Intrinsic Sphincter Deficiency Research Articles

Biofilms on Indwelling Artificial Urinary Sphincter Devices Harbor Complex Microbe-Metabolite Interaction Networks and Reconstitute Differentially In Vitro by Material Type.

The artificial urinary sphincter (AUS) is an effective treatment option for incontinence due to intrinsic sphincteric deficiency in the context of neurogenic lower urinary tract dysfunction, or stress urinary incontinence following radical prostatectomy. A subset of AUS devices develops infection and requires explant. We sought to characterize biofilm composition of the AUS device to inform prevention and treatment strategies. Indwelling AUS devices were swabbed for biofilm at surgical removal or revision. Samples and controls were subjected to next-generation sequencing and metabolomics. Biofilm formation of microbial strains isolated from AUS devices was reconstituted in a bioreactor mimicking subcutaneous tissue with a medical device present. Mean patient age was 73 (SD 10.2). All eighteen artificial urinary sphincter devices harbored microbial biofilms. Central genera in the overall microbe-metabolite interaction network were Staphylococcus (2620 metabolites), Escherichia/Shigella (2101), and Methylobacterium-Methylorubrum (674). An rpoB mutation associated with rifampin resistance was detected in 8 of 15 (53%) biofilms. Staphylococcus warneri formed greater biofilm on polyurethane than on any other material type (p < 0.01). The results of this investigation, wherein we comprehensively characterized the composition of AUS device biofilms, provide the framework for future identification and rational development of inhibitors and preventive strategies against device-associated infection.

Long-term results of artificial urinary sphincter implantation for urinary incontinence due to intrinsic sphincter deficiency in children.

To report long-term results of artificial urinary sphincter implantation for urinary incontinence due to intrinsic sphincter deficiency in children. This retrospective monocentric study included all patients who underwent artificial urinary sphincter (AMS 800) implantation before 18 years of age between 1986 and October 2018 for intrinsic sphincter deficiency. The primary outcome was the continence rate at the last follow-up, defined by the daily use of 0 pads. The secondary outcome was the overall survival of the device, defined as the absence of any repeated surgery (revision or explantation) during follow-up. Reoperation-free, revision-free, and explantation-free device survival rates were estimated using the Kaplan-Meier method. Thirty-sixpatients with a median age of 12 years (interquartile range [IQR]: 10-14) were included (15 females, 21 males). The median follow-up was 18.7 years (IQR: 9-26). The main underlying condition was spinal dysraphism (n = 24; 67%). The median time to the first reoperation was 9 years (IQR: 3.75-14.7). At the last follow-up, survival rates without revision were 84%, 71%, 55%, and 33% at 5, 10, 15, and 20 years, respectively. Survival rates without explantation were 91%, 84%, 80%, and 72% at 5, 10, 15, and 20 years, respectively. At the last follow-up, 29 patients had a functional device. The overall continence rate was 88%. All patients who had their device still in place were continent at the last follow-up. The artificial urinary sphincter is an effective long-term treatment for urinary incontinence related to intrinsic sphincter deficiency in children, providing a high rate of continence, even if associated with a high rate of reoperation.

Tension-Free Vaginal Tape and Polyacrylamide Hydrogel Injection for Primary Stress Urinary Incontinence: 3-Year Followup from a Randomized Clinical Trial.

We sought to determine whether polyacrylamide hydrogel (PAHG) is noninferior to tension-free vaginal tape (TVT) in the treatment of women with primary stress urinary incontinence (SUI). In this noninferiority trial, 223 women eligible for operative SUI treatment were randomized for TVT (110) or PAHG (113). Primary outcome was patient satisfaction and the noninferiority margin for the difference was 20%. Secondary outcomes were effectiveness and complications. At 3 years, 188 (84.3%) women attended the followup. The satisfaction score (visual analogue scale 0-100) median was 98.5 (IQR 90-100) in the TVT group and 90.0 (IQR 70-100) in the PAHG group, whereas a score ≥80 was reached in 87 (94.6%) and 65 (67.7%), respectively (difference 26.9%, 95% CI 16.7% to 36.8%). Thus, PAHG did not meet the noninferiority criteria set in our study. The cough stress test was negative in 88 (95.7%) of TVT patients vs 75 (78.1%) of PAHG patients (difference 17.5%, 95% CI 8.6% to 26.9%). Any peri- or postoperative complication before crossover between the groups was detected in 40 (43.5%) women in the TVT group and 23 (24.0%) women in the PAHG group (difference 19.5%, 95% CI 6.8% to 31.4%). In midterm followup, PAHG did not reach in patient satisfaction the noninferiority set in our study. Furthermore, mid urethral TVT slings show better subjective and objective cure rates than PAHG. However, complications were more often associated with TVT. Since the majority of PAHG treated women were also cured or improved, primary SUI women can be offered PAHG as a safe and durable alternative treatment.

The Effects of Suburethral Tension Adjustable Sling (Remeex system) for Female Urinary Incontinence between Pure Intrinsic Sphincter Deficiency and Intrinsic Sphincter Deficiency with Overactive Bladder: Initial Experience with Propensity Score Matching

Objective: To compare the therapeutic efficacy after suburethral adjustable sling (Remeex system) for female stress urinary incontinence (SUI) between pure intrinsic s phincter deficiency (ISD) and ISD with overactive bladder (OAB) group. Methods: The study subjects were 86 female patients with ISD who underwent Remeex system to treat female SUI and who were available for 12 months follow-up. We retrospectively studied both patients who underwent Remeex system due to pure ISD (group I) and those who underwent Remeex system due to ISD with OAB (group II). Improvement in objective and subjective symptoms were retrospectively evaluated using a 1hr pad weight test, global response assessment (GRA) and overactive bladder symptom score (OABSS). Results: Group I included 43 patients and group II included 43 patients of mean ages 56.8 ± 7.5 and 57.4 ± 6.6 years, respectively. Use of 1 hr pad weight test showed that incontinence decreased after the procedures in both groups, and that of group I patients was significantly lower than that of group II patients. The mean GRA score was significant a higher score in group I. The OABSS of patients in group II were 8.2 ± 1.1 and 7.2 ± 1.1, respectively, before and at 12 months after operation, did differ significantly. The mean change of OABSS of group II patients was significantly more decreased than that of group I patients. Conclusions: The Remeex system showed a greater patient satisfaction and a higher cure rate in pure ISD than ISD with OAB in female patients with urinary incontinence.

Efficacy of the new adjustable I-stop-mini sling system in women with stress urinary incontinence and intrinsic sphincter deficiency: A retrospective cohort study.

We aimed to evaluate the efficacy, surgical outcomes, and adverse events of the adjustable midurethral sling I-stop-mini in women with intrinsic sphincter deficiency (ISD)-type stress urinary incontinence. We compared this new sling system with the Obtryx transobturator midurethral sling system. This retrospective cohort study was conducted at a single center from June 2017 to December 2020. A total of 141 women who underwent placement of an I-stop-mini or Obtryx and were followed up for at least 1year were enrolled. ISD was defined as a Valsalva leak point pressure of ≤60 cmH2 O or a maximal urethral closure pressure of ≤20 cmH2 O. Student t test was used to compare continuous variables, and chi-square test was used to compare the distribution of categorical data. In terms of objective success, I-stop-mini and Obtryx showed no significant differences in the postoperative 1-month, 6-month, and 12-month. The two devices showed similar effectiveness regardless of the ISD definition. The I-stop-mini group had a significantly shorter operative time, whereas the adverse event rates were similar. The subjective cure rate, objective success, and adverse event rate did not differ in the two devices. I-stop-mini had a significantly shorter operative time.

59 - Intrinsic sphincter deficiency and urethral hypermobility: Are they independent factors in the causation of stress urinary incontinence?

59 - Intrinsic sphincter deficiency and urethral hypermobility: Are they independent factors in the causation of stress urinary incontinence?

Usefulness of videourodynamic study in the decision-making of surgical intervention and bladder management for neurogenic lower urinary tract dysfunction among patients with myelomeningocele.

Neurogenic lower urinary tract dysfunction (NLUTD) is common among children with myelomeningocele (MMC). If NLUTD is not appropriately managed, recurrent urinary tract infection (UTI) can persist and may affect upper urinary tract function. This study investigated the usefulness of videourodynamic study (VUDS) in the urological management of MMC. We retrospectively analyzed 57 patients with MMC who underwent VUDS and received urological treatments at the hospital, including surgeries, minimally invasive therapies, and conservative management. The baseline VUDS parameters of patients who received different treatments were evaluated, and the treatment outcomes of the different treatment subgroups were compared. There were 29 male and 28 female patients with a mean age of 24.1 ± 15.9years upon enrollment. Patients had dysuria or urinary retention (n = 42, 73.7%), urinary incontinence (n = 40, 70.2%), recurrent UTI (n = 35, 61.4%), hydronephrosis (n = 27, 47.4%), and vesicoureteral reflux (n = 26, 45.6%). VUDS revealed detrusor sphincter dyssynergia in 32 (56.1%) patients, bladder neck dysfunction in 13 (22.8%), and intrinsic sphincter deficiency in 20 (35.1%). Among them, 21 (36.8%) received surgical intervention, 17 (29.8%) minimally invasive therapy, and 19 (33.3%) conservative management. After a mean follow-up of 8.5years, the incidence rates of recurrent UTI (61.4% vs 31.6%, p = 0.001), hydronephrosis (47.4% vs 14.0%, p < 0.0001), urinary incontinence (70.2% vs 35.1%, p < 0.0001), and vesicoureteral reflux (45.6% vs 21.1%, p < 0.001) decreased. The overall global response assessment rate was 73.7%, and patients who underwent surgery had the best rate (90.5%). The predictive value of bladder compliance for treatment selection was > 20.5ml/cm H2O. VUDS can be used to comprehensively assess lower and upper urinary tract dysfunction among patients with MMC. To improve NLUTD and prevent complications, minimally invasive therapies or surgical procedures should be recommended to patients with MMC who have low bladder compliance.

Medium-term clinical efficacy and safety of single incision and modified trans-obturator mid-urethral slings for female stress urinary incontinence

AimsTo evaluate the medium term efficacy and safety of Altis and Solyx single incision slings (SIS) compared with tension-free vaginal tape (TVT) Abbrevo trans-obturator sling. We hypothesize that both SIS show little difference in efficacy and safety and perform similarly to TVT Abbrevo. MethodsWe conducted an ambispective comparative cohort study of women with stress urinary incontinence who received a SIS in comparison to matched TVT Abbrevo subjects from a concurrent randomized controlled trial (RCT). Subjects were identified retrospectively, and prospectively invited for examination and questionnaires>12 months post-operatively. Exclusions included intrinsic sphincter deficiency, previous sling surgery, and others. Primary outcome was subjective cure [negative response to International Consultation Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) question 6, leakage during coughing/activity]. Secondary outcomes include objective cure (negative cough stress test), functional outcomes, and adverse events. ResultsBetween 2012 and 2018, a total of 113 women received one of two SIS surgeries; Solyx (n ​= ​50) followed by the Altis (n ​= ​63); 104 were available for final efficacy analysis. Mean follow-up was 21.7 (Altis), 46.0 (Solyx), and 29.0 (Abbrevo) months. Baseline characteristics were comparable between the groups. There was no significant differences in the subjective or objective cure rates between the groups, and no differences in functional outcomes such as patient global impression of improvement, and post-operative ICIQ-UI SF score. There was a low rate of mesh related complications and no differences seen between the groups. ConclusionsDespite being an underpowered study, Altis and Solyx SIS have favourable efficacy and safety profiles which are comparable to an established trans-obturator mid-urethral slings (MUS).

Does Medicaid Cover Male Urethral Sling Surgery? A State-by-State Analysis

ABSTRACT Introduction Male suburethral slings are one treatment option for stress urinary incontinence (SUI) due to intrinsic sphincter deficiency post-prostatectomy in appropriately selected patients. Some studies report up to 55% social continence, and 23% of respondents reduced use of pads by greater than 50%. Male slings may be preferred in men with limited manual dexterity who have difficulty manipulating an artificial urinary sphincter, or in men with more mild SUI, particularly if there is no history of prior radiation. Existing literature regarding insurance coverage and physician reimbursement overwhelmingly focuses on Medicare and commercial plans, leaving a knowledge gap with respect to the Medicaid population which may contribute to inequitable utilization of this treatment modality for SUI. Objective To quantify Medicaid coverage for placement and revision of male suburethral slings for correction of male SUI by state. Methods State Medicaid websites were utilized to access publicly available physician fee schedules. Individual search queries were performed for CPT codes 53440 and 53442, which represent sling operation for correction of male urinary incontinence and removal or revision of sling for male urinary incontinence, respectively. Data were recorded for each device, including the coverage status and physician fees. Results Medicaid physician fee schedules were accessible for 49 out of 50 US states. All 49 of these states reported coverage for placement of a male urethral sling, and 48 states reported coverage for removal or revision of a male urethral sling. Means and range of physician reimbursement for each procedure were $834.26 ($198.00-$5,237.35) for placement of a male urethral sling (53440) and $616.88 ($104.27-$2,288.93) for removal or revision of a male urethral sling (53442). Conclusions Male suburethral sling placement and revision for SUI in the Medicaid population are covered by nearly all states as confirmed by publicly available data. Knowledge of Medicaid coverage for SUI related surgery may result in improvement in the utilization of this treatment option for male SUI and may improve quality of life in the Medicaid cancer survivorship population. Disclosure No

Does Medicaid Cover Artificial Urinary Sphincter Surgeries? A State-by-State Analysis

ABSTRACT Introduction Artificial urinary sphincter (AUS) placement is the most effective long-term treatment for men with severe stress urinary incontinence (SUI), typically due to post-prostatectomy intrinsic sphincter deficiency. Published success rates range from 59 to 90 percent and the procedure is associated with very high patient satisfaction. Existing literature regarding insurance coverage and physician reimbursement overwhelmingly focuses on Medicare and commercial plans, leaving a knowledge gap with respect to the Medicaid population, which may contribute to inequitable utilization of this treatment modality for SUI. Objective To quantify Medicaid coverage for AUS placement and revision for male SUI by state. Methods State Medicaid websites were utilized to access publicly available physician fee schedules. Individual search queries were performed for CPT codes 53444, 53445, 53446, and 53447, which represent insertion of tandem cuff, insertion of inflatable urethral/bladder neck sphincter, removal of inflatable urethral/bladder neck sphincter, and removal and replacement inflatable urethral/bladder neck sphincter. Data were recorded for each device, including the coverage status and physician fees. Results Medicaid physician fee schedules were accessible for 49 out of 50 US states. All 49 of these states reported coverage for removal with and without revision of the AUS, 48 states reported coverage for insertion of an AUS, and 48 states reported coverage for insertion of a tandem cuff. Means and range of physician reimbursement for each AUS related procedure were $1,007.59 ($181.84-$10,960.90) for insertion of tandem cuff (53444), $1,087.40 ($199.89-$11,949.86) for insertion of AUS (53445), $596.93 ($146.90-$1893.12) for removal of AUS (53446), and $1020.14 ($208.55-$11,586.74) for removal and replacement of AUS (53447). Conclusions AUS related surgeries in the Medicaid population are covered by nearly all states as confirmed by publicly available data. Interestingly, removal with and without replacement of AUS was covered by all 49 states with publicly reported data. Knowledge of Medicaid coverage for AUS related surgery may result in improvement in the utilization of this treatment for male SUI and may improve access to care in the Medicaid population. Disclosure No

2021 opinion from the CUROPF on THE efficacy and safety of mid-urethral slings used in women WITH urinary stress incontinence.

To determine the usefulness of mid-urethral slings (MUS) in the surgical management of women presenting with urinary stress incontinence (USI) METHOD: A consensus committee of multidisciplinary experts (CUROPF) was convened and focused on PICO questions concerning the efficacy and safety of MUS surgery compared to other procedures and concerning which approach (retropubic (RP) vs transobturator (TO)) should be proposed as a first-line MUS surgery for specific subpopulations (obese; intrinsic sphincteric deficiency (ISD); elderly) RESULTS: As compared to other procedures (urethral bulking agents, traditional slings and open colposuspension), the MUS procedure should be proposed as the first-line surgical therapy (strong agreement). MUS surgery can be associated with complications and proper pre-operative informed consent is mandatory (strong agreement). Mini-slings (SIS/SIMS) should only be proposed in clinical trials (strong agreement). Both RP and TO approaches may be proposed for the insertion of MUS (strong agreement). However, if the woman is willing to accept a moderate increase in per-operative risk, the RP approach should be preferred (strong agreement) since it is associated with higher very long-term cure rates and as it is possible to completely remove the sling surgically if a severe complication occurs. The RP approach should be used for the insertion of MUS in a woman presenting with ISD (strong agreement). Either the RP or TO approach should be used for the insertion of MUS in an obese woman presenting with USI (strong agreement). In very obese women (BMI ≥35-40kg/m2), weight loss should be preferred prior to MUS surgery and bariatric surgery should be discussed (strong agreement) CONCLUSION: The current Opinion provides an appropriate strategy for both the selection of patients and the best therapeutic approach in women presenting with USI.

Long-term surgical outcome of anterior colporrhaphy and autologous fascial sling (AFS) reinforcement for treatment of high-grade cystocoele

Objective: To determine the long-term outcomes of anterior colporrhaphy with pubovaginal sling reinforcement in the management of high-grade cystocoele and significant urethral dysfunction. Materials and Methods: This is a retrospective case series. From May 2008 to October 2017, all patients who underwent concurrent anterior colporrhaphy and pubovaginal fascial sling performed by a single surgeon were included. Subjective success rates were determined from patient-reported outcomes on follow-up questionnaires using The Patient Global Impression of Improvement (PGI-I) scores. Primary outcome of this study was subjective cystocoele recurrence-free survival. Secondary outcome was complication rate. Results: Eighty patients were included with a median age of 63 years. All women had urethral dysfunction (type II urethral hypermobility or intrinsic sphincter deficiency) on fluoroscopic urodynamics in association with a high-grade cystocoele. The median follow-up time for recurrence of cystocoele was 36 months. The 1- and 5-year estimated cystocoele recurrence-free survival was 97.2% and 84.8%, respectively. Conclusion: Anterior colporrhaphy with concurrent pubovaginal sling reinforcement for treatment of high-grade cystocoele is a safe procedure with a high rate of success durable up to 5 years. The risk of complications is low with no patient developing chronic pain or rejection of the fascial graft. Level of evidence: Not applicable.

The Efficacy and Mid-term Durability of Urethral Sphincter Injections of Platelet-Rich Plasma in Treatment of Female Stress Urinary Incontinence.

Aims: This study investigated the therapeutic effect of repeated urethral sphincter injections of autologous platelet-rich plasma (PRP) in treatment of stress urinary incontinence (SUI) in women due to intrinsic sphincter deficiency (ISD) refractory to medical treatment or after the first anti-incontinence surgery. Methods: Twenty-six women with SUI due to urodynamically proven ISD were prospectively enrolled. Five milliliters of PRP (2.5–5 times of the platelet concentrations in peripheral blood) were injected into the external sphincter at 5 sites, with 4 treatments at monthly interval. The primary end-point was post-treatment Global Response Assessment (GRA, scored 0–3) score after four PRP treatments. A GRA ≥ 2 was considered as a successful result. The secondary endpoints included changes in visual analog scale (VAS) of SUI and urodynamic parameters. The follow-up date was 12 months after the fourth PRP treatment. Results: The mean age was 61.7 ± 15.3 years. The overall success rate was 50% with the post-treatment mean GRA of 1.5 ± 1.1. Complete dryness was achieved in 12 patients (46.2%) after the PRP treatment, and 7 (26.9%) kept total continence at 12 months. The mean VAS of SUI score decreased significantly from 6.4 ± 2.3 to 3.9 ± 2.3 after treatment (p < 0.001). The abdominal leak point pressure increased significantly from 117.5 ± 63.8 to 133.6 ± 61.7 cmH2O (p = 0.045). No perioperative adverse events or severe complications occurred, except 1 (3.8%) patient reported straining to void which was self-limited. Conclusion: Repeated urethral sphincter injections of autologous PRP are a safe procedure that provides significant reduction in the severity of female SUI and a mid-term durability, suggesting PRP treatment is effective to increase urethral sphincter resistance for female SUI.

Treatment of female recurrent or not stress urinary incontinence with intrinsic sphincter deficiency: Sub-urethral retropubic adjustable sling (Remeex)

Recommendations for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincteric deficiency (ISD) or recurrent, are complex. They accept the use of sub-urethral slings (BSU), if unsuccessful the artificial urinary sphincter. The objective was to report the results in terms of continence and morbidity of the Remeex® Adjustable BSU in the treatment of SUI by ISD recurrent or non-recurrent. Monocentric retrospective study of 70 patients with a mean age of 67.7 years (±12) operated of Remeex sling, between 2015 and 2019, was conducted. Preoperative and postoperative characteristics were analyzed from medical records. Two groups were analyzed: Group A (n=28) with no history of incontinence surgery and Group B (n=42) with history (recurrent). Patients who were totally continent (0 protection) and those who were socially continent (1 safety protection) were considered successful. Postoperative success rate was similar between groups B (90%) and A (92%) with respectively: 64% versus 71% of totally continent patients, 26% versus 21% wearing safety protection. The postoperative complications were mainly Clavien II (28%) such as urinary tract infections (6%), transient urinary retention (3%) and de novo bladder overactivity (20%) with no significant statistical difference between the groups. Six patients were reoperated (Clavien III): BSU detension (1%), vaginal exposure (4%) (including one total material removal for infection), varitensor explantation (1%) or scar disunion (1%). The Remeex® BSUA seems to lead to satisfactory perioperative results in patients with SUI with ISD recurrent or non-recurrent.

A0648 - Preliminary experience with adjustable periuretral balloons (ACT™) to treat stress urinary incontinence due to intrinsic sphincter deficiency in children

A0648 - Preliminary experience with adjustable periuretral balloons (ACT™) to treat stress urinary incontinence due to intrinsic sphincter deficiency in children

Five-Year Follow-up in Patients with Transobturator Tape - A Retrospective Observational Study.

Background:Stress urinary incontinence (SUI) could be due to urethral hypermobility due to the weakening of the pelvic floor muscles which support the urethra and bladder or the intrinsic sphincter deficiency. The mid-urethral tape acts as an anchored pubo-urethral neo-ligament thus increasing the level of mid-urethral support. The purpose of this study is to evaluate the safety and efficacy of transobturator tape (TOT) for SUI at 5 years of follow-up.Materials and Methods:This was a retrospective observational single-arm study of 40 patients. Ten patients were lost to follow-up; hence, only 30 patients were included in the study. Patients who underwent TOT from 2010 to 2012 were followed up till December 2017. Patients were evaluated for early and late postoperative complications and efficacy of the tape at 5 years.Results:The mean age of the patients with SUI was 48.07 (standard deviation ± 9.38). About 76.66% (n = 23) of patients had only pure stress incontinence, whereas 23.3% of patients (n = 7) had mixed urinary incontinence (MUI). The cure rate in our study was 93.33% at 5 years. Out of the seven patients with MUI, urge incontinence was cured in 71.42% (n = 5). De novo urgency was observed in 6.6% (n = 2). No major complications such as bladder and bowel perforation, vascular hemorrhage, or mesh erosion were seen. Patient satisfaction was graded as excellent in 46.66% (n = 14), good in 30% (n = 9), and poor in 23% (n = 7).Conclusion:TOT for stress incontinence has a high cure rate and very good efficacy at 5 years. No major complications are seen when the procedure is performed by expert hands.

Comparison of penoscrotal and perineal approaches for implantation of an artificial urinary sphincter in man

Artificial urinary sphincter is considered the gold standard of treatment for male urinary incontinence because of intrinsic sphincter deficiency. The objective of our study was to compare the functional results and complications of the penoscrotal and perineal incision for the implantation of artificial urinary sphincter. A retrospective, monocentric study comparing the perioperative and long-term results of primary implantation of an artificial urinary sphincter in men, performed by the penoscrotal or the perineal incision, was conducted in a French university hospital. Between April 2004and February 2019, 175patients were implanted (118by penoscrotal incision and 57by perineal incision) by 19surgeons. Cuff placement approach depended on surgeon preference. The average follow-up was 34.2±35.6months. Cuff size was smaller in the penoscrotal group (4 [4;5] vs 4.5[4;5] p<0.001). At the end of follow-up, the rates of complete continence, social continence, reintervention for any reason, explantation, and revision was similar between the two groups. Long-term outcomes of penoscrotal and perineal artificial sphincter implantation were similar between the two groups. Prospective multicenter studies are needed to confirm these results.

Getting Ready for Continence Certification: Assessing and Managing Stress Incontinence.

Getting Ready for Continence Certification: Assessing and Managing Stress Incontinence.

Adjustable continence therapy (ACT®) balloons to treat neurogenic and non-neurogenic female urinary incontinence.

To compare efficacy and safety between neurogenic and non-neurogenic women after adjustable continence therapy (ACT®) balloons implantation to treat stress urinary incontinence (SUI) due to intrinsic sphincter deficiency. In the present retrospective multicentric study, all neurogenic and non-neurogenic women implanted with ACT® balloons between 2000 and 2018 were considered for inclusion. Efficacy was compared 1 year after implantation, and women were allocated in three different groups as follows. Success: maximum 1 pad per day and patient's impression of improvement assessed using a numeral rating scale (NRS) ≥8/10. Improvement: decrease of daily pad use and/or NRS ≥5/10. Failure: increase or stability of daily pad use or NRS <5/10. Overall surgical complications and explantations were compared 1 year after implantation. Among the 277 included women, 51 presented with a neurologic underlying disease. Mean age at implantation was 68.5 years. There was no significant difference in efficacy between neurogenic and non-neurogenic women with a success rate of 39.2% and 36.3%, respectively (p = 0.69). Similarly, improvement rate was reported to be 31.4% and 33.6%, in neurogenic and non-neurogenic women, respectively (p = 0.92). The overall surgical complications rate (24% vs. 34.5%, p = 0.15) and the explantation rate (19.6% vs. 28.8%, p = 0.18) were not significantly different. ACT balloons may be proposed to treat mixed or SUI in females with ISD. Efficacy and safety profiles appear to be similar in both neurogenic and non-neurogenic patients.

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

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