Incontinence Quality Research Articles

Impact of Urinary Incontinence on Quality-Of-Life among Females Receiving Pelvic Floor Muscles Strengthening Exercises for Urinary Incontinence

Background: Among women urinary incontinence (UI) is the most familiar problem and complain of lower urinary symptoms in urinary incontinence has found between 15% and 55%. It is a symptom with a lot of influence on quality of life of women majorly in their community-based, confidential and sexual domains. Aim: To see the impact of urinary incontinence on quality of life among females receiving pelvic floor muscles strengthening exercises for urinary incontinence. Study design: Cross-sectional study. Methodology: Patients (n=165) females with urinary incontinence were enrolled. The effect of urine incontinence on female quality of life, as well as the effect of pelvic floor muscle strengthening exercises on urine incontinency. The study inquired about the respondents' backgrounds, daily routines, and the impact of incontinence on their social relationships, as well as the effects of urine incontinence on emotional and mental health. All female volunteers who have been dealing with urine incontinence for a few months will be included in the study. Analysis of data was done by SPSS v.26. Results: They were having physiotherapy for urine incontinency and it had not affected their quality of life but shown a positive effect in their household, social and personal activities. When the standard scoring method of IIQ-7 questionnaire applied the results of 0=Not at all,1= slightly, 2= moderate, 3= greatly, total mean of 7 items was 2.60 and 85% out of 100 get recovered and their quality of life improved by physiotherapy. Conclusion: It was concluded that the females who were receiving pelvic floor muscles strengthening exercises had good quality of life and urinary incontinence had not affected their quality of life (IIQ-7 score = 2.60) and had good impact on their quality of life. Keywords: Urine Incontinency, Quality of Life, Physiotherapy and Pelvic Floor Muscles.

Pelvic Floor Muscle Exercise pada Pasien Post Radikal Prostatektomi dalam Menurunkan Inkontinensia Urine dan Kualitas Hidup

This study aims to determine the effect of Pelvic Floor Muscle Exercise (PMFE) on urinary incontinence and quality of life (QOL) in post-radical prostatectomy prostate cancer patients. This research method is a systematic review by searching literature through several indexed electronic databases (Scopus, Science Direct, CINAHL, PubMed, ProQuest, SAGE, Springer Link). The study results were obtained from 10 articles on pelvic floor muscle exercise (PFME) modality therapy. Eight pieces explained that PFME without a combination effectively reduced urinary incontinence and improved the quality of life (QOL) of post-RP patients; one article explained the effectiveness of the variety of PFME with electrical stimulation in reducing incontinence urine in post-RP patients. One article describes the combination of PFME with the WeChat application reducing urine leakage and improving urinary continence. In conclusion, Pelvic Floor Muscle Exercise (PFME) is a therapy that is effective for urinary incontinence and men's quality of life after radical prostatectomy (RP).
 
 Keywords: Urinary Incontinence, Pelvic Floor Muscle Exercise, Radical Prostatectomy

Ventral Pelvio-anal Reconstruction as a Variation of Established Surgical Management of Severe and Refractory Fecal Incontinence: A Case Series Study

Background: Conventional treatments may not be effective in some severe cases of fecal incontinence (FI). Objectives: In the present study, we evaluated the applicability of ventral pelvio-anal reconstruction (VPAR) as a modified operative technique for 17 patients with severe and refractory FI. Methods: We performed VPAR by placing a mesh in the perineum and securing it at the sacrospinal ligament on both sides. The Cleveland Clinic Incontinence Score (CCIS) and Fecal Incontinence Quality of Life (FIQoL) questionnaires were completed by the patients, and anorectal manometry was performed before and after the operation (3,6 and 12 months), and the results were compared against the baseline values. Results: The operation was successful in all patients; no mesh was explanted during the follow-up period, and all patients reported satisfactory outcomes. Postsurgical anorectal manometry showed an increase in both rest and squeeze pressures. The CCIS decreased while the FIQoL increased significantly during the first-year follow-up (P < 0.001). Conclusions: By incorporating the implant into the perineal body, we hypothesized that our combined technique would lead to favorable outcomes, and the preliminary results confirmed this. Further studies with larger patient populations and more extended follow-up periods are needed to confirm our satisfactory results and conclude that the VPAR approach is a safe and appropriate therapeutic option for patients with severe and refractory FI.

Effects of Modified Pilates on Incontinence Severity and Quality of Life in Females with Urinary Incontinence

Background: Urinary Incontinence is a state in which an individual is unable to control urine and may leak it out without reaching to the toilet. The urgency of urine becomes out of control in such patients. Aim: To determine the effects of modified Pilates on incontinence severity and quality of life in females with urinary incontinence. Study Design: Randomized Controlled Trial. Methodology: Patients (n=50) were analyzed. The Group A received modified Pilates along with standard physical therapy while group B received standard physical therapy exercises only. Baseline treatment that was standard physical therapy (pelvic floor muscle training, home exercises plan and life style advice) was given to both groups. Outcome measures were calculated by Symptom Severity Index and Incontinence Quality of Life questionnaire. Results: The mean value of Symptoms Severity Index score of group A before intervention was 21.04 which was more than 16.04, the value obtained after the treatment. This value was less than the post Symptoms Severity Index mean of group B (standard physical therapy only). The Symptoms Severity Index score between both groups has massive difference with P value <0.05. Conclusion: It was concluded that modified Pilates combined with standard physical therapy improves urinary incontinence severity and quality of life in females with urinary incontinence. Keywords: Modified Pilates, Quality of Life, Standard Physical Therapy and Urinary Incontinence.

The effect of acupuncture on postpartum stress urinary incontinence: A protocol for systemic review and meta-analysis.

Background:Postpartum stress urinary incontinence (PSUI) is a widespread complaint in postpartum women, which significantly affects their quality of life. Acupuncture has been widely used as an alternative complementary therapy for the treatment of PSUI. This protocol is carried out to comprehensively explore the effectiveness and safety of acupuncture for treating PSUI.Methods:Randomized clinical trials related to acupuncture treatment of PSUI will be searched in Chinese and English literature databases: PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang Database, and the Technology Periodical Database. Changes in pelvic floor muscle strength compared with baseline will be accepted as the primary outcomes, and secondary outcomes will be the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score, the urodynamic indexes, the incontinence quality of life questionnaire, and adverse effects of acupuncture. All publications will be screened and extracted by 2 reviewers independently. Quality of the eligible publications will be assessed according to the Cochrane Risk of Bias tool and statistical analyses will be conducted by using the Review Manager V.5.3.Results:This study will provide a high-quality comprehensive evaluation for the clinical efficacy and safety of acupuncture for PSUI.Conclusion:This systematic review will provide comprehensive evidence of acupuncture treatment on specific outcomes for PSUI.Ethics and Dissemination:Because of the study will not collect personal information, ethical approval will not be required. The results will be published in a peer-reviewed journal.Trial registration:INPLASY 202220045.

A New Technique for Continent Urinary Diversion: Initial Experience and Description of the Technique.

Orthotopic neobladder is a well-established surgical solution for continent urinary diversion after radical cystectomy. Nevertheless, it still represents a challenging surgery. Some critical issues of orthotopic bladder substitution include relevant complication rates, renal function impairment, urinary incontinence and patient quality of life. We present a new ileal neobladder technique, Vesuvian Orthotopic Neobladder (VON), performed for the first time at our institution in 2020. The main purpose of this new surgical procedure is to simplify and speed up the reservoir reconstruction through a ten standardized technical steps and obtain an appropriate bladder capacity at the same time. METHODS: Inclusion criteria were muscle-invasive bladder carcinoma or non muscle-invasive high risk bladder cancer patients fit for bladder substitution. The exclusion criteria were locally advanced cancer, presence of hydronephrosis, renal or hepatic impairment. A chest-abdominal CT scan and urinary cytology were performed before the procedure. Patients received neoadjuvant chemotherapy, as required. Overall, operative time, bladder reconfiguration time, hospitalization time, catheterization time were recorded. All complications associated with the procedure were classified according to the Clavien Dindo score. The bladder volume was evaluated by ultrasound three months after the surgery. RESULTS: A total of six male patients diagnosed with non-metastatic muscle-invasive or high-risk non-muscle invasive bladder cancer who underwent radical cystectomy followed by VON reconfiguration were included in the study. Mean age was 62.8 (±4.9) years; all selected patients enjoyed good health conditions (Charlson Comorbidity Index 4-6). One patient presented with high-risk non-muscle invasive bladder cancer. Four patients received neoadjuvant chemotherapy. Mean overall operative time was 273.3 (±18.6) minutes. Average time for neobladder reconstruction was 63.7 (±16.1) minutes. There were no intraoperative complications. A single case of urethral anastomosis leakage occurred and was treated conservatively. Bladder volume on ultrasound evaluation ranged between 250 and 290 ml. Day time and nocturnal continence were observed in four and three patients, respectively. CONCLUSION: The new VON technique is a good alternative to traditional orthotopic bladder procedures. VON reconstruction seems to offer the advantage of speeding up the procedure, reducing intestinal compromise with good storage capacity. The ten surgical steps can be considered a good starting point for further improvements in surgical technique. More robust data regarding the number of procedures and the duration of follow-up is required.

Commercially Available Home Pelvic Training Devices for the Treatment of Pelvic Floor Disorders: A Systematic Review and Meta-analysis.

To assess the clinical efficacy of commercially available pelvic muscle training devices on the treatment of pelvic floor disorders. We searched MEDLINE, Web of Science, and ClinicalTrials.gov through April 2020. We included observational cohort studies and randomized trials. Case reports, case series, and conference poster presentations were excluded. Studies using vaginal weights or cones and those conducted in the peripartum periods were also excluded. A total of 294 studies were screened. Twenty-six studies were included in the qualitative analysis, and 15 studies were eligible for meta-analyses. Study characteristics and quality were recorded for each study. Meta-analysis showed a large positive effect of commercially available pelvic floor training devices on pelvic floor muscle strength by both objective and subjective measures. Meta-analysis of objective measures showed a reduction of 1.2 pads per day (P<.01), 1.3 incontinence episodes per day, (P<.01) and 11 g on 24-hour pad test (P<.01). Meta-analysis of subjective measures showed a reduction in UDI-6 (Urogenital Distress Inventory, Short Form) scores by 25.1 points (P<.01) and in IIQ-7 scores (Incontinence Impact Questionnaire, Short Form) by 14.1 points (P=.01). There was an increase in I-QOL (Incontinence Quality of Life) scores by 16.8 points (P<.01). The minimal important difference was met for the UDI-6 and I-QOL but not for the IIQ-7. We were unable to perform meta-analysis to evaluate whether pelvic floor training devices are as effective as traditional supervised pelvic floor physical therapy. Commercially available home pelvic floor training devices are effective in increasing strength of pelvic floor muscles and in the treatment of pelvic floor disorders.

Do levels of self-efficacy affect urinary incontinence, falls, quality of life, sleep, and physical activity in elderly people with urinary incontinence?

Our study aims to determine whether different self-efficacy (SE) levels affect urinary incontinence symptoms, falls, quality of life, sleep, and physical activity in elderly individuals with incontinence. Our secondary aim is to examine the relationship between SE levels and urinary incontinence severity, quality of life, sleep status, fear of falling, and physical activity level. One hundred twenty elderly individuals (median age: 71years) with urinary incontinence participated in the cross-sectional study. Participants were divided into 3 groups as levels of low, moderate, and high according to their Geriatric SE Index for Urinary Incontinence (GSE-UI). Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), Incontinence Quality of Life Scale (I-QOL), Pittsburgh Sleep Quality Index (PSQI), Fall Efficacy Scale (FES), Rapid Assessment Physical Activity (RAPA), and International Physical Activity Questionnaire Short Form (IPAQ-SF) assessments associated with incontinence were performed. Data were analyzed using Mann-Whitney U, Kruskal-Wallis tests, and Spearman's correlation. A significant difference was found in UDI-6, IIQ-7, I-QOL, and FES belonging to three groups according to GSE-UI levels (p ˂0.01, p ˂0.01, p ˂0.01). It was determined that the group with low GSE-UI level had the highest incontinence symptoms, fear of falling, and the lowest quality of life statistically significant. A negative moderate significant correlation was found between GSE-UI scores and UDI-6 (r: - .67, p ˂0.01), IIQ-7 (r: - .67, p ˂0.01), and FES (r: - .46, p ˂0.01). In elderly individuals with urinary incontinence, the level of SE may affect incontinence symptoms, severity, fear of falling, and quality of life and may be an important factor for incontinence. An increased level of SE may lead to positive effects on the user interface. Further studies in this field are needed.

Is There an Association between the Quality of Life of Incontinence Symptoms and the Hip Joint Muscles Strength in Women with Stress Urinary Incontinence?

Background For establishing an accurate target for rehabilitation of stress urinary incontinence (SUI), it is necessary to determine whether there is an association between the pelvic floor muscle (PFM) and hip joint muscle strength and quality of life (QoL) of incontinence symptoms. Purpose The purpose of the current study was to confirm the correlation between QoL of incontinence symptoms and PFM strength, hip extensor, abductor, and adductor strength in women with SUI. Study design Cross sectional study Methods Forty-two women with SUI were recruited for the present study. PFM performance was measured by perineometry. Hip extensor, abductor and adductor strength were measured by dynamometry. QoL of incontinence symptoms was measured by incontinence quality of life questionnaire (I-QOL). The significance of the correlations between I-QOL and hip joint muscle and PFM strength was assessed using Pearson correlation coefficients. Alpha value was set at 0.05. Results Avoidance and limiting behaviors factor in I-QOL was correlated with PFM strength (<italic>r</italic>=0.524, <italic>p</italic>&lt;0.05), hip adductor strength (<italic>r</italic>=0.356, <italic>p</italic>&lt;0.05) and hip abductor strength (<italic>r</italic>=0.352, <italic>p</italic>&lt;0.05) in the order. The total score in I-QOL was correlated with PFM strength (<italic>r</italic>=0.368, <italic>p</italic>&lt;0.05). Conclusions When designing which muscles to train for improving QoL of incontinence symptoms, the hip joint muscle as well as the PFM could be considered.

Rehabilitation Effects of Traditional Chinese Medicine Hot Pressing on Female Patients with Stress Urinary Incontinence

<bold>Objective</bold> To investigate the rehabilitation effects of traditional Chinese medicine hot pressing on female patients with stress urinary incontinence (SUI). <bold>Methods</bold> A total of 80 patients with female SUI were selected and divided into experimental group and control group according to computer random grouping method, with 40 cases in each group. Finally, 77 patients completed the study with 2 cases dropped out in the experimental group and 1 case dropped out in the control group. The control group was treated with conventional rehabilitation and nursing, and the experimental group was given traditional Chinese medicine hot pressing additionally. Both groups were treated for 4 weeks. The leakage of urine (1-hour pad test) and Urogenital Distress Inventory (UDI-6) score before and after treatment and the Incontinence Quality of Life Questionnaire (I-QOL) scores before and after treatment and 1 month follow-up were evaluated. <bold>Results</bold> 1) The urine leakage of 1-hour pad test in both groups after treatment was less than before treatment, and the difference was statistically significant (<italic>P</italic>&lt;0.05). After treatment, the amount of urine leakage in the experimental group was less than that in the control group, and the difference was statistically significant (<italic>P</italic>&lt;0.05). 2) After treatment, the irritation symptoms, stress symptoms, discomfort symptoms and the total scores of UDI-6 were found significantly lower in the experimental group than in the control group (<italic>P</italic>&lt;0.05). These scores were significantly lower in both groups after treatment (<italic>P</italic>&lt;0.05), except for the discomfort symptoms in the control group. 3) In the dimensions of limited behavior, psychological impact, social barriers and total scores of I-QOL, the intergroup, time and intergroup, and time interaction effects of the two groups were statistically significant (<italic>P</italic>&lt;0.05). After treatment and at follow-up, the scores of overall I-QOL and limited behaviors, psychological impacts, social barriers were improved in both groups (<italic>P</italic>&lt;0.05), and the experimental group improved more than the control group (<italic>P</italic>&lt;0.05). At follow-up, the score of social barriers in the experimental group was higher than that after treatment (<italic>P</italic>&lt;0.05), but there were no significant differences in the scores of overall I-QOL and other dimensions compared with those after treatment (<italic>P</italic>&gt;0.05). <bold>Conclusion</bold> Traditional Chinese medicine hot pressing can improve the symptoms of urinary leakage in female patients with SUI and enhance the quality of life, which is better than conventional rehabilitation and nursing.

Objective and Subjective Assessment of Bladder Function after Robot-assisted Laparoscopic Radical Hysterectomy for Early-stage Cervical Cancer

To examine whether objective bladder function after robot-assisted radical hysterectomy (RRH) for early-stage cervical cancer is correlated with subjective patient-reported outcomes and quality of life during the first year after RRH. Prospective observational study. Karolinska University Hospital, Sweden. Women with early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA2-IB1) between July 2017 and May 2019 were assessed for eligibility. RRH. Subjective bladder function was evaluated with the Female Lower Urinary Tract Symptoms and Urinary Incontinence Quality of Life modules of the International Consultation on Incontinence Questionnaire. Objective urinary function was characterized with urodynamic tests, and the nerves ablated at RRH were quantified by using immunohistochemical staining of biopsies from the resected paracervix, vesicouterine, and sacrouterine ligaments. Twenty-seven women were included for analysis at baseline, 2 weeks, 3 months, and 12 months after surgery. RRH caused hypotonia of the urinary bladder (p <.05). Patient-reported outcomes of voiding and filling dysfunction were most significant 2 weeks after surgery (p <.05) but for most of the women, bladder function recovered within 3 months. No correlations were found with either subjective or objective urinary function and the number of ablated nerves. For most women, objective and subjective urinary bladder dysfunction recovered within 3 months after RRH. The absence of correlation between functional outcomes and ablated autonomous nerves suggests that other underlying causes play a significant role. Early detection of bladder overextension after RRH is paramount, and the role of postoperative bladder catheterization needs further investigation.

Urinary symptoms and incontinence in postmenopausal women and the effects on quality of life

AbstractThis study was conducted to determine the effects of urinary symptoms and incontinence on quality of life in postmenopausal women. The sample of the cross‐sectional study consisted of 327 women aged 50–65 who visited primary healthcare centers between 16 April and 30 July 2018. The data were collected using a personal information form, the Urinary Symptom Profile Questionnaire (USP) and the Incontinence Quality of Life Scale (I‐QOL). The mean age of the women participating in the study was 57.89 ± 5.05. It was found that 50.5% of the women had a history of incontinence. While the total mean USP score of all women participating in the study was 4.94 ± 4.81, it was 7.98 ± 4.85 for the women with a history of incontinence. The mean total I‐QOL score was 87.09 ± 16.04 in all women and 76.95 ± 16.93 in the women with a history of incontinence. The women with a history of incontinence were found to have a strong negative correlation between their total USP and total I‐QOL scores. In this study, it was found that the quality of life of women with urinary incontinence, especially their psychosocial health, was found to be significantly affected.

An evaluation of the long-term effectiveness of Gatekeeper™ intersphincteric implants for passive faecal incontinence

BackgroundImplantation of Gatekeeper™ prostheses presents an option for the treatment of passive faecal incontinence (FI). Whilst preliminary results are encouraging, long-term data regarding its sustained benefit are limited. The aim of this study was to assess and evaluate the long-term clinical function and quality of life of patients with passive faecal incontinence who were treated with Gatekeeper™ prostheses.MethodsThis was a single centre, single surgeon retrospective study of prospectively collected clinical data in patients with FI treated between June 2012 and May 2019. Patients with passive FI with symptoms refractory to conservative treatment and endoanal ultrasonography showing intact or disrupted internal anal sphincter were included. Formal clinical and quality of life assessments were carried out using the St. Mark’s Incontinence Score (SMIS) and Faecal Incontinence Quality of Life (FIQoL) questionnaires at baseline, 3 months, 6 months, 12 months and then annually. Endoanal ultrasonography was performed both before and after surgery.ResultsForty patients (14 males, 26 females) with a median age of 62.5 (range 33–80) years were treated with the Gatekeeper™ implant. The majority of patients (87.5%) received six implants. There were no peri or post-operative complications. Prosthesis migration was observed in 12.5% patients. The median follow-up duration was 5 years (interquartile range (IQR) 3.25–6.00 years). A sustained improvement in median SMIS and FIQoL scores from baseline to follow-up was noted. Significant differences were observed between the median baseline SMIS score and last follow-up score of 16.00 (IQR 15.00–16.75) to 7.00 (IQR 5.00–8.00) respectively (p < 0.001), a 56.25% decrease. The overall median FIQoL score showed a significant improvement from 7.95 (IQR 7.13–9.48) to 13.15 (IQR 12.00–13.98) (p < 0.001) a 65.40% increase.ConclusionsGatekeeper™ implantation is a safe approach to treating passive FI and is minimally invasive, reproducible and has minimal complications. Long-term sustained clinical improvement is achievable beyond 5 years. Careful patient selection is paramount, as is consistency of technique and follow-up protocol.

Patient-Reported Bowel and Urinary Function in Long-Term Survivors of Squamous Cell Carcinoma of the Anus Treated With Definitive Intensity Modulated Radiation Therapy And Concurrent Chemotherapy

Definitive radiation therapy with concurrent chemotherapy is curative for nonmetastatic squamous cell carcinoma of the anus (SCCA). However, the true effect of chemoradiation on long-term functional outcomes is poorly understood owing to limited follow-up and patient-reported outcomes (PROs). We conducted a cross-sectional survey of 248 patients with SCCA treated with definitive intensity modulated radiation and concurrent chemotherapy from 2010 to 2018 who were alive and without recurrence. PRO measures were collected, including Functional Assessment of Cancer Therapy-General (FACT-G7), Fecal Incontinence Quality of Life (FIQoL), Low Anterior Resection Syndrome (LARS), and International Consultation on Incontinence Questionnaires (ICIQ). Models were used to determine the association between demographic, tumor, treatment, and dosimetric data with PROs. One hundred twelve (45%) patients completed PROs. Median [interquartile range (IQR)] time from radiation completion to survey was 51 [37-85] months. The median scores [IQR] for FACT-G7, FIQoL, and LARS were 21 [15-24], 14 [11-16], and 32 [25-37], respectively. For men, median subscores [IQR] for ICIQ voiding and incontinence subscores were 5 [2-6] and 1 [1-3], respectively. For women, median subscores [IQR] for ICIQ voiding, incontinence, and filling were 1 [1-3], 5 [3-8], and 4 [2-5], respectively. Higher (better) FIQoL scores were associated with higher (better) FACT-G7 scores (β=0.83; 95% confidence interval, 0.58-1.09; P < .001), and higher (worse) LARS scores were associated with lower (worse) FACT-G7 scores (β=-0.22; 95% confidence interval, -0.31 to -0.13; P < .001). A separate multivariable analysis revealed higher bowel bag D1% was associated with lower (worse) FIQoL (P=.001) and higher (worse) LARS (P=.003) scores. Higher bladder V40 Gy was associated with increased (worse) ICIQ voiding subscore (P=.001). Patients treated with modern chemoradiation for SCCA experience significant long-term bowel toxic effects with considerable effect on quality of life. Minimizing bowel hotspots and bladder V40 Gy may improve bowel and urinary function. Other interventions to reduce long-term toxic effects and improve quality of life are needed.

Comparison of long-term results of obliterative colpocleisis and reconstructive vaginal surgery including sacrospinous ligament fixation in patients with total genital prolapse.

Treatment of total genital prolapse in elderly patients is still controversial in terms of postoperative objective and subjective results. The present study aimed to compare the long-term objective and subjective cure rates of sacrospinous ligament fixation and Le Fort operation for treatment of total genital prolapse. Patients over the age of 60 with stage 3 or 4 pelvic organ prolapse that presented to the Obstetrics and Gynaecology Clinic of the Faculty of Medicine of *** University. The study sample consisted of 17 patients that underwent Le Fort operation and 29 patients that underwent sacrospinous ligament fixation. Data on duration of operation, intraoperative complications, duration of hospital stay, and differences between preoperative and postoperative estimated blood loss, postoperative complications, and relapse in the long term were obtained. Questionnaires exploring quality of life, incontinence, and pelvic floor disorders were applied to the patients. As subjective cure rates, postoperative patient satisfaction (P = 0.001), regret rate (P = 0.038) and recommendation rate (P = 0.044), as well as postoperative questionnaire results, Pelvic Floor Impact Questionnaire and SF36 were found to be significantly better in the Le Fort group (respectively P = 0.039 and 0.042). As objective cure rates, there was no difference between the two groups in terms of postoperative cystocele, rectocele, and cystorectocele (P = 0.955) and postoperative recurrence of prolapse beyond the hymen (P: 0.893). Duration of operation and duration of hospital stay were found to be significantly shorter in the Le Fort group (respectively P = 0.032 and 0.012). Le Fort operation could be the intervention of choice in sexually inactive elderly patients with stage 3 or 4 pelvic organ prolapse.

Application of nanofat for treatment of traumatic faecal incontinence after sphincteroplasty - A pilot study.

The aim of this study was to investigate whether the application of nanofat containing stem cells improves continence in women who had previously undergone anal sphincteroplasty with unsatisfactory long-term outcomes. This prospective pilot study included nine women with various degrees of anal incontinence who had previously undergone anal sphincteroplasty due to obstetric trauma. In all patients, the Wexner Incontinence Score (WS) and Faecal Incontinence Quality of Life Score (FIQLS), as well as anal manometry and endoanal ultrasound measurements, were performed before the procedure and during follow-up. In all patients, liposuction was performed and 50ml of raw lipoaspirate was obtained and processed using a NanoFat Kit device. Approximately 20ml of the mechanically emulsified and filtrated fat was obtained and the anal sphincter complex was infiltrated with it. Patient follow-up was conducted in person or via telephone 6 and 12months after the procedure. The squeeze pressure was significantly increased 6 months after the procedure (p= 0.01). The external anal sphincter measured at the 12 o'clock position was significantly thicker (p= 0.04). A significant decrease in the WS was observed both 6 and 12months after the procedure compared with baseline values (p< 0.05 for both). This study is the first to show that the application of nanofat as an injectable product improves continence in patients with unsatisfactory results after sphincteroplasty, suggesting it to be a promising and effective therapeutic tool. The procedure is safe and can be easily performed as an ambulatory procedure.

Robotic surgery contributes to the preservation of bowel and urinary function after total mesorectal excision: comparisons with transanal and conventional laparoscopic surgery

BackgroundDetermine whether robotic surgery is more effective than transanal and conventional laparoscopic surgery in preserving bowel and urinary function after total mesorectal excision (TME).MethodsOf 79 lower rectal cancer patients who underwent function-preserving TME between 2016 and 2020, 64 patients consented to a prospective questionnaire-based functional observation study (52 responded). At 6 months post-resection or ileostomy closure, Wexner, low anterior resection syndrome (LARS), modified fecal incontinence quality of life, and international prostate symptom scores were used to evaluate bowel and urinary function, comparing robotic surgery (RTME) with transanal (taTME) or conventional laparoscopic surgery (LTME).ResultsRTME was performed in 35 patients (54.7%), taTME in 15 (23.4%), and LTME in 14 (21.9%). While preoperative bowel/urinary functions were similar in all three procedures, and the distance from the anal verge to tumor was almost the same, more hand-sewn anastomoses were performed and the anastomotic height from the anal verge was shorter in taTME than RTME. At 2 years post-resection, 8 patients (12.5%) had a permanent stoma; RTME showed a significantly lower rate of permanent stoma than taTME (2.9% vs. 40%, p < 0.01). Despite no significant difference, all bowel function assessments were better in RTME than in taTME or LTME. Major LARS was observed in all taTME and LTME cases, but only 78.8% of RTME. No clear difference arose between RTME and taTME in urinary function; urinary dysfunction was more severe in LTME than RTME (36.4% vs. 6.1%, p = 0.02).ConclusionsIn function-preserving TME for lower rectal cancer, robotic surgery was suggested to be more effective than transanal and conventional laparoscopic surgery in terms of bowel and urinary functions.

Clinical Report of Baliao Electroacupuncture Treatment on a Stroke Patient Suffering from a Neurogenic Overactive Bladder

Objective: The purpose of this case study is to report the effectiveness of Baliao acupoints electro-acupuncture treatment on a neurogenic overactive bladder induced by stroke.Method: A patient suffering from middle cerebral artery infarction was diagnosed with a neurogenic overactive bladder and treated by Korean medicine, including electro-acupuncture on Baliao acupoints six times per week. The evaluation was performed by monitoring urinary frequency and using the Korean versions of the Overactive Bladder Symptom Score (OABSS) and Urinary Incontinence Quality of Life (I-QoL).Results: After 27 days of electro-acupuncture treatment, the OABSS score improved from 6 to 3. The I-QoL total score improved from 60 to 87. The patient also showed a decrease in nocturia frequency.Conclusion: This case suggests that electro-acupuncture on Baliao acupoints can be effective for overactive bladders due to supra-pontine lesions.

Autologous pubovaginal sling for recurrent stress urinary incontinence after two or more failed synthetic midurethral sling

ObjectiveTo determine efficacy and safety of salvage autologous pubovaginal sling (PVS) placement after a two or more failed synthetic midurethral sling. MethodsWomen undergoing autologous PVS placement for two or more failed synthetic MUS between 2008 and 2019 were identified. Those patients were conducted a follow-up examination. Outcomes of surgery were assessed using the cough stress test with a full bladder and symptom questionnaire, including Incontinence Visual Analogue Scale (I-VAS) and Incontinence Quality of Life (I-QOL) questionnaire. Surgical results were categorized into three classes: cured, improved, and failed. Secondary measures included patients’ recommendation of autologous fascial sling (AFS). ResultsA total of 18 eligible patients met the criteria, of whom median age at surgery was 67 (52–74) years with a median follow-up of 80 (12–144) months. Preoperatively, all patients were identified by urodynamic test with Valsalva leak point pressure (VLPP) < 60 cmH2O. All patients had concomitant part sling excision combined with urethrolysis at the salvage operation. At the follow-up examination, sixteen in eighteen (88.89%) patients were cured and improved. The postoperative total score and each individual domain in I-QOL improved significantly compared with the baseline (p < 0.001). Postoperative I-VAS was significantly lower than preoperative (1.3 ± 0.6 vs. 7.8 ± 2.2, p < 0.001). A total of 16 patients (88.89%) recommended the AFS to others. Neither perioperative blood transfusions nor other complications above Clavien level 3 were observed. ConclusionsOur study indicates that autologous PVS is effective and safe in women with recurrent stress urinary incontinence after two or more failed synthetic MUS.

Первые результаты применения стволовых клеток в лечении стрессового недержания мочи у женщин

Introduction. Stress urinary incontinence is a problem not only for the female, but is also a social, medical and economic issue for the community. The main method of treating stress urinary incontinence in women is surgical intervention with the use of synthetic mesh tape. Possibilities of intra and post-surgical complications is a major setback of surgical treatment. Attempts to restore/improve urethral sphincter functions by implanting stem cells has become a perspective method. Methods and materials. Ten female patients from the Urological Clinic of the Grodno State Medical University were chosen for treatment using autologous mesenchymal stem cells. All of them were undergone tourological and gynecological examinations. All chosen patients filled in an Incontinence Quality of Life questionnaire, related to the continention of urine before and after the implant of stem cells. After the explantation of fatty tissue, autologous mesenchymal stem cells were extracted and cultivated, a mixture of stem cells with a gelatine-based substance. Stem cells were introduced para-urethrally and into the urethral wall. Results. After 12 months after the implant 9 women completely retained urine during physical activity. No imperative disorders noted. One patient continued losing urine during physical activity, and her condition remained without improvement. Conclusion. A positive result by criteria of urine retention, urination disorder, and a subjective evaluation of quality of life was achieved in 90% of patients. A lack of even a small positive effect on one patient gives evidence to pathological changes in the organs of the genitourinary, in which stem cell therapy has a low effectiveness. First results inspire a careful optimism, but a continuation of research is required due to a small number of observations.