Management Of Stress Urinary Incontinence Research Articles

Retropubic versus single-incision mid-urethral sling for concomitant management of stress urinary incontinence during native tissue vaginal repair: a randomized clinical trial

Retropubic versus single-incision mid-urethral sling for concomitant management of stress urinary incontinence during native tissue vaginal repair: a randomized clinical trial

Changes in Stress Urinary Incontinence Symptoms after Pelvic Organ Prolapse Surgery: a Nationwide Cohort Study (FINPOP)

Introduction and hypothesisVarious strategies are employed to manage stress urinary incontinence (SUI) during pelvic organ prolapse (POP) surgery. This study was aimed at facilitating shared decision-making by evaluating SUI symptom changes, staged SUI procedures, and their prognostic factors following POP surgery without concomitant SUI intervention.MethodsWe analyzed 2,677 POP surgeries from a population-based observational cohort, excluding patients with prior SUI surgery. The outcome measures were subjective SUI utilizing the Pelvic Floor Distress Inventory-20 questionnaire and number of subsequent SUI procedures. Multivariable linear models were applied to identify predictors of persistent SUI, procedures for persistent SUI, and de novo SUI. The primary assessment occurred at the 2-year follow-up.ResultsAt baseline, 50% (1,329 out of 2,677) experienced SUI; 35% (354 out of 1,005) resolved, an additional 14% (140 out 1,005) improved, and 5.1% (67 out of 1,308) underwent a procedure for persistent SUI. De novo SUI symptoms developed in 20% (218 out of 1,087), with 3.2% (35 out of 1,087) reporting bothersome symptoms; 0.8% (11 out of 1,347) underwent a procedure for de novo SUI. High baseline symptom severity increased the risk of persistent SUI (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.65–2.53), whereas advanced preoperative apical prolapse decreased the risk (aOR 0.89, 95% CI 0.85–0.93). De novo SUI was more common with advancing age (aOR 1.03, 95% CI 1.01–1.05), baseline urgency urinary incontinence (aOR 1.21, 95% CI 1.06–1.38), and after transvaginal mesh surgery (aOR 1.93, 95% CI 1.24–3.00). It was not dependent on the compartment or preoperative degree of prolapse.ConclusionsIn a pragmatic setting, POP surgery results in a low rate of subsequent SUI procedures.

Autologous Slings in Female Stress Urinary Incontinence Treatment: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The aim of this study is to evaluate the efficacy and safety of autologous fascial slings (AFS) compared with other surgical methods for female stress urinary incontinence (SUI) treatment. The search was performed on studies published before September 2023 to identify articles assessing the effectiveness and safety of AFS compared with other surgical methods in female SUI. Inclusion criteria were randomized controlled trials (RCTs) and adult women with SUI. Exclusion criteria were other urinary incontinence types, combined pharmacological treatment, pregnancy, and lactation. This systematic review was conducted according to the Population, Intervention, Comparison, and Outcome framework, Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist, and was registered in the Prospective Register of Systematic Reviews. Twenty RCTs were included in the systematic review and 10 RCTs in the meta-analysis. Comparison between AFS and synthetic midurethral slings (SMUS) did not show any statistically significant differences in the cure rate, frequency of urinary retention, or self-catheterization. SMUS showed more long-term postoperative complications (RR = 0.12, 95% CI: 0.03 to 0.50, p = 0.004), AFS had more in de novo urgency cases: (RR = 2.84, 95% CI: 1.13 to 7.10, p = 0.03). Operation time of SMUS was lower: (RR = 2.87, 95% CI: 2.56 to 3.19, p < 0.00001, I2 = 97%). SMUS showed significantly lower hospital stay duration: (RR = 1.92, 95% CI: 1.44 to 2.41, p < 0.00001). In this systematic review and meta-analysis, autologous slings demonstrated the same efficacy in comparison with SMUS in the management of SUI in women. AFS showed lower incidence of long-term postoperative complications. SMUS demonstrated lower operation time, hospital stay and de novo urgency.

Evaluating Patient Preferences and Clinical Outcomes for Modified Laparoscopic Burch Colposuspension and Transobturator Tape Procedures in Stress Urinary Incontinence Treatment.

This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two prominent surgical techniques for treating Stress Urinary Incontinence (SUI): the modified laparoscopic Burch colposuspension and the transobturator tape (TOT) procedure. A prospective cohort study was conducted on 145 patients who recieved surgical treatment for SUI, of which 71 patients (49%) underwent the modified laparoscopic Burch procedure, while 74 patients (51%) received the TOT procedure. Data on clinical characteristics, treatment success rates, and postoperative outcomes were collected and analyzed to understand patient preferences and real-world clinical effectiveness. This study revealed notable differences in patient demographics and clinical characteristics between the two groups. At the 2-year follow-up, a success rate of 100% was reported in the modified laparoscopic Burch group and 86.48% in the TOT group. A total of 99 patients (68.28%) were considered cured postoperatively, with 47 (66.20%) in the modified laparoscopic Burch group and 52 (70.27%) in the TOT group (p = 0.598). A significant difference was found in the incidence of dyspareunia, with six cases (8.10%) reported in the TOT group, compared to none reported in the modified laparoscopic Burch group (p = 0.028). The median operation time was significantly shorter in the TOT group, namely 15 min, compared to the modified laparoscopic Burch group, which had a median equal to 27 min (p < 0.001). Despite these differences, patient preference for either surgical technique was observed, along with similar success rates and varied postoperative outcomes. The findings provide a comprehensive overview of patient preferences and factual clinical outcomes for the two surgical techniques in SUI treatment. This study contributes to understanding the factors influencing patient choice and offers valuable insights into the real-world application of these techniques, enhancing patient-centered care in SUI management.

Primary implantation of an artificial urinary sphincter using the perineal and penoscrotal approaches: Functional results and assessment of reoperative procedures

IntroductionArtificial urinary sphincter (AUS) is the standard treatment for severe stress urinary incontinence in men. While the perineal access is considered the gold standard, some authors have proposed penoscrotal AUS in order to facilitate the procedure. The main objective of our study was to evaluate the duration of survival without revision surgery (SSRC) according to the surgical approach for primary implantation. Material and methodsData from 1179 patients implanted in France between 1991 and 2020 with an AMS 800 AUS were retrospectively analyzed. A total of 762 men were implanted perineally (VP) and 417 penoscrotally (VPS). ResultsMedian follow-up was 20 vs. 25months respectively. The groups were equivalent overall, apart from the use of anticoagulants (11% VP vs. 6.3% VPS P=0.014). In our population, 54% patients were considered as “dry” in the case of VPS vs. 42% for VP. There was no significant difference in terms of survival time without reoperation, revision, replacement or explantation. In univariate and multivariate analysis, age over 70years was predictive of more reinterventions, whereas the use of a 4.5cm cuff was protective, with hazard ratios of 1.42 (P=0.001) and 0.78 (P=0.04), respectively. ConclusionThe penoscrotal approach does not appear to be associated with more complications, has good functional results and no significant difference in reoperation-free survival. A prospective multicenter non-inferiority study could be of interest to confirm our findings. Level of evidence4.

Primary care providers practice patterns regarding female pelvic floor disorders

IntroductionPelvic floor disorders (PFDs) pose substantial physical and psychological burdens for a growing number of women. Given the ubiquity of these conditions and known patient reluctance to seek care, primary...

Current Approaches for the Diagnosis and Conservative Treatment of Stress Urinary Incontinence - A Guideline of Guidelines

Urologists utilize evidence-based guidelines organized by urological organizations in the management of stress urinary incontinence (SUI). The objective of this study is to provide guidance in the clinical management of stress urinary incontinence (SUI) by reviewing key guidelines. We conducted a medical literature analysis in the following databases: PubMed, Medline, Embase, National Guideline Clearinghouse, the National Institute for Health and Care Excellence, and Cochrane Library. We also manually searched the websites of the following international and national societies to identify relevant guidelines for inclusion in this review: the International Consultation on Incontinence, American College of Obstetrics and Gynecology, American Urogynecologic Society, American Urological Association/Society of Urodynamic, Female Pelvic Medicine and Urogenital Reconstruction, National Institute for Health and Care Excellence, European Association of Urology, and Canadian Urological Association. The recommendations in the guidelines are summarized in different areas, including the diagnostic standards of SUI, examination and evaluation methods, and conservative treatment methods. This ‘guideline of guidelines’ presents the similarities and differences between prominent authorities in the management of SUI.

Provider Practice Patterns Regarding Over-The-Counter Continence Devices.

Vaginal inserts and continence devices are recommended as a conservative treatment option for the management of stress urinary incontinence (SUI); however, practice patterns for recommendation and use of such devices are currently unknown. Our objectives were to better understand counseling patterns relating to over-the-counter (OTC) continence devices, to assess perceived barriers to recommending these devices, and to estimate clinician familiarity with three such devices currently available in the USA. In this cross-sectional study, an anonymous electronic survey was distributed to all Accreditation Council for Graduate Medical Education-accredited OB/GYN and Urology residency and Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowship programs. A total of 326 survey responses were collected. Multivariate logistic regression was used to assess respondent characteristics associated with recommending OTC continence devices to patients. Sixty-four percent of respondents expressed familiarity with any OTC continence device. Of respondents who reported regular evaluation and treatment of women with SUI (n = 269), 60% reported ever recommending OTC devices for SUI. On multivariate regression, being a trainee and general OB/GYN provider were associated with being less likely to recommend OTC devices for SUI. Of respondents who did not regularly recommend OTC continence devices, reported barriers to doing so included a lack of training with these devices, leading to clinician discomfort (70%) and not remembering OTC devices as an option (15%). Given the low risk associated with patient use of these easily accessible devices, our study highlights barriers to clinician recommendation with the goal of increasing clinician awareness and consideration of OTC continence devices.

(211) Comparable Continence Rates Following Male Urethral Sling Surgery in “Standard” versus “Nonstandard” Patients

Abstract Introduction Transobturator male urethral slings are a surgical option for the management of stress urinary incontinence (SUI). Historically, patient continence and satisfaction rates are influenced by several variables, including: baseline incontinence severity, prior surgical interventions, and exposure to radiation. Ideal or “standard” patients for sling placement have mild or moderate incontinence and no prior incontinence procedures or radiation exposure. Standard patients have been proposed to have better postoperative continence and satisfaction rates than their “nonstandard” counterparts. Objective In this study we sought to compare the efficacy and complication rates of transobturator male sling placement between standard and nonstandard patients. Methods A retrospective, single-institution review was performed of all patients who underwent either an AdVance™ or an AdVanceXP™ sling insertion between October 2016 and May 2023. Patient demographics, preoperative and postoperative continence rates, and complication rates were collected. Patients were then stratified as “standard’ vs “nonstandard”. Standard patients were defined as having a history of radical prostatectomy (robotic or open) and no prior radiation or prior incontinence procedure. Nonstandard patients had prior history of transurethral resection of the prostate, simple prostatectomy, radical cystectomy, prior sling insertion, or prior radiation. The continence and complication rates were compared between groups. Continence was measured in pads per day (PPD). Improvement in continence was defined as a reduction of at least 50% in PPD at 6 weeks postoperatively. Baseline and postoperative PPD were tabulated with median and 25th-75th percentiles, then compared using Wilcoxon signed-rank test. Other variables were summarized with frequency and percentages, and compared using Fisher’s exact test. Results 62 patients were included in this study, of which 48 and 14 were standard and nonstandard, respectively. Mean age was 66 (52-85) years and body mass index (BMI) was 29 (20.3-39.8) kg/m2. No difference in baseline characteristics were noted between the groups (Table 1). 77% of patients had an improvement in SUI following sling placement: 38/48 (79%) patients in the standard group and 10/14 (71%) patients in the non standard group. The most common complication among both groups was urinary retention requiring catheterization (29%), which resolved spontaneously within two weeks in all patients. In the nonstandard group, one patient developed an abscess, one had a scrotal hematoma, and two patients had urinary tract infections (UTI). One patient with history of radiation developed a urethrocutaneous fistula requiring sling removal. There was no significant difference in overall complication rates between standard and nonstandard patients. Comparable rates of improvement in preoperative to postoperative SUI were noted: 2.5 to 0.8 PPD in the standard group and 3.3 to 1.0 PPD in the nonstandard group (Figure 1). Conclusions In this study, nonstandard and standard patients had similar continence and complication rates following urethral sling placement. Future prospective studies are warranted to assess the safety and long-term outcomes of standard and nonstandard patients. Disclosure No.

Management of stress urinary incontinence associated with perimenopause

Pelvic health physiotherapy is recommended as first-line treatment for those with lower urinary tract symptoms and pelvic floor dysfunction. Pelvic health physiotherapists treat a number of genitourinary conditions conservatively, including stress urinary incontinence, overactive bladder, pelvic organ prolapse and vaginal atrophy. When physiotherapy management alone does not fully resolve symptoms, medication may be required. Independent prescribing enables the physiotherapist to maintain continuity of care, allowing a smoother, more effective patient journey. This offers quicker access to medicines and helps avoid delays in commencing appropriate treatment, reducing waiting times across other services. In this article, the role of the pelvic health physiotherapy independent prescriber is detailed in a case study of a patient referred with symptoms of stress urinary incontinence associated with impaired pelvic floor function and episodic constipation, in addition to perimenopausal vaginal dryness causing dyspareunia.

Autologous Fascial Slings for Stress Urinary Incontinence: a 17-year Follow-up of a Randomised Controlled Study.

Safety concerns with the use of mesh in vaginal surgery have been ongoing. Autologous fascial slings (AFS) avoid foreign body complications. We compared the long-term (17-year) outcomes of two AFS repair methods-the standard sling and short sling (sling-on-string), and assessed durability and patient satisfaction of these for the treatment of stress urinary incontinence (SUI). A total of 107 patients from three urogynaecology units who had participated in a randomised controlled trial assessing standard (n = 52) and short (n = 55) slings were followed up for a median period of 17 years. Primary outcomes were Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores to assess the impact on the quality of life and symptom distress. Logistic quantile regression was employed to compare the two methods. Secondary outcomes included long-term complications and patient satisfaction. Mean scores showed no statistically significant difference between the standard and short slings at the 17-year follow-up relating to IIQ and UDI scores, leakage or urgency (p > 0.05). Improved bladder function was observed at 17 years compared with baseline (standard sling-IIQ scores mean difference [MD] 1.22 [CI: 0.69, 1.74], UDI scores MD 0.83 [CI: 0.70, 0.97]; short sling-IIQ score MD 1.14 [CI: 0.73, 1.54], UDI scores MD 0.54 [CI: 0.40, 0.67]) with age-related deterioration over time. Re-operation rates were low and patient satisfaction rates were high (67.2%) at follow-up. Autologous fascial slings are an effective and durable option for management of SUI and the short sling procedure can be recommended owing to plausible surgical advantages.

THE SYSTEMATIC REVIEW OF STRESS URINARY INCONTINENCE

Introduction: Stress urinary incontinence (SUI) affects around 400,000 women in Switzerland, constituting 60 of cases, with symptoms impacting daily life for over 77.5 of affected individuals, especially those over 40 and in nursing homes. The condition, often triggered by activities like laughing or coughing, ranges from minor leaks to more substantial urine loss, significantly affecting quality of life due to weakened pelvic muscles and other factors like menopause and obesity. Treatment options, from pelvic exercises to surgical procedures, require individualized care and a collaborative healthcare approach. This review aims to explore these advancements, focusing on recent studies in SUI management. Methods: The researchers in this study followed the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to ensure that their work met the required standards. This was done to ensure the precision and reliability of the conclusions derived from the research. Result: Our search produced 14 results. After looking at the titles and summaries, we discovered 12 papers that fit our criteria after excluding several articles because they did not fit into criteria. But after reading the full papers carefully, we included five papers in our final analysis. These papers included a retrospective observational study and several case reports. Conclusion: Stress urinary incontinence (SUI) affects around 400,000 women in Switzerland, constituting 60 of cases, with symptoms impacting daily life for over 77.5 of affected individuals, especially those over 40 and in nursing homes. The condition, often triggered by activities like laughing or coughing, ranges from minor leaks to more substantial urine loss, significantly affecting quality of life due to weakened pelvic muscles and other factors like menopause and obesity. Treatment options, from pelvic exercises to surgical procedures, require individualized care and a collaborative healthcare approach. This review aims to explore these advancements, focusing on recent studies in SUI management

Evaluating Patient Preferences and Clinical Outcomes in Stress Urinary Incontinence Treatment: A Short-Term Follow-Up Study of the Transobturator Tape Procedure and Pubourethral Ligament Plication (a Minimally Invasive Technique).

This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two surgical techniques for treating stress urinary incontinence (SUI): the transobturator suburethral sling (TOT) procedure and the pubourethral ligament plication (PUL) procedure. We evaluated the rates of postoperative complications, the duration of each procedure, hemoglobin loss, and days of hospitalization. This prospective study included 80 patients who underwent surgery for SUI: 40 patients for the TOT procedure and 40 patients for the PUL procedure. Clinical data on patient characteristics, treatment efficacy, and post-surgical outcomes were analyzed to assess patient preferences and real-world clinical effectiveness. Regarding patient preferences, those who underwent TOT surgery were more likely to be older, had a higher average number of pregnancies, and were more often postmenopausal, in contrast to those who underwent PUL surgery (p < 0.001 for each comparison). TOT patients had a hospital stay on average of 1.02 days, while PUL patients benefited from ambulatory stays only. In addition, the TOT group had a significantly longer average operating time (16.80 min) compared to the PUL group (9.90 min, p < 0.001). The study revealed notable outcomes in both groups, with high cure rates for both TOT (N1 = 33, 82.5%) and PUL (N2 = 28, 70%) procedures. Specifically, 76.25% of the patients (61 out of 80) were cured after the procedures. Chronic pelvic pain was present in 3.75% of all patients and was notably only observed in the TOT group, with 3 (7.5%) cases being noted. Similarly, vaginal erosion was experienced by 5% of all patients, with 10% of patients in the TOT group and none in the PUL group being affected. Dyspareunia occurred in 2.5% of all patients, with there being two (5%) cases in the TOT group and none in the PUL group. This study highlights that while the PUL procedure achieves cure rates comparable to TOT, it offers a less invasive option with shorter operating times and no hospitalization required. These findings suggest that PUL could be a viable alternative for stress urinary incontinence (SUI) treatment, especially in contexts where avoiding mesh use is preferred. This adds significant value to patient-centered care in SUI management, offering tailored treatment options based on patient characteristics, preferences, and risk profiles.

Urethral Mesh Assessment in Cancer Patients

Urethral mesh placement has become a common surgical intervention for the management of stress urinary incontinence. While this procedure offers significant benefits, it is not without potential complications. This review article aims to provide a comprehensive overview of urethral mesh assessment in oncologic patients. The article explores normal magnetic resonance imaging (MRI) and computed tomography (CT) mesh appearances and highlights the pathological aspects associated with urethral mesh complications including both short-term and long-term post-operative complications. By understanding the spectrum of normal findings of urethral mesh and the possible complications, clinicians can improve patient outcomes and make informed decisions regarding urethral mesh management in this patient population.

The Independent Medicines and Medical Devices Safety Review: Regulatory Reform and Remedies

For years, groups of patients and their families in the United Kingdom raised their concerns about three medical interventions. The first was a possible link between hormone pregnancy tests and fetal malformations and deaths; the second was the physical and neurodevelopmental impacts of in utero valproate exposure; and the third was life-changing adverse events caused by pelvic mesh implants for pelvic organ prolapse repair and stress urinary incontinence management. In response to their tireless campaigning, the Independent Medicines and Medical Devices Safety (IMMDS) Review was commissioned by the Secretary of State for Health and Social Care in 2018. The review, chaired by Baroness Cumberlege, found a catalogue of institutional, systems and structural failures within both the medical establishment and healthcare system more broadly. Drawing on the IMMDS Review findings on pelvic mesh, in this article, I consider the dire consequences when medical devices go wrong. Drawing on firsthand experience as lead researcher for the IMMDS Review, I examine some of the background, outline some key findings and reflect on the strategic changes recommended to medical device regulation and the redress prompted by the pelvic mesh scandal. In so doing, I contextualise and consider the relevant regulatory frameworks, the fundamental systems failures and the other issues identified. Three years on, this article also provides an opportunity to assess the extent to which the IMMDS Review recommendations have been successfully operationalised, as well as to take stock of the improvements that still need to be made.

Effects of Pilates and Conventional Treatment Methods in The Management of Stress Urinary Incontinence Among Women

Stress Urinary Incontinence is a common condition among women that requires attention. The main aim of thisstudy was to compare the effects of Pilates and conventional treatment methods in managing stress urinary incontinence amongwomen. This study is an experimental design, comparative pre-post-test type. 30 female subjects with stress urinaryincontinence were randomly divided into groups, Group A and Group B, with 15 subjects in each group. Group A receivedPilates exercises, and Group B subjects received conventional Kegel's exercises. The study duration was 12 weeks. The pad test,cough stress test, and International Consultation on Incontinence (ICIQ) Questionnaire were outcome measures. The results ofthis study revealed that on comparing the Mean values of Group A &amp; Group B on the International Consultation onIncontinence Questionnaire (ICIQ) and Pad test, Group A (Pilates Exercise) showed 4.46 and 4.93 post-test values which weremore effective than Group B (Conventional kegel's Exercise) at 8.60 and 9.46 at P ≤ 0.001. The Pilates group experienced ahighly significant improvement on the cough stress test compared to the conventional group at P&lt; 0. 001.Pilates exercises wereproven highly effective in managing stress urinary incontinence among women. This study is one of its kind, which demonstratedthe effect of Pilates and its clinical usage for the effective management of Stress Urinary Incontinence.

Effect of Comprehensive Nursing Interventions on Quality of life among Women with Stress Urinary Incontinence

Stress Urinary Incontinence (SUI) is called a silent epidemic which is not a life threatening condition, but a worldwide problem at the same time which contributes to poor quality of life. Aim: Design, implement comprehensive nursing interventions for adult women with stress urinary incontinence and evaluate the effect of these interventions on improving their quality of life. Quazi experimental research design was utilized to conduct this study. This study was carried out in the Urology and Nephrology Assuit University Hospital and its affiliate Clinic. A sample of 50 adult women, the mean age of studied patients was (42.22±11.84). Two tools were used by the researcher namely: Tool I: A structured interview questionnaire sheet it included two parts, part i: demographic data of patient and part ii: medical&amp; urological data assessment. Tool II: Kings Health Questionnaire (KHQ), it is a standardized questionnaire used to assess the impact of stress urinary incontinence on quality of life. The results showed that the quality of life among adult women with stress urinary incontinence were improved after the implementation of comprehensive nursing interventions with a statistically significance difference (p&gt;0.05) in all quality of life domains. . We conclude that provided comprehensive nursing interventions are effective in improving QOL in adult women with SUI. Given the study results, it is recommended that expand of public education efforts through various methods about importance of health educational interventions for appropriate management of stress urinary incontinence among women.

The added value of devices to pelvic floor muscle training in radical post-prostatectomy stress urinary incontinence: A systematic review with metanalysis.

To investigate the role of pelvic floor devices (e.g., biofeedback, electrical stimulation, magnetic stimulation, or their combination) as adjunctive treatments in pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) after radical prostatectomy. A systematic review with meta-analysis. We searched for randomised controlled trials (RCTs) and prospective non-randomised studies investigating the effectiveness of pelvic floor devices as an adjunctive treatment for SUI symptoms assessed with weight pad-test or standardised questionnaires. To assess the risk of bias (RoB) and overall certainty of evidence, the RoB 2.0 or the ROBINS-I, and the GRADE approach were used. Eleven RCTs met our eligibility criteria. One was at a 'low' RoB, one had 'some concerns', while nine were at a 'high' RoB. Two meta-analyses were conducted to analyse the pooled results of six RCTs included. Specifically, two RCTs reported at week 4 with a 1h pad test a mean difference of 0.64 (95% CI = [-13.09, 14.36]), and four RCTs reported at week 12 with a 24h pad test a mean difference of -47.75 (95% CI = [-104.18, 8.69]). The heterogeneity was high in both analyses (I2 = 80.0%; I2 = 80.6%). The overall level of certainty was very low. In line with our results, we cannot conclude whether pelvic floor devices add any value as adjunctive treatment in the management of SUI after radical prostatectomy. Future studies require more comprehensive and standardised approaches to understand whether these devices are effective.

Urinary Artificial Sphincter in Male Stress Urinary Incontinence: Where Are We Today? A Narrative Review

Introduction: Urinary incontinence is a prevalent condition, especially in elderly men, with stress urinary incontinence (SUI) being a common cause after radical prostatectomy. The artificial urinary sphincter (AUS), particularly the AMS 800™ device, has been the gold-standard treatment for moderate-severe male SUI for decades. Despite some technical advancements and alternative devices like ZSI-375, Victo, and BR-SL-AS 904 being introduced, there is limited literature comparing their effectiveness to the AMS 800™. Methods: This literature review compares the AMS 800™ to the newer technologies in the management of SUI. We reviewed the current literature on urinary sphincter implant in male stress incontinence, including AMS 800™, ZSI-375, Victo, and BR-SL-AS 904. Findings: The AMS 800™ is a sophisticated system consisting of an inflatable cuff, a pressure-regulating balloon, and a control pump. Studies show continence rates ranging from 61% to 100% with AMS 800™ implants, with low infection rates and significant improvement in patients’ quality of life. The ZSI-375 sphincter is a unique single-piece cuff without an abdominal reservoir, simplifying implantation. Preliminary data show a social continence rate of 73% at six months, with lower complication rates than the AMS 800™. The VICTO® device offers adjustable pressure and a stress relief mechanism, providing conditional occlusion of the urethra. Early studies report a satisfaction rate of up to 94.2% and a complication rate of 17.6%. BR-SL-AS 904 is a newly proposed urinary sphincter, but due to the limited number of cases and a single study, its efficacy and complication rates remain uncertain. Conclusions: Overall, AMS 800™ remains the gold-standard treatment for SUI after radical prostatectomy. Alternative devices like ZSI-375 and VICTO® show promising results, but longer studies and more data are needed to establish their effectiveness and safety compared with the AMS 800™. Further research and ongoing monitoring are essential to address mechanical issues associated with AUS implants.

Pelvic floor muscle exercises plus biofeedback versus pelvic floor muscle exercises for patients with stress urinary incontinence: A systematic review and meta-analysis of randomized controlled trials

&lt;b&gt;Background:&lt;/b&gt; Stress urinary incontinence (SUI) is a widespread illness that mostly affects women, particularly those who have recently given birth or gone through menopause. The purpose of this meta-analysis is to compare the effectiveness of pelvic floor muscle exercises (PFME) plus biofeedback to PFME alone in treating SUI in female patients.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; We systemically searched six electronic databases (PubMed, Scopus, and Web of Science) from inception until February 7, 2022. We included randomized controlled trials (RTCs) comparing patients who had undergone PFME plus biofeedback to PFME alone. For risk of bias-2 (RoB2) assessment, we used cochrane risk of bias assessment tool. Continuous data were pooled as standardized mean difference (SMD), and dichotomous data were pooled as odds ratio with the corresponding 95% confidence intervals (CI).&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; 15 RCTs were included, with a total of 788 patients with SUI. The overall effect estimate between PFME+BF and PFME alone groups favored the PFME+BF group in improving PFME strength (SMD=0.33, 95% CI [0.14 to 0.52], p=.0009) and did not favor either of the two groups for quality of life (SMD=-0.22, 95% CI [-0.44 to 0.00], p=0.05), leakage (SMD=-0.10, 95% CI [-0.37 to 0.17], p=0.47), pad weight test (SMD=-0.22, 95% CI [-0.44 to 0.00], p=0.05), cure rate (odd ratio [OR]=2.44, 95% CI [0.52 to 11.42, p=0.26), and social activity (SMD=0.66, 95% CI [-0.04 to 1.36], p=0.07).&lt;br /&gt; &lt;b&gt;Conclusion: &lt;/b&gt;BF addition to PRME improves cure rate and PFME strength without affecting leakage or quality of life. Healthcare providers must consider patient safety and comfort while choosing BF devices with PFME. SUI management strategies should include BF to improve results.