Female Incontinence Surgery Research Articles

The completeness and accuracy of the Norwegian Female Incontinence Registry.

Medical quality registries have gained popularity as tools for monitoring the quality of medical treatments and they serve as data sources for research. The Norwegian Female Incontinence Registry (NFIR) was established in 1998 to monitor and improve the quality of surgery for women with stress and mixed urinary incontinence in Norway and to collect data for research. This study aimed to assess the completeness and accuracy of the Norwegian Female Incontinence Registry, and potential differences in data accuracy over time and according to surgical volume of the reporting hospitals. A random selection of 300 women from a total of 20610 operated for urinary incontinence between 1998 and 2016 reported to the Norwegian Female Incontinence Registry from 28 public hospitals were selected for validation. The database completeness was estimated for 2008-2017 by comparing surgical procedures registered both in the Norwegian Female Incontinence Registry and the Norwegian National Patient Registry. Historical data recorded in the Registry for 10 selected key variables were extracted and compared with the patients' individual medical records at the reporting hospitals as reference. The reviewers were blinded to the previously stored information. The intraclass correlation coefficient for continuous variables and Cohen's kappa for categorical variables were calculated. Primary source data on 285 of the 300 women selected from Norwegian Female Incontinence Registry were successfully retrieved. The completeness of the registry has increased from 61% in 2008 to 99% in 2017. The national coverage has increased from 12 reporting departments in 1998 to all 38 public departments performing female incontinence surgery in 2017. Excellent accuracy was found for both continuous variables (intraclass correlation coefficient >0.94) and categorical variables (Cohen's kappa >0.86). No differences in data accuracy were found comparing high-volume hospitals with low-volume hospitals, or when comparing data accuracy over time. The Norwegian Female Incontinence Registry is a reliable tool for quality assessment of incontinence surgery and research. The registry completeness has improved over time and now contains data on nearly all women undergoing incontinence surgery in Norway.

PD64-10 LONG TERM OUTCOME FOLLOWING BLADDER NECK ARTIFICIAL URINARY SPHINCTER IMPLANTATION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction II1 Apr 2017PD64-10 LONG TERM OUTCOME FOLLOWING BLADDER NECK ARTIFICIAL URINARY SPHINCTER IMPLANTATION Simon Bugeja, Stella Ivaz, Stacey Frost, Mariya Dragova, Daniela E Andrich, and Anthony R Mundy Simon BugejaSimon Bugeja More articles by this author , Stella IvazStella Ivaz More articles by this author , Stacey FrostStacey Frost More articles by this author , Mariya DragovaMariya Dragova More articles by this author , Daniela E AndrichDaniela E Andrich More articles by this author , and Anthony R MundyAnthony R Mundy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2947AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Implantation of the artificial urinary sphincter (AUS) around the bladder neck (or prostate in men) remains the goldstandard treatment for women with refractory sphincter weakness incontinence (SWI) or patients with neuropathic pathology. This study evaluates long-term outcomes of the AMS800 device in this patient population. METHODS Over a 20 year period (January 1995 - December 2014), 140 bladder neck (BN) AUS were implanted in 111 patients (mean age 39.1 years) by a single surgeon. Aetiology of incontinence: Spina bifida n=53, neuropathic (other) n=15, failed female incontinence surgery n=22, pelvic fracture n=18, extrophy/epispadias n=15, following undiversion cystoplasty n=6, other n=4. 73 were primary procedures, 18 revision after previous infection/erosion and 49 replacement for malfunction. Mean follow-up was 112.8 months (range 12.4 - 243.7 months). RESULTS 55 of 140 (39.3%) devices were explanted at a mean of 39.1 months; 26 for erosion (50.4 months), 22 for malfunction (65.1 months), 7 for infection (1.5 months). 30 of 73 (41.1%) primary, 8 of 18 (44.4%) revision and 17 of 49 (34.7%) replacement implants were explanted. 118 devices were implanted in a single stage (n=51, 43.2% explanted) while 22 were done as a staged procedure (n=4, 18.2% explanted). In 68 cases patients performed self catheterisation (ISC) with the device explanted in 25 (37.3%) compared to 30 of 72 (41.4%) with no ISC. Interestingly, with ISC there was a much lower rate of erosion then no ISC (10% vs 26%) but a much higher malfunction rate (24% vs 8%). Cystoplasty was present in 67 cases of which 26 (38.8%) were explanted compared to 73 with no cystoplasty in which 31 (42.3%) were explanted. 85 devices (66.6%) remain in situ (42 primary, 10 revision, 33 replacement). 78 (91.8%) are keeping their users continent and happy with the outcome of their surgery. 2 of these, done as a staged procedure, are continent with only the cuff in situ. The other 7 are incontinent due to failure of the surgery or de novo detrusor overactivity. CONCLUSIONS Apart from being more surgically challenging, implantation of a bladder neck AUS is associated with excellent functional outcomes albeit with a significantly higher explantation rate when compared to bulbar AUS. Contrary to what we have previously demonstrated with bulbar AUS, we have hereby shown no difference in explantation rate between primary and non-primary bladder neck AUS. The overall explantation rate is no difference whether a cystoplasty is present or not or whether patients performing ISC. ISC is nonetheless associated with a significantly higher rate of device malfunction. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1264 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Simon Bugeja More articles by this author Stella Ivaz More articles by this author Stacey Frost More articles by this author Mariya Dragova More articles by this author Daniela E Andrich More articles by this author Anthony R Mundy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Female incontinence surgery: state of the art

Female urinary incontinence represents a medical and social problem with huge impact regarding both patient's quality of life and social costs. The diagnosis is important for therapeutic choice and should consider some factors: the degree of urethral mobility, urodynamics parameters, patient's will and expectations, information about surgical complications and risks. Nowadays suburethral sling evolution and bulking therapy for selected cases consent to perform miniinvasive surgery; the most relevant problem concerns the management of postoperative complications: in this sense autologous slings are used after urethrolisis. In most difficult cases, it is possible to consider artificial sphincter as the best option.

Arthrites septiques spontanées à streptocoques de la symphyse pubienne

Septic arthritis of the pubic symphysis is uncommon, and usually occurs in patients with predisposing conditions (female incontinence surgery, sports). Staphylococcus aureus and Pseudomonas aeruginosa are the main bacteria responsible of these infections. Streptococcal infections of the pubic symphysis are uncommon. We report three cases of streptococcal infections of the pubic symphysis that occurred in the absence of predisposing condition such as surgery or endocarditis. The diagnosis of septic arthritis was difficult, particularly in one patient who underwent an orchidopexy for a suspected of spermatic cord torsion before diagnosis was corrected. All three patients had a favourable outcome after an antibiotic treatment combining amoxicillin and rifampicin. Septic arthritis of the pubic symphysis should be suspected in patients with sudden groin pain, pubic tenderness and fever to avoid traumatic treatments and useless investigations.

Klinische Behandlungspfade

Clinical pathways are directions for standardised treatment processes for different diseases or procedures in a hospital. These pathways are developed within a team of several professions and are used as order and procedure sheets. Experiences with this element of quality management are limited in Germany. The development and the implementation process of 15 pathways in a urological department are described. A clinical pathway for female incontinence surgery (suburethral tape) is presented as an example. The effects of the pathways are evaluated on a routine basis. Seventy-two percent of the patients were treated according to a clinical pathway. The advantages of clinical pathways are a better structuring and transparency of medical processes, a reduction of documentation, improvements in medical education and savings in time, hospital stay of the patients and costs. Expenses for pharmaceuticals were significantly reduced in connection with development of the pathways. The implementation of clinical pathways is a complex but rewarding project. It can be expected that clinical pathways will be rapidly distributed in the near future and that they will contribute to improvements of health care quality.

Sling procedures for urinary incontinence in women.

There are many different techniques of sling surgery for female incontinence and numerous materials are available for use as a suburethral sling. Autologous materials are associated with more success and fewer complications than cadaveric material. The objectives of this review are to identity the benefits and adverse effects of suburethral sling procedures. There is no evidence that suburethral slings are better or worse than other surgical or conservative management because no trials have addressed this comparison.

Septic arthritis of the pubic symphysis: review of 100 cases.

We report a novel case of septic arthritis of the symphysis pubis due to Streptococcus pneumoniae and review 99 previously reported cases of infection of this joint. Typical features of pubic symphysis infection included fever (74%), pubic pain (68%), painful or waddling gait (59%), pain with hip motion (45%), and groin pain (41%). Risk factors included female incontinence surgery (24%); sports, especially soccer (19%); pelvic malignancy (17%); and intravenous drug use (15%). Septic arthritis of the pubic symphysis is often misdiagnosed as osteitis pubis, a sterile inflammatory condition. Causative organisms differed according to risk factors. Staphylococcus aureus was the major cause among athletes, Pseudomonas aeruginosa among intravenous drug users, and infections among patients with pelvic malignancies were usually polymicrobial, involving fecal flora. Patients with recent urinary incontinence surgery usually had monomicrobial infection, with no predominant pathogen. Since osteomyelitis is present in 97% of patients, we recommend antibiotic courses of 6 weeks' duration. Surgical debridement is required in 55% of patients.

Vaginal Granulation Tissue Secondary to Bone Anchors: Experience in Two Patients

Bone anchors have been used for the last decade in surgery for stress incontinence to create a “stable fixation point.” Relative risks and benefits of bone anchors have been debated, as significant complications, although rare, can occur. 1–3 Complications related to bone anchors used in female incontinence surgery can be difficult to recognize, resulting in delayed diagnosis. Bone anchor removal can be difficult. We report 2 cases of vaginal granulation tissue involving transvaginally placed bone anchors, and our experience with extraction. CASE REPORTS Case 1. A 60-year-old woman was referred with a 2-year history of vaginal discharge and persistent granulation tissue after transvaginal bone anchored ProteGen (Microvasive Urology, Natick, Massachusetts) sling. The patient had a 3 4 cm. excrescence of friable tissue arising from the right vaginal fornix (fig. 1). She had undergone removal of the sling and 3 excisions of recurrent granulation tissue. On exploration through an inverted U-shaped anterior vaginal incision granulation tissue was encountered to the level of the bone anchor. The anchor and a tiny piece of remnant sling material were visualized. To gain access to the anchor, the endopelvic fascia was perforated. The anchor was then grasped with a rongeur, which was used to remove the anchor and a small piece of surrounding portion of bone. All granulation tissue and a portion of the vaginal flap were also excised. Three weeks postoperatively bloody vaginal drainage and fever developed. Computerized tomography revealed a 5 10 cm. pelvic abscess. An infected hematoma was drained by taking down the previous flap. A small Foley catheter was

Experimental Evaluation of Free Versus Pedicled Fascial Flaps for Sling Surgery of Urinary Stress Incontinence

Bladder neck suspension using an autologous fascial sling is an established surgical technique for treatment of urinary stress incontinence. However, the biological fate and physical properties of autologous fascial sling yet remain to be determined. Our study was designed to evaluate in an animal model of twenty rabbits fascial slings from free and pedicled fascial flaps of two different widths (7 mm and 15 mm.) and uniform length (60 mm.) in respect to changes of length, width, tensile strength and histological criteria of vitality and integrity 3 months after surgery. The results 3 months after surgery revealed shrinkage in length by 37% (31%-46%) of the original length, shrinkage in width by 63% (60%-69%) of the original width and reduction of tensile strength of 53% (51%-55%) without consistent differences between free and pedicled flaps or 7 mm. and 15 mm. wide flaps. In the groups with 7 mm. wide flaps a total of two dystrophic slings (1 pedicled, 1 free) were seen; however, no dystrophies were seen in 15 mm. wide flaps. On microscopy, all slings were vital regardless of their surgical configuration. In summary, on macroscopic, microscopic and physical examination no gross differences between free and pedicled slings could be detected, so that preferences for use of free or pedicled fascial flaps could not be established for clinical applications in sling surgery. However, 15 mm. wide flaps had a lower incidence of dystrophy and retained greater absolute tensile strength than 7 mm. wide flaps.

Prevalence and outcome of surgery for female incontinence

A 4.7 percent surgery rate to correct urine loss conditions was found by a large scale survey of sixty-year and older non-institutionalized women in a Michigan county. The initial postoperative results reported by the respondents were 74 percent complete continence and 23 percent partial relief. The long-term self-reported outcomes (two years or more post-surgery) were an absolute continence rate of 39 percent and 17 percent with mild incontinence (the median time since surgery was 12 years), whereas the short term (4–23 months, mean 7.1 months) absolute continence rate was 71 percent. The characteristics of the incontinence respondent who had previous surgery showed 70 percent having mixed stress-urge type of incontinence and 66 percent losing urine almost weekly or daily. Bladder emptying symptoms were reported by 30.4 percent of the continent previously-operated respondents compared with 13.0 percent of the incontinent previously-operated respondents. All continent respondents and 84 percent of the incontinent respondents believed that physicians can help people with a urine loss condition.

Surgery of female incontinence. Second edition. Stuart L. Stanton and Emil A. Tanagho. 275 × 195 mm. Pp. 285+xxii. Illustrated. 1986. London: Springer-Verlag. $47.00

Surgery of female incontinence. Second edition. Stuart L. Stanton and Emil A. Tanagho. 275 × 195 mm. Pp. 285+xxii. Illustrated. 1986. London: Springer-Verlag. $47.00 Get access Surgery of Female Incontinence. Second edition. Stuart LStanton and Emil ATanagho. 275 × 195 mm. Pp. 285+xxii. Illustrated. 1986. London: Springer-Verlag. $47.00. N W Harrisons N W Harrisons Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 73, Issue 11, November 1986, Page 945, https://doi.org/10.1002/bjs.1800731158 Published: 08 December 2005

Book Reviews

British Journal of UrologyVolume 54, Issue 2 p. 199-199 Book Reviews First published: April 1982 https://doi.org/10.1111/j.1464-410X.1982.tb13556.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Abstract Book reviewed in this article: Surgery of Female Incontinence. Edited by S. L. Stanton and E. A. Tanagho. Current Trends in Urology, Volume 1. Edited by M. I. Resnick. Bladder Cancer-Principles of Combination Therapy. Edited by R. T. D. Oliver, W. F. Hendry and H. J. G. Bloom. Volume54, Issue2April 1982Pages 199-199 RelatedInformation

BOOK REVIEWS

Book Reviews in this article Surgery of Female Incontinence. Edited by Stuart L. Stanton and Emil A. Tabagho.

Book Review: Surgery of Female Incontinence

Book Review: Surgery of Female Incontinence