ICIQ Score Research Articles

The International Consultation on Incontinence Questionnaire Short Form as a Substitute for 1-Hour Pad Weight Testing in the Evaluation of Urinary Incontinence in Patients With Pelvic Organ Prolapse Undergoing Surgery.

Stress urinary incontinence is a postoperative complication occurring in patients with pelvic organ prolapse (POP). Although the 1-hour pad test measures the degree of urinary incontinence qualitatively and quantitatively, some elderly women undergoing POP surgery do not have the daily activities of living to perform the pad test. Therefore, we examined whether the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) could be used as an alternative tool for pad tests. We retrospectively evaluated 132 patients with POP. In our hospital, 57 patients were treated by laparoscopic sacrocolpopexy (LSC), whereas 75 were treated by transvaginal mesh surgery (TVM). We measured the changes in symptoms preand postoperatively using the ICIQ-SF and 1-hour pad weight testing, and investigated the correlation between the total plus component question scores of the ICIQ-SF and 1-hour pad weight. The preoperative ICIQ total scores in all patients decreased significantly as the amount of leakage on the 1-hour pad weight decreased. The component question scores also decreased significantly with decreasing levels of 1-hour pad weight. The LSC and TVM groups had decreased ICIQ-SF total and component question scores as pad weight decreased. At 12 months postoperatively, the ICIQ total scores in all patients significantly declined as the amount of leakage on the 1-hour pad weight decreased. In the LSC group, the ICIQ-SF total and component question scores also decreased with decreased pad weight, but the differences were not always significant between ICIQ scores and pad weight. In the TVM group, the ICIQ-SF total and component question scores also significantly decreased as the pad weight decreased. The ICIQ-SF could be an appropriate substitute for the 1-hour pad weight testing in predicting the severity of urinary incontinence. In the future, we hope to predict the level of urine leakage based on the ICIQ-SF score.

Predictor of Surgical Failure Following Transvaginal Mesh Repair Using Minimally Invasive Prolapse System Device (MIPS).

Background: The Minimally Invasive Prolapse System (MIPS) device, a novel single-incision transvaginal mesh, represents recent advancements in mesh technology, providing lightweight, biocompatible support for pelvic organ prolapse while reducing erosion, allowing for customization and improving surgical outcomes. This study aimed to identify factors associated with pelvic organ prolapse (POP) recurrence after transvaginal mesh (TVM) repair using the Minimally Invasive Prolapse System device. Methods: Two hundred and eighteen women with symptomatic stage II to IV POP underwent TVM. Preoperative and postoperative assessments included urinalyses and pelvic examinations using the POP quantification (POP-Q) staging system. Results: During a follow-up period of 12-46 months, 7 of 218 (3.2%) women experienced POP recurrence. Univariate analysis was conducted to identify predictors of surgical failure, revealing no significant differences in body mass index, POP stage, or preoperative urinary symptoms between the recurrence and success groups (p > 0.05). However, functional urethral length <20 mm based on urodynamics (p = 0.011), ICI-Q scores ≥7 (p = 0.012), and the first 60 surgical cases (p = 0.018) were significant predictors of surgical failure. Multivariate logistic regression confirmed these findings. Conclusions: Functional urethral length <20 mm, ICI-Q scores ≥7, and limited surgical experience were significant predictors of TVM failure using the Minimally Invasive Prolapse System kit. POP recurrence after mesh repair is less likely beyond the learning curve.

A Retrospective Study Analyzing the Incidence of Urine Incontinence after Cesarean Section Delivery in Comparison with Vaginal Delivery

Introduction: Urine incontinence is the involuntary leakage of urine. Its actual prevalence is underestimated. There is a general belief that vaginal delivery is a major risk. Elective cesarean delivery is increasing worldwide; one reason is to protect against pelvic floor disorders, including urine incontinence. Previous studies included small samples with controversial results. This study aimed to compare the risk of urine incontinence in women who had cesarean delivery with those who had vaginal delivery. Methods: It was a retrospective study on 1751 women delivered in a university hospital over a 5- year period. Data collected on number of deliveries, age at first and last delivery, mode of each delivery, gestational age, birth weight, indication of cesarean section, induction of labor, episiotomy, perineal tears, smoking, chronic cough, chronic constipation, presence and severity of urine incontinence using ICIQ score. Patients were categorized into 2 groups: all cesarean section deliveries and at least one vaginal delivery. Results: A total of 600 respondents delivered only by cesarean section, and 1151 had at least one vaginal delivery. Urine incontinence prevalence in the cesarean group was 5.8%, and 6.9% in the vaginal group. Age, perineal tear, chronic cough, and chronic constipation were found to be significantly associated with urinary incontinence. After adjusting for all other variables, vaginal delivery was not found to be significantly associated with incontinence compared to cesarean. Conclusion: Vaginal and cesarean deliveries have a comparable incidence of urinary incontinence. It is difficult to get a firm conclusion on whether cesarean is protective. Chronic constipation and cough are important factors regardless of delivery mode.

The effect of biofeedback pelvic floor training with ACTICORE1 on urinary incontinence: a multicenter randomized clinical pilot trial.

Pelvic floor training with biofeedback has been shown to significantly reduce symptoms of urinary incontinence. The present study aimed to evaluate the effectiveness of pelvic floor training with the ACTICORE1 biofeedback device, which uses a noninsertable pelvic floor sensor with a digital interface. A multicenter randomized controlled clinical pilot study in Germany was conducted between October 2021 and January 2022. The intervention group was instructed to use ACTICORE1 for 6min daily to train the pelvic floor for 12 weeks. The control group was instructed not to do any pelvic floor training. Over 18-year-old men and women with urinary incontinence and an International Consultation on Incontinence Questionnaire score (ICIQ) of ≥5 were included in the study. The primary endpoint was the ICIQ score 12 weeks after enrollment. The secondary endpoints were the ICIQ score and quality of life using the EG-5D-3L questionnaire 4, 8, and 12 weeks after patients' enrollment. A total of 40 individuals with urinary incontinence were recruited for the present study (35 females, 5 males; 40% lost to follow-up). In terms of biometric data, both groups did not differ. At 4, 8, and 12 weeks, the ICIQ scores of those in the ACTICORE1 group decreased from 12.9 to 7.5. The ICIQ score in the control group decreased from 11.0 to 10.5. The intraindividual improvement of patients in the ACTICORE group was statistically significant. Biofeedback training with ACTICORE1 significantly reduces symptoms of urinary incontinence after 12 weeks.

Is Surgical Treatment for Obesity Able to Cure Urinary Incontinence in Women?-A Prospective Single-Center Study.

There is enough evidence to support weight loss in order to improve urinary incontinence. Nevertheless, weight loss and maintaining a lower weight are not easy to achieve in the general population. Our study aims to evaluate whether bariatric surgery has a positive effect on the symptoms of urinary incontinence in female patients. We performed a prospective study on obese female patients before and after bariatric surgery, over a period of 9 years. Patients with a BMI ≥ 33 kg/m2 were included if they described involuntary loss of urine and no previous surgery for urinary incontinence was performed. The patients underwent laparoscopic surgery, either gastric sleeve, bypass or banding, performed by four surgeons in our hospital. The type of incontinence was not assessed at the initial visit carried out by the surgeon. All patients who declared being incontinent were referred to the urologist where they received the ICIQ-UI-SF questionnaire before their bariatric surgery and during follow -up visits. The sum of points obtained at questions 3, 4 and 5 was used to evaluate the severity of incontinence, as well as the impact on the quality of life. Our evaluation collected data on age, time since onset of symptoms, pad usage, number and type of deliveries, concomitant conditions and medications. The type of incontinence was assessed by the urologist before bariatric surgery as urge, stress or mixed incontinence. At follow-up visits, the patients were also asked to fill out a 10-point VAS questionnaire evaluating their perception on the evolution of incontinence symptoms. Data were analyzed using t-test statistical analysis. Our objective defined changes in incontinence as cure, improved, no change and worse. We included 54 women from whom initial data and at least 18 months of follow-up were available. We observed that about 50% of all women undergoing bariatric surgery have some degree of urinary incontinence. The ICIQ score improved from 13.31 ± 5.18 before surgery to 8.30 ± 4.49 points after surgery (p < 0.0001). Before surgery, 38 patients (70%) described severe incontinence compared to only 20 patients (37%) after surgery. A total of 16 women (31%) reported complete cure of urinary incontinence after bariatric surgery. Data from the VAS questionnaire show improvement in 46 cases (85%). Pad usage improved from 7.04 ± 2.79 to 3.42 ± 2.77 (p < 0.001) per day. The number of patients using more than one pad per day decreased from 35 (65%) to 9 (17%). The type of incontinence did not seem to be relevant, but our sample size was too small to lead to statistically significant results. There was no impact on the outcome of incontinence of number/type of delivery, age or BMI. Our data show that bariatric surgery is able to cure urinary incontinence in one of three obese women. A significant improvement was obtained in more than two-thirds of the patients, regardless of the type of incontinence. For an obese female with urinary incontinence, treatment for obesity should prevail and incontinence should be treated only if symptoms remain.

Patient-reported outcome measures compared to clinician reported outcomes regarding incontinence and erectile dysfunction in localized prostate carcinoma after robot assisted radical prostatectomy: Impact on management

Purpose/ BackgroundPatient-reported outcome measures (PROMs) are widely used after robot assisted radical prostatectomy (RARP) in order to evaluate the impact/burden of the treatment. The most bothersome side effects of RARP are urine incontinence (UI) and erectile dysfunction (ED). During the follow up consultations, clinicians report these side effects in interviewing patients. Our study examined the discrepancy between the PROMs and clinician report outcomes (CROs) and hypothesized that the disagreement could have an impact on the management of UI and ED. MethodsUp to 1 year after RARP, UI and ED recovery of 312 men with localized and locally advanced prostate cancer were assessed using the International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF) and the International Index of Erectile Function (IIEF-EF) and CROs by interview. Discrepancies between PROs and CROs were studied in light of treatment offered and management. ResultsThe ICIQ-SF Score matched with CROs in all sum score categories except in ICIQ sum score 6 to 12; here the UI was underreported by clinicians in 58% and 59% of patients at 8 and 12 months (P < 0.001). Furthermore, at 8 and 12 months postoperatively, clinicians underreported UI in 29% and 23% of patients with ICIQ score 13-18 (P < 0.001). The clinician significantly over-reported the recovery of erectile function (“normal erection”) (P < 0.001), especially in men with IIEF-EF sum score 6 to 16. Independently of ICIQ-SF/IIEF-EF scores, discrepancy between PROs and CROs did not affect rate of health care offered to patients. ConclusionsThis is to our knowledge the first study that compared the PROs with clinician reported functional outcomes and the impact of discrepancies on the management of side effects of RARP in prostate cancer. Observed discrepancies between the PROs and CROs did not affect offered management and counseling of UI and ED.

Effectiveness of Home-Based Pelvic Floor Muscle Training on Stress Urinary Incontinence and Quality of Life in Multiparous Women

Aim: This study aims to determine the effectiveness of home-based pelvic floor muscle training on decreasing the symptoms of stress urinary incontinence and improving the quality of life among multiparous women Methods: Women who were diagnosed with Stress Urinary Incontinence were invited to take part in this study. These subjects were randomly allocated to either an intervention group or a control group. A 6-week assessment of both groups were carried out for the pelvic floor muscle strength using the modified oxford grading system, for the severity of Incontinence, the ICIQ- short form was used, &amp; for the Quality of Life, Incontinence QoL Scale was used. Results: A total of 60 subjects were included in the study. At the baseline, both the groups were similar in terms of PFM strength, ICIQ score&amp; Incontinence QoL Scale. At the end of 6 weeks of assessment, there was a significant difference (p&lt;0.001) between the control &amp; the intervention group in terms of MOGS, ICIQ score and Incontinence QoL Scale score. Conclusion: The home-based pelvic floor muscle training was found as a safe and effective intervention in decreasing the severity of symptoms and improving the quality of life in multiparous women with SUI.

To Compare the Effectiveness of Kegel’s Exercise and Paula Method in women with Urinary Incontinence

Objective of The Study: The study aims to compare the effectiveness of Paula method and Kegel's exercise in women with urinary incontinence. Background of The Study: Pelvic floor muscle weakness is one of the cause for urinary incontinence. Conservative management such as pelvic floor muscle training and Paula method is commonly recommended as first-line therapy for women with urinary incontinence. The purpose of the study is to examine the efficacy of circular muscle strengthening (Paula method) as opposed to pelvic floor muscle training (PMFT) on stress urinary incontinence. Methodology: This study was a comparative study design with pre and post type with 40 subjects randomly divided into two groups (group A and group B). Group A received Kegel’s exercise and Group B received Paula method. Result: On comparing Pre test and Post test within Group A and Group B of ICIQ score, QOL score, sexuality questionnaire score shows highly significant difference in mean values at P ≤ 0.001. Conclusion: This study concludes that Paula method decreases frequency of urinary incontinence by strengthening sphincter muscles. Compared to the Kegel’s exercise, Paula method showed greater difference in decreasing the frequency of urinary incontinence.

MP37-12 SURGICAL TREATMENT OF OBESITY IS ABLE TO CURE URINARY INCONTINENCE - 9 YEARS EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP37-12 SURGICAL TREATMENT OF OBESITY IS ABLE TO CURE URINARY INCONTINENCE - 9 YEARS EXPERIENCE Cristian Persu, Narcis Chirca, Bogdan Gabriel Buzescu, Irina Ciofu, and Viorel Jinga Cristian PersuCristian Persu More articles by this author , Narcis ChircaNarcis Chirca More articles by this author , Bogdan Gabriel BuzescuBogdan Gabriel Buzescu More articles by this author , Irina CiofuIrina Ciofu More articles by this author , and Viorel JingaViorel Jinga More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is enough evidence to support weight loss in order to improve urinary incontinence. Nevertheless, weight loss and maintaining a lower weight are not easy to achieve in general population. Our study aims to evaluate whether bariatric surgery has a positive effect on the symptoms of urinary incontinence in female patients. METHODS: We performed a prospective study on obese female patients before and after bariatric surgery, over a period of 9 years. Patients with a BMI≥33 kg/m2 were included if they described involuntary loss of urine and no previous surgery for urinary incontinence was performed. The patients underwent laparoscopic surgery: gastric sleeve, bypass or banding, performed by four surgeons in our hospital. The type of incontinence was not assessed at the initial visit done by the surgeon. All patients who declared being incontinent were referred to the urologist where they received the ICIQ – UI -SF questionnaire before their bariatric surgery and during follow up visits. The sum of points obtained at questions 3,4 and 5 was used to evaluate the severity of incontinence as well as the impact on the quality of life. Our evaluation collected data on age, time since onset of symptoms, pad usage, number and way of deliveries, concomitant conditions and medications. The type of incontinence was assessed by the urologist before bariatric surgery, as urge, stress or mixed incontinence. At follow up visits, the patients were also asked to fill in a 10 point VAS questionnaire evaluating their perception on the improvement of incontinence symptoms. Data was analyzed using the t-test statistical analysis. Our objective defined change in incontinence as cure, improved, no change and worse. RESULTS: Our study included 54 women in which initial data and at least 18 months of follow up were available. We observed that about 50% of all women undergoing bariatric surgery have some degree of urinary incontinence. The ICIQ score improved from 13,31±5,18 before to 8,30±4,49 points after surgery (p<0.0001). Before surgery, 38 patients (70%) described severe incontinence, compared to only 20 patients (37%) after surgery. 16 women (31%) report complete cure of urinary incontinence after bariatric surgery. Data from the VAS questionnaire shows improvement in 46 cases (85%). Pad usage improved from 7,04±2,79 to 3,42±2,77 (p<0.001) per day. The number of patients using more than one pad per day decreased from 35 (65%) to 9 (17%). The type of incontinence doesn’t seem to be relevant, but our sample size was too small to lead to statistically significant results. There is no impact on the outcome of incontinence of number/type of delivery, age or BMI. CONCLUSIONS: Our data shows that bariatric surgery is able to cure urinary incontinence in one of three obese women. Significant improvement is obtained in more than two thirds of the patients, regardless the type of incontinence. For an obese female with urinary incontinence, the treatment for obesity should prevail and incontinence should be treated only if symptoms remain. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e519 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cristian Persu More articles by this author Narcis Chirca More articles by this author Bogdan Gabriel Buzescu More articles by this author Irina Ciofu More articles by this author Viorel Jinga More articles by this author Expand All Advertisement PDF downloadLoading ...

Bryophyllum pinnatum and Improvement of Nocturia and Sleep Quality in Women: A Multicentre, Nonrandomised Prospective Trial.

Nocturia is a pathologic condition that significantly affects the quality of sleep. The aetiology of nocturia is multifactorial, and the evidence available on its management remains limited. Besides behavioural measures, validated pharmaceutical treatment options exist but are, however, associated with marked side effects. Prospective clinical studies with tablets prepared from the leaf press juice of the plant Bryophyllum pinnatum revealed a tendency towards reduction of micturition in patients with overactive bladder (OAB) and several improvements in sleep quality. These observations are in part supported by in vitro and in vivo data. In the present study, we investigated the effectiveness of Bryophyllum 50% chewable tablets in the treatment of nocturia and associated sleep disorders. Altogether, 49 women with idiopathic OAB and nocturia of ≥2 voids/night were treated with Bryophyllum 50% tablets for 3 weeks (350 mg chewable tablets, dosage 0-0-2-2 oral tablets; WELEDA AG, Arlesheim, Switzerland). Nocturia, voiding volumes at night (ml), quality of life, sleep quality, and daily sleepiness were assessed before and after treatment with a 3-day micturition diary, the International Consultation on Incontinence evaluating overactive bladder and related impact on quality of life (QoL) [ICIQ-OAB], the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS), respectively. The age of the study population was 68.5 ± 11.6 y. After treatment, nocturia diminished from 3.2 ± 1.4 to 2.3 ± 1.3 (P < 0.001) and the PSQI score decreased from 7.7 ± 3.7 to 6.6 ± 3.4 (P=0.004). Urgency, the ICIQ score, and the ESS lowered significantly, and the micturition volume showed a tendency to increase. No serious adverse drug reactions were reported, and compliance was good. The results show a beneficial effect on the nocturnal voids and sleep quality of women with OAB. Bryophyllum 50% tablets can be regarded as a well-tolerated alternative in the treatment of nocturia and broaden the repertoire of standard management.

Hip dysfunction-related urinary incontinence and total hip arthroplasty with the direct lateral approach.

There is a functional relationship between the hip joint and the pelvic floor muscles. In patients with secondary osteoarthritis of the hip, urinary incontinence is also seen. Research has shown that total hip arthroplasty (THA) surgery improves the symptoms of urinary incontinence. This prospective cross-sectional study without a control group was performed on THA candidates with urinary incontinence and secondary osteoarthritis with the aim of investigating the effect of THA with a direct lateral approach and subsequent routine physiotherapy on the symptoms of urinary incontinence. Sampling was performed using a simple method among those referred to orthopedic clinics in the private sector. Data were collected in all patients before and 3 months after THA using demographic, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and hip range of motion record tables. The results are presented as mean with standard deviation. In this study, 16 men with a mean age of 76.75 years (±4.65) and 8 women with a mean age of 72.75 years (±7.32) participated. Before THA, stress urinary incontinence (54.16%) and urgency urinary incontinence (20.83%) had the highest frequency. However, after THA, the frequency of stress and urgency urinary incontinence decreased (16.66% and 8.33%, respectively). According to the results of the ICIQ, complete improvement of urinary incontinence symptoms was observed in up to 62.5% of the subjects. After THA, there was a significant difference between the mean total score obtained from the WOMAC questionnaire compared to before surgery. There was a significant improvement in the range of motion of the hip joint in all directions. THA and routine hip physiotherapy in patients with urinary incontinence and secondary hip osteoarthritis have a significant positive effect on improving symptoms of urinary incontinence and hip function. In addition, it significantly improves the ICIQ and WOMAC questionnaire scores.

A modified mid-urethral sling technique for stress urinary incontinence: Three-year results of a prospective randomized trial in comparison with original transobturator tape procedure.

Stress urinary incontinence (SUI) is the most common subtype of urinary incontinence, which causes many social, psychological, and economic problems. Mid-urethral sling (MUS) surgery is popular worldwide for the treatment of SUI. We aimed to define a new modified mid-urethral sling technique (mMUS) in SUI treatment and to compare it with transobturator tape (TOT) surgery in terms of safety and efficiency. A prospective, randomized study was planned with 126 women suffering from SUI. The patients were randomly divided into two groups, TOT and mMUS. In mMUS, the obturator membrane was not perforated. The objective and subjective symptoms, pain, quality-of-life measures, and side effect profiles were assessed in a 3-year follow-up. The visual analogue scale (VAS) was used for postoperative pain assessment. The International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Patient Global Impression of Improvement (PGI-I) were used for cure assessment scales. In total, 96 patients completed 3-year follow-up (TOT, n = 49 and mMUS, n = 47). There was no statistical difference between the procedures in terms of cure rates (87.75% and 87.23%, respectively; p = 0.614). Mean VAS scores at 8 and 24 h postoperatively were significantly higher in the TOT group (p < 0.05). There was no significant difference between the groups in VAS scores after 24 h. There was no significant difference between groups in terms of pad test results, ICIQ, or PGI scores at baseline and 36 months after surgery. We showed that the mMUS procedure was as safe and effective as TOT, with less postoperative groin pain and complications.

Causative factors, social and surgical outcomes of vesicovaginal fistulas treated via an abdominal transvesical approach: A single-center experience.

To study the demographics, and surgical and social outcomes of patients with fistula repair performed at our hospital. This cross-sectional study included 120 patients with fistula repair performed between 2014 and 2019 in the Urology Department of Lady Reading Hospital, Peshawar using an open transvesical repair method without omental interposition. Data were collected on patients' demographics, and social and surgical outcomes. Fistula severity was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). About 80 (66.6%) fistulas were iatrogenic and 40 (33.3%) were ischemic, with 36 (90%) due to obstructed labor. The median age of patients was 36 years (29-40 years). The majority of the patients were multiparous and premenopausal (99; 82.5%). Fifty (56.5%) of the iatrogenic fistulas were due to non-obstetric hysterectomy, and 20 (25%) were due to cesarean hysterectomy. Women had the fistulas for 4-49 weeks before seeking treatment with an average ICIQ score of 18. In all, 73 (73%) of the fistula caused by delivery had involved stillbirths, 4 (3.96%) were early neonatal deaths, and nearly 25 (21%) of patients were divorced. About 114 (95%) of patients were completely cured on discharge. Vesicovaginal fistula is a devastating condition, with a rising trend in iatrogenic fistulas in low-income countries. In the hands of experienced surgeons, trans-abdominal repair without omental interposition shows a high success rate.

The key role of levator ani thickness for early urinary continence recovery in patients undergoing robot-assisted radical prostatectomy: A multi-institutional study.

Urinary continence (UC) recovery dramatically affects quality of life after robot-assisted radical prostatectomy (RARP). Membranous urethral length (MUL) has been the most studied anatomical variable associated with UC recovery. To investigate whether levator ani thickness (LAT), assessed with multi-parametric magnetic resonance imaging (mpMRI), correlates with UC recovery after RARP. The study included 209 patients treated with RARP by expert surgeons with extensive robotic experience from 2017 to 2019. All patients had complete, clinical, mpMRI, pathological, and postoperative data including pelvic floor muscle training (PFMT) protocols. After a radiologist-specific training, two urologists independently examined the files, blinded to clinical and pathological findings as well as to postoperative continence status. On mpMRI, LAT, bladder neck (BN) shape, MUL, and apex overlapping (AO) were measured. UC recovery was defined as use of 0 or 1 safety pad at follow-up. Multivariable models were used to assess the association between variables and UC recovery. Overall, 173 (82.8%) patients were continent after a median follow-up of 23 months (interquartile range[IQR]: 17-28). Of these, 98 (46.9%) recovered within 3 months after surgery, 42 (20.1%) from 3 to 6 months, and 33 (15.8%) from 6 months onwards. A significant higher rate of patients with LAT > 10 mm (88.1 vs.75.8%; p = 0.03) experienced UC recovery, compared to those with LAT < 10 mm. This difference was observed in the first 3 months after surgery. At multivariable analysis, LAT (odds ratio [OR]: 1.18, 95% confidence interval [CI]: 1.02-1.37; p = 0.02), Preoperative ICIQ score (OR: 0.91, 95% CI: 0.82-0.98, p = 0.03) and PFMT (OR: 1.98, 95%CI: 1.01-3.93; p = 0.04) independently predict higher UC recovery within 3 months, after accounting for age, BMI, preoperative PSA, D'Amico risk group, MUL, BN shape and AO. LAT greater than 1 cm was associated with greater UC recovery. Specifically, LAT greater than 1 cm seems to be associated with higher UC rate at 3 months after RARP, compared to those with LAT < 1 cm. Magnetic resonance features can help in predicting the risk of incontinence after robot-assisted radical prostatectomy and should be taken into account when counseling patients before surgery.

Laparoscopic resection rectopexy significantly affects preexisting urinary symptoms in female patients

PurposeIt has previously been noted that following rectopexy, some patients report changes in urinary function. So far, not much is known about the extent of such changes. This study assesses the effects of laparoscopic rectopexy on urinary symptoms.MethodsProspective observational study with 100 consecutive female patients indicated for laparoscopic resection rectopexy. Stated urinary symptoms, pre- and postoperative “International Consultation on Incontinence Questionnaire” (ICIQ), supplemented by a “quality of life “ (QoL) visual analogue scale, and residual urine measurements (RUM) were compared and correlated.ResultsPostoperative QoL was significantly improved, irrespective of preexisting urinary symptoms. Twenty-four (24%) patients noticed improved urinary function. This corresponded with 42% of 45 patients who had positive preoperative ICIQ scores indicating preexisting urinary symptoms. Conversely, 14 (14%) patients noticed a postoperative increase of urinary complaints. The stated symptom change was only in part reflected by changes of the ICIQ scoring. Comparing ICIQ, 19 (19%) patients scored “better” postoperatively against 8% scoring worse; 5 of the 8 patients experienced “de novo” symptoms. The improved postoperative ICIQ scoring was highly significant. RUM did not sufficiently correlate to symptoms/ICIQ for any meaningful conclusion.ConclusionsLaparoscopic resection rectopexy had predominantly beneficial and to a lesser extent detrimental effects on urinary symptoms. Effects were highly significant; they were mainly noted in patients with preexisting urinary complaints. So far, it is not possible to predict such effects on an individual basis. It appears likely that similar effects may be found for most of the alternative operative procedures for the treatment of rectal prolapse. Without more factual knowledge and awareness about the extent of potential “collateral” effects of pelvic floor repair procedures, expert guidance of patients appears limited.

Effect of Acupuncture for Mixed Urinary Incontinence in Women: A Systematic Review

BackgroundMixed urinary incontinence increasingly undermines women's quality of life. Previous studies showed some effects of acupuncture for MUI, but no systematic review has been done to evaluate the efficacy and safety of acupuncture for MUI in women.ObjectiveTo systematically review the efficacy and safety of acupuncture for women with MUI.MethodsTen databases (i.e., PubMed, Web of Science, Embase, ClinicalTrials.gov, the Cochrane Library, CBM, Scoups, CNKI, VIP and WANFANG DATA) were searched up to July 19th, 2021, using tailored search strategies with keywords not limited to “female,” “mixed urinary incontinence,” “acupuncture,” and “randomized controlled trial,” etc. RCTs and quasi-RCTs were included if investigating effect of any type of acupuncture for female patients with MUI. Data were extracted from eligible studies, and risks of bias were assessed according to the Cochrane Handbook from seven aspects using the RevMan 5.4 software.ResultsA total of three randomized studies with 591 women were included. The risk of bias among the studies varied, with major concerns on blinding of participants and outcome assessor. Liu's study (497) mainly showed that electroacupuncture's effect on reduction of numbers of incontinence, urgency, nocturia episodes, and amount of urine leakage etc. was not inferior to that of PFMT-Solifenacin group at 12, 24, and 36 weeks. Zhan's study (60) showed that electroacupuncture reduced significantly more amount of urine leakage than Tolterodine at 8 weeks, with no data on incontinence episodes frequency. All 3 studies reported that acupuncture significantly increased the quality of life assessed by ICIQ score. In addition, incidence of acupuncture-related adverse events was rare, while antimuscarinic agents related adverse events were common in two studies.ConclusionAlthough acupuncture showed some benefit for women with MUI, more evidences were required to draw a solid conclusion of effectiveness and safety of acupuncture for women with MUI.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021224600.

MP50-08 HOW DID THE VARIABILITY IN THE DEFINITIONS OF POST-PROSTATECTOMY CONTINENCE AFFECT THE CONTINENCE OUTCOMES IN A CONTEMPORARY SERIES OF 1000 RARPS?

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP50)1 Sep 2021MP50-08 HOW DID THE VARIABILITY IN THE DEFINITIONS OF POST-PROSTATECTOMY CONTINENCE AFFECT THE CONTINENCE OUTCOMES IN A CONTEMPORARY SERIES OF 1000 RARPS? Mahmoud Abuelnaga, Rasha Gendy, Mark Yao, Curtis Phelan, Julie Pain, Sashi Kommu, and Ben Eddy Mahmoud AbuelnagaMahmoud Abuelnaga More articles by this author , Rasha GendyRasha Gendy More articles by this author , Mark YaoMark Yao More articles by this author , Curtis PhelanCurtis Phelan More articles by this author , Julie PainJulie Pain More articles by this author , Sashi KommuSashi Kommu More articles by this author , and Ben EddyBen Eddy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002076.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The prevalence of continence after prostatectomy varies noticeably, with a reported range of 13% to 97.5%, depending on the definition of continence considered. Nine definitions of post-prostatectomy continence have been identified in the literature. Herein, we report on the continence rates using 6 different definitions of post-prostatectomy continence. METHODS: A prospectively maintained database of men undergoing RARP by a single surgeon in a regional cancer center between 2003 and 2019 was retrospectively analyzed. All men completed ICIQ-UI-SF questionnaire and a question on pad usage at baseline, 6 weeks, 3, 6, 12, 18, 24 months after RP. Six different definitions were applied including ICIQ score 0, ICIQ score <5, ICIQ score improvement or return to baseline, 0 Pad use, 0 or safety pad use and 0 or 1 pad use. RESULTS: Of the 1000 men included in the study, 76.6% reported pre-operative ICIQ-UI-SF score of 0. When continence is defined as "0 or 1 pad use", continence rate at 24 months was found to be 98%, however, when “ICIQ-UI-SF score 0” definition was applied, it dropped to 58.6%. Continence rates varied between 11.9%-68%, 23.7-86%, 35.6%-95%, 45.8%-97%, 55%-97% and 58.6%-98% at 6 weeks, 3, 6, 12, 18 and 24 months respectively depending on whether the most strict or most inclusive definition was applied. CONCLUSIONS: The post prostatectomy continence definition applied may have a significant impact on the reported outcome. The findings of this study underpins the importance to standardize the definition of post-prostatectomy continence to ensure the balance among reliability of reporting. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e888-e889 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mahmoud Abuelnaga More articles by this author Rasha Gendy More articles by this author Mark Yao More articles by this author Curtis Phelan More articles by this author Julie Pain More articles by this author Sashi Kommu More articles by this author Ben Eddy More articles by this author Expand All Advertisement Loading ...

MP64-02 THE KEY ROLE OF LEVATOR ANI THICKNESS FOR EARLY URINARY CONTINENCE RECOVERY IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY: A MULTI-INSTITUTIONAL STUDY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI (MP64)1 Sep 2021MP64-02 THE KEY ROLE OF LEVATOR ANI THICKNESS FOR EARLY URINARY CONTINENCE RECOVERY IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY: A MULTI-INSTITUTIONAL STUDY Manuela Tutolo, Giuseppe Rosiello, Dirk De Ridder, Davide Oreggia, Francesco Barletta, Simone Scuderi, Giovanni Tasso, Giorgio Stabile, Donato Cannoletta, Liesbeth De Wever, Antonio Esposito, Francesco De Cobelli, Wouter Everaerts, Andrea Salonia, Francesco Montorsi, Frank Van der Aa, and Alberto Briganti Manuela TutoloManuela Tutolo More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Dirk De RidderDirk De Ridder More articles by this author , Davide OreggiaDavide Oreggia More articles by this author , Francesco BarlettaFrancesco Barletta More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Giovanni TassoGiovanni Tasso More articles by this author , Giorgio StabileGiorgio Stabile More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Liesbeth De WeverLiesbeth De Wever More articles by this author , Antonio EspositoAntonio Esposito More articles by this author , Francesco De CobelliFrancesco De Cobelli More articles by this author , Wouter EveraertsWouter Everaerts More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Frank Van der AaFrank Van der Aa More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002104.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary continence (UC) recovery dramatically affects quality of life of patients after radical prostatectomy (RP). Membranous urethral length (MUL) has been the most studied anatomical variable associated with UC recovery. The aim of this study is to investigate whether Levator Ani thickness (LAT), assessed with multi-parametric magnetic resonance imaging (mpMRI), correlates with UC recovery in patients undergoing robot assisted radical prostatectomy (RARP). METHODS: The study included 209 patients treated with RARP at San Raffaele Hospital - Milan, Italy and Gasthuisberg Hospital - Leuven by expert surgeons with extensive robotic experience (>100 cases AND >30 cases/year) from 2017 to 2019. All patients had complete, clinical, mpMRI, pathological and post-operative data including pelvic floor muscle training (PFMT) protocols. Two urologists (after a training with an expert radiologist) examined the images, independently. They were blinded to clinical and pathological findings as well as to postoperative continence status. On mpMRI, LAT, bladder neck (BN) shape, membranous urethral length (MUL) and apex overlapping (AO) were measured. UC recovery was defined as use of 0 or 1 safety pad at follow-up. Multivariable models were used to assess the association between the aforementioned variables, and UC recovery. RESULTS: Overall, 173 (82.8%) patients, were continent after a median follow-up of 23 months (IQR: 17-28). Of these, 98 (46.9%) recovered within 3-months after surgery, 42 (20.1%) from 3 to 6 months, and 33 (15.8%) from 6 months onwards. A significant higher rate of patients with LAT >10 mm (88.1 vs. 75.8%; p=0.03) experienced UC recovery, compared to those with LAT<10 mm. This difference was observed in the first 3 months after surgery. At multivariable analysis, LAT (OR: 1.18, 95%CI 1.02-1.37; p=0.02), pre-operative ICIQ score (OR 0,91, 95%CI 0.82-0,98, p=0.03) and PFMT (OR: 1.98, 95%CI 1.01-3.93; p=0.04) independently predict higher UC recovery within 3 months, after accounting for age, BMI, preoperative PSA, D’Amico risk group, MUL, BN shape and AO. CONCLUSIONS: This study demonstrates that LAT is an independent predictor of early UC recovery and patients with a LAT greater than 1cm seem to present a higher urinary continence rate at 3 months after RARP compared to those with LAT < 1cm. The inclusion of LAT in future predictive models could improve this accuracy and could be used in the pre-operative counselling to better inform patients about the probability of urinary continence recovery. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1110-e1110 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manuela Tutolo More articles by this author Giuseppe Rosiello More articles by this author Dirk De Ridder More articles by this author Davide Oreggia More articles by this author Francesco Barletta More articles by this author Simone Scuderi More articles by this author Giovanni Tasso More articles by this author Giorgio Stabile More articles by this author Donato Cannoletta More articles by this author Liesbeth De Wever More articles by this author Antonio Esposito More articles by this author Francesco De Cobelli More articles by this author Wouter Everaerts More articles by this author Andrea Salonia More articles by this author Francesco Montorsi More articles by this author Frank Van der Aa More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Loading ...

Urodynamic and questionnaire findings in urinary incontinent women with and without diabetes. Data from a health study.

Our aim was to compare urodynamic findings in urinary incontinent (UI) women with and without diabetes. In the extensive Lolland-Falster Health Study, women with lower urinary tract symptoms were offered urodynamic testing. After excluding 6 women with incomplete urodynamic testing and 88 women without UI, our analysis ended up including 417 women (31 with and 386 without diabetes). Student's t-test and chi-squared test were used to compare differences of urodynamic findings. Urodynamic testing consisted of a 2-day bladder diary, post-void residual urine volume, filling cystometry, pressure-flow study, cough stress test, and uroflowmetry. Three experienced physicians in urogynecology evaluated all urodynamic findings leading to an overall conclusion of the test results. Self-reported data showed that compared to incontinent women without diabetes, incontinent women with diabetes had more frequent leakage, a larger amount of leakage, and a higher ICIQ score. A positive ICS Uniform cough stress test was more prevalent in women with diabetes. There were no significant differences in other urodynamic findings or overall conclusion between the two groups. Controlling for age and BMI did not affect our findings. Women with diabetes complained more about UI, had a higher ICIQ score, and had a positive ICS Uniform cough stress test more often than women without diabetes. Based on these findings, we recommend to include the history of urinary incontinence in the care of women with diabetes. This sample consists of women from a comprehensive health study with different severity of UI. Therefore, it can serve as a reference cohort for future studies.

877 The Transobturator Male Sling: Does It Stand the Test of Time?

Abstract Introduction The commonest cause of stress urinary incontinence in men is radical prostatectomy. We aimed to determine the efficacy, complication rate and need for salvage surgery in the medium-long term for male sling insertion. Method Retrospective review of all patients undergoing male sling insertion at one centre between 2009-2018. Data was collected on complications, patient satisfaction and need for further surgery. Preoperative severity was categorized as mild, moderate, or severe. We assessed ICIQ score, 24h-pad usage, patient satisfaction and identified risk factors for treatment success/failure. Results 91 men had slings inserted (median age- 67.3). Three months success rates in mild, moderate and severe SUI groups were 96%, 86% and 80% respectively which dropped to 65%, 62% and 47% in the medium term. The rate of AUS implantation was 6%, 15% and 33% respectively. Complications included pain, infection, retention and OAB. Patient satisfaction at 5-years was 57%. Only factor predicting success or failure was pre-operative ICIQ-UI(SF) score. Conclusions Male sling success rates deteriorate over time. 15% will have an AUS. The risk of complications is low and transient. A pre-operative ICIQ-UI(SF) score of &amp;gt; 18 is a predictor of failure. Sling insertion remains a reasonable treatment option for male patients suffering with SUI.