Literature assessing patient-perceived recovery after urogynecologic surgery is limited, and postoperative activity restrictions vary widely among surgeons. The objective of this study was to describe patient-reported recovery in women undergoing minimally invasive surgery for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI). We performed a prospective cohort study of women undergoing minimally invasive urogynecologic surgery between September 2023 and November 2024 at a single tertiary care center. Women were provided liberal postoperative activity recommendations with no restrictions on lifting or high-impact activities. Participants were asked the following question weekly for 6 weeks after surgery: "To what extent do you feel physically recovered after surgery?" Answer choices were "I don't feel at all recovered," "I feel recovered up to 25%," "I feel recovered up to 50%," "I feel recovered up to 75%," and "I feel fully recovered." For analysis, we defined "recovered" as patients who answered "I feel recovered up to 75%" or "I feel fully recovered." Fifty-four women had POP surgery, and 50 had an isolated midurethral sling (MUS) placed for SUI. After POP surgery, most women (53.7%) met the definition of "recovered" by 2 weeks, and 92.6% were recovered at 6 weeks. Two thirds of participants (62.0%) were recovered at 1 week after MUS surgery, and 86% were recovered by 6 weeks. Most women felt recovered within 1 week after MUS surgery and 2 weeks after POP surgery, supporting evidence-based, unrestricted postoperative activity instructions after urogynecologic surgery.

Background: Stress urinary incontinence (SUI) following radical prostatectomy (RP) can impair quality of life (QoL). While surgical treatments have shown promising short-term results, data on long-term patient-reported outcomes remain limited. Objectives: To evaluate symptom burden, perceived improvement, and health-related quality of life (HRQoL) at extended follow-up after adjustable male obturator system (ATOMS) surgery. Design: Retrospective questionnaire-based observational study. Methods: Men with post-RP SUI who underwent ATOMS implantation between 2012 and 2023 at a single tertiary centre were retrospectively identified ( n = 111). Postoperative follow-up beyond the early postoperative period was conducted on an on-demand basis. Survivors ( n = 99) were contacted and, following informed consent, completed the EPIC-26, RAND-12, and Patient Global Impression of Change questionnaires. Follow-up duration was defined as the time from ATOMS surgery to questionnaire completion. Results: Eighty-three patients participated (median age: 75 years; median follow-up: 87 months). At follow-up, 66% reported perceived improvement. Perceived improvement correlated with higher RAND-12 physical and mental scores. Pad use negatively correlated with both physical and mental HRQoL ( r = −0.4, p < 0.001). Prior radiotherapy and higher BMI were associated with poorer EPIC-26 incontinence scores. RAND-12 scores were comparable to age-matched general population data. Device removal did not significantly impact HRQoL scores. At final follow-up, only 11% used were completely pad-free. Conclusion: ATOMS surgery was associated with symptom improvement and favourable quality-of-life outcomes for most patients. In the context of an on-demand postoperative follow-up strategy without routine scheduled refilling, continence outcomes likely reflect the management model employed, and structured reassessment and refilling may therefore serve to optimise long-term results.

This study aims to evaluate the national trends in the surgical management of male stress incontinence (SUI) in the Australian population over the 21st century. Data was sourced from the Australian Institute of Health and Welfare (AIHW) national morbidity database and Medicare Benefits Schedule (MBS) statistics reports. Annual data from financial years (FY) 2000/01 to 2022/23 was collected. Male SUI procedures are grouped into slings, paraurethral bulking agents (PBA) and artificial urinary sphincters (AUS). The annual procedural counts, revisions and yearly changes were obtained. The estimated subsidy burden was reported as AUD per capita (per 100 000 persons). Between FY2000/01 and 2022/23, the aggregate number of male SUI procedures (excluding revisions) increased by 272% (from 288 to 1072). This is largely driven by the increase in AUS procedures, particularly amongst men aged 70-74 years. Male sling procedures demonstrated a substantial early increase followed by plateauing in recent years, while PBA declined over the same period. Revision procedures increased by 444% (from 41 to 223), largely due to AUS revisions and replacement. Over the same period, the estimated aggregate subsidy burden has increased from $13 749 to $53 269 per capita. The surgical management of male SUI in Australia has been transformative over the past two decades. Trends indicate an increase in male SUI procedures, particularly AUS procedures accompanied by an increase in AUS revision and replacement. These trends reflect both expanding surgical demand and durability of continence devices, which has subsequently led to a substantial increase in estimated subsidy burden.

To evaluate the impact of radical prostatectomy (RP) modality on functional outcomes, safety, and patient satisfaction following Adjustable Transobturator Male System (ATOMS) implantation. Incontinence after prostate treatment (IPT) is a challenging complication of RP. While ATOMS is an established option for IPT, the influence of RP approach-open RP (ORP) versus robot-assisted RP (RARP)-on outcomes has not been investigated. We retrospectively analyzed 131 men undergoing ATOMS implantation for severe IPT after RP (11/2018-05/2024). Patients with prior incontinence surgery, non-RP-related IPT, or urgency/mixed incontinence were excluded. Propensity score matching (1:1; caliper 0.2) for age, interval from RP to ATOMS, locally advanced disease, and prior pelvic radiotherapy yielded 106 matched patients. Primary endpoints were complete continence (0 pads/day), daily pad usage, 24-h pad test, satisfaction, and device explantation. Secondary endpoints included perioperative parameters and complications. RARP patients achieved higher immediate complete continence rates (60.8% vs. 39.2%, p = 0.032), lower daily pad usage (1.0 vs. 2.0 pads, p = 0.048), and fewer explantations (3.8% vs. 15.0%, p = 0.046) than ORP patients. Perioperative parameters and complication rates did not differ. Long-term functional outcomes, satisfaction (84% vs. 76%), and recommendation rates (92% vs. 84.6%) were comparable. This first comparative analysis of ATOMS outcomes by RP modality found RARP to be associated with superior early continence and lower explantation rates, potentially reflecting improved periurethral preservation. However, long-term efficacy, safety, and satisfaction were equivalent, supporting ATOMS as an effective treatment regardless of RP approach.

Flexible cystoscopy is well tolerated by women. Reprocessing of cystoscopes requires sterilization or, at least, high-level disinfection (HLD). This study aims to assess the incidence of bacteriuria after flexible cystoscopy using ortho-phthalaldehyde HLD. This is a prospective study. Seventy-eight women undergoing diagnostic outpatient flexible cystoscopy were included. Exclusion criteria were microbiologically confirmed or acute urinary tract infection, significant urethral stricture, and bleeding disorders. Cystoscopes were reprocessed using ortho-phthalaldehyde. Pre-cystoscopic urine cultures were obtained via catheterization 3-5days prior. Post-cystoscopic urine cultures were obtained immediately after the procedure. No antibiotics prophylaxis. One woman (1.3%) developed post-cystoscopy bacteriuria. The overall mean age was 58.7 ± 11.2years; the mean BMI was 23.4 ± 3.3kg/m2. In the non-bacteriuric cohort, the mean age was 58.87 ± 11.3years, 40 (51.9%) were in the older age group (> 60years), 60 (77.9%) were postmenopausal, 69 (89.6%) were non-diabetic, 20 (26%) had a prior hysterectomy, 13 (16.9%) had previous pelvic reconstructive surgery, 10 (13%) had undergone anti-stress urinary incontinence surgery, and no woman had current pelvic organ prolapse. The most common indication for flexible cystoscopy was hematuria (n = 45, 58.4%). Seventy-three (94.8%) women had unremarkable cystoscopic findings. The single bacteriuric woman was 53years old, postmenopausal, non-diabetic, with a BMI of 22.3kg/m2, and an intact uterus; cystoscopy was performed for interstitial cystitis. The incidence of bacteriuria following flexible cystoscopy was 1.3%. Ortho-phthalaldehyde is effective for HLD in flexible cystoscopy, provided robust rinsing, drying, and exposure-tracking protocols are maintained.

10-year evolution of the number of surgeries for female urinary incontinence in France (2015-2024).

A0022 10-year evolution of the number of surgeries for female urinary incontinence in France (2015-2024)

Minimally Invasive Single-Incision Sling Surgery for Stress Urinary Incontinence: Age-Related Outcomes and Predictors of Failure.

P0512 Complications and causes of readmission following midurethral sling surgery for stress urinary incontinence in 88,880 patients

Objective: This study aimed to investigate factors influencing the surgical outcomes of patients undergoing transobturator tape (TOT) surgery for stress urinary incontinence (SUI), focusing on the predictive value of Valsalva Leak Point Pressure (VLPP) and the presence of urge incontinence. Material and Methods: A retrospective study was conducted involving 117 patients from 561 who underwent TOT surgery between May 2017 and March 2024. We excluded patients with prior pelvic surgeries or neurogenic bladder, and included SUI with urethral hypermobility as an inclusion criterion. We performed urodynamic testing, including VLPP measurement, preoperatively. Postoperative outcomes were evaluated using stress tests, the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-SF), and assessments of urge incontinence and cystocele presence. Results: Postoperative stress tests revealed 14.5% failure and 85.5% success rates. We observed significant differences in urinary incontinence (UI) amount based on VLPP values (p = 0.001), where lower VLPP was associated with higher postoperative UI rates. Urge incontinence had a significant impact on postoperative UI (p = 0.023), but it did not correlate with preoperative UI frequency. Postoperatively, ICIQ-SF scores and impact on daily life showed significant improvement (p <0.001). ROC analysis indicated that the impact on daily life was a significant predictor of surgical success (p = 0.035). Conclusion: TOT surgery may significantly improve urinary incontinence symptoms and have a positive impact on daily life. However, a VLPP of less than 90 cmH2O is associated with higher rates of postoperative UI, suggesting a potential intrinsic sphincter deficiency (ISD). Post-surgical urge incontinence presents a significant challenge for individuals, likely due to detrusor muscle overactivity following the surgery. We need further research to refine predictive measures and improve surgical techniques. Keywords: stress urinary incontinence, transobturator tape, urge incontinence, valsalva leak point pressure

Prior studies of patient decision aids in urogynecology have not shown benefit, but these tools may have been written at a reading level above that of the average patient. The primary aim was to determine if consent using an audiovisual decision aid (AVDA) written below eighth-grade reading level in English or Spanish affects patient preparedness for surgery. Secondary aims included correlating health literacy with preparedness and assessing patient satisfaction with the decision for surgery. We conducted a randomized controlled trial on patients undergoing surgery for pelvic organ prolapse or urinary incontinence. We compared standard informed consent (control) with watching the AVDA. The primary outcome was the overall response on the "Preoperative Preparedness For Surgery" questionnaire. Health literacy was assessed using the Short Test of Functional Health Literacy in Adults. Postoperatively, satisfaction with the decision for surgery was assessed. One hundred fifty-one participants completed the study. In each group, 98.7% of participants strongly agreed or agreed that they felt prepared for surgery (AVDA 74/75, control 75/76, P = 0.364). Most participants had adequate health literacy (AVDA 82.1%, control 81.8%). Among those with low health literacy, there was no significant difference in preparedness for surgery between AVDA and control (P = 0.363). Most participants in both groups were satisfied with their decision for surgery (AVDA 98.6%, control 100%, P = 0.737). Use of an audiovisual decision aid written below eighth-grade reading level did not significantly affect preparedness for surgery, even among participants with low health literacy. Preparedness for surgery was high in both groups.

The National Institute of Health and Care Excellence in the United Kingdom have recommended the development of a patient-reported outcome measure (PROM) specific to surgery for pelvic organ prolapse (POP), stress urinary incontinence (SUI), and complications of pelvic mesh surgery (MC). To identify all aspects of quality of life (QoL) that may be impacted by surgery for POP, SUI and MC, to inform the development of a new PROM. Thirty-one patients who had undergone surgery for POP, SUI and MC (ranging from <6 months to >5 years ago) were purposively recruited from various National Health Service (NHS) Trusts, as well as community support groups for the conditions. Semi-structured interviews were undertaken over the phone or via video-conferencing software, and a framework approach was employed to analyse the data. A Patient and Public Involvement group, comprising seven women who had undergone surgery for POP, SUI and/or MC, were consulted on various aspects of the study. We identified nine themes for potential inclusion in the PROM. The themes are short-term impacts of surgery; long-term impacts on pre-surgery symptoms; pain and/or discomfort; impact on daily activities; social and leisure activities; emotional wellbeing; sexual activity; personal relationships; and work/education. While some participants showed improvements in these areas following surgery, it was also evident that for some, issues persisted, worsened, or developed post-surgery. Those in the sample who had previous surgery involving mesh reported worse QoL outcomes overall. The impact of surgery for POP, SUI and MC on QoL is multidimensional and complex. It is recommended that a future PROM encompasses the potential for improvement of symptoms, the failure of surgery to improve symptoms, the development of new symptoms after surgery, and the consequential positive and negative impacts of surgery on activity, roles, psychological well-being and ultimately QoL, in both the short and long term.

A 66-year-old female patient visited another hospital complaining of frequent urination. Computed tomography scan revealed a 3 cm urethral stone, and she was referred to our hospital for surgery. The patient had a history of tension-free vaginal tape (TVT) surgery for stress urinary incontinence approximately 15 years ago. When transurethral lithotripsy was initiated, the lower end of the stone was found near the external urethral meatus, and an attempt to push it into the bladder was unsuccessful. When fragmentation of the stone was performed using a Ho-YAG laser, exposure of the mesh, presumably from the previous TVT surgery, was detected. A loop electrocautery was used to remove as much of the exposed mesh and the stone as possible. Cystoscopic observation was not possible, but no stone recurrence or mesh-related complications have been noted six months after the surgery. Cases of urethral stones caused by mesh exposure in the urethra after TVT are rare, and we report this case together with a literature review.

This review examines the role of urodynamics (UDS) in evaluating lower urinary tract symptoms (LUTS) following radical prostatectomy. We first present typical urodynamic findings in post-prostatectomy men, then discuss applications of UDS, and finally examine treatment pathways for post-prostatectomy LUTS beyond stress urinary incontinence (SUI) surgery. A narrative review was performed focusing on the current primary literature and society guidelines on the role of UDS post-prostatectomy. LUTS after prostatectomy are common, most frequently storage LUTS, specifically SUI. For the index patient with clinically suspected SUI after prostate treatment, routine UDS before SUI surgery have not been shown to impact postsurgical continence outcomes. In cases where there is diagnostic uncertainty following noninvasive lower urinary tract evaluation, UDS plays an important role. UDS are highly beneficial in complex scenarios, such as severe mixed LUTS, prior radiation therapy, impaired bladder compliance, detrusor underactivity, and/or previous SUI surgery. Fluoroscopy during UDS and cystoscopy can provide additional clarity and confirmation of the diagnosis suggested by UDS. UDS are useful adjuncts in appropriately selected post-prostatectomy patients with LUTS, typically with complicating factors.

The primary aim was to evaluate the impact of body mass index (BMI) category on objective and subjective cure following single incision sling (SIS) surgery for stress urinary incontinence (SUI). The secondary aim was to compare outcomes among different SIS types within and across BMI categories. This retrospective study included 636 women (mean age 57.4 ± 10.4years) with urodynamic SUI who underwent SIS using the Ophira, Solyx, or I-stop mini between 2015 and 2023. Patients were stratified into BMI categories: normal (< 25kg/m2), overweight (25-29.9kg/m2), and obese (≥ 30kg/m2). Objective cure was defined as no leak on urodynamic testing and the 1-h pad test < 2g, while subjective cure was based on patient-reported outcomes using the UDI-6. Objective and subjective cure rates differed across BMI categories, with the highest rates observed in patients with normal BMI (93.1% and 90.5%) and the lowest in obese patients (77.8% and 75%). Within each BMI category, cure rates did not differ significantly by sling type. However, when outcomes were examined across BMI categories for individual sling types, fixed-length SIS (Ophira and Solyx) showed a significant decline in cure rates with increasing BMI, whereas the adjustable length I-stop mini maintained more consistent outcomes. Independent risk factors for failure included age ≥ 66, menopause, intrinsic sphincter deficiency (ISD), and maximal urethral closure pressure (MUCP) < 40cm H2O. BMI category is associated with SIS outcomes, with obese patients demonstrating lower cure rates compared with normal BMI patients. While sling type does not influence outcomes within BMI groups, preoperative counseling is essential for high-risk patients.

Patient satisfaction is a key indicator of the quality of care after urogynecological surgery. The aim of this study was to adapt and validate the Polish version of the International Consultation on Incontinence Questionnaire-Satisfaction (ICIQ-S) among women after urinary incontinence (UI) and/or pelvic organ prolapse (POP) surgery. This was a multicenter, cross-sectional study including 283 women 6-12 months after surgery. Translation was performed according to ICIQ guidelines. Participants completed the ICIQ-S twice via telephone interviews to assess test-retest reliability. Construct validity was analyzed using confirmatory factor analysis (CFA) and group comparisons. Concurrent validity was assessed through correlations with ICIQ lower urinary tract symptoms (LUTS), ICIQ female lower urinary tract symptoms (FLUTS), and the Pelvic Floor Distress Inventory (PFDI-20). Reliability was evaluated using Cronbach's alpha and intraclass correlation coefficients (ICC). The six-item ICIQ-S core showed strong internal consistency (Cronbach's α = 0.913) and excellent test-retest reliability (ICC = 0.958). CFA confirmed good construct validity (Comparative Fit Index = 0.985, Tucker-Lewis Index = 0.967, Standardized Root Mean Squared Residual = 0.021). The ICIQ-S total score demonstrated a very strong negative correlation with PFDI-20 total score (r = -0.764) and moderate negative correlations with ICIQ-LUTS and ICIQ-FLUTS. Group comparisons showed significant differences in satisfaction between UI, POP, and POP + UI groups. The Polish version of the ICIQ-S is a valid and reliable tool for assessing patient satisfaction after surgical treatment of UI and POP. It can be recommended for clinical practice and research to evaluate patient-centered outcomes in urogynecology.

Multiple procedures exist to treat stress urinary incontinence. A database records outcomes and complications and ascertains how surgical and patient characteristics affect outcomes. A retrospective cohort study of 31,901 women undergoing continence surgery from the British Society of Urogynaecologists Surgical Database (2008-2019), including 24,923 retropubic mesh-tapes, 4740 bulking agents, 538 fascial slings and 1700 colposuspension. Multivariable logistic regression was used for primary analyses to compare outcomes between treatments and secondary analysis to assess how different characteristics affect outcomes within treatment groups. Similar outcomes for patient reported global impression of improvement were observed following retropubic mesh-tapes, fascial slings and colposuspension (91%, 89%, 87%, respectively) compared to bulking agents (56.6%). For retropubic mesh-tapes, reduced odds of positive global impression of improvement was seen with increased age, body mass index, detrusor overactivity and intraoperative bladder injury. Odds of bladder injury increased with non-consultant grade operator and decreased with increasing BMI. For colposuspension, increased age led to decreased odds of success and increased odds of return to hospital and readmission. Repeat procedures led to decreased odds of success for retropubic tapes, bulking agents and colposuspension. This large national database demonstrated that increased age, higher BMI, preoperative detrusor overactivity and bladder injury are associated with treatment failure. This information should be used in bespoke counselling to encourage personalised medical decision-making. Missing data is a limitation and would be improved with a mandatory database.

To examine the effects on depression, anxiety, and overall emotional health in patients undergoing artificial urinary sphincter (AUS) surgery for stress urinary incontinence (SUI). Few reports focus on the impact of AUS implantation on emotional health in men with SUI. The AUS Clinical Outcomes Trial (AUSCO) was a prospective, single-arm, multi-site study designed to evaluate outcomes in men with SUI treated with the AMS 800 AUS (NCT04088331). A total of 115 subjects were implanted. Follow-up assessments at 3-, 6-, and 12-months post device activation were compared to baseline. These analyses focus on emotional health, measured with the Incontinence QOL (I-QOL), Incontinence Impact Questionnaire (IIQ-7), and EQ-5D-5L. At 12 months, 100 had completed QOL assessments. Depression rating (Item 5, I-QOL) significantly improved, with 85% (85/100) of patients reporting feeling at least "a little" depressed at baseline decreasing to 39% (39/100) at 12 months (p<0.0001). Emotional health rating (Item 6, IIQ-7) also improved, with 16% (16/100) reporting being "greatly" affected by incontinence at baseline decreasing to 3% (3/100) at 12 months (P<.0001). The anxiety/depression domain on the EQ-5D-5L (Item 5) was also significantly improved, with 50% (50/100) of patients reporting being at least "slightly" anxious or depressed at baseline decreasing to 30% (30/100) at 12 months (P=<0.0001). These data demonstrate that treatment of SUI with the AUS improves emotional health in men with SUI.

Patient-specific Anatomical Registration Marker-guided Surgical Navigation Using a Wearable Mixed-reality Head-mounted Display in Transvaginal Surgery.

To explore how patient characteristics related to health care disparities are associated with access to care and clinical outcomes among patients receiving surgical treatment for pelvic floor disorders in the United States. We searched MEDLINE, EMBASE, and ClinicalTrials.gov through March 25, 2024. Patient characteristics related to health care disparities included race, ethnicity, geographic location, and insurance status, among others. Outcomes included access to surgery, surgical outcomes, and patient-reported outcomes. Eligible studies reported multivariable regression analyses that included at least one patient characteristic related to health care disparities and an included study outcome. For each outcome, we describe the consistency (in direction), strength of association, and number of studies of the patient characteristic related to health care disparities. Meta-analysis was not performed because of study heterogeneity. This review was conducted by the Systematic Review Group of the Society of Gynecologic Surgeons. Of 6,853 abstracts screened, 42 studies with a total of 84 multivariable analyses were included. Characteristics associated with decreased access to apical suspension during prolapse surgery included being from a rural area or of Hispanic ethnicity, and Black racial identity was associated with decreased access to mesh augmentation. Black racial identity and Hispanic ethnicity were also associated with decreased access to reconstructive prolapse repair compared with obliterative procedures and hemorrhage during prolapse repair; older age and having Medicare insurance were associated with increased risk of overall complications. Not being from the Northeast was associated with increased risk of overall complications after prolapse surgery. Patients from a minority race were less likely to undergo reoperation after stress urinary incontinence (SUI) surgery. Black race was not associated with complications after SUI surgery. Patients in minoritized groups in the United States, those with Medicare insurance, and those not from the Northeast were more likely to have health care disparities related to surgical treatment for pelvic floor disorders. PROSPERO, CRD42021234511.