De-novo Stress Urinary Incontinence Research Articles

Persistent and De Novo Stress Urinary Incontinence After Minimally Invasive Sacrocolpopexy.

Data on stress urinary incontinence (SUI) after minimally invasive sacrocolpopexy (SCP) with or without midurethral sling placement are limited. The aim of the study was to determine the incidence of SUI after minimally invasive sacrocolpopexy. This was a secondary analysis of 2 randomized clinical trials of participants undergoing SCP. Participants completed symptom assessment and urodynamic testing. Participants underwent SCP with or without midurethral sling placement. Preoperatively, participants were defined as having symptomatic SUI, occult SUI, or no SUI. Participants completed the Pelvic Floor Distress Inventory-20 at 6 and 12 months postoperatively and were categorized as having persistent SUI in the setting of symptomatic or occult SUI or de novo SUI. Eighty-one participants were included. Sixty-one participants met inclusion criteria for the persistent SUI analysis: 42 participants with symptomatic SUI and 19 participants with occult SUI. There were 20 participants in the de novo SUI group. The overall incidence of persistent SUI was 26.2% (95% confidence interval [CI], 15.8%-39.1%) with 33.3% (95% CI, 19.6%-49.6%) of symptomatic and 10.5% (95% CI, 1.5%-33.1%) of occult participants. Bothersome symptoms were defined as "moderately" or "quite a bit" bothered postoperatively. Of participants with symptomatic SUI, 14.3% participants were bothered and no participants underwent retreatment. No patient with occult SUI was bothered; however, 1 patient underwent retreatment. The incidence of de novo SUI was 45% (95% CI, 23.1%-68.5%). No patient in the de novo SUI group was bothered or underwent SUI treatment. Approximately 1 in 4 participants reported persistent SUI. Almost 50% reported de novo SUI. However, few participants were bothered or underwent treatment.

MP22-07 OUTCOMES OF DORSAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY IN PATIENTS WITH POST-PROSTATECTOMY, POST-RADIATION ANASTOMOTIC CONTRACTURE

You have accessJournal of UrologyCME1 May 2022MP22-07 OUTCOMES OF DORSAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY IN PATIENTS WITH POST-PROSTATECTOMY, POST-RADIATION ANASTOMOTIC CONTRACTURE Joshua Sterling, Alex Wang, Kelly Crane, Javier C. Angulo, Wagner Franca, Brian Flynn, Francisco Martins, Erick A. Ramirez, Paul Rusilko, Jay Simhan, Daniel Swerdloff, and Dmitriy Nikolavsky Joshua SterlingJoshua Sterling More articles by this author , Alex WangAlex Wang More articles by this author , Kelly CraneKelly Crane More articles by this author , Javier C. AnguloJavier C. Angulo More articles by this author , Wagner FrancaWagner Franca More articles by this author , Brian FlynnBrian Flynn More articles by this author , Francisco MartinsFrancisco Martins More articles by this author , Erick A. RamirezErick A. Ramirez More articles by this author , Paul RusilkoPaul Rusilko More articles by this author , Jay SimhanJay Simhan More articles by this author , Daniel SwerdloffDaniel Swerdloff More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment of patients with vesicourethral anastomotic contracture (VUAS) /membranous stenosis (Sp) following a combination of prostatectomy and radiation treatment for prostate cancer (CaP) are understudied. We evaluate feasibility of dorsal onlay buccal mucosal graft urethroplasty (D-BMGU) and evaluate patency and continence outcomes in patients with a history of prior radical prostatectomy and radiation therapy. METHODS: Retrospective multi-institutional review of patients with post-prostatectomy, post-radiation VUAS/Sp from 8 institutions between 2013-2021 was performed. Patients with at least 8-months follow-up were assessed. Patient demographics, stenosis characteristics, peri-operative outcomes, and post-operative clinical and patient-reported outcomes were analyzed. The primary outcomes were recurrence and development of de-novo stress urinary incontinence (SUI). Secondary outcomes were surgical complications, changes in voiding and patient-reported satisfaction using a Global Response Assessment (GRA). RESULTS: Of 48 patients treated with D-BMGU for stenosis following prostatectomy and radiation, 38 met the inclusion criteria. Median age and stenosis length were 68.5 years, (IQR 63.25-72), and 2.75 cm (IQR 2-4 cm), respectively. Prior CaP treatment modalities included primary robotic prostatectomy and subsequent salvage or adjuvant radiotherapy in 89% (34/38) and primary radiation and salvage prostatectomy in 11% (4/38). The mean length of stay after D-BMGU was 1.5 days (IQR 1-2). At a median follow-up of 21 months (IQR 13-39), 5 patients (13%) had recurrence. Among 11 preoperatively-continent patients (31%) all retained continence. Of 20 patients with preoperative SUI (52%), all but one (95%) remained incontinent post-operatively. Continence was unknown for 7 patients and 3 had post operative incontinence. 47% (17/36) of the cohort subsequently received an artificial urinary sphincter. Patients experienced significant improvement in PVR (158 to 47 cc, p <0.001) and Uroflow (6.3 to 15.4 cc/s, p <0.001), and also reported high overall satisfaction, with 84% reporting a GRA of +2 or better. CONCLUSIONS: Dorsal onlay buccal mucosa graft urethroplasty is a safe and feasible technique in patients with post-radiation post prostatectomy anastomotic contracture. Although our findings suggest the DBMGU technique may confer lower rates of de-novo SUI compared to conventional urethral transection, head-to-head comparisons are needed to further characterize any continence benefit. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e374 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Sterling More articles by this author Alex Wang More articles by this author Kelly Crane More articles by this author Javier C. Angulo More articles by this author Wagner Franca More articles by this author Brian Flynn More articles by this author Francisco Martins More articles by this author Erick A. Ramirez More articles by this author Paul Rusilko More articles by this author Jay Simhan More articles by this author Daniel Swerdloff More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement PDF DownloadLoading ...

YV-plasty in the treatment of patients with recurrent bladder neck stenosis

Introduction. Bladder neck stenosis (BNS) is a late complication of surgical treatment for benign prostatic hyperplasia. Available methods of endoscopic correction in primary BNS have limited effectiveness, while in recurrent cases their use does not lead to satisfactory results at all. YV-plasty of the bladder neck (BN) is one of the available methods of treatment for recurrent BNS.Purpose of the study. To evaluate the treatment results of patients with recurrent BNS using endovideoscopic YV-plasty of the BN.Materials and methods. We retrospectively analyzed the treatment results of 8 patients with recurrent BNS who underwent endovideoscopic YV-plasty of the BN in the Urology Division No.1 of the St. Luke St. Petersburg Clinical Hospital from 2019 to 2021.Results. Endovideoscopic YV-plasty of the bladder neck was successfully performed in all 8 patients. The mean preoperative Qmax was 3.7 ml/s (1.8 – 5.7). At 6 months after surgery, the mean Qmax was 21.4 mL/s (16.7 – 24.1). The mean preoperative I-PSS score was 20.5 (17 – 24). The mean I-PSS score 6 months after surgery was 7.1 (5.0 – 9.0). No cases of de-novo stress urinary incontinence were registered.Conclusions. Endovideoscopic YV-plasty of the BN may be an effective and safe method of treatment of patients with recurrent BNS. However, further studies are needed to obtain long-term results.

Success of Concomitant Versus Interval Slings for Prevention and Treatment of Bothersome de Novo Stress Urinary Incontinence.

Despite large trials designed to guide management on whether to perform a prophylactic continence procedure at the time of pelvic organ prolapse (POP) repair, it remains unclear if a staged or interval approach confers advantages in treatment of bothersome stress urinary incontinence (SUI) in women without bothersome SUI before their POP repair. The objective of this study was to compare success of concomitant versus interval slings for the prevention/treatment of de novo bothersome SUI after POP repair. This multicenter retrospective cohort with prospective follow-up enrolled women with minimal or no SUI symptoms who underwent minimally invasive apical surgery for stage 2 or higher POP between 2011 and 2018 and had a concomitant sling placed at the time of POP surgery or an interval sling placed. Prospectively, all patients were administered the Urogenital Distress Inventory Short-Form 6, the Patient Global Impression of Improvement, and questions on reoperation/retreatment and complications. A total of 120 patients had concomitant slings, and 60 had interval slings. There were no differences in the proportion of patients who had intrinsic sphincter deficiency (22% vs 20%), although the concomitant sling group was more likely to have a positive cough stress test result (30% vs 8%, P = 0.006). The interval sling group was more likely to report "yes" to SUI symptoms on Urogenital Distress Inventory Short-Form 6 (3% vs 30%, P = 0.0006) and during their postoperative visit (0% vs 24%, P < 0.0001). There were no differences in surgical complications. Among women with minimal or no SUI symptoms undergoing prolapse repair, concomitant slings resulted in lower rates of bothersome SUI compared with similar women undergoing interval sling placement.

EDITORIAL COMMENTS

We commend the authors for completion of this systematic review evaluating the efficacy of urethroplasty and rates of stress urinary incontinence (SUI) during the repair of radiation-induced urethral stenosis (RIUS). Until recently, only few surgeons reported surgical success rates with such repairs, as only 246 patients in the present series met inclusion criteria over a near 4 decade time period! Nevertheless, the authors report the rate of stenosis resolution at 80% and that 20% of patients developed de-novo SUI.

Anatomical and functional outcomes of uterus preservation and pelvic organ prolapse repair with vaginal trocar-less mesh kit (Endofast): A retrospective study of 239 patients

ObjectiveThe aim of the study was to assess safety and long term efficacy as well as short and long term complications of vaginal prolapse mesh repair using single incision trocar-less system while preserving the uterus. Study DesignA single-center, retrospective cohort study including all patients who underwent vaginal prolapse mesh repaier surgery with EndoFast Reliant™ kit between October 2010 and January 2015. Outcomes included anatomical changes (POP-Q), overactive bladder symptoms (OAB) stress urinary incontinence (SUI), sexual function and constipation as well as the rate of surgical failure, immediate and long-term complications. Results239 women, with an average follow-up period of 1.7 years (range: 6 weeks to 7 years), were included. Uterus was preserved in 87 % of patients (184 out of 211 patients with intact uterus) and concurrent surgery for SUI was performed in 46 %. POP-Q significantly improved as well as OAB and SUI symptoms and remained without significant change during follow-up period. In 11 patients (4.6 %) a new/recurrent prolapse was observed during the follow up period.Immediate complications occurred in 4 patients. One case of bladder perforation, one case of mesh contamination, 2 cases of urinary retention, one of them permanent. Late complications included mesh erosion, de novo dyspareunia, cervical elongation and de-novo SUI, and were observed in 38 cases (16 %). Surgical intervention was required in 20 (8.4 %) cases; 10 cases of de-novo SUI, 2 cases of partial mesh removal because of dyspareunia, 1 case of mid urethral sling removal because of erosion and 7 cases of cervical amputation. ConclusionsRepair of prolapse with vaginal trocar-less mesh kit while preserving the uterus for the majoroty of women, is a relatively safe and effective surgery,with a low incidence of complications and re-operation rate which was mainly for de novo SUI or elongation of cervix. Randomiesed prospective long term studies are neaded to establish the results.

Resident Involvement in Laparoscopic Sacrocolpopexy: A Review of Operative Times and Surgical Outcomes

Study Objective To evaluate laparoscopic sacrocolpopexy operative times, complication rates and long-term surgical outcomes at one academic institution with significant trainee involvement. Design This is a retrospective chart review of laparoscopic sacrocolpopexy cases. Setting Cases took place in an operating room at a large academic medical center. Patients were in dorsal lithotomy position with five abdominal laparoscopic trocar sites. Patients or Participants A series of 181 consecutive laparoscopic sacrocolpopexy cases (with or without concomitant procedures) were examined between February 2014 and August 2019. Interventions None. Measurements and Main Results Descriptive statistics were used to compare primary outcomes with published literature. The average operative time was 139.9 minutes, compared to 180-190 minutes noted in other studies. Four cases of intraoperative cystotomy (2.2%) and one enterotomy (0.6%) were noted compared to 5-6% and 1.4% respectively in the literature (Sheyn et al 2019). There were 16 cases of postoperative urinary tract infection (8.8%). At their most recent postoperative visit, which occurred on average at postoperative day 278, recurrent prolapse was noted in 11.7% of patients and 3.9% of those patients underwent a subsequent repair to correct their prolapse. Other complications included 0.6% small bowel obstruction, 1.1% mesh erosion and 7.7% de-novo stress urinary incontinence; all of these were less than those documented in the literature. The overall complication rate was 15.4% compared to 18% in the literature (Nosti et al 2014). Conclusion This institutional demonstrates short operative times, low complication rates and favorable outcomes with resident involvement in laparoscopic sacrocolpopexy. This indicates advanced urogynecology procedures can be performed with significant resident involvement without compromising operative time and surgical outcomes.

A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis

To critically evaluate a multi-institutional patient cohort undergoing Dorsal-Onlay Buccal Mucosal Graft Urethroplasty (D-BMGU) for recurrent post-radiation posterior urethral stenosis. Retrospective multi-institutional review of patients with posterior urethral stenosis from 10 institutions between 2010-2019 was performed. Patients with at least 1-year follow-up were assessed. Patient demographics, stenosis characteristics, peri-operative outcomes, and post-operative clinical and patient-reported outcomes were analyzed. The primary outcomes were stenosis recurrence and de-novo stress urinary incontinence (SUI). Secondary outcomes were changes in voiding, sexual function, and patient-reported satisfaction. Seventy-nine men with post-radiation urethral stenosis treated with D-BMGU met inclusion criteria. Median age and stenosis length were 72years, (IQR 66-75), and 3.0cm (IQR 2.5-4cm), respectively. Radiation modalities included: 36 (45.6%) external beam radiotherapy (EBRT), 13 (16.5%) brachytherapy (BT), 10 (12.7%) combination EBRT/BT, and 20 (25.3%) EBRT/radical prostatectomy. At a median follow-up of 21months (IQR 13-40), 14 patients (17.7%) had stenosis recurrence. Among 37 preoperatively-continent patients, 3 men (8.1%) developed de-novo SUI following dorsal onlay urethroplasty. Of 29 patients with preoperative SUI all but one remained incontinent post-operatively (96.6%). Following repair, patients experienced significant improvement in PVR (92.5 to 26cc, p = 0.001) and Uroflow (4.6 to 15.9cc/s, p = 0.001), and high overall satisfaction, with 91.9% reporting a GRA of + 2 or better). Dorsal onlay buccal mucosa graft urethroplasty is a safe and feasible technique in patients with post-radiation posterior urethral stenosis. This non-transecting approach may confer low rates of de-novo SUI. Further research is needed to compare this technique with excisional urethroplasty.

699 - Pre-operative MRI findings and predictors of De Novo stress urinary incontinence after urethral diverticulum excision

699 - Pre-operative MRI findings and predictors of De Novo stress urinary incontinence after urethral diverticulum excision

015 The Impact of Incontinence Procedures at the Time of Vaginal Vault Suspension on Pelvic Pain and Dyspareunia: A Study of Sexually Active Women with Post Hysterectomy Prolapse

Pelvic organ prolapse is becoming more prevalent and reoperation rate is about thirty percent. Stress urinary incontinence often coexists with apical prolapse. The CARE trial found placement of a prophylactic colposuspension at the time of sacrocolpopexy reduces the rate of de-novo stress urinary incontinence. Though stress urinary incontinence negatively impacts sexual function and self image, some studies have indicated that incontinence procedures worsen self-reported sexual function. Anterior repairs and anterior dissections for suburethral sling procedures area associated with increased risk of pelvic pain; minimally invasive procedures yield the best patient satisfaction with regard to pain.

Concomitant stress urinary incontinence and pelvic organ prolapse surgery: Opportunity or overtreatment?

ObjectivesThe association between pelvic organ prolapse (POP) and stress urinary incontinence (SUI) is very common. When POP surgery is indicated and the patient has concomitant SUI, there are two treatment strategies: the one-step strategy (concomitant correction of POP and SUI) and the two-step strategy (correction of POP with subsequent evaluation of SUI). Guidelines from the International Continence Society and International Consultation on Incontinence recommend that a urodynamic assessment (UA) should be performed before surgery as this can reveal the presence of urodynamic SUI, but the role of UA is the subject of debate as it does not seem to improve treatment decisions. The aim of this study was to identify the presence of pre-operative urodynamic parameters that were predictive of POSUI, and to identify patients who could benefit from concomitant correction of SUI during POP surgery Study designA retrospective evaluation was undertaken of 155 patients with at least second-degree POP who underwent POP surgery after UA between 2009 and 2016 in an Italian gynaecology and obstetrics department. Of these, 61 patients were clinically incontinent before surgery and 94 patients were clinically continent. After UA, patients were stratified using a maximum urethral closure pressure (MUCP) cut-off of 50 cmH2O; the risk of POSUI was calculated using this value. ResultsPOP surgery alone resolved SUI in 60 % of the 61 clinically incontinent patients; only 30 % of these patients had urodynamic SUI and >50 % did not have POSUI. Thirty-six percent of the 94 continent patients had occult SUI on UA and 16 % developed de-novo POSUI. Seventy-five percent of all patients with occult SUI did not develop de-novo SUI. MUCP was lower in patients with POSUI than in patients without POSUI (p=0.013). The probability of POSUI was higher in patients with MUCP ≤50 cmH2O. The number needed to treat (NNT) to prevent one case of POSUI in these patients was 2, compared with an NNT of 4 in the continent group. Eight percent of patients underwent further surgery for SUI. ConclusionsClinically incontinent patients with MUCP ≤50 cmH2O will gain the greatest benefit from concomitant POP and SUI surgery. However, concomitant surgery has more severe adverse events. Given that 62.3 % of patients resolved SUI after POP surgery alone, it is important not to overtreat these women. Clinical pre-operative SUI is the best indicator of POSUI and was found to increase the risk of POSUI (odds ratio 3.2, 95 % confidence interval 1.5–6.8; p=0.003). Despite the small sample size, the two-step strategy appears to result in lower use of mid-urethral slings and a clear reduction in complications. It is important not to focus on the diagnosis of urodynamic SUI in continent patients but to evaluate MUCP carefully.

MP35-18 DORSAL ONLAY URETHROPLASTY FOR RADIATION-INDUCED URETHRAL STENOSIS; A MULTI-INSTITUTIONAL RETROSPECTIVE REVIEW

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP35)1 Apr 2020MP35-18 DORSAL ONLAY URETHROPLASTY FOR RADIATION-INDUCED URETHRAL STENOSIS; A MULTI-INSTITUTIONAL RETROSPECTIVE REVIEW Michael Hughes*, Connor Policastro, Francisco Martins, Jay Simhan, Nicolaas Lumen, Krishnan Venkatesan, Javier Angulo, Shubham Gupta, Paul Rusilko, Erick Alejandro Ramírez Pérez, Alan Quach, Michael Altwell, Kirk Redger, Brian Flynn, Stephen Blakely, and Dmitriy Nikolavsky Michael Hughes*Michael Hughes* More articles by this author , Connor PolicastroConnor Policastro More articles by this author , Francisco MartinsFrancisco Martins More articles by this author , Jay SimhanJay Simhan More articles by this author , Nicolaas LumenNicolaas Lumen More articles by this author , Krishnan VenkatesanKrishnan Venkatesan More articles by this author , Javier AnguloJavier Angulo More articles by this author , Shubham GuptaShubham Gupta More articles by this author , Paul RusilkoPaul Rusilko More articles by this author , Erick Alejandro Ramírez PérezErick Alejandro Ramírez Pérez More articles by this author , Alan QuachAlan Quach More articles by this author , Michael AltwellMichael Altwell More articles by this author , Kirk RedgerKirk Redger More articles by this author , Brian FlynnBrian Flynn More articles by this author , Stephen BlakelyStephen Blakely More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000879.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of recurrent post-radiation urethral stenosis is notoriously difficult due to poorer success rates and the risk of de-novo stress urinary incontinence (SUI) following reconstruction. Although many prior reports describe outcomes of anastomotic or ventral buccal mucosa graft (BMG) augmentation techniques, dorsal onlay BMG urethroplasty (D-BMGU) has not been sufficiently assessed. Here we report patency and continence outcomes following dorsal onlay BMG urethroplasty in a large multi-institutional cohort undergoing treatment of post-radiation urethral stenosis. METHODS: Men with a history of radiotherapy for prostate cancer treatment who underwent D-BMGU for posterior urethral stenosis from 10 institutions between 2010-2019 were reviewed. Patients with a minimum of 8 months follow up were included. Preoperative patient characteristics and continence status were reviewed. Postoperative outcomes including urethroplasty failure, SUI, uroflow, post-void residual volume and PROM questionnaires were analyzed. RESULTS: Of 86 men with post-radiation stenosis treated with D-BMGU, 67 (78%, mean age 69, (range 52-85)) met inclusion criteria with a mean length of stenosis 3.9 cm (1.5-18). Radiation modalities included: 30 (45%) external beam radiotherapy (EBRT), 10 (15%) brachytherapy (BT), 9 (13%) combination EBRT and BT; and 18 EBRT and radical prostatectomy (27%). At a mean follow up of 27 months (8-88), 13 patients (19%) had urethral stenosis recurrence. Of 31 patients who had no SUI prior to surgery, only 2 men (6.4%) developed de-novo SUI following dorsal onlay urethroplasty. All 27 patients (27/67, 40%) with SUI prior to surgery remained incontinent post operatively. Of the remaining 9/67 (13.4%) men whose baseline continence status was unknown, 4/9 (44%) were incontinent post operatively. CONCLUSIONS: With comparable success rates to previously reported techniques, dorsal onlay urethroplasty with BMG is a feasible management option in patients with post-radiation posterior urethral stenosis. This non-transecting approach demonstrates diminished rates of de-novo stress incontinence compared to historically reported rates with excisional urethroplasty. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e519-e520 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Hughes* More articles by this author Connor Policastro More articles by this author Francisco Martins More articles by this author Jay Simhan More articles by this author Nicolaas Lumen More articles by this author Krishnan Venkatesan More articles by this author Javier Angulo More articles by this author Shubham Gupta More articles by this author Paul Rusilko More articles by this author Erick Alejandro Ramírez Pérez More articles by this author Alan Quach More articles by this author Michael Altwell More articles by this author Kirk Redger More articles by this author Brian Flynn More articles by this author Stephen Blakely More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement PDF downloadLoading ...

Three-year follow-up in patients with urinary stress incontinence treated with Altis® single-incision sling.

The purpose of the study is to report three years follow-up of single incision slings for the treatment of stress urinary incontinence (SUI). The main outcomes are to evaluate the efficacy of the device and to assess safety, adverse events, quality of life, demographic features of treated women and prognostic factors for SUI. We performed a retrospective, double-center, single-arm study. Data were collected by medical records and a telephone interview 3 years after the implant of the mini-sling. Complication rate, subjective efficacy and degree of satisfaction were investigated. Fifty-four patients were treated between March 2015 and March 2017, of which 47 answered the survey. Forty-one of 47 procedures (87.2%) were considered effective. Among more relevant complications, there was one case of extrusion of mesh and three cases of new onset of urinary disfunction, of which two cases of urgency urinary incontinence (UUI) and one case of de-novo SUI. Most complications were solved within few days after the procedure. Concerning the subjective impression of improvement, investigated by using the Patient Global Impression of Improvement (PGI-I) questionnaires, 41 patients reported subjective satisfaction, three reported no change in quality of life and three patients had worsening of symptoms. The procedure was safe and effective for the treatment of SUI but more data are needed to confirm our preliminary results.

Evaluation of single-incision apical vaginal suspension for treatment of pelvic organ prolapse

ObjectiveTo present a comprehensive evaluation of anterior/apical and/or posterior prolapse repair systems with a focus on safety and surgical efficacy. MethodsTwo hundred and twenty women with pelvic organ prolapse (POP) stage II–IV were referred for single-incision transvaginal mesh procedures in a single institution. Pre- and postoperative assessments included pelvic examination, urodynamic studies, and personal interviews about patients’ quality of life and urinary symptoms. ResultsThe anatomical success rate was 92.3 % (203/220), regardless of primary or de-novo POP, at 12–38 month follow-up. The POP quantification parameters, except total vaginal length, improved significantly after surgery (p < 0.05). Complications included bladder injury (one case), mesh exposure (six cases) and urinary retention that required intermittent catheterization (five cases). There were no cases of bowel injury during surgery. The results indicated that 29 % of patients had de-novo stress urinary incontinence and 7.7 % of patients had de-novo POP after surgery. ConclusionThe apical vaginal suspension system is a safe and effective procedure, creating good anatomical restoration and significant improvement in quality of life. However, the rate of de-novo POP in the anterior compartment of the vagina (31.8 %) seems high after treatment with apical and posterior prolapse repair systems.

Anchorless implant for the treatment of advanced anterior and apical vaginal prolapse – Medium term follow up

Objectiveto evaluate the mid-term safety and efficacy of a surgical technique using an anchorless implant. Study designThis is a prospective study. Women with symptomatic POP were recruited. The technique involved placement of an open trapezoid-shaped frame which retains a polypropylene mesh stretched within its parameter. No fixation techniques used. Demographic data and pre-operative quality of life (QoL) questionnaires were collected. Peri-operative data were documented. Patients were followed at 2, 6, 12, 24 and 36 months. Follow-up included repeated QoL questionnaires, Pelvic Organ Prolapse- Quantification (POP-Q) measurements and assessment for possible complications. ResultsSeventy women were recruited. Mean age was 63.1 years, mean parity was 4.6 deliveries. Mean pre-operative POP-Q were Ba = 3.1 (-1 to 6) cm and C = 0.4 (-8 to 6) cm. No intra-operative complications were observed. Surgical time averaged 24.7 min. Estimated blood loss averaged 155 cc. Mean follow up at last visit was 27.7 months. Two patients (2.8 %) underwent partial frame resection and two patients (2.8 %) underwent a TVT-O for de-novo stress urinary incontinence (SUI). At follow-up, the mean POP-Q were Ba= -2.8 (-3 to -1) cm and C = -6.8 (-10 to 1) cm. Two patients (2.8 %) had recurrent prolapse. One was symptomatic and received treatment. No mesh erosion or chronic pelvic pain were documented. Pelvic Function Distress Inventory (PFDI20) scores showed significant improvement. Thirty-eight (54 %) patients completed the Pelvic organ prolapse/Urinary Incontinence Sexual Questionnaire (PISQ12) showing no chronic dyspareunia. ConclusionThe Self Retaining Support (SRS) implant provides 97 % subjective and 94.3 % objective cure. Two patients (2.8 %) had the implant’s frame removed surgically. The SRS is a safe and effective treatment for pelvic organ prolapse.

2512 Extra Peritoneal Sling Surgery vs Pectopexy in Nulliparous Prolapse

Video Objective At our center we compared the two methods of conservative operations for nulliparous genital prolapse in young women: sling surgery Vs pectopexy. Setting Tertiary referral centre (Tulip Multispeciality Hospital) it is a retrospective cohort study. Interventions Young Patient with 2nd or 3rd degree prolapse with absent or minimal cystocele/rectocele. We had randomly selected 24 patients who underwent sling surgery & 28 patients whounderwent pectopexy as consecutive surgery. Sling Surgery was performed using TOT mesh which is attached to the post surface of cervix (polypropylene mesh)going intraperitoneally and further attached to anterior rectus sheath extra peritoneally.The procedure is followed by moscowitz repair. Pectopexy was mesh placement on iliopectineal ligaments (Bony attachment) on both sides. Conclusion The long term follow-up showed a clear difference in the complication rates of the two procedures. 3 patients who had undergone sling surgery had skin site infection with pus extruding from the skin site. On exploration there was pelvic infection as a consequence of mesh from pelvis up to skin, which had to be removed. No such complication was seen in pectopexy group. The incidence of denovo stress urinary incontinence and rectocele were similar in both the groups. The apical descensus relapse rates were similar in both the group. Laparoscopic pectopexy is a novel method of vaginal prolapse therapy that offers clear practical advantages compared with laparoscopic sling surgeries with minimally associated complications & equivocal satisfaction rates. At our center we compared the two methods of conservative operations for nulliparous genital prolapse in young women: sling surgery Vs pectopexy. Tertiary referral centre (Tulip Multispeciality Hospital) it is a retrospective cohort study. Young Patient with 2nd or 3rd degree prolapse with absent or minimal cystocele/rectocele. We had randomly selected 24 patients who underwent sling surgery & 28 patients whounderwent pectopexy as consecutive surgery. Sling Surgery was performed using TOT mesh which is attached to the post surface of cervix (polypropylene mesh)going intraperitoneally and further attached to anterior rectus sheath extra peritoneally.The procedure is followed by moscowitz repair. Pectopexy was mesh placement on iliopectineal ligaments (Bony attachment) on both sides. The long term follow-up showed a clear difference in the complication rates of the two procedures. 3 patients who had undergone sling surgery had skin site infection with pus extruding from the skin site. On exploration there was pelvic infection as a consequence of mesh from pelvis up to skin, which had to be removed. No such complication was seen in pectopexy group. The incidence of denovo stress urinary incontinence and rectocele were similar in both the groups. The apical descensus relapse rates were similar in both the group. Laparoscopic pectopexy is a novel method of vaginal prolapse therapy that offers clear practical advantages compared with laparoscopic sling surgeries with minimally associated complications & equivocal satisfaction rates.

Validation of a Model Predicting De Novo Stress Urinary Incontinence in Women Undergoing Pelvic Organ Prolapse Surgery.

To validate a previously developed prediction model for de novo stress urinary incontinence (SUI) after undergoing vaginal surgery for pelvic organ prolapse (POP). Model performance was determined using a cohort of women who participated in two, 14-center randomized trials in the Netherlands that evaluated whether postoperative SUI 1 year after surgery was reduced with or without concomitant midurethral sling at the time of surgery for symptomatic women who had at least stage 2 POP. Age, number of previous vaginal births, urine leakage associated with urgency, history of diabetes, body mass index, preoperative stress test result, and placement of a midurethral sling were used to calculate the predicted probability of an individual developing de novo SUI. Predicted probabilities were compared with outcomes and quantitated using the concordance index and calibration curves. Model accuracy was compared with and without the preoperative stress test, and net reclassification improvement was measured using probability cutoffs of 0.2, 0.3, and 0.4. Of 239 participants who did not report preoperative SUI and underwent surgery, 152 were eligible for analysis with complete baseline and outcome data. Model discrimination was acceptable and consistent with performance in the original development cohort when the preoperative stress test result was included (concordance index 0.63; 95% CI 0.52-0.74) and had lower discrimination than when the stress test variable was not included (concordance index 0.57; 95% CI 0.46-0.67, P=.048). The model that included the stress test variable was most accurate when predicted probabilities of de novo SUI were between 0 and 50%, and it correctly reclassified upward 5.9% (95% CI -14.8 to 26.8) of participants with de novo SUI and correctly reclassified downward 16.9% (95% CI 6.6-27.7) of participants without de novo SUI. On external validation, the model was predictive of de novo SUI after vaginal prolapse surgery and may facilitate decision making regarding concomitant sling placement. Nederlands Trial Register, NTRR 1197 en 1070.

PD02-07 PROPHYLACTIC MIDURETHRAL SLINGS AT THE TIME OF PELVIC ORGAN PROLAPSE REPAIR SURGERY TO PREVENT DE-NOVO STRESS URINARY INCONTINENCE- A NEED TO REAPPRAISE?

INTRODUCTION AND OBJECTIVES:Prophylactic sling placement may prevent de-novo stress urinary incontinence (SUI) in women undergoing pelvic organ prolapse (POP) surgery, however at the potential cost...

Does the Degree of Cystocele Predict De Novo Stress Urinary Incontinence After Prolapse Repair? Further Analysis of the Colpopexy and Urinary Reduction Efforts Trial.

Cystoceles may cause urethral obstruction by altering the vesicourethral angle. Restoration of normal anatomy after pelvic organ prolapse (POP) repair can relieve this obstruction but may unmask stress urinary incontinence (SUI). The association between the severity of cystocele and developing de novo SUI after prolapse repair, however, is poorly understood. We hypothesized that, in women undergoing prolapse repair, increasing degrees of bladder prolapse would be associated with increasing rates of postoperative de novo SUI. We performed a secondary analysis of the Colpopexy and Urinary Reduction Efforts (CARE) trial data. Using the control arm (women undergoing prolapse repair without a prophylactic SUI procedure), we identified de novo SUI using a composite definition based on original trial criteria. We performed logistic regression to evaluate the relationship between the degree of cystocele and the development of new SUI. Of the 164 women who underwent abdominal sacrocolpopexy alone, 54% developed de novo postoperative SUI. Stratifying by the degree of anterior prolapse (point Ba), we found a linear increase in the rate of SUI with worsening preoperative cystocele. The incidence of de novo SUI based on the POP Quantification stage of anterior prolapse was 41.3%, 52.5%, and 66.1%, for stage 2, early stage 3, and advanced stage 3 or stage 4, respectively. Point Ba was found to be significantly associated with de novo SUI on both univariate (odds ratio = 1.17, P = 0.015) and multivariate analysis (odds ratio = 1.16, P = 0.04). The incidence of de novo SUI after prolapse repair directly correlates to the degree of cystocele on preoperative examination. This simple yet novel relationship should further guide discussions about potential postoperative incontinence.

Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, and laparoscopic pectopexy for apical prolapse.

ABSTRACTObjective:To investigate differences in perioperative complications and short-term outcomes of patients who underwent abdominal sacrocolpopexy / sacrohysteropexy, laparoscopic sacrocolpopexy / sacrohysteropexy, or laparoscopic pectopexy due to apical prolapse.Materials and Methods:A retrospective cohort study was performed on 110 patients who underwent apical prolapse surgery between January 1, 2011, and July 31, 2017. Only symptomatic uterine or vaginal vault prolapse patients with stage 2-4, according to the pelvic organ prolapse quantification system, were included. Baseline and intraoperative variables of groups; perioperative complications, including hemorrhage, urinary, and wound complications, blood transfusion, ileus, and short-term outcomes were compared.Results:A total of 68 abdominal sacrocolpopexies (44 sacrocolpopexies and 24 sacrohysteropexies), 14 laparoscopic sacrocolpopexies (10 sacrocolpopexies and 4 sacrohysteropexies), and 28 laparoscopic pectopexies (16 pectopexies and 12 pectohysteropexies) were analyzed. Baseline characteristics and intraoperative variables were similar. However, the mean operating time was significantly shorter in the laparoscopic pectopexy group (74.9 min) when compared with that of the other groups (p < 0.01). During the six-month follow-up period, no prolapse recurrence and mesh erosion / exposure were observed in any group. De-novo stress urinary incontinence, urgency, and defecation problems, as well as perioperative complication rates, were not statistically significantly different between the groups.Conclusions:Although the complication rates and short-term outcomes were not significantly different between the groups, minimally invasive approaches were associated with reduced procedural-related morbidity. Laparoscopic pectopexy is a promising endoscopic prolapse surgery and can be an alternative technique to sacrocolpopexy.