Management Of Stress Urinary Incontinence Research Articles

Rising Rates of Urethral Bulking: A Retrospective Study of a National Database.

Stress urinary incontinence (SUI) affects approximately 50% of women. There are limited data regarding trends in management as treatment options have changed. This study aimed to analyze trends in the surgical management of SUI, including slings and urethral bulking, from 2012 to 2022. Patients from the American College of Surgeons National Surgical Quality Improvement Program database who had undergone a sling or urethral bulking procedure were identified by Current Procedural Terminology code. Descriptive statistics and independent paired t tests were performed. A total of 81,657 patients received either slings or urethral bulking from 2012 to 2022. The number of slings performed peaked in 2017, decreased in 2020, and has subsequently increased. The rate of urethral bulking increased from 2019 to 2022. The average age patients who received urethral bulking was 64 years versus 56 years for sling patients (P < 0.05). These patients were more likely to be American Society of Anesthesiology class III compared to those receiving slings (39% vs 25%, respectively, P < 0.05). Readmission and reoperation rates were not statistically different. Less invasive procedures were more likely to be performed concurrently with bulking. Sling placement is the most common surgical procedure for SUI but it decreased in 2020, likely due to COVID-19-related delays, and has not yet returned to prepandemic levels. Urethral bulking has become more common, possibly due to new agents available in U.S. markets. Patients who received urethral bulking were more likely to be older, have severe systemic disease, and underwent a less invasive concurrent procedure. Further research is needed to understand these trends.

Prevalence, Diagnosis, and Management of Stress Urinary Incontinence in Women: A Collaborative Review.

Stress urinary incontinence (SUI), defined as any involuntary leakage of urine associated with physical activity, remains underdiagnosed and undertreated. This review aims to provide an updated overview of the prevalence, diagnosis, and treatment of SUI in women, drawing upon recent evidence-based literature and clinical guidelines. A systematic search of the MEDLINE database was conducted to identify only the most up-to-date and relevant studies published up to February 26, 2024, including the reference ESTER systematic review. The search was limited to systematic reviews published in the preceding 1yr. Any additional included publications were limited to those published or referenced as part of the existing/current guidelines. Diagnosis of SUI involves a comprehensive assessment, including medical history, physical examination, and in some cases, invasive urodynamics. Pelvic floor muscle training emerges as a first-line management strategy, showing efficacy in symptom improvement when good educational instructions and supervision are provided. Surgical interventions with midurethral and single-incision slings offer a second-line option, although concerns regarding mesh-related complications persist with a decrease in its use. Moreover, the long-term efficacy of single-incision slings remains to be confirmed. Urethral bulking agents, colposuspension, and autologous fascial slings are existing alternatives supported by robust evidence, albeit with a different adverse event profile. Management of complicated and severe SUI remains challenging, with autologous fascial sling and artificial urinary sphincters being established treatments, but high-quality data remain lacking. Heightened awareness and accessibility to SUI treatment are imperative to address the gap between prevalence and medical care-seeking behavior. Pelvic floor muscle training and surgical interventions represent key modalities. However, a notable escalation in invasiveness and complication rates when transitioning to surgical interventions is clear and has resulted in a hesitance among patients to proceed along the treatment continuum, particularly in light of mesh-related complications. Ongoing research is necessary to optimize outcomes and ensure patient safety, particularly for complicated SUI where data on comparative effectiveness remain limited.

Comparison of Trans-Viginal Tape (TVT) and Trans-Obturator (TOT) Tape Methods for Management of Stress Urinary Incontinence among Women with Post-Menopausal Condition

Objective To compare the frequency of success of TVT versus TOT for SUI in postmenopausal women. Methodology: A randomized control trial study was conducted at department of Urology, Sharif Institute of Urology and Renal Transplant, Lahore from 11-07-2019 to 10-01-2020. Females of postmenopausal age presenting with stress urinary were included in the study however, the patients with bleeding diathesis, untreated urinary tract infection. Diabetes and chronic kidney diseases were excluded from study. Patients were divided into two groups (A &amp;B) after taken an informed consent. In group A, patients underwent TVT and in group B, patients underwent TOT. After 3 months, patients were evaluated for symptoms of stress urinary incontinence and stress test. Both groups were compared by using chi-square test for desired outcome with p value ≤ 0.05 as significant. Results: Mean durations of menopause were 10.94±3.91 and 6.75±1.05 years and mean duration of symptoms were 6.42±2.94 and 7.39±1.82 years in groups A and B, respectively. Majority of patients were married i.e. 66.0% and 74.0% and sexually inactive i.e. 88.0% and 94.0%, in groups A and B, respectively. Successful treatment was observed in 70.0% patients after TVT procedure and 94.0% patients after TOT procedure (p-value= 0.002). Conclusion: Higher success rates were observed in postmenopausal women of &lt; 50 and &gt; 70 years of age, underweight and normal weight women, unmarried, sexually inactive, women with less than 5 years of Duration of menopause and less than 5 years of duration of symptoms of urinary stress incontinence. Objective: To determine the impact of midlife on professional life by exploring the workplace challenges faced by women

Effectiveness and Safety Profile of Urethral Bulking with Bulkamid® for Stress Urinary Incontinence: A French Multi-Center Cohort Study.

Various treatment options are currently available for the management of stress urinary incontinence (SUI). This study was aimed at determining the effectiveness and safety profile of Bulkamid®, and identify predictive factors of clinical success. This retrospective study conducted in two French urogynecology university centers between September 2019 and December 2023 included all patients with urinary incontinence who received Bulkamid®. Among the 320 patients included (median age 58.2years), the median follow-up was 24 months. Urethral hypermobility was found in 93.4% of patients (n = 282) and 92% (n = 275) had a positive cough test. At 1 month, 68.7% of patients (n = 220) achieved clinical success, 25.6% (n = 82) improved, and 5.6% (n = 18) reported failure. At last follow-up, 63.7% of patients (n = 204) were still cured, 21.9% (n = 70) had improved, and 14.4% (n = 46) reported failure. Among the 16 patients with overactive bladder (OAB) 43.7% had a Patient Global Improvement (PGI) score of 1-2 at 1month and 50.0% at last follow-up, with significant difference compared with patients without OAB, 81.0% had a PGI score of 1-2 at 1month and 74.8% at last follow-up (p = 0.0006 and p = 0.04 respectively). Regarding complications, acute urinary retention occurred in 3.1% of patients (n = 10), urinary infections in 2.2% (n = 7), and transient hematuria in 7.2% (n = 23). In multivariate analysis, follow-up time was significantly associated with failure compared with improvement/cure (OR = 1.05, 95%CI 1.02-1.08, p = 0.0002). The present large series of patients reported the effectiveness of Bulkamid® injection, a minimally invasive procedure providing good clinical outcomes at 2years' follow-up.

Conservative treatments for women with stress urinary incontinence: a systematic review and network meta-analysis.

This study aimed to compare the effectiveness of various conservative treatment strategies for women with stress urinary incontinence. A comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library was conducted from their inception through March 2024, without restrictions on language or location. Randomized controlled trials (RCTs) comparing the efficacy of conservative treatments for stress urinary incontinence, using short-term pad test or the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) score as outcome measures, were included. We conducted a network meta-analysis using a random-effects model to compare the effectiveness of different conservative treatment strategies, employing prediction interval plots and league tables, and ranked them according to the surface under the cumulative ranking curve (SUCRA). The quality of the included studies was assessed following the Cochrane Handbook for Systematic Reviews of Interventions. A total of 31 RCTs involving 1,900 patients across 8 intervention categories were included in the analysis. SUCRA rankings indicated that electrical stimulation (SUCRA = 95.9%) was the most effective therapy for improving ICIQ-UI SF scores, followed by biofeedback electrical stimulation (SUCRA = 84.9%), radiofrequency (SUCRA = 77.5%), biofeedback (SUCRA = 57.8%), magnetic stimulation (SUCRA = 45.3%), pelvic floor muscle training (SUCRA = 38.4%), Er: YAG laser (SUCRA = 37.4%), and CO2 laser (SUCRA = 7.4%). In terms of reducing urine leakage, the treatments were ranked in descending order as follows: Er: YAG laser (SUCRA = 97.5%), biofeedback electrical stimulation (SUCRA = 83.4%), biofeedback (SUCRA = 67.0%), radiofrequency (SUCRA = 59.5%), electrical stimulation (SUCRA = 48.4%), pelvic floor muscle training (SUCRA = 43.0%), magnetic stimulation (SUCRA = 27.8%), and CO2 laser (SUCRA = 21.4%). Based on the clustered rankings of the two metrics, biofeedback electrical stimulation was identified as the most effective therapy for improving stress urinary incontinence. Based on the combined analysis of two indicators, we found that biofeedback electrical stimulation may be the optimal therapy for the conservative management of stress urinary incontinence. https://www.crd.york.ac.uk/prospero/, identifier CRD42024569845.

Platelet-rich plasma for treatment of female stress urinary incontinence.

Stress urinary incontinence (SUI) poses a significant burden on affected individuals, impairing their quality of life and causing embarrassment due to involuntary urine leakage during activities such as sneezing or coughing. While conservative and surgical treatments exist, a subset of patients experiences persistent symptoms despite these interventions. This review provides insights into the potential role of platelet-rich plasma (PRP) as a therapeutic adjunct for patients with SUI that does not respond to conventional non-surgical or surgical treatments. We conducted a literature review of studies in English to evaluate PRP efficacy in managing SUI. The studies conducted on PRP therapy suggest that it is an effective and safe treatment option for SUI in women. PRP injections, when used alone or in combination with other therapies, have shown significant improvements in SUI symptoms. Moreover, these studies indicate that PRP injections offer a less invasive and low-risk alternative to surgical procedures for managing SUI, which could lead to shorter recovery times. The efficacy of PRP therapy is evidenced by significant reductions in SUI symptoms, as well as improvements in bladder function variables, without significant adverse effects reported. However, further research is necessary to establish the long-term effectiveness and safety of PRP therapy for managing SUI in diverse patient populations. Additionally, ongoing evaluations of PRP therapy in combination with other interventions will be essential for optimizing treatment outcomes and broadening the potential applications of PRP in the management of SUI.

Position of the Ibero-American Society of Neurourology and Urogynecology (SINUG) on the urodynamics (UDS) in women undergoing surgical treatment for stress urinary incontinence (SUI)

Introduction:Most clinical practice guidelines currently recommend not to necessary perform routine urodynamic studies (UDS) before surgery for female stress urinary incontinence (SUI). However, there is no consensus in the literature. Our objective was to evaluate the available evidence and to establish a position as a scientific society. Methods:A search was conducted using PubMed, Web of Science and Scopus databases. Inclusion criteria were manuscripts in English with the terms “female urinary incontinence” and “urodynamics”. The analysis included 25 studies. Results:Regarding the usefulness of UDS in female undergoing SUI, two randomised, controlled trials have been published showing that preoperative UDS do not improve the results of SUI surgery. The review of data from different series on the surgical treatment of female SUI shows that up to 36% of patients undergoing surgery for SUI are complicated cases due to previous anti-incontinence surgery, pelvic prolapse that exceeds the hymen, radiotherapy or pelvic surgery. Moreover, the performance of UDS before treatment of SUI leads to a change in diagnostic orientation in 74% of patients with complicated SUI and 40% in the case of uncomplicated SUI. It should be noted that the UDS study modifies the proposed treatment in 23.8% and 11% of patients with complicated and uncomplicated SUI, respectively. A review by Serati et al. reported that the UDS results are congruent with the clinical diagnosis of SUI in 74.5% of cases. However, there is overactive detrusor in 10.6%, mixed urinary incontinence in 8% and the results of the UDS are inconclusive in 6.8% of cases. Therefore, it is estimated that UDS before surgery is more likely to change the management of SUI in 17% of patients. Conclusions:In women referring SUI, it is necessary to individualise the indication for UDS before surgical correction. UDS are complementary tests to be considered after non-invasive studies of the patient with a detailed clinical history, physical examination and other complementary tests such as a voiding diary, specific questionnaires and flowmetry with residual urine. We consider it necessary in cases of complicated or non-pure SUI.

146 - 9 year analysis of the efficacy, longevity and safety of the Adjustable Transobturator Male System® (ATOMS) in Managing Stress Urinary Incontinence in Men.

146 - 9 year analysis of the efficacy, longevity and safety of the Adjustable Transobturator Male System® (ATOMS) in Managing Stress Urinary Incontinence in Men.

An update on surgical management for stress urinary incontinence.

Stress urinary incontinence (SUI) is a common condition for which women often opt for surgical management. Synthetic midurethral slings (MUS) have been the dominant treatment for decades. Single-incision slings (SIS) have been introduced to lower the morbidity associated with trocar passage during MUS placement. Urethral bulking has been used less frequently owing to its lower cure rates. New data have recently emerged in support of single-incision slings (SIS) and urethral bulking with Bulkamid polyacrylamide hydrogel (PAHG). Several studies with a follow-up ≥10 years have shown stable efficacy and complication rates of retropubic (RMUS) and transobturator (TMUS) midurethral slings over time. SIS products show equivalent efficacy to traditional TMUS and RMUS at up to 3 years of follow-up and can be placed under local anesthesia. While urethral bulking with PAHG results in lower cure rates compared to slings, satisfaction rates are high and responders have sustained improvement at 7 years follow-up. All three types of available slings, TMUS, RMUS, and SIS, are now considered appropriate surgical options for the treatment of SUI. Although the absence of comparative data precludes a formal recommendation for one injectable over another, urethral bulking with PAHG has favorable long-term results and an excellent safety profile.

Adjustable continence therapy (ProACT/ACTTM) with periurethral balloons for treatment of stress urinary incontinence: a narrative review.

First-line surgical management of stress urinary incontinence (SUI) currently involves implantation of an artificial urinary sphincter (AUS) in male patients and midurethral sling in female patients. Still, there is demand for a less invasive treatment option without the need to use a device during voiding. Since its first description in 2005, many clinics have implemented adjustable continence therapy balloons in male (ProACTTM) and female patients (ACTTM). Publications on the use of ProACT/ACTTM were reviewed from 2002 until September 2022, focusing on functional and safety outcomes, including predictors of treatment failure and complications. Most publications report the use of ProACTTM in patients after prostate surgery, with approximately 60% experiencing a cure rate and 82% achieving over 50% improvement. Consistent functional outcome assessment in female and neurogenic lower urinary tract dysfunction (NLUTD) patients lacks. Few predictors of treatment failure were described, resulting in an advise to not use the balloons after male pelvic radiation therapy. High revision rates were observed in all patient groups, with balloon defects as one of the most common causes for revision. Based on the current literature, ProACTTM is safe and effective in male patients after prostate surgery, but the role of ProACT/ACTTM in female and NLUTD patients is still unclear. There is need for research of higher level of evidence with uniform outcome assessments. Preferably, ProACTTM is prospectively compared with AUS in a randomized setting. In addition, development of better-quality balloons should reduce mechanical failure and revision surgeries, resulting in improved functional and patient satisfaction outcomes.

(140) CHANGES IN SEXUAL QUALITY OF LIFE IN PATIENTS WITH STRESS URINARY INCONTINENCE TREATED WITH AN ARTIFICIAL URINARY SPHINCTER; ANALYSIS OF THE ARTIFICIAL URINARY SPHINCTER CLINICAL OUTCOMES TRIAL (AUSCO)

Abstract Introduction The artificial urinary sphincter (AUS) remains a “gold standard” in the treatment of male stress urinary incontinence (SUI). Despite being a standard of care for over 50 years, there is sparse data regarding the connection between SUI and sexual quality of life (QoL). Objective To examine the relationship between SUI and sexual QOL in men treated with the AUS. Analysis of the sexual health-related Incontinence Quality of Life (IQoL) item 22 in patients before and after AUS implant provides insight to understanding of this relationship. Methods The Artificial Urinary Sphincter Clinical Outcomes Trial (AUSCO) is a single-arm, prospective, multi-center study designed to evaluate objective and subjective outcomes of men with SUI treated with the AMS 800. This was approved by each institutional committee on ethics in human investigation (NCT04088331). A total of 115 patients served as their own controls and follow-up assessments at 12-months post device activation were compared to baseline values. The change in response to IQoL item 22, “I worry about having sex because of my urinary problems or incontinence,” was analyzed between baseline and 12 months. Patients who had ED recorded in their baseline medical history were also analyzed separately. Results Of the 115 implanted patients, 98 patients completed IQoL assessments at 12 months as of May 2024. Overall, there was a statistically significant improvement in responses to level of worry about having sex due to urinary problems (p &amp;lt; 0.001, Table 1). Improvement was observed in men with (p = 0.031) and without ED (p &amp;lt; 0.001). Specifically, 43.3% (39/90) of men without ED reported feeling “extremely” worried about having sex at baseline, which fell to 12.2% (11/90) at 12 months. Conversely, their responses of “not at all” worried about having sex increased from 18.9% (17/90) at baseline to 40.0% (36/90) at 12 months. Men with ED who reported being “extremely” worried about having sex decreased from 50% (4/8) at baseline to 25% (2/8) at 12 months. The number of responses of “not at all” worried about having sex increased from 0% at baseline to 12.5% (1/8) at 12 months. Lower pad weight and decreased pad use post-AUS were associated with improvement in this sexual quality of life measure. Improvement in sexual QOL was independent of age, BMI, and diabetes. Conclusions Men with and without ED showed an improvement in sexual quality of life at 12 months post AUS. The treatment of SUI in men with the AUS improves their level of worry as it relates to sexual activity. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific Corporation. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific Corporation.

Urethral Bulking.

This Clinical Practice Statement aims to provide clinicians with evidence-based guidance for the use of urethral bulking agents (UBAs) in the treatment of stress urinary incontinence (SUI). We conducted a structured search of the English literature published from January 1960 to November 2022. Search terms identified studies of both current and historic UBAs. Data extracted at the time of full-text review included type of study, research setting, number of participants, age group, bulking agent, primary outcome, secondary outcome, efficacy, and complications. One thousand five hundred ninety-four nonduplicate articles were identified using the search criteria. After limiting the article types to randomized control led trials, prospective studies, guideline documents, reviews, meta-analyses, and case reports of complications, 395 studies were screened. Based on our findings, we propose the following recommendations for clinicians when considering UBA: First, UBA is indicated in cases of demonstrable SUI. Intrinsic sphincter deficiency is not predictive of patient outcomes. Second, patients should be counseled on the risks, lack of long-term efficacy data, potential need for repeat injections, possible need for surgery for recurrent SUI, implications for future procedures, and pelvic imaging findings that may be observed after UBA. Third, UBA may be considered for initial management of SUI. Fourth, UBA is an option for patients with persistent or recurrent SUI after a sling procedure. Fifth, clinicians may prioritize UBA over surgery in specific patient populations. Sixth, polyacrylamide hydrogel demonstrates marginally improved safety and durability data over other available agents.

Management of Stress Urinary Incontinence by Obstetricians and Gynecologists in Jordan: A Nationwide Survey Study.

Stress urinary incontinence (SUI) is a common condition that can significantly impact a patient's quality of life. Although multiple diagnostic and treatment options exist, significant variability in SUI management exists between countries. Since women's SUI prevalence in Jordan is high, and Jordan is a lower-middle-income country, this study aimed to investigate how obstetricians and gynecologists (OBGYNs) across Jordan manage and treat women with SUI. A Google Forms survey was prepared and sent out to Jordanian OBGYNs via WhatsApp. The results were collected and arranged in Microsoft Excel and then transferred to SPSS for statistical analysis. Out of the 804 Jordanian registered OBGYNs, 497 could be reached, 240 conduct gynecological surgeries, and 94 completed the survey, providing a response rate of 39.2%. Most of the respondents were females between 41 and 55 years old. More than 70% of the OBGYNs worked in the private sector, and 88.3% operated in the capital of Jordan. Most of the respondents favored lifestyle and behavior therapy (43.6%) or pelvic floor physiotherapy (40.4%) as the first-line management for SUI. The transobturator mid-urethral sling (MUS) was the most common initial surgical treatment option. The physicians preferred two-staged procedures for the repair of pelvic organ prolapse alongside concomitant SUI. In the case of recurrent SUI following surgery, 77% of the respondents chose to refer to a urologist or urogynecologist. The Jordanian OBGYNs preferred using lifestyle/behavioral therapy and pelvic floor muscle physiotherapy as the first-line treatment to manage SUI. Secondly, the MUS would be the most frequently preferred surgical choice. To effectively manage SUI, adequate training in urogynecology and referral resources are essential in lower-middle-income countries.

Dorsolateral fibromuscular tissue preservation during artificial urinary sphincter placement: Technique description and review

ABSTRACT The artificial urinary sphincter AMS800 is considered the gold standard for the treatment of non-neurogenic stress urinary incontinence in men following prostate cancer treatment. While optimizing patient risk factors and device modifications have been helpful, the surgical technique remains the cornerstone in establishing excellent patient outcomes. Meticulous intraoperative tissue handling and dissection are the key to the successful placement of the device. Our center has used the same technique for the past 10 years with a low complication rate. In this article, we will describe our surgical approach.

Research Focusing on How Qinge Pill Functions in Managing Stress Urinary Incontinence, Utilizing Network Pharmacology

Objective: Investigating how Qing-e pill aids in managing stress urinary incontinence through network pharmacology. Methods: Utilizing the TCM system's pharmacological database and analytical framework (TCMSP), along with literature exploration, the active components and their respective targets for Qing-e pill were identified, leading to the creation of a network of compound TCM - active ingredients - targets. The focus of SUI was identified using the GeneCards and OMIM databases. The active ingredient SUI-target network model was developed and examined using the Cytoscape 3.10.1 software. The protein interaction network (PPI) was created using the STRING database, incorporating gene ontology functional annotation (GO) and Tokyo Genome Encyclopedia (KEGG) pathway enrichment analysis on key targets through DAVID online, with molecular docking performed using Surflex software. Results: Screening yielded 86 active components, 461 possible targets, 2551 SUI targets, and 187 typical targets for Qing-e pill and SUI. The outcomes of network analysis revealed Qing-e pill's primary targets for SUI treatment were AKT1, IL6, JUN, TNF, HSP90AA1, ESR1, CTNNB1, EGFR, among others. The primary biological mechanisms encompassed reactions to lipopolysaccharide, molecules originating from bacteria, metal ions, growth of epithelial cells, and the control of membrane potential, among others. KEGG enrichment primarily aims to utilize the AGE-RAGE signaling pathway in treating a range of conditions, including diabetes complications, prostate cancer, fluid shear stress, atherosclerosis, lipid and atherosclerosis, IL-17 signaling pathway, and more. Conclusion: Initially, network pharmacology shed light on the foundational materials and operational methods of Qing-e pill in treating SUI, offering a theoretical foundation for their clinical use.

A randomized prospective comparison of the needleless mini-sling "hammock" and "U-shape" configurations for management of stress urinary incontinence: 60-month follow-up results.

To compare needleless mini-slings placed in a retropubic (U-shape) or trans-obturator (hammock-shape) configuration for treating stress urinary incontinence at 60th month. All surgeries, conducted by a senior surgeon, involved objective and subjective assessments preoperatively and at 6, 12, 18, and 60 months postoperatively using cough-stress tests, ICIQ-SF, PGI-I, and a Likert scale. After 60 months, no significant differences were found in cure rates, mesh complications, or reinterventions between U-shaped and hammock-shaped groups. However, a significant decrease in cure rates was observed at 18 and 60 months in both groups. Notable differences in ICIQ-SF, Likert scale, and PGI-I scores were seen in the hammock-shaped group, while the U-shaped group showed differences in ICIQ-SF and PGI-I scores, but not in the Likert scale. Given the lack of significant differences, asserting the superiority of either retropubic (U-shape) or transobturatorly (hammock-shape) needleless mini-slings for treating stress urinary incontinence is challenging.

Systematic Review of the Global Use of Validated Questionnaires in the Management of Stress Urinary Incontinence in Women.

Our goal was to systematically review the most commonly used validated questionnaires in recent global literature on stress urinary incontinence (SUI) treatment. PubMed, Embase, and Ovid databases were queried for manuscripts containing "female stress urinary incontinence" AND "diagnosis" AND "treatment" AND "questionnaire." Two independent reviewers screened studies for randomized controlled trials, prospective, and retrospective studies between 2018 and 2023. Exclusion criteria included male participants, non-SUI incontinence, and articles not originally written in English. The review was registered in PROSPERO [465721] and conformed to PRISMA guidelines. In 117 manuscripts meeting study criteria, the median of the mean ages was 52 years, with a median of 164 participants per study. Most studies originated in Europe (59/117). The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form was the most frequently used (52%), followed by the Patient Global Impression of Improvement (31%), the Urinary Distress Inventory 6 Short Form (25%), the Incontinence Quality of Life (20%), and the Incontinence Impact Questionnaire-Short Form (19%). These leading questionnaires were short, translated into several languages, and globally addressed important SUI-related domains, including the presence and severity of SUI, additional lower urinary tract symptoms, and the impact of SUI on quality of life, as well as changes perceived after treatment. This systematic review of the validated questionnaires used in contemporary SUI management literature could help guide recommendations for incorporating these favored instruments into future SUI treatment outcome documents.

Structural health care reality in the surgical treatment of male stress incontinence in Germany

Stress urinary incontinence in men is predominantly iatrogenic after radical prostatectomy or transurethral interventions. Current studies show that there is adeficit in the availability of surgical therapy not only in Germany. The aim of this study is to investigate in more detail the structural health care situation of surgical treatment of male stress incontinence in Germany. The evaluation of the surgical therapy of male stress incontinence in Germany is based on the OPS (Operationen- und Prozedurenschlüssel-German procedural classification) codes from hospital quality reports from 2011-2019. From 2012-2019, the number of male incontinence surgeries declined from 2191 to 1445. The number of departments performing incontinence surgeries decreased from 275 to 244. In the multivariate analysis, ahigh number (≥ 50) of radical prostatectomies/year (RPE/year) is an independent predictor of ahigh-volume centre (≥ 10procedures/year; odds ratio [OR] 6.4 [2.3-17.6]; p < 0.001). The most significant decrease was in sling surgery (from 1091 to 410; p < 0.001). Here, the number of cases decreased especially in departments that implanted ahigh number of slings (≥ 10slings/year; -69%; -62.4 ± 15.5 surgeries/year; p = 0.007). In addition, the number of departments implanting slings decreased over the investigated time period (from 34to 10; p < 0.001). This particularly affected departments that also had alow number of RPE/year (from 9to 0; -100%). The situation of surgical treatment of male stress urinary incontinence in Germany shows aclear decline in sling implantation, especially in small departments. On the one hand, this reflects the increasingly differentiated indications for sling implantation. On the other hand, it raises the suspicion that agap in care has developed, as the decline was not compensated for by other surgical therapies.

ProACT™ (Uromedica, Plymouth, USA) balloons for male urinary incontinence: A fourteen-year-old cohort

BackgroundMale urinary incontinence is attributed to SUI consecutive to benign prostate hypertrophy surgery, trauma, neurological diseases, or injury. Medical devices are developed to treat male urinary incontinence among them proACT® balloons. This technique was chosen in our center to achieve continence. Our study aims to evaluate safety and efficacy of proACT® balloons implanted in our center by measuring the rate of efficacy. MethodsWe performed a retrospective and single centre study. A single expert surgeon performed all surgeries. Seventy-one balloons were implanted in 57 male patients between 2007 and 2020. Primary endpoint was the efficacy time lapse of the balloons after surgery. The analysis was performed using Kaplan-Meier method. Factors, which could affect the efficacy of the balloons, were analysed using a Cox regression analysis. ResultsIn all, 45 balloons successfully cured stress urinary incontinence among the 57 men implanted resulting in a 63.38% success rate. Twenty-six balloons failed to treat stress urinary incontinence and were retrieved out of the 71 implanted. Ten balloons failed to treat urinary stress incontinence without organic cause, 6 balloons deflated, 5 balloons migrated out of the initial implantation site, 2 eroded, and 3 ended up infected. Fifty percent of the balloons were successful for a median time of 95 months. Univariate analysis did not reveal any predictive factor of failure. ConclusionsOur study showed 50% success rate at 95 months follow-up, therefore allowing a life expectancy of 7.9 years for the balloons. This safe mini-invasive technique ensured stress urinary incontinence in men. Level of evidence4.

A randomized trial of retropubic vs single-incision sling among patients undergoing vaginal prolapse repair

The choice of midurethral sling type may impact efficacy and complications in women undergoing transvaginal native tissue repair of pelvic organ prolapse. The primary aim was to determine if the single-incision sling is noninferior to retropubic sling for the management of stress urinary incontinence among patients undergoing reconstructive or obliterative native tissue vaginal repair. The secondary aims were to compare adverse events and surgeon ease of use with sling assignment. A multicenter, noninferiority, randomized trial of women with ≥ stage II pelvic organ prolapse and objectively confirmed stress urinary incontinence undergoing reconstructive or obliterative vaginal repair was performed. Women were randomized to concomitant single-incision (Altis sling, Coloplast Minneapolis, MN) with suprapubic sham incisions or retropubic slings. The primary dichotomous outcome was abnormal lower urinary tract function within 12 months postsurgery, defined as bothersome stress urinary incontinence symptoms (>1 Pelvic Floor Distress Inventory question no. 17); retreatment for stress urinary incontinence or treatment for urinary retention. Secondary outcomes were adverse events, Patient Global Impression of Improvement of bladder function, and surgeon ease of use (1, worst; 10, best). All subjects completed validated questionnaires and underwent a Pelvic Organ Prolapse Quantification, cough stress test, and postvoid residual preoperatively, at 6 weeks and 12 months postoperatively. Assuming a subjective cure rate for retropubic of 82%, 80% power, and 1-sided 5% significance level, we estimated that 127 patients in each arm were needed to declare noninferiority of the single-incision sling if the upper bound of the 95% confidence interval for the between-group difference per protocol in abnormal bladder function was <12%. Assuming a 10% loss to follow-up, the total enrollment goal was280. Between December 2018 and January 2023, 280 subjects were enrolled across 7 sites, and 255 were randomized: 126 were for single-incision, and 129 were for retropubic sling. There were no preoperative or operative characteristic differences between groups. Overall, 81% had reconstructive, and 19% had obliterative native tissue repairs. The primary outcome, abnormal lower urinary tract function at 12 months, occurred in 29 (25%) of single-incision vs 24 (20%) of the retropubic sling group (risk difference, 0.04472 [95% confidence interval,-0.03 to 0.1133]; P=.001 for noninferiority). Bothersome stress urinary incontinence occurred in 20% vs 17% (P=.27) and was retreated in 4% vs 2% (P=.44) of single-incision vs retropubic groups, respectively. Adverse events were reported in 24 (16%) of single-incision vs 14 (9%) of the retropubic group (95% confidence interval, 0.95-3.29; P=.70) and included de novo or worsening urgency incontinence symptoms, urinary tract infection, mesh exposure, need for prolonged catheter drainage, and de novo pain, without differences between groups. Patient Global Impression of Improvement (very satisfied and satisfied) was 71% vs 67% (P=.43), and median surgeon ease of sling use was 8 (7-10) vs 9 (8-10), P=.03 in single-incision vs retropubic, respectively. For women undergoing vaginal repair, single-incision was noninferior to retropubic sling for stress urinary incontinence symptoms, and complications, including treatment for urinary retention, did not differ.