women without SUI the urethral funneling was absent. In the remaining 16.3% funneling was visible but its relative length was less than 50% of urethral length and urine flow was not observed (short urethral funneling). Long urethral funneling (> 50% of urethral length) seems to be a characteristic sign for SUI in women. The presence of urethral funneling shorter than 50% of urethral length (short urethral funneling) is not a SUI symptom - it is probably a sign of asymptomatic funneling of bladder neck.

196 Refining Male Sling Selectivity Improves Outcomes: Role of Standing Cough Test in Physical Demonstration of Mild Male Stress Urinary Incontinence

We reviewed our 9-year surgical experience with male AdVance sling cases, determining clinical features associated with treatment success in an effort to refine procedure selectivity. We hypothesized that preoperative physical demonstration of stress urinary incontinence (SUI) by standing cough test (SCT) improves patient selection for male transobturator sling surgery. A retrospective review of men undergoing primary AdVance sling surgery between 2008-2016 was performed. Patients without preoperative SCT were excluded. Treatment success was defined as ≤1 PPD postoperatively and no further intervention. SCT was performed during preoperative consultation and objectively graded using the Male Stress Incontinence Grading Scale (MSIGS). Of the 203 male sling patients with complete data, 80 (39%) failed during a median follow up of 63.5 months. From 2008-2016, the proportion of male transobturator slings performed as a surgical treatment modality for SUI declined from 66% to 13%. Increasing sling selectivity correlated with greater treatment success. Treatment success was greater among men without radiation (64% vs 41%; p=0.02), having a history (≤2 PPD; 77% vs 36%; p<0.0001) and physical findings of mild SUI (MSIGS grade 0-2 incontinence on SCT; 67% vs 26%; p<0.0001). In combination, non-radiated men with mild SUI and favorable SCT had an 81% treatment success rate. Incremental increases in PPD usage (OR 1.8 per pad; p<0.0001) and MSIGS grade (OR 1.7 per grade; p=0.005) were independently associated with treatment failure, while history of radiation trended towards significance (OR 2.2; p=0.09).

Effectiveness and quality of life 10 years after transobturator suburethral tape surgery for stress urinary incontinence.

We aimed to measure the effectiveness and quality of life (QoL) 10 years after transobturator suburethral tape surgery. We carried out a prospective observational study of 42 women assessed 10 years after surgical intervention with the transobturator technique. The main outcome measures were subjective and objective cure or improvement, complications, and changes in QoL. The median abdominal leak point pressure had been 92 (82-113) mL H2 O prior to surgery. Thirty-six women (85.7%) remained cured (negative cough test) and 13 (31%) reported urine leakage during physical activity, percentages which were similar to those at a previous assessment at the 5th year. Urgency urinary incontinence was reported by 18 women (42.9%), 16 of whom required the use of anticholinergic drugs. Nineteen women had undergone some form of surgical pelvic reconstruction concomitantly with the TOT procedure, four of whom presented with relapse. The QoL tests indicated that cure and improvement persisted in 85.7% (n = 36, Urogenital Distress Inventory-6) and 92.9% (n = 39, Incontinence Impact Questionnaire-7) of the 42 evaluable women, respectively. Rates of objective and subjective effectiveness remained stable after 10 years of surgery and QoL did not deteriorate significantly during that interval. The increase in urgency incontinence needs to be further investigated.

Analysis of cough detection index based on decision tree and support vector machine

In clinical medicine, cough is a common disease. Years of cough diagnosis have been collected from a large number of patients as test data. Using these test data, it is possible to find the hidden rules inside these data, which can improve the diagnosis accuracy of cough. In recent years, these related problems have been concerned by the relevant medical staff. From the known medical data, medical data mining and processing can extract knowledge, and summarize the experiences of medical experts. This technology is becoming more and more important in the medical information field. In this paper, cough test attributes ,such as peak expiratory flow and fractional exhaled nitric oxide (FENO), are modeled by decision tree and support vector machine. The experimental results show that FENO and percentage of eosinophils have a great effect on the diagnosis of cough, which are important attributes for cough diagnosis.

Anatomical and Functional Results of Pelvic Organ Prolapse Mesh Repair: A Prospective Study of 105 Cases

Objective: We assess the anatomical and functional results of pelvic organ prolapse (POP) repair with application of transvaginal synthetic meshes. Keywords: pelvic organ prolapse, vaginal repair, urogynecology. Methods: We analyzed a cohort of 105 women who underwent transvaginal pelvic floor repair using mesh (Elevate Prolapse Repair System). A gynecological examination, cough test, uroflowmetry and an administration of the overactive bladder Awareness Tool were done. Parametric and nonparametric methods of descriptive statistics, as well as logistic regression were used for data analysis. Results: Prolapse recurrence after vaginal repair was noted in 3.81% (n=4) of patients. The proportion of patients with de novo onset of incontinence after surgery was 8.57% (n=9). In 26.7% (n=28) of women with stress urinary incontinence (SUI), SUI symptoms persisted after surgery. The mean Qmax in the patient group was 19.5 ml/s. The mean Qmax in patients reporting bladder-emptying problems was 14 ml/s, and the mean post-void residual (PVR) was 50±15.0 ml. After surgery, the mean Qmax increased to 27.6 ml/s. The PVR after surgery decreased to 30±5.0 ml. The number of patients with bladder outlet obstruction symptoms decreased to 17 (16.19%). Conclusion: The management of genital prolapse with synthetic prostheses interposed through vaginal approach is an efficient method with good midterm outcomes.

Inkontinensia Urin Pascapersalinan dan Faktor-Faktor Risiko yang Memengaruhinya

Postpartum urinary incontinence is an important and often overlooked form of maternal morbidity. The aim of thisstudy is to obtain prevalence of postpartum urinary incontinence and its influential risk factors. This is an observationalstudy. The subjects were all primipara stayed in Obstetric &amp; Gynecology of Arifin Achmad Pekanbaru – Riau hospital,between July 1st and December 31st 2014. The data of risk factors (demographic and obstetric) was obtained frommedical records and cough test was done too. The data was analyzed with computerized statistic data analysis 12 (Stata 12 ). The distribution of data were analyzed with descriptive univariate and presented in (n) and (%). Bivariateanalysis was done to see any influential risk factors to postpartum urinary incontinence event. The prevalence ofurinary incontinence in this study was 30% and the influential risk factors were BMI, body weight changing duringpregnancy, delivery mode, birthweight and length of second stage.

The long-term effectiveness analysis of retropubic and transobturator tension-free vaginal tape in the treatment of female stress urinary incontinence

Objective To compare the long-term outcomes of the retropubic tension-free vaginal tape (TVT) versus the transobturator tension-free vaginal tape (TVT-O) for women with stress urinary incontinence (SUI). Methods From July 2001 to June 2011, data of 120 female patients with SUI were retrospectively reviewed, of which 45 patients received TVT treatment, while 75 patients received TVT-O. The median age in TVT group was 45.1 years (range 35-72 years), and the median age in TVT-O group was 50.5 years (range 39-76 years). We retrospectively analyzed the long-term subjective effect, objective effect and the rate of complications in the two groups. Results Median follow-up period was 121 months (range 72-192 months). The complete satisfaction rate was 89%(40/45) in TVT group, and 92%(69/75) in TVT-O group, with no statistical difference between the two groups. The negative rate of cough test was 84.4%(38/45) in TVT group, and 76.0%(57/75)in TVT-O group, with a statistically significant difference. The rate of urinary tract injury was 8.9% (4/45)in TVT group, and 4.0%(3/75) in TVT-O group. The rate of thigh pain was 0 in TVT group, and 6.7%(3/45) in TVT-O group. The rate of micturition frequency and urinary incomplete emptying after operations was 6.7%(5/75) in TVT group, and 5.3%(4/75) in TVT-O group. Conclusions The long-term subjective effect between TVT and TVT-O groups was similar. The objective effect in TVT group was better. There was no statistical difference in complication rate between the two groups, which showed different types of complications in different procedures. Key words: Stress urinary incontinence(SUI); Tension-free vaginal tape(TVT); Transobturator vaginal tape(TVT-O); Long-term effect

Improving Male Sling Selectivity and Outcomes—A Potential Role for Physical Demonstration of Stress Urinary Incontinence Severity?

IntroductionWe reviewed our 9-year experience with AdVance™ Male Sling System cases to determine clinical features associated with treatment success and to refine procedure selectivity. We hypothesized that preoperative physical demonstration of stress urinary incontinence by the standing cough test improves patient selection for male sling surgery. MethodsRetrospective review of primary AdVance sling surgeries between 2008 and 2016 was performed. Patients without standing cough test results were excluded from study. Success was defined as 1 pad per day or less postoperatively and no further intervention. Standing cough test was performed during preoperative consultation and objectively graded using the MSIGS (Male Stress Incontinence Grading Scale). ResultsOf the 203 male patients who underwent sling placement 80 (39%) experienced treatment failure during a median followup of 63.5 months. From 2008 to 2016 the proportion of AdVance slings performed as a surgical treatment modality for stress urinary incontinence decreased from 66% to 13%. Increasing selectivity correlated with greater treatment success. Success was greater among men using 2 pads per day or less preoperatively (77% vs 36%, p <0.0001), having physical findings of mild stress urinary incontinence (MSIGS grade 0-2 on standing cough test, 67% vs 26%, p <0.0001) and without a history of radiation (64% vs 41%, p=0.02). In combination, men without prior radiation with mild stress urinary incontinence and favorable standing cough test were “ideal patients” with an 81% success rate. Incremental increases in pad per day use (OR 1.8 per pad, p <0.0001) and MSIGS grade (OR 1.7 per grade, p=0.005) were independently associated with treatment failure. ConclusionsIncreasing selectivity has improved sling outcomes for men with stress urinary incontinence. Ideal sling candidates have not received radiation therapy, and have history and physical findings suggestive of mild stress urinary incontinence.