Management Of Stress Urinary Incontinence Research Articles

1365 EFFECT OF PREOPERATIVE PELVIC FLOOR MUSCLE THERAPY VERSUS STANDARD CARE ON STRESS URINARY INCONTINENCE IN MEN UNDERGOING RADICAL LAPAROSCOPIC PROSTATECTOMY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence, Evaluation & Therapy (III)1 Apr 20131365 EFFECT OF PREOPERATIVE PELVIC FLOOR MUSCLE THERAPY VERSUS STANDARD CARE ON STRESS URINARY INCONTINENCE IN MEN UNDERGOING RADICAL LAPAROSCOPIC PROSTATECTOMY Petra Voorham- van der Zalm, Joke Dijkstra- Eshuis, Rosa Splinter, Hein Putter, Rob F.M. Bevers, and Rob C.M. Pelger Petra Voorham- van der ZalmPetra Voorham- van der Zalm Leiden, Netherlands More articles by this author , Joke Dijkstra- EshuisJoke Dijkstra- Eshuis Leiden, Netherlands More articles by this author , Rosa SplinterRosa Splinter Leiden, Netherlands More articles by this author , Hein PutterHein Putter Leiden, Netherlands More articles by this author , Rob F.M. BeversRob F.M. Bevers Leiden, Netherlands More articles by this author , and Rob C.M. PelgerRob C.M. Pelger Leiden, Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2719AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic Radical prostatectomy (LRP) is one of the treatments of organ confined prostate cancer. Stress urinary incontinence (SUI) could be a consequence of this treatment. SUI is the complaint of involuntary loss of urine on effort or physical exertion. Dysfunction of the bladder neck as well as intra operative damage of the nerves and sphincter may play a causative role. In this regard, damage of the urethral sphincter can result both from direct damage to the muscle or the neurovascular bundles. When achieving continence the pelvic floor could play a major role. Whether pelvic floor muscle therapy (PFMT) given prior to the RP could decrease the incidence of SUI after this procedure, is a matter of debate in literature at present. The aim of this study is to investigate the effectiveness of PFMT on SUI in men planned to undergo a LRP. METHODS Patients scheduled to undergo a LRP are randomized into a group that will receive preoperative PFMT(inclusive biofeedback) or into a control group. Validated questionnaires, the Pelvic Floor Inventories (PelFIs), the King's Health Questionnaire (KHQ), the International Prostate Symptom Score (IPSS), a voiding dairy, a 24h pad test and examination of the pelvic floor are used to determine the effect of preoperative PFMT on SUI. Six weeks, three months, six months, nine months and one year postoperatively both groups are requested to fill in the KHQ, IPSS and the 24h voiding diary again and to conduct a 24h pad test. In addition, the PelFIs is administered one year postoperatively and the quantitative and qualitative examination of the pelvic floor is repeated. Continence has been defined as completely dry. RESULTS Of 110 patients the results have been analyzed one year postoperatively. The mean age was 63.6 years (range 51-75 years), the mean prostate specific antigen was 10.9 μg/l and over 90% of the patients had a T1 or T2 stage. In the KHQ, IPSS and pad tests the score changed significantly over time (p=0.0001. There were no significant differences between the intervention group and the control group in the incidence of SUI for the KHQ, IPSS and pad tests (p= > 0.05). Continence was achieved in 19,5% of the patients at 6 weeks , 43,2 % at 3 months, 66,1 % at 6 months, 79,7 % at nine months and 83,9 % at one year. In total 16,1 % of the patients was still incontinent one year post operatively. CONCLUSIONS Preoperative PFMT is not effective in the prevention of SUI after a LRP. Other confounders play a major role in achieving continence after LRP. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e558-e559 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Petra Voorham- van der Zalm Leiden, Netherlands More articles by this author Joke Dijkstra- Eshuis Leiden, Netherlands More articles by this author Rosa Splinter Leiden, Netherlands More articles by this author Hein Putter Leiden, Netherlands More articles by this author Rob F.M. Bevers Leiden, Netherlands More articles by this author Rob C.M. Pelger Leiden, Netherlands More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1039 THE MINIARCR-SINGLE INCISION SLING: LONG TERM SUCCESS!

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence, Evaluation & Therapy (II)1 Apr 20131039 THE MINIARCR-SINGLE INCISION SLING: LONG TERM SUCCESS! Saad Juma Saad JumaSaad Juma Encinitas, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.625AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The success rate of MINIARCR-Single Incision Sling (MINIARCR) in the management of stress urinary incontinence (SUI) at short and intermediate follow-up is well documented in the literature. The objective of this retrospective analysis is to evaluate the success rate of MINIARCR in patients with SUI at short, intermediate and long term follow-up using dry rates and patient satisfaction rates as reported on quality of life questionnaire (QOL). METHODS One hundred and thirty two patients who had MINIARCR were the subjects of this review. Preoperative and postoperative evaluation included; history [including pads used per day (PPD)], physical examination, and QOL [Incontinence impact questionnaire (IIQ), Urogenital distress inventory (UDI), and patient satisfaction visual analog scale (VAS)]. All patients had preoperative urodynamic studies and cystoscopy. RESULTS The patients were divided in 4 groups. Group-1 (n=64) mean follow-up 6 (1-12) months, group-2 (n=36) mean follow-up 16 (12-24) months, group-3 (n=12) mean follow-up 25 (24-36) months, and group-4 (n=20) mean follow-up 51 (36-60) months. Preoperatively, group-1 QOL scores were IIQ 10.19, UDI 8.03, VAS 2.94, and PPD 2.03. Group-2 QOL scores were IIQ 10.25, UDI 9.22, VAS 3.44, and PPD 2.54. Group-3 QOL scores were IIQ 9.36, UDI 10.18, VAS 2.54, and PPD 2.0. Group-4 QOL scores were IIQ 9.11, UDI 9.44, VAS 2.85, and PPD 1.85. Postoperatively; group-1 reported incidence of SUI 12.5%, urge urinary incontinence (UUI) 15.62%, and PPD 0.36. QOL scores improvement for IIQ 74.97%, UDI 69.98% and VAS 181.97%. Group-2 reported incidence of SUI 16.6%, UUI 41.66%, and PPD 0.75. QOL scores improvement for IIQ 68.97%, UDI 63.88% and VAS 112.20%. Group-3 patients reported incidence of SUI 25%, UUI 33%, and PPD 0.58. QOL scores improvement for IIQ 50.21%, UDI 64.04% and VAS 127.16%. Group-4 reported incidence of SUI 40%, UUI 50%, and PPD 0.68. QOL scores improvement for IIQ 45.77%, UDI 52.11% and VAS 83.15%. CONCLUSIONS These data demonstrate progressive decline in dry rates after MINIARCR-Single Incision Sling at more than 3 years follow-up, though patients' satisfaction remains high. Higher rates at short and intermediate follow up support a successful technique. Further studies are needed to validate the long-term success of the MINIARCR-Single Incision Sling in the management of SUI. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e426-e427 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Saad Juma Encinitas, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Transvaginal electrical stimulation with surface-EMG biofeedback in managing stress urinary incontinence in women of premenopausal age: a double-blind, placebo-controlled, randomized clinical trial

Introduction and hypothesisThe aim of this study was to evaluate the results of conservative treatment of urodynamic stress urinary incontinence (SUI) using transvaginal electrical stimulation with surface-electromyography-assisted biofeedback (TVES + sEMG) in women of premenopausal age.MethodsOne hundred and two patients with SUI were divided into two groups: active (n = 68) and placebo (n = 34) TVES + sEMG. The treatment lasted for 8 weeks and consisted of two sessions per day. Women were evaluated before and after the intervention by pad test, voiding diary, urodynamic test, and the Incontinence Quality of Life Questionnaire (I-QOL).ResultsMean urinary leakage on a standard pad test at the end of 8th week was significantly lower in the active than the placebo group (19.5 ± 13.6 vs. 39.8 ± 28.5). Mean urinary leakage on a 24-h pad test was significantly reduced in the active group at the end of 8th and 16th weeks compared with the placebo group (8.2 ± 14.8 vs. 14.6 ± 18.9 and 6.1 ± 11.4 vs. 18.2 ± 20.8, respectively). There was also a significant improvement in muscle strength as measured by the Oxford scale in the active vs the placebo group after 8 and 16 weeks (4.2 vs 2.6 and 4.1 vs 2.7, respectively). No significant difference was found between groups in urodynamic data before and after treatment. At the end of 8th week, the mean I-QOL score in the active vs the placebo group was 78.2 ± 17.9 vs 55.9 ± 14.2, respectively, and at the end of 16th week 80.8 ± 24.1 vs. 50.6 ± 14.9, respectively.ConclusionOur study showed that TVES + sEMG is a trustworthy method of treatment in premenopausal women with SUI; however, its reliability needs to be established.

Long‐term impact of surgical repair for stress urinary incontinence on female sexual functions, distress and behaviours

To evaluate sexual functions, distress and behaviours in women who underwent surgical repair of stress urinary incontinence (SUI) in long-term follow-up. Contemporary management of SUI includes conservative therapy and surgical repair - the choice of treatment modality depends on the severity of symptoms. If conservative treatment fails, surgical correction is necessary. The outcomes of the surgery for SUI and their influence on sexual functions are satisfactory in short-term follow-up. A total of 50 women diagnosed with SUI according to International Continence Society standards were included in the study. The patients were qualified for surgical procedures such as: transobturator suburethral tape (TOT) (n = 35), Perigee (n = 6) or MiniArc (n = 9). Sexual functions and behaviours were evaluated prior to the operation and 1-3 years postoperatively in all patient using Female Sexual Function Index (FSFI) and non-validated questions. The mean time after the operation was 1·96 ± 0·83 years. Postoperatively, all women reported significant reduction of urinary incontinence symptoms. According to DSM-IV criteria, female sexual dysfunctions were diagnosed in 12% of females after the urogenital operation. However, sexual complaints (FSFI scores equal or <26·55 points) without distress were reported by 62% of the patients. The comparison of sexual complaints declared prior to and after the operation showed significant differences in the prevalence of decreased desire, decreased arousal and decreased orgasm frequency. In addition, we documented significant improvement of sexual attractiveness and sexual life evaluation after the SUI operation. Surgical repair for SUI improves female sexual functions and reduces sexual distress, as observed in a long-term follow-up. Sexual functions, distress and behaviours in women who underwent surgical repair of SUI; the impact of SUI female quality of life as well as on sexual functions.

Early results of a European multicentre experience with a new self‐anchoring adjustable transobturator system for treatment of stress urinary incontinence in men

To report our experience with a new self-anchoring adjustable transobturator male system (ATOMS®; AMI, Vienna, Austria) for the treatment of stress urinary incontinence (SUI) in men. A total of 99 men, in a number of centres, were treated for SUI with the new ATOMS® device. The device was implanted in all patients using an outside-in technique by passing the obturator foramen and anchoring the device to the inferior pubic ramus. The titanium port was placed s.c. on the left symphysis region. Adjustments were performed via port access. Postoperative evaluation consisted of physical examination, 24-h pad test, and 24 h-pad count. Preoperatively and at 6-month follow-up, patients completed a validated quality-of-life questionnaire. Two-way ANOVA was used to analyse changes over time. Within-group effects for time were tested using post hoc Dunnett's contrasts of baseline values vs subsequent measurements. The most common indication was SUI after radical prostatectomy (92.9%). Failure of previous surgeries was present in 34.3% patients and 31.3% patients had undergone secondary radiation. The mean (SD; range) surgery time was 47 (13.8; 29-112) min. Temporary urinary retention occurred in two patients (2%) and transient perineal/scrotal dysaesthesia or pain was reported by 68 patients (68.7%) and resolved after 3-4 weeks of non-opioid analgesics. There were four (4%) cases of wound infection at the site of the titanium port leading to explantation. No urethral or bladder injuries related to the device or erosions occurred. The mean (SD; range) number of adjustments to reach the desired result (dryness, improvement and/or patient satisfaction) was 3.8 (1.3; 1-6). After a mean (SD; range) follow-up time of 17.8 (1.6; 12-33) months, the overall success rate was 92% and the mean pad use decreased from 7.1 to 1.3 pads/24 h (P < 0.001). Overall, 63% were considered dry and 29% were improved. Treatment of male SUI with this self-anchored adjustable system is safe and effective.

Randomized trial of graft materials in transobturator tape operation: biological versus synthetic

To compare the outcome of outside-in biological and synthetic transobturator tape (TOT) operation, including subjective and objective success rates, urodynamics, and quality of life. One hundred patients suffering from clinical and/or urodynamic stress urinary incontinence (SUI) were randomized into biological material TOT (PELVILACE® TO) or synthetic material TOT (ALIGN®TO Urethral Support System) groups. Preoperative and at 1 year postoperative urogynecological symptom assessment, 1-h pad test, 4-day bladder diary, stress test, Q-tip test, and urodynamics were performed. For the evaluation of quality of life, the King's Health Questionnaire, Urogenital Distress Inventory-6, Incontinence Impact Questionnaire-7, and Prolapse Quality of Life were used. There was no significant difference between the two groups regarding objective and subjective cure rates and quality of life. At 1-year follow-up, the subjective cure rate was 68 % in the biological material TOT and 70 % in the synthetic material TOT group. No perioperative complications developed. Groin pain developed in 2 patients in the biological TOT group and 1 patient had dehiscence in the periurethral incision, which healed with local estrogen. Two patients had transient urinary retention in the synthetic TOT group, 1 patient developed groin pain, and 1 patient had mesh erosion observed at the 1-year follow-up. Transobturator tape with biological material in the management of SUI has a rate of success and patient satisfaction similar to those of synthetic material at 1-year follow-up. Studies with longer follow-up and larger cohorts are necessary to evaluate possible autolysis and degradation of biological slings and a possible reduction in efficacy over time.

Transobturator vaginal tape for the treatment of stress urinary incontinence in elderly women without concomitant pelvic organ prolapse: is it effective and safe?

To evaluate the efficacy and safety of the transobturator approach (TVT-O) for the surgical management of stress urinary incontinence (SUI) in older women. Between 2007 and 2010, all consecutive women with SUI undergoing an isolated TVT-O procedure were prospectively enrolled in this study. Patients were divided into two groups by age: older women (≥ 70 years old) were included in group 1, while younger women (< 70 years old) in group 2. Intra- and post-operative outcomes were compared between the groups. During the study period 181 women met the inclusion criteria and were included for final analysis. Among these women, 60 (33.1%) and 121 (66.9%) were included in groups 1 and 2 respectively. After a median follow-up of 26 (IQR 15-41) months for the younger and 25 (IQR 18-40) months for older patients (p>0.99), no differences were observed between the two groups in terms of cure rate (92.5% vs. 88.3%; p=0.40). No differences were observed in terms of voiding dysfunction, vaginal erosion and persistent groin pain, or in terms of onset of de novo overactive bladder (9.0% vs. 13.3%; p=0.44). TVT-O appears to be a safe and effective procedure for the management of stress urinary incontinence also in elderly population.

Surgical management of stress urinary incontinence: A rational approach to treatment selection.

There are a number of operative approaches to correct stress urinary incontinence (SUI). There is clearly not one procedure that "fits all." This review provides a summary of key available data comparing the various interventions. These findings are then incorporated into an algorithm, which attempts to outline a rational approach to select the most appropriate procedures in women seeking surgical treatment of SUI.

Surgical management of stress urinary incontinence: A rational approach to treatment selection

There are a number of operative approaches to correct stress urinary incontinence (SUI). There is clearly not one procedure that “fits all.” This review provides a summary of key available data comparing the various interventions. These findings are then incorporated into an algorithm, which attempts to outline a rational approach to select the most appropriate procedures in women seeking surgical treatment of SUI.

Stress urinary incontinence in women and lower urinary tract symptoms in men: What are the remaining questions?

The educational sessions of the 2012 Canadian Urology Forum were informative not only because of the evidence-based and practical guidance they provided, but also due to the gaps in knowledge identified during these comprehensive overviews. The following brief review provides a recap of the most important of these outstanding questions, whose answers would provide invaluable information in helping health-care professionals manage stress urinary incontinence (SUI) in women and lower urinary tract symptoms (LUTS) in men.

CT diagnosis of foreign body in urinary bladder after surgical management of stress urinary incontinence

This 49-year-old Taiwanese woman pre-sented with voiding urethral pain, frequency and hematuria. She had the past history of diabetes mellitus, hypertension and schizophrenia. The la-bor history was G7P2. She had suffered from stress urinary incontinence (SUI) for several years and received repair surgery using polypropylene mesh sling (SPARC™ sling system) two years ago. Since one week after the surgery, she had had several episodes of urinary tract infection and no specific cause could be identified. This time she was admit-ted for the same symptoms. The most recent uri-analysis showed positive for occult blood, white blood cell (WBC) 11-20/ high power field and many bacteria. The urinary culture yielded Escherichia coli more than 10

75NC007 device for noninvasive stress urinary incontinence management in women: a randomized controlled trial

Management of stress urinary incontinence (SUI) with intravaginal devices is an alternative to surgical management, but data of a high level of evidence remain scarce. Our goal was to assess efficacy, tolerance, and acceptability of the 75NC007 intravaginal device for SUI management. A phase III, multicenter randomized controlled trial was conducted. After an initial washout period with no treatment, allowing baseline evaluation, women with SUI were randomly assigned to a treatment or control group (no treatment). The primary endpoint was the reduction of incontinence episode frequency (IEF), according to bladder diaries, as compared to baseline. Secondary endpoints were variation of the Urinary Symptom Profile (USP) score, of 24-h pad test, and of CONTILIFE questionnaire scores as compared to baseline. Intent-to-treat and per-protocol analyses were conducted. Fifty-five patients were enrolled and analyzed (26 controls and 29 treated). The mean relative variations of IEF, SUI USP subscore, and overactive bladder (OAB) USP subscore were more significant in the treatment group than in the control group (-31.7 ± 65.1 % vs -7.6 ± 24.5 %, p = 0.002, -2.4 ± 2.6 vs 0.2 ± 2.2, p = 0.004, and -1.5 ± 2.8 vs 0.2 ± 1.8, p = 0.016, respectively). The dysuria USP subscore was slightly decreased in the treatment group. CONTILIFE scores were slightly improved in the treatment group. Pad test variations were not different between groups. No serious adverse event was noted throughout the entire study. The 75NC007 intravaginal device is a safe and effective noninvasive treatment of SUI in women.

Trends in the Surgical Management of Stress Urinary Incontinence

To estimate the rates of stress urinary incontinence (SUI) surgery from 2000 to 2009 by type of procedure, year, age, and region of the country. We used data between 2000 and 2009 from a database containing health care claims data from employer-based plans in the United States. We analyzed data for all women age 18-64 years, identifying all SUI procedures in this population. Rates per 100,000 person-years and 95% confidence intervals (CI) were calculated each year by procedure type, age, and region. The study population included 32.9 million women age 18-64 years observed for 74,007,937 person-years between 2000 and 2009. During that time, there were 182,110 SUI procedures for a rate of 246.1 per 100,000 person-years (95% CI 239.7-252.6). The most common SUI surgery was sling (198.3 per 100,000 person-years, 95% CI 192.8-203.9) followed by Burch (25.9 per 100,000 person-years, 95% CI 24.8-27.2). There was a dramatic increase in slings, with a corresponding decrease in Burch procedures from 2000 to 2009. Other SUI surgeries had lower rates. Although this trend was evident across all regions, the Northeast had the lowest rate of SUI surgery, whereas rates in the West, Midwest, and South were 1.44-times, 1.76-times, and 2.09-times higher, respectively. In a dramatic shift over the past decade, slings have become the dominant procedure for SUI among women age 18-64 years. Although this trend was seen across the United States, considerable variability exists in the SUI surgery rates by region. III.

2147 EDUCATIONAL EXPERIENCE AND PRACTICE PATTERNS OF SYNTHETIC MESH USE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20122147 EDUCATIONAL EXPERIENCE AND PRACTICE PATTERNS OF SYNTHETIC MESH USE Tristan Keys and Gopal Badlani Tristan KeysTristan Keys Winston-Salem, NC More articles by this author and Gopal BadlaniGopal Badlani Winston-Salem, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2318AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In light of the U.S. Food and Drug Administration's safety update in July 2011 warning of the complications associated with trans-vaginal mesh repair of Pelvic Organ Prolapse (POP), we sought to assess current trends in mesh use by practicing urologists, as well as evaluate their training methodology. Approaches to the surgical management of Stress Urinary Incontinence (SUI) and POP have experienced several recent paradigm shifts with the introduction of synthetic mesh-based repair procedures. The subsequent advent of commercialized mesh kits has allowed for wide-spread use, and there has been an associated significant increase in the application of these kits for treating POP. Experience of the surgeon has been shown to impact success and complication rates of mesh procedures, but the rapid incorporation of commercial kits into clinical practice may hinder appropriate training and education, leading to higher complication rates. METHODS Current members of the American Urological Association in the United States were sent an anonymous questionnaire in September 2011. The questionnaire evaluated each member's incorporation of mesh in their daily practice, their sources of training for mesh-based procedures, and their opinion on educational programs. RESULTS The questionnaire was sent to 8,008 practicing urologists in the United States, and 1,329 (16.6%) responded. A majority of urologists (86.8%) currently perform synthetic mesh-based procedures, with an average of 5 procedures performed per month (range 0–100). Most of the procedures are surgical correction of SUI, averaging 4.27 procedures per month (range 0-100), as compared to 1.34 procedures per month for POP (range 0–35). Concerning training modalities, 74.4% have received training through an industry-sponsored course, while only 13% have trained at a specialty society course. One-third (31.9%) indicated self-training as an educational source, whereas another third (32.2%) indicated training received primarily during residency and/or fellowship. Lastly, 75.9% believe the AUA should conduct educational courses regarding surgical mesh use for SUI/POP repair, with the highest percentile of responders (19.3%) being “Extremely Interested” in taking such a course. CONCLUSIONS A majority of responders have received training directly from a surgical device company course, demonstrating the large influence held by the manufacturing sector. Complications vary based on training and patient selection. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e867 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tristan Keys Winston-Salem, NC More articles by this author Gopal Badlani Winston-Salem, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

68 WHICH OUTCOME MEASURE(S) TO SELECT FOR THE REPORTING OF A LONG-TERM STUDY ON THE SURGICAL TREATMENT OF STRESS URINARY INCONTINENCE (SUI) IN WOMEN?

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 201268 WHICH OUTCOME MEASURE(S) TO SELECT FOR THE REPORTING OF A LONG-TERM STUDY ON THE SURGICAL TREATMENT OF STRESS URINARY INCONTINENCE (SUI) IN WOMEN? Rubiao Ou, Hong Zhao, Xian-Jin Xie, and Philippe Zimmern Rubiao OuRubiao Ou Guangzhou, China, People's Republic of More articles by this author , Hong ZhaoHong Zhao Dallas, TX More articles by this author , Xian-Jin XieXian-Jin Xie Dallas, TX More articles by this author , and Philippe ZimmernPhilippe Zimmern Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.114AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Faced with the decision of selecting one or more outcome measures (OM) in a long-term study on the surgical management of SUI in women, it was not clear which OM to preferentially adopt. This prompted a review of reported studies with a minimum of 5 years follow-up in search for some common ground in OM reporting. METHODS A Pubmed search of all English-written, full text, articles published between 1995 and 2010 describing at least a 5 year follow-up after surgical management of SUI (prolapse excluded) was performed. Data analyzed included number of participating centers for each study, study design (R:retrospective, P:prospective, RCT: randomized controlled trial), surgical SUI technique, number of patients enrolled, SUI outcome measures, and the mode of follow-up (office visit versus mail, phone call …). OMs were divided in 3 categories: Subjective, including validated and non-validated questionnaires; Objective, with stress test, pad usage, Q-tip test, pad test; and Others, such as flow rate, residual, voiding diary, urodynamic testing, or imaging. RESULTS 53 articles with more than 5 year follow-up including 35 R, 12 P and 6 RCT were identified. Office visit with a physical examination was documented in 31/53 articles. An average of 2 OMs per study for R, 4 for P, and 3 for RCT was observed. For R studies, 17/35 used unspecified questionnaires, 9/35 a stress test, 7/35 a pad test and 3/35 a voiding diary. For P studies, 8 different questionnaires were selected with no predominance for anyone, whereas stress test was done in 6/12, pad test in 7/12 and voiding diary in 1/12. For RCT studies, 4 chose UDI-6 or IIQ-7, Q-tip test in 3, and pad test or stress test in 2 each. The least performed OMs were BFLUTS, PGI-I, KHQ, ICIQ-SF, pad usage, Bonney test, voiding diary and imaging. Urodynamic was chosen in 6 R, 5 P and 1 RCT, and flow rate in 6 R, 4P and 1 RCT. Studies since 2006 tended to report more OMs than studies from prior years. CONCLUSIONS We found no uniformity in reporting in the long-term studies of surgery for SUI in women. Regardless of study design, few OMs were used, although an increase was noted in the past 5 years. Study comparisons and meta-analyses will remain hampered by the lack of agreement on a minimum set of OM that all studies should provide for meaningful interpretation.[1] References 1 NUU2010; 29: 715. Google Scholar © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e29 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rubiao Ou Guangzhou, China, People's Republic of More articles by this author Hong Zhao Dallas, TX More articles by this author Xian-Jin Xie Dallas, TX More articles by this author Philippe Zimmern Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Can we, and do we need to, define bladder neck hypermobility and intrinsic sphincteric deficiency?: ICI‐RS 2011

Bladder neck hypermobility (BNH, also called urethral hypermobility), and intrinsic sphincteric deficiency (ISD) are terms frequently used in the clinical evaluation and management of stress urinary incontinence, and as subject qualifiers in clinical research. The terms also infer pathophysiologic concepts, as BNH and ISD appear to represent two different aspects of failure of the continence mechanism. Unfortunately, neither term is well-defined, and the various clinical and urodynamic characterizations of these terms do not correlate well with one another. The value of these concepts and these specific terms was debated at the ICI-RS meeting, Bristol, UK, June 2011. Two clinicians were asked to take opposing viewpoints, with three weeks lead-time prior to the meeting. Each discussant presented one viewpoint, "for" or "against," followed by a brief discussion to review the presentations. The consensus was that, while we currently cannot adequately define these terms, there is a need to develop terminology employing these concepts. Terminology should permit improved definition of the sphincteric mechanism, allow individual patient characterization and serve as useful waypoints in treatment decisions.

The adult urology perspective on management of stress urinary incontinence in pediatric urology: ICI‐RS 2011

The modern era of patient-centered, multidisciplinary professional practice comes with the expectation of effective interaction between specialties dealing with closely related clinical areas. Interaction between adult and pediatric urology is generally limited in terms of training, conferences, and joint diagnostic/treatment algorithms. However, in the more complex cases managed by pediatric urologists, long-term medical input is commonly necessary. Accordingly, regular interaction between the relevant specialties would be beneficial for continuity of care of individual patients, achieving best results at transition to adolescence, awareness of long-term outcome of pediatric urological procedures and development of new surgical techniques. This article reviews the discussions at the 2011 International Consultation on Incontinence Research Society meeting in Bristol.

Systematic review and meta-analysis of “inside-out” versus “outside-in” transobturator tapes in management of stress urinary incontinence in women

To directly compare the current evidence for the efficacy, complications, quality of life and cost to health services of both transobturator tension free vaginal tape procedures - "inside-out" versus "outside-in" - in the surgical treatment of female stress urinary incontinence. A prospective peer-reviewed protocol was prepared a priori, and a systematic search of relevant databases from 1966 to January 2011 was performed. Meta-analyses of five randomised trials and three cohort studies were performed separately in accordance with PRISMA and MOOSE, respectively. There was no significant difference in patient-reported cure/improvement (OR 1.25, 95%CI 0.78, 1.99; p=0.35) nor in objective cure/improvement (OR 1.66, 95%CI 0.8, 3.43, p=0.17) between the two groups at 12-month follow-up. Vaginal angle injuries were significantly higher with the outside-in route (OR 0.14, 95%CI 0.05, 0.41, p=0.0003). Groin/thigh pain and de-novo urgency were non-significantly higher with the inside-out route (OR 1.42, 95%CI 0.94, 2.13, p=0.10 and OR 1.46, 95%CI 0.63, 3.36, p=0.38, respectively). There was no significant difference in postoperative quality of life scores between the two groups (WMD -1.65; 95% CI -5.76, 2.46, p=0.43). None of the trials reported a "health-cost" analysis. Meta-analysis of cohort studies confirmed similar results. This is the first reported direct meta-analysis comparing both routes of transobturator tapes. It showed no evidence of significant differences in the efficacy and impact on women's quality of life between "inside-out" and "outside-in" transobturator tapes up to one-year follow-up. The "inside-out" route was associated with significantly fewer vaginal angle injuries but with trends towards higher risk of postoperative groin pain. Long-term follow-up of adequately powered RCTs is required to assess if these results pertain.

Initial Experience and Results With a New Adjustable Transobturator Male System for the Treatment of Stress Urinary Incontinence

We report on our initial experience in terms of efficacy and safety with a new, self-anchoring adjustable transobturator male system (A.M.I.® ATOMS System) for the treatment of male stress urinary incontinence after prostate surgery. In this prospective, nonrandomized single center study conducted between March and December 2009, patients with stress urinary incontinence secondary to prostatic surgery were treated with the ATOMS device. Urethroscopy, filling and voiding cystometry were performed preoperatively for all patients. In addition, incontinence symptoms were assessed, and a physical examination, 24-hour pad test and 24-hour pad count were performed before and after surgery. A total of 38 patients were included in the study (36 after radical prostatectomy, 2 after benign prostatic hyperplasia surgery). No intraoperative complications occurred. Mean number of adjustments during followup was 3.97 (range 0 to 9). At a mean followup of 16.9 months (range 13 to 21) the overall success rate was 84.2%. Of the successful cases 60.5% were considered dry (0 to 1 pad and less than 15 ml/24-hour pad test) and 23.7% improved (more than 1 pad per 24 hours but more than 50% decrease in pad use and less than 100 ml per 24-hour pad test). In 15.8% of the patients the treatment was considered to have failed (more than 2 pads daily and greater than 100 ml on 24-hour pad test). The treatment of male stress urinary incontinence with the ATOMS is safe and effective. It is an excellent first or second line treatment for mild to moderate male stress urinary incontinence, even after external irradiation. The option of long-term, minimally invasive adjustment to respond to patient needs is a significant advantage of this new implant.

Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review.

We reviewed the incidence, predisposing factors, presentation and management of complications related to the use of synthetic mesh in the management of stress urinary incontinence and pelvic organ prolapse repair. Immediate complications, such as bleeding, hematoma, injury to adjacent organs during placement of mesh and complication of voiding dysfunction are not discussed in this review, since they are primarily related to technique. A PubMed search of related articles published in English was done from April 2008 to March 2011. Key words used were urinary incontinence, mesh, complications, midurethral sling, anterior prolapse, anterior vaginal repair, pelvic organ prolapse, transvaginal mesh, vault prolapse, midurethral slings, female stress urinary incontinence, mesh erosion, vaginal mesh complications, and posterior vaginal wall prolapse. Since there were very few articles dealing with the management of mesh-related complications in the period covered in the search we extended the search from January 2005 onwards. Articles were selected to fit the scope of the topic. In addition, landmark publications and Manufacturer and User Facility Device Experience (MAUDE) data (FDA website) were included on the present topic. A total of 170 articles were identified. The use of synthetic mesh in sub-urethral sling procedures is now considered the standard for the surgical management of stress urinary incontinence. Synthetic mesh is being increasingly used in the management of pelvic organ prolapse. While the incidence of extrusion and erosion with mid-urethral sling is low, the extrusion rate in prolapse repair is somewhat higher and the use in posterior compartment remains controversial. When used through the abdominal approach the extrusion and erosion rates are lower. The management of mesh complication is an individualized approach. The choice of the technique should be based on the type of mesh complication, location of the extrusion and/or erosion, its magnitude, severity and potential recurrence of pelvic floor defect.