Midurethral Sling Research Articles

Single Incision Mini-Sling Versus Mid-Urethral Sling (Transobturator/Retropubic) in Females With Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

Stress urine incontinence (SUI) is most common in middle-aged women and the second most common in those over 75. SUI causes significant discomfort and suffering for patients and has a considerable financial impact on the healthcare system. Conservative approaches are recommended as the first step in treatment. However, surgery is often necessary to improve a patient's quality of life due to the high failure rate of conservative treatments. A thorough literature review of studies published before March 2023 was conducted on the safety and effectiveness of single-incision mini slings (SIMS) and standard mid-urethral slings (MUS). PubMed, Embase, Cochrane Library, and Elsevier's ScienceDirect were used to retrieve the studies. Two reviewers independently searched and evaluated the data based on inclusion and exclusion criteria. Review Manager 5.4 software was used for meta-analysis. Included were seventeen studies involving 3,503 female SUI patients without intrinsic sphincter deficiency (ISD) or mixed urinary incontinence. According to the results of our meta-analysis, the clinical efficacy of SIMS is comparable to that of MUS in terms of objective cure rate (RR: 0.99; 95% CI: 0.95 to 1.03, p: 0.66, I2: 29%). In contrast, it increases the post-procedure International Consultation on Incontinence Questionnaire (ICIQ) score (WMD: 0.08; 95% CI: -0.08 to 0.08). CI: -0.02 to 0.18, p: 0.11, I2: 55%) and improves the PGI-I score to a greater extent (RR: 1.04; 95% CI: 0.96 to 1.08, p: 0.36, I2: 76%). In contrast, there is no difference between the two groups regarding patient satisfaction (RR: 0.96; 95% CI: 0.92 to 1.01, p: 0.16, I2: 0%) and Sandvik score reduction (RR: 0.98; 95% CI: 0.94 to 1.02, p: 0.35, I2: 0%). In conclusion, single-incision mid-urethral slings (SIMS) are as effective as mid-urethral slings (MUS) for treating pure stress urinary incontinence (SUI) without intrinsic sphincter deficiency (ISD), with a shorter operation time. However, the SIMS procedure has a higher incidence of dyspareunia. At the same time, bladder perforation, mesh-related complications, pelvic/groin pain, urinary tract infection (UTI), worsening urgency, dysuria, and pain score are less likely to occur with SIMS. Only the decrease in pelvic/groin pain was statistically significant.

Adjustable slings versus other surgical methods in female stress urinary incontinence: a systematic review and meta-analysis.

The objective of this study was to evaluate the efficacy and safety of different adjustable slings compared to other surgical methods for the treatment of stress urinary incontinence (SUI) among women. The inclusion criteria were as follows: randomized controlled trials (RCTs) and non-RCTs assessing adult women with SUI. The exclusion criteria were as follows: other types of urinary incontinence, studies that combined conservative interventions and pharmacological treatment, pregnant and lactating patients. Databases were searched up to November 2022 to identify articles evaluating the effectiveness and safety of different adjustable slings compared to other surgical methods for the treatment of SUI among women. The systematic review was conducted in accordance with the PRISMA 2020 checklist and registered in PROSPERO. Risk-of-bias assessment tools recommended by the Cochrane Society were used to evaluate the risk of bias in the included studies. Eighteen clinical trials were included in this systematic review, and 11 studies were included in the meta-analysis. Fourteen studies were RCTs, and four were retrospective studies. Only RCTs were included in the meta-analyses. There was no statistically significant difference in the objective cure rate, subjective cure rate, or long-term postoperative complication rate between Ajust single-incision mini-slings (SIMS) and standard mid-urethral slings (SMUS) or MiniArc SIMS. However, the operation time in the adjustable SIMS group was significantly shorter (RR = -4.20, 95% CI: [-7.51, -0.89], p = 0.01). This systematic review and meta-analysis revealed that adjustable SIMS is equally effective when compared with SMUS for the treatment of SUI among women. Moreover, the operation time for the adjustable SIMS was shorter. However, additional well-designed studies with standard outcome measures and complete follow-up periods will help to increase confidence in the choice of different options for treating SUI among women.

MP37-04 SINGLE-INCISION MINISLINGS IN 2022: A META ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP37-04 SINGLE-INCISION MINISLINGS IN 2022: A META ANALYSIS Ann C. Stolzle, Harrison Torres, Clifton F. Frilot, and Alex Gomelsky Ann C. StolzleAnn C. Stolzle More articles by this author , Harrison TorresHarrison Torres More articles by this author , Clifton F. FrilotClifton F. Frilot More articles by this author , and Alex GomelskyAlex Gomelsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The TVT-Secur, which comprised many of the randomized controlled trials (RCTs) in the 2017 Cochrane Review of single-incision minislings (SIMS), has since been withdrawn from the market. Our purpose is to review the emerging RCTs in which SIMS comprises at least one of the trial arms. METHODS: A comprehensive PubMed search was performed, and several reviewers independently assessed the quality of the studies and extracted data. Study exclusion criteria included: abstract only, non-English language publication, minimum follow-up <6 months, and TVT-Secur as the sole other trial arm. A meta-analysis of surgical outcomes and adverse postoperative sequelae was performed. RESULTS: Literature search yielded 31 unique data sets (research groups) and 43 RCTs. SIMS comprising at least one arm included: Ajust, Altis, Contasure Needleless, EFA, MiniArc, Ophira, TFS, and TVT-Abbrevo. While all studies were randomized, there was significant variation in study design, allocation concealment, blinding of outcome assessment, and handling of incomplete data sets. There was also significant variation in inclusion/exclusion criteria, outcome criteria, and adverse event reporting. In all, 2844 women had a SIMS in at least one study arm. Six studies either had a combination of two SIMS or two MUS in a trial arm, or two separate SIMS individually compared to one MUS. Objective and subjective outcomes stratified by length of follow-up and comparison device are summarized in the Table 1. Only one study reported outcomes at >48 months. Most of the comparisons were SIMS vs. transobturator midurethral slings (MUS), with only four data sets comparing SIMS and retropubic MUS. Overall, SIMS were non inferior to other MUS procedures and no one SIMS was associated with significantly better outcomes. Rates of de novo urgency and urgency incontinence, long-term pain, vaginal mesh exposure, and repeat surgery were low and were not significantly different between groups. CONCLUSIONS: Short- and medium-term results from RCTs suggest that SIMS are safe and non-inferior to other MUS. The majority of the comparisons are between SIMS and transobturator MUS and significant variations in study design make grouping of outcomes challenging. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e514 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ann C. Stolzle More articles by this author Harrison Torres More articles by this author Clifton F. Frilot More articles by this author Alex Gomelsky More articles by this author Expand All Advertisement PDF downloadLoading ...

MP71-14 SURGICAL TIMING IN PATIENTS WITH RETENTION/DYSURIA AFTER MID-URETHRAL SLING: A MODIFIED DELPHI CONSENSUS

You have accessJournal of UrologyCME1 Apr 2023MP71-14 SURGICAL TIMING IN PATIENTS WITH RETENTION/DYSURIA AFTER MID-URETHRAL SLING: A MODIFIED DELPHI CONSENSUS Cosimo De Nunzio, Riccardo Lombardo, Alberto Saracino, G. Lamberti, G. Di Rienzo, A. Giammo, G. Del popolo, F. Savoca, M. Spinelli, V. Mancini, G. Carrieri, and R. Carone Cosimo De NunzioCosimo De Nunzio More articles by this author , Riccardo LombardoRiccardo Lombardo More articles by this author , Alberto SaracinoAlberto Saracino More articles by this author , G. LambertiG. Lamberti More articles by this author , G. Di RienzoG. Di Rienzo More articles by this author , A. GiammoA. Giammo More articles by this author , G. Del popoloG. Del popolo More articles by this author , F. SavocaF. Savoca More articles by this author , M. SpinelliM. Spinelli More articles by this author , V. ManciniV. Mancini More articles by this author , G. CarrieriG. Carrieri More articles by this author , and R. CaroneR. Carone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.14AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract INTRODUCTION AND OBJECTIVE: To develop a modified Delphi consensus statement regarding the surgical timing in patients with retention/dysuria after mid-urethral sling. METHODS: A Systematic review of Pubmed, Embase and Scopus was performed to evaluate the available evidence on the best surgical timing in patients with retention/dysuria after mid-urethral sling. Overall, only 4 studies with poor evidence were identified, therefore a consensus statement was performed. Four rounds of Delphi were performed and final statements were submitted anonymously using Survey Monkey. All statements were voted on a 1 to 10 scale. In order to approve the statement consensus should be >80%. In case of a consensus between 60 and 80% the statement was discussed by all the members of the consensus and submitted again in a fourth round. RESULTS: Overall, four studies were identified evaluating the best surgical timing in patients with retention/dysuria after mid-urethral sling. No randomized clinical trials were retrieved, and the level of evidence was low. In the first round based on four expert opinion and on the evidence retrieved four statements were developed. On round two a group of ten experts discussed and modified the statements to avoid redundancy and improve readability before submitting it to the expert panel resulting in two final statements. On round three the statements (Table 1) were submitted to 40 experts which voted the statements. One statements needed a round four and reached consensus after discussion. Results of the consensus are written in table 1. CONCLUSIONS: The present consensus statement answers some unmet needs on the right timing of surgical treatment of retention/dysuria after MUS. The lack of evidence in this setting warrants well designed clinical trials to answer these questions. Source of Funding: No one Header Statement Agreement Round 3 Agreement Round 4 Early surgical treatment of urinary retention / dysuria after MUS should be preferred 85% Timing of surgical treatment of retention/dysuria after MUS depends on the severity of the urinary retention / dysuria 79% 90% © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1020 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cosimo De Nunzio More articles by this author Riccardo Lombardo More articles by this author Alberto Saracino More articles by this author G. Lamberti More articles by this author G. Di Rienzo More articles by this author A. Giammo More articles by this author G. Del popolo More articles by this author F. Savoca More articles by this author M. Spinelli More articles by this author V. Mancini More articles by this author G. Carrieri More articles by this author R. Carone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pain resolution and functional outcomes of total mesh excision: a case series.

The objective was to assess the impact of total excision of polypropylene midurethral slings (MUS) on patient pain levels and to report on functional outcomes including recurrent/de novo stress urinary incontinence (SUI), sexual function, and quality of life measures. This is a retrospective analysis of patients who underwent total MUS excision from March 2017 to December 2019. The primary outcome was the impact on pain assessed by a Numeric Rating Scale (NRS). Questionnaires analyzed were: Pain Catastrophizing Scale, Pelvic Floor Distress Inventory Short Form-20, Female Sexual Function Index, and McGill Pain Index questionnaires. Thirty-two women underwent total mesh excision within the inclusion period; with follow-up data available for 31 out of 32; 14 (43.8%) had previously undergone one or more partial vaginal mesh excision procedures. Types of MUS removed were: 14 (43.8%) transobturator midurethral slings, 12 (37.5%) retropubic midurethral slings, 4 (12.5%) mini-slings, and 2 (6.3%) mesh slings placed by laparotomy. Pain was the main reason for referral in 31 patients (96.9%). Mean pain NRS reduced from 6.1 pre-operatively to 3.3 post-operatively, with paired comparison showing a significant difference (p<0.01). Qualitatively, complete symptoms resolution was observed in 10 out of 31 (32.3%), another 9 out of 31 (29.0%) patients experienced clinically significant improvement, 2 out of 31 (6.5%) did not experience improvement in pain, and 10 out of 31 (32.3%) reported new/worsening pain. Post-operative complications occurred in 9 (29.0%) patients; all were Clavien-Dindo grade II. Nineteen (61.3%) reported de novo/recurrent SUI post-operatively. Total MUS mesh excision yields high complication and SUI recurrence rates, counter-balanced by a 61.3% pain resolution/improvement rate. These data are pertinent for patient counseling.

V12-07 ROBOTIC-ASSISTED TRANSABDOMINAL REMOVAL OF ERODED MID-URETHRAL MESH SLING

You have accessJournal of UrologyCME1 Apr 2023V12-07 ROBOTIC-ASSISTED TRANSABDOMINAL REMOVAL OF ERODED MID-URETHRAL MESH SLING Shreeya Popat, Gjanje Smith-Mathus, Alvaro Lucioni, and Una Lee Shreeya PopatShreeya Popat More articles by this author , Gjanje Smith-MathusGjanje Smith-Mathus More articles by this author , Alvaro LucioniAlvaro Lucioni More articles by this author , and Una LeeUna Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003347.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Depending on the indication for excision, there are multiple surgical approaches for the removal of mid-urethral mesh slings: transvaginal, endoscopic, open abdominal, and robotic. In this video, we demonstrate the robotic approach to treat mid-urethral mesh slings that have eroded into the bladder. The robotic approach offers excellent exposure, visualization, and accessibility. Compared to endoscopic approaches, the entire arm of the sling can be removed from the bladder wall, the bladder repaired, and the foreign body thereby completely eliminated from the bladder. Robotic mid-urethral mesh sling excision is ideal in any patient that would be best served by maximal removal of the mesh from the bladder in order to prevent future complications. METHODS: In this video, we display two different cases to show two unique approaches to robotic mid-urethral mesh sling excision depending on the location of the mesh sling erosion: 1) If a retropubic sling is eroded through the anterior bladder, we begin by dropping the bladder and entering the space of Retzius to locate the mesh arm. 2) If the sling is eroded into the posterior bladder, a cystotomy is made on the anterior dome to visualize the posterior bladder wall. RESULTS: Once the mesh is identified, we follow the mesh graft carefully and delicately and dissect it away from surrounding tissues. The dissection is immediately close to the mesh, without fragmenting it, to allow for complete excision. This also allows for protection of adjacent critical structures. The surgical principles and instrument techniques of robotic mesh excision mirror the surgical technique utilized for transvaginal mesh excision. CONCLUSIONS: For treatment of mesh erosion into the bladder, a robotic approach offers excellent visualization, is feasible, and well-tolerated. Compared to fragmenting the mesh using an endoscopic approach, the robotic approach has the advantage of excising the mesh definitively, eliminating the foreign body in the bladder and preventing future recurrences of mesh erosion. Properly selected patients should be offered the robotic approach to mesh excision. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1066 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shreeya Popat More articles by this author Gjanje Smith-Mathus More articles by this author Alvaro Lucioni More articles by this author Una Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

MP07-06 TWELVE YEAR EXPERIENCE WITH SALVAGE ROBOTIC SACROCOLPOPEXY. SURGICAL TECHNIQUE AND REASONS FOR FAILURE IN THE INITIAL SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP07-06 TWELVE YEAR EXPERIENCE WITH SALVAGE ROBOTIC SACROCOLPOPEXY. SURGICAL TECHNIQUE AND REASONS FOR FAILURE IN THE INITIAL SURGERY Cassandra Schuster, Spencer Kortum, Benjamin Behers, Genesis Dolgetta, Karim Ghazli, Victoria Bird, and Robert Carey Cassandra SchusterCassandra Schuster More articles by this author , Spencer KortumSpencer Kortum More articles by this author , Benjamin BehersBenjamin Behers More articles by this author , Genesis DolgettaGenesis Dolgetta More articles by this author , Karim GhazliKarim Ghazli More articles by this author , Victoria BirdVictoria Bird More articles by this author , and Robert CareyRobert Carey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic sacrocolpopexy (RASCP) is a transabdominal approach for repair of pelvic organ prolapse (POP) that reliably provides durable repair of high grade prolapse. Although reoperation for recurrent prolapse after RASCP should be a rare event, the techniques and problems associated with robotic salvage in these cases is under reported. METHODS: Data is collected from an IRB-approved prospectively maintained database of robotic POP repair in a tertiary care hospital. The surgery is performed with a da Vinci Si or Xi system with 4 robotic ports and 1 assistant port by a single surgeon. Commercially available 4×24 cm Y-shaped wide pore polypropylene mesh is modified to accommodate the anterior and posterior dissections of the vaginal walls and these are attached with running barbed suture with 16-20 sites of fixation. The long Y-arm of the mesh is trimmed to size for attachment to the anterior longitudinal ligament with GoreTex sutures. Posterior peritoneal flaps are created and the entirety of the mesh and repair is completely covered by peritoneum. No mesh or suture is left exposed. Mid-urethral slings were placed at the time of salvage RASCP (sRASCP) to prevent de novo stress incontinence. All repairs restored maximal vaginal length and desired vaginal axis. All patients for RASCP had stage 4 prolapse. There were no conversions from robotic to open. RESULTS: Between 2010 and 2022, a total of 450 patients underwent RASCP at the same institution. 8 (1.8%) were done in the salvage setting with a previous attempt at open or RASCP performed and pre-existing mesh inside the abdomen. On reoperation for these RASCP patients for the purpose of salvage, 8/8 (100%) were found to have no connectivity of the mesh to the anterior longitudinal ligament (ALL). 4/8 (50%) had no connectivity to the either the anterior or posterior vaginal vault. Mean age at salvage operation was 69.5 years and mean BMI 28.5. Cases were completed with robotic console time between 105 and 123 minutes. CONCLUSIONS: sRASCP is a safe and durable surgery for repair of prolapse in the setting of a failed first attempt of RASCP with pre-existing mesh. Every case achieved excellent repair of prolapse. The most common finding is these cases was non-attachment of the mesh to the ALL. All patients required dissection of the ALL for appropriate mesh attachment. Pre-existing mesh can be used to help in repair as long as there is appropriate attachment to the vaginal vault. Pre-existing mesh should be excised if there is no useful vaginal or ALL attachment. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e86 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cassandra Schuster More articles by this author Spencer Kortum More articles by this author Benjamin Behers More articles by this author Genesis Dolgetta More articles by this author Karim Ghazli More articles by this author Victoria Bird More articles by this author Robert Carey More articles by this author Expand All Advertisement PDF downloadLoading ...

MP07-05 RISK FACTORS ASSOCIATED WITH POST-OPERATIVE SMALL BOWEL OBSTRUCTION FOLLOWING ROBOTIC SACROCOLPOPEXY WITH 12-YEAR EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP07-05 RISK FACTORS ASSOCIATED WITH POST-OPERATIVE SMALL BOWEL OBSTRUCTION FOLLOWING ROBOTIC SACROCOLPOPEXY WITH 12-YEAR EXPERIENCE Cassandra Schuster, Benjamin Behers, Spencer Kortum, Genesis Dolgetta, Karim Ghazli, Victoria Bird, and Robert Carey Cassandra SchusterCassandra Schuster More articles by this author , Benjamin BehersBenjamin Behers More articles by this author , Spencer KortumSpencer Kortum More articles by this author , Genesis DolgettaGenesis Dolgetta More articles by this author , Karim GhazliKarim Ghazli More articles by this author , Victoria BirdVictoria Bird More articles by this author , and Robert CareyRobert Carey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic sacrocolpopexy (RASCP) is a transabdominal approach for repair of pelvic organ prolapse (POP) that avoids placement of transvaginal mesh and provides durable repair of high grade prolapse. Given that the procedure has a trans-peritoneal component, there is a risk of reoperation due to small bowel obstruction (SBO). METHODS: Data was collected from an IRB-approved prospectively maintained database of RASCP in a tertiary care hospital. The surgery is performed with a da Vinci Si or Xi system with 4 robotic ports and 1 assistant port by a single surgeon. Commercially available 4×24 cm Y-shaped wide pore polypropylene mesh is modified to accommodate the anterior and posterior dissections of the vaginal walls and are attached with running barbed suture with 16-20 sites of fixation. The long Y-arm of the mesh is trimmed to size for attachment to the anterior longitudinal ligament with GoreTex sutures. Posterior peritoneal flaps are created and the entirety of the mesh and repair is completely covered by peritoneum. No mesh or suture is left exposed. Mid-urethral slings were placed at the time of sacrocolpopexy to prevent de novo stress incontinence. All patients for RASCP had stage 4 prolapse. There were no conversions from robotic to open. RESULTS: Between 2010 and 2022, 450 patients underwent RASCP at the same institution. 80 (17.8%) involved extensive lysis of adhesions (ELOS) and 370 did not code for ELOS. At mean 78-month (12–140 month) follow-up, there were 8 (1.8%) reoperations for SBO. 6/80 (7.5%) patients with ELOS had reoperations for SBO had ELOS. Age, BMI, procedure time, suture type, and brand of mesh were not associated with SBO. Only ELOS was found to be associated with SBO on multivariate analysis. Mean age was 66.1 years and mean BMI 28.2. Robotic console time between 59 and 123 min. All 8 reoperations for SBO had previous abdominal procedures, and 6 were coded as ELOS. There were no reoperations for SBO in patients with no previous abdominal surgery. CONCLUSIONS: RASCP is a safe and durable surgery for repair of POP. Risk of reoperation for SBO is associated with concomitant ELOS. In ELOS patients the risk of SBO is 7.5% and in patients without ELOS the risk is 0.5%. Although many patients presenting for RASCP have had previous abdominal operations, not all such patients require ELOS. For patients with histories of numerous prior bowel or abdominal surgeries who are at increased risk for ELOS at time of RASCP, careful patient selection is recommended and appropriate preoperative counseling suggested. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e86 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cassandra Schuster More articles by this author Benjamin Behers More articles by this author Spencer Kortum More articles by this author Genesis Dolgetta More articles by this author Karim Ghazli More articles by this author Victoria Bird More articles by this author Robert Carey More articles by this author Expand All Advertisement PDF downloadLoading ...

MP07-07 ROBOTIC SACROCOLPOPEXY WITH UTERUS PRESERVATION: SURGICAL TECHNIQUE AND 12 YEAR EXPERIENCE FOR WOMEN WITH COMPLETE VAGINAL VAULT EVERSION

You have accessJournal of UrologyCME1 Apr 2023MP07-07 ROBOTIC SACROCOLPOPEXY WITH UTERUS PRESERVATION: SURGICAL TECHNIQUE AND 12 YEAR EXPERIENCE FOR WOMEN WITH COMPLETE VAGINAL VAULT EVERSION Cassandra Schuster, Benjamin Behers, Spencer Kortum, Genesis Dolgetta, Karim Ghazli, Victoria Bird, and Robert Carey Cassandra SchusterCassandra Schuster More articles by this author , Benjamin BehersBenjamin Behers More articles by this author , Spencer KortumSpencer Kortum More articles by this author , Genesis DolgettaGenesis Dolgetta More articles by this author , Karim GhazliKarim Ghazli More articles by this author , Victoria BirdVictoria Bird More articles by this author , and Robert CareyRobert Carey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic sacrocolpopexy with uterus preservation (RASCP-UP) is a transabdominal approach for repair of pelvic organ prolapse (POP) that avoids placement of transvaginal mesh and preserves female sexual organs. Although hysterectomy may be performed at the time of POP repair, many women choose to preserve their uterus for reasons of sexuality, female identity, religion, maintenance of maximal vaginal length and undisturbed vaginal blood supply, and resistance to removal of a normal organ. METHODS: Data was collected from an IRB-approved prospectively maintained database of robotic POP repair in a tertiary care hospital. The surgery is performed with a da Vinci Si or Xi system with 4 robotic ports and 1 assistant port. Commercially available 4×24 cm Y-shaped wide pore polypropylene mesh is modified to accommodate >10 cm anterior and posterior dissections of the vaginal walls. The anterior vaginal wall component is brought through the broad ligament and joined with the posteriorly placed component for attachment to the anterior longitudinal ligament with GoreTex sutures. The mesh is then completely covered by peritoneum. Mid-urethral slings were placed at the time of sacrocolpopexy to prevent de novo stress incontinence. All patients for RASCP-UP had stage 4 prolapse with maximal anterior, posterior, and apical descent with the cervix at the apex of the descent. All patients had normal Pap smears and pelvic ultrasounds. RESULTS: Between 2010 and 2022, a total of 450 patients underwent RASCP at the same institution. Of these, 65 presented with complete vaginal vault eversion requesting RASCP-UP. Mean age was 65.9 years and mean BMI 28.0. Cases were completed with robotic console time between 59 and 123 minutes and all patients discharged within 24-48 hours. At mean 78-month (12 – 140 month) follow-up, there were no mesh erosions, hernias, or reoperations for prolapse. There was one reoperation for hysterectomy at 6 year follow up for suspected endometrial carcinoma and two reoperations for small bowel obstruction in patients with extensive lysis of adhesions. CONCLUSIONS: RASCP-UP is feasible for patients with severe POP who desire uterus preservation. The surgery restores normal vaginal axis and length without placement of mesh material through vaginal mucosa. Long-term results show durable functional repair. Women presenting with vaginal vault eversion and maximal descent of cervix can undergo repair of pelvic floor prolapse with concomitant hysterectomy. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e86 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cassandra Schuster More articles by this author Benjamin Behers More articles by this author Spencer Kortum More articles by this author Genesis Dolgetta More articles by this author Karim Ghazli More articles by this author Victoria Bird More articles by this author Robert Carey More articles by this author Expand All Advertisement PDF downloadLoading ...

MP37-05 SATISFACTION WITH DECISION AND DECISIONAL REGRET AFTER MID-URETHRAL SLING AND URETHRAL BULKING INJECTION FOR STRESS URINARY INCONTINENCE

You have accessJournal of UrologyCME1 Apr 2023MP37-05 SATISFACTION WITH DECISION AND DECISIONAL REGRET AFTER MID-URETHRAL SLING AND URETHRAL BULKING INJECTION FOR STRESS URINARY INCONTINENCE Leia Kessler, Michael Schumeister, Dimindra Karki, Melissa Laudano, and Nitya Abraham Leia KesslerLeia Kessler More articles by this author , Michael SchumeisterMichael Schumeister More articles by this author , Dimindra KarkiDimindra Karki More articles by this author , Melissa LaudanoMelissa Laudano More articles by this author , and Nitya AbrahamNitya Abraham More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are currently limited data regarding patient-centered outcomes of satisfaction and decisional regret for treatment of stress urinary incontinence (SUI) in women. The objective of this study was to investigate long-term satisfaction and decisional regret amongst women who underwent mid-urethral sling surgery or urethral bulking injection for SUI. METHODS: This was a retrospective cohort study of patients who underwent a mid-urethral sling or urethral bulking procedure for SUI from 2015 to 2022 at our diverse, urban academic center. Demographic data were collected through chart review and surveys were conducted via telephone calls. Patient satisfaction and decisional regret were measured with the validated modified SDS-DRS scale (Satisfaction with Decision Scale- Decision Regret Scale). On the DRS, a score of 1 correlates with low decisional regret and a score of 5 correlates with high decisional regret. On the SDS, a score of 1 correlates with low satisfaction and a score of 5 correlates with high satisfaction. Descriptive statistics and Wilcoxan rank-sum tests were performed using STATA 15.0 with p<0.05 being significant. RESULTS: Of 97 women who underwent mid-urethral sling surgery called, 68 agreed to participate (70% response rate). The mean time since surgery was 46.7+/-23.11 months. The median score for the SDS was 4.0 (IQR 3.7, 4.8) and the median score on the DRS was 2.0 (IQR 1.2, 2.4). Nine (13%) women experienced surgical complications, which were not significantly associated with SDS (p=0.54) or DRS scores (p=0.54). In comparison, of 60 patients who underwent urethral bulking injection called, 31 agreed to participate (52% response rate). The mean time since surgery was 30.6+/-30.08 months. The median SDS score was 4.0 (IQR 3.5, 4.8) and median DRS score was 2.0 (IQR 1.4, 3.0). Three (10%) women experienced surgical complications, which were not significantly associated with SDS (p=0.17) or DRS scores (p=0.44). CONCLUSIONS: The results of this study show high satisfaction with decision and low decisional regret in women undergoing surgical treatment for SUI. The Satisfaction with Decision and Decisional Regret Scale allows a patient-centered analysis of surgical success that may aid in choosing a treatment option for women considering SUI surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e514 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leia Kessler More articles by this author Michael Schumeister More articles by this author Dimindra Karki More articles by this author Melissa Laudano More articles by this author Nitya Abraham More articles by this author Expand All Advertisement PDF downloadLoading ...

MP19-17 SPECIALTY-SPECIFIC TRENDS IN THE SURGICAL MANAGEMENT OF APICAL PELVIC ORGAN PROLAPSE POST VAGINAL MESH

You have accessJournal of UrologyCME1 Apr 2023MP19-17 SPECIALTY-SPECIFIC TRENDS IN THE SURGICAL MANAGEMENT OF APICAL PELVIC ORGAN PROLAPSE POST VAGINAL MESH Rahul Dutta, Gopal Badlani, and Catherine Matthews Rahul DuttaRahul Dutta More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , and Catherine MatthewsCatherine Matthews More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since transvaginal mesh (VM) for apical pelvic organ prolapse (APOP) repair was labeled “high-risk” in 2016 and subsequently banned in 2019 by the US Food and Drug Administration, remaining surgical treatment options include abdominal mesh-augmented sacrocolpopexy (AS) via laparoscopic (LAS) and open (OAS) approaches and vaginal native tissue apical suspension (VN). Our aim was to determine trends in APOP procedures post VM and whether differences existed between urologists and gynecologists. METHODS: Between 2011-2020, the National Surgical Quality Improvement Program (NSQIP) database was queried for AS, VM, and VN performed by both urologists and gynecologists. Trends in surgical approach were analyzed. RESULTS: 26,477 cases of APOP repair (32% AS, 6% VM, 62% VN) were included, 9% by urologists. Urologists operated on older (65 vs 61 years) patients with higher ASA score (32% vs 25% ASA III) with a higher prevalence of diabetes, chronic obstructive pulmonary disease, and bleeding disorders (p<0.05). Mean BMI was 28 and did not vary by specialty. Urologists performed significantly higher proportion of AS (65% vs 29%) and VM (8% vs 6%) relative to VN (27% vs 65%) than gynecologists (p<0.0001). VM utilization has decreased over time for both urologists (p=0.0242) and gynecologists (p=0.0001); a trend towards increasing AS (p=0.1646) in urologists and VN (p=0.0913) in gynecologists has concurrently occurred. Both specialties have increasingly favored LAS over OAS (p<0.0001). Operating room times did not vary for AS (p=0.1719) and were slightly higher for urologists in VM (111 vs 106 min, p=0.0432) and VN (118 vs 111 min, p<0.0001). Concurrent mid-urethral mesh sling placement occurred in 29% of cases overall; this has remained unchanged over time for urologists (p=0.8348) and decreased (p=0.0003) for gynecologists. CONCLUSIONS: Significant differences in the surgical approach to apical prolapse repair procedures and concomitant mid-urethral mesh slings exist between specialties. Urologists tend to operate on more medically complex and older patients with APOP and continue to demonstrate a strong preference for mesh-augmented repairs compared to transvaginal native tissue repairs. Minimally-invasive sacrocolpopexy is being more frequently performed by both specialties treating APOP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e272 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rahul Dutta More articles by this author Gopal Badlani More articles by this author Catherine Matthews More articles by this author Expand All Advertisement PDF downloadLoading ...

V09-07 HOW TO USE A MESH SLING SAFELY AFTER THE POST-VESICOVAGINAL FISTULA REPAIR REPAIR PATIENT WITH STRESS URINARY INCONTINENCE

You have accessJournal of UrologyCME1 Apr 2023V09-07 HOW TO USE A MESH SLING SAFELY AFTER THE POST-VESICOVAGINAL FISTULA REPAIR REPAIR PATIENT WITH STRESS URINARY INCONTINENCE Micheal Breen Tamatave, Madagascar, Ly Hoang Roberts, and Larry Sirls Micheal Breen Tamatave, MadagascarMicheal Breen Tamatave, Madagascar More articles by this author , Ly Hoang RobertsLy Hoang Roberts More articles by this author , and Larry SirlsLarry Sirls More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003317.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with complicated obstetric fistulas may have stress urinary incontinence (SUI) after vesicovaginal fistula repair (VVF), especially if the urethra in involved. Various techniques to treat post-VVF SUI have low success rates or is technically challenging due to thin and scarred peri-urethral tissue. We describe a technique to place a midurethral mesh sling outside of the pre-existing vaginal mucosa. METHODS: With the patient in dorsal lithotomy under spinal anesthesia, a foley catheter is placed into the bladder and the labial majora is retracted for adequate exposure. A rectangular area of the same size as the mesh sling (3x1cm) at the midurethra is marked. A number 15 scalpel is used to incise the vaginal mucosa at the marked lines, and Metzenbaum scissors are used to dissect and mobilize the edges. The dissection is then carried out laterally to be behind the inferior pubic bone. This is done on both sides. The island of vaginal mucosa is then superficially scored using low power bovie cauterization to allow for mesh adhesion and tissue ingrowth. The mesh is sutured to the island of skin using a 3-0 Chromic or vicryl suture at the mesh edges in 4 areas. 0- prolen sutures are then placed on each lateral edge of the mesh in a running stitch. The Metzenbaum scissors are then used to enter into the endopelvic fascia behind the pubic bone to develop the retropubic space. Next, a suprapubic incision is made 1cm cranial to the pubic bone down to the rectus fascia. The Stamey needle is passed in a top-down approach approximately 2cm from midline and end delivered into the vaginal incision. To check for bladder perforation, a metal catheter is placed into the bladder and swept laterally to evaluate for any metallic noise indicative of contact. The prolene suture is passed up to the suprapubic incision and the same is done contralaterally. Bladder is backfilled with sterile saline with methylene blue by gravity and foley removed. Sutures are tied together midline with the sling tension adjusted while patient performs a Valsalva. Suprapubic incision is then closed in multiple layers. The vaginal incision is closed with mobilization of the proximal vaginal mucosa and reapproximation to the distal edge. For larger incisions, a Singapore flap can be done for adequate coverage. RESULTS: Successful managment of SUI. CONCLUSIONS: For challenging cases of SUI after a post-VVF repair, this technique can be an option. Further investigation is needed for clinical outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e839 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Micheal Breen Tamatave, Madagascar More articles by this author Ly Hoang Roberts More articles by this author Larry Sirls More articles by this author Expand All Advertisement PDF downloadLoading ...

MP37-06 VALIDATION OF THE LURN SI-10 QUESTIONNAIRE IN WOMEN UNDERGOING MIDURETHRAL SLING SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP37-06 VALIDATION OF THE LURN SI-10 QUESTIONNAIRE IN WOMEN UNDERGOING MIDURETHRAL SLING SURGERY Grace Lai, Joel Vetter, and H Henry Lai Grace LaiGrace Lai More articles by this author , Joel VetterJoel Vetter More articles by this author , and H Henry LaiH Henry Lai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The LURN SI-10 (10-item LURN Symptom Index) was developed by the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) to measure LUTS in men and women (Cella et al 2019). LURN SI-10 consists of ten items on LUTS, plus an additional question on global urinary bother. Two of the items focus on stress urinary incontinence with coughing/sneezing/laughing (SUI-1), and SUI with physical activities (SUI-2). Here we validate and evaluate the responsiveness of the LURN SI-10 questionnaire by comparing patients’ responses before and after midurethral sling surgery. METHODS: Adult women completed the LURN SI-10 and Urinary Distress Inventory (UDI-6) questionnaires before and after midurethral sling surgery (retropubic or trans-obturator TVT). Mean change in total LURN SI-10, SUI-1 and SUI-2 scores after surgery, paired t-tests, effect sizes (ES) of the change, and standardized response means (SRM) were tabulated. For ES and SRM, value of 0.5 to 0.7 is considered moderate responsiveness, 0.8 to 1.0 is considered good, and values >1.0 is considered excellent responsiveness to change. LURN SI-10 scores were compared to scores on the UDI-6. RESULTS: Total LURN SI-10, SUI-1 and SUI-2 scores on LURN SI-10 decreased by 59%, 85% and 90% respectively after midurethral sling surgeries (n=37, all p<0.001, paired t-tests, see Table 1). The effect sizes (ES) of the changes for SUI-1 and SUI-2 were 3.03 and 2.19 respectively, indicating excellent responsiveness to change to known effective treatments of SUI. The standardized response means (SRM) were 2.14 and 2.11 respectively, again indicating excellent responsiveness to change. The ES of SUI-1 was greater than the ES of UDI-6. The SRM of SUI-1 and SUI-2 were both greater than UDI-6. There were strong correlations between LURN SI-10 and UDI-6 before and after surgery (r=0.84 and 0.65 respectively, p both <0.01). CONCLUSIONS: The two stress urinary incontinence questions (SUI-1, SUI-2) on LURN SI-10 questionnaire were responsive to change to known effective treatments of SUI, and may be used to assess SUI symptom change or improvement after SUI treatments. Source of Funding: Midwest Stone Institute © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e515 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grace Lai More articles by this author Joel Vetter More articles by this author H Henry Lai More articles by this author Expand All Advertisement PDF downloadLoading ...

V12-10 COMPLETE BLADDER PROLAPSE THROUGH THE URETHRA: ROBOTIC-ASSISTED LAPAROSCOPIC BURCH COLPOSUSPENSION AND BLADDER NECK RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023V12-10 COMPLETE BLADDER PROLAPSE THROUGH THE URETHRA: ROBOTIC-ASSISTED LAPAROSCOPIC BURCH COLPOSUSPENSION AND BLADDER NECK RECONSTRUCTION Connie Wang, Rainjade Chung, Miyad Movassaghi, and Doreen Chung Connie WangConnie Wang More articles by this author , Rainjade ChungRainjade Chung More articles by this author , Miyad MovassaghiMiyad Movassaghi More articles by this author , and Doreen ChungDoreen Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003347.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present a unique case report of complete bladder prolapse through the urethra. We additionally demonstrate the surgical technique of robotic-assisted Burch Colposuspension and bladder neck reconstruction to address multiple urologic problems for a patient who was not a candidate for a mid-urethral sling, and who required concomitant pelvic organ prolapse repair. METHODS: The patient’s initial presentation of bladder prolapse through the urethra was repaired with manual reduction, urethroplasty, bladder neck closure, and cystorrhaphy. Her subsequent Burch Colpopsuspension was performed robotically. The Da Vinci Xi robot was used with a 5-port configuration, including an assistant port. Surgical steps described in this video include dissection of vagina off bladder, apical uterosacral ligament suspension, dropping the bladder, bladder neck reconstruction, Burch Colposuspension, paravaginal repair, and new suprapubic tube placement. RESULTS: A successful treatment of a freely mobile, prolapsing bladder and near absent urethra causing severe urinary incontinence is achieved. The patient remains continent and her bladder remains well reduced post-operatively. CONCLUSIONS: Robotic-assisted laparoscopic Burch Colposuspension represents a minimally-invasive, effective option for patients who present with multiple different urologic issues, including pelvic organ prolapse and stress urinary incontinence. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1067 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Connie Wang More articles by this author Rainjade Chung More articles by this author Miyad Movassaghi More articles by this author Doreen Chung More articles by this author Expand All Advertisement PDF downloadLoading ...

MP37-08 PATIENT SATISFACTION AND QUALITY OF LIFE IN A MULTICENTER PROSPECTIVE STUDY OF SINGLE INCISION MINI-SLING (ALTIS®) IN THE MANAGEMENT OF FEMALE STRESS URINARY INCONTINENCE

You have accessJournal of UrologyCME1 Apr 2023MP37-08 PATIENT SATISFACTION AND QUALITY OF LIFE IN A MULTICENTER PROSPECTIVE STUDY OF SINGLE INCISION MINI-SLING (ALTIS®) IN THE MANAGEMENT OF FEMALE STRESS URINARY INCONTINENCE Craig Hanson, Ty Erickson, and Rebecca Mccrery Craig HansonCraig Hanson More articles by this author , Ty EricksonTy Erickson More articles by this author , and Rebecca MccreryRebecca Mccrery More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To compare the non-inferiority of the Altis® Single Incision Sling (SIS) with standard midurethral transobturator and/or retropubic sling, including an evaluation of patient satisfaction, improvement in quality of life, return to normal, and pain at 6 months post surgery. METHODS: Prospective, nonrandomized FDA 522 cohort study comparing the Altis SIS to FDA cleared transobturator and/or retropubic slings for the treatment of stress urinary incontinence (SUI) through 36 months. Surgical Satisfaction Questionnaire (SSQ-8) for patient satisfaction at 6 months post surgery, Incontinence Impact Questionnaire (IIQ-7), Urodynamic Distress Inventory (UDI-6), and Visual Analog Scale (VAS) for pain were assessed at baseline and 6 months post surgery. RESULTS: 355 women underwent the sling procedure (Altis n=184 vs Comparator n=171). Subjects in both treatment groups had a high degree of satisfaction with their surgery as indicated on the SSQ-8 at 6 months Altis (n=165) 28.1±4.9 vs Comparator (n=148) 28.7±4.3 (p=0.257). There was no difference in satisfaction between groups in the amount of time to return to daily activities (p=0.877) and return to work (p=0.939). The IIQ-7 at 6 months indicated a trend of improvement in quality of life in both groups, of an average of 50%, with a mean change from baseline Altis (n=164) 50.6±25.3 vs Comparator (n=146) 49.9±27.9 (p=0.816). The UDI-6 at 6 months indicated an improvement in quality of life in both groups with a mean change from baseline Altis (n=164) 40.9±20.2 vs Comparator (n=145) 43.0±22.7 (p=0.387). Dyspareunia, de Novo, related to the procedure and/or device, was similar between groups (Altis 1.6% vs Comparator 1.2%, p=1.00). Pelvic/Urogenital Pain (Groin) was also similar between groups for all events (Altis 6.0% vs Comparator 2.9%, p=0.205). CONCLUSIONS: The patients had a high degree of satisfaction with their surgery and pain decreased similarly following either SIS or standard midurethral slings for treatment of SUI. Improvement in Quality of Life and Return to Normal increased similarly at 6 months following either SIS or Midurethral slings for treatment of SUI. Source of Funding: Coloplast funding for this FDA 522 required comparative trial. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e516 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Craig Hanson More articles by this author Ty Erickson More articles by this author Rebecca Mccrery More articles by this author Expand All Advertisement PDF downloadLoading ...

MP07-11 IMPACT OF PREOPERATIVE URODYNAMICS ON THE SURGICAL TREATMENT OF ADVANCED PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyCME1 Apr 2023MP07-11 IMPACT OF PREOPERATIVE URODYNAMICS ON THE SURGICAL TREATMENT OF ADVANCED PELVIC ORGAN PROLAPSE Susane Hwang, Luis Gustavo Toledo, Silvia Carramao, Raphael Moreira, Carolina Jesus, Sarah Carvalho, Raquel Richetti, and Antônio Auge Susane HwangSusane Hwang More articles by this author , Luis Gustavo ToledoLuis Gustavo Toledo More articles by this author , Silvia CarramaoSilvia Carramao More articles by this author , Raphael MoreiraRaphael Moreira More articles by this author , Carolina JesusCarolina Jesus More articles by this author , Sarah CarvalhoSarah Carvalho More articles by this author , Raquel RichettiRaquel Richetti More articles by this author , and Antônio AugeAntônio Auge More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One quarter of women without urinary incontinence can develop de novo stress urinary incontinence (SUI) after surgery for pelvic organ prolapse (POP). This condition has been reported more frequently in women with occult SUI. However, studies are diverse as far as the investigation of occult SUI is concerned, and it has not been possible to reach a consensus on the benefits of preoperative urodynamics (UDS). The aim of this study was to investigate the impact of preoperative UDS on the surgical treatment of POP by analyzing whether performing UDS added diagnoses, modified surgical planning, and changed postoperative outcomes in women with advanced POP. METHODS: Retrospective observational study including women having POP stages III and IV, without symptoms of SUI, undergoing surgery for POP, between May 2015 and January 2020, with a minimum three-month follow-up period. Preoperative evaluation included the patients' standard clinical history, a physical examination (PE) to quantify genital prolapse, and stress testing with and without prolapse reduction at PE. Multi-channel UDS was performed when the surgeon so indicated. Postoperative outcomes were measured by excluding women with occult SUI on PE, and analyzing the incidence of de novo SUI, and need for a second approach for midurethral sling or urethrolysis. RESULTS: A total of 226 patients met the inclusion criteria, and 102 (45.1%) performed UDS. UDS added diagnoses in 64/102 (62.6%), having added 21/102 (20.6%) occult SUI cases. After UDS, there was a change in surgical procedure in 20/102 (19.6%) cases (18 indications for sling and two contraindications for it). The overall rate of occult SUI in the 226 patients was 28.8% (65/226). Among the 182 patients that were continent upon physical examination (PE), 68 (37.4%) underwent UDS. Postoperatively, patients in the UDS group maintained more urge incontinence (p=0.006) and storage symptoms (p<0.001) than the PE group. No statistical difference was found in the incidence of de novo SUI between the UDS group 6/68 (8.8%) and the PE group 11/114 (9.6%) (p=0.853), nor in the need of postoperative sling: 4/68 (5.9%) and 5/114 (4.4%), respectively. CONCLUSIONS: Preoperative UDS in women with POP stages III and IV increments diagnoses, changes surgical planning, increases the number of concomitant slings placement and does not change outcome in continent women upon PE. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e88 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Susane Hwang More articles by this author Luis Gustavo Toledo More articles by this author Silvia Carramao More articles by this author Raphael Moreira More articles by this author Carolina Jesus More articles by this author Sarah Carvalho More articles by this author Raquel Richetti More articles by this author Antônio Auge More articles by this author Expand All Advertisement PDF downloadLoading ...

A 10- to 20-year follow-up after tension-free vaginal tape for stress urinary incontinence.

Midurethral slings (MUS) have become the gold standard in the treatment of stress urinary incontinence (SUI). Some information is already available on the outcome of tension-free vaginal tape (TVT) after 10 years or more. Our objective was to assess the current outcome (efficacy, adverse events) of women who had been successfully operated upon for SUI by means of a TVT procedure 10 to 20 years ago. We performed a retrospective cohort study including 291 women (mean age 69.4 years) who underwent a successful TVT procedure (retropubic bottom-to-top route) in a teaching hospital between January 2001 and December 2010. The main outcome measure was the incidence of SUI at 10-20 years' follow-up. Others were incidence of re-operation, tape exposure and de novo overactive bladder symptoms. We carried out a univariate logistic regression analysis to examine the relationship between outcomes and a set of clinical variables. After a median of 15 years, TVT remains highly effective: 272 women (94%) experienced either no leakage under any circumstance (214=74%) or leakage less than weekly (58=20%). Mesh exposure (8=2.7%; 1.8 events per 1,000 patient-years) and repeat surgery for SUI (11=3.8%; 2.5 events per 1,000 patient-years) were low. Three women (1%) needed to perform intermittent self-catheterisation. Bothersome overactive bladder symptoms (45=15%) were common and associated with polypharmacy, cardiovascular medication and obesity. The efficacy of TVT is demonstrated up to 20 years. The presence of bothersome OAB symptoms in the population may be an indicator of multimorbidity.

Retropubic slings are more efficient than transobturator at 10-year follow-up: a Swedish register-based study

Introduction and hypothesisLong-term performance of mid-urethral slings (MUS) and potential differences between the retropubic and the transobturator technique for insertion are scarcely studied. This study aims to evaluate the efficacy and safety 10 years after surgery and compare the two main surgical techniques used.MethodsWomen who underwent surgery with a MUS between 2006 and 2010 were identified using the Swedish National Quality Register of Gynecological Surgery and were invited 10 years after the operation to answer questionnaires regarding urinary incontinence and its impact on quality-of-life parameters (UDI-6, IIQ-7) and impression of improvement, as well as questions regarding possible sling-related complications and reoperation.ResultsThe subjective cure rate reported by 2421 participating women was 63.3%. Improvement was reported by 79.2% of the participants. Women in the retropubic group reported higher cure rates, lower urgency urinary incontinence rates and lower UDI-6 scores. No difference was shown between the two methods regarding complications, reoperation due to complications or IIQ-7 scores. Persisting sling-related symptoms were reported by 17.7% of the participants, most commonly urinary retention. Mesh exposure was reported by 2.0%, reoperation because of the tape by 5.6% and repeated operation for incontinence by 6.9%, significantly more in the transobturator group (9.1% vs. 5.6%). Preoperative urinary retention was a strong predictor for impaired efficacy and safety at 10 years.ConclusionsMid-urethral slings demonstrate good results for the treatment of stress urinary incontinence and tolerable complication profiles in a 10-year perspective. The retropubic approach displays higher efficacy than the transobturator, with no difference regarding safety.

Surgical treatment of stress urinary incontinence: comparison of robotic-assisted Burch urethropexy with retropubic midurethral sling.

Synthetic retropubicmidurethralslings (RMUS) and robotic-assisted Burch urethropexies (RA-Burch) are common surgical treatment options for stress urinary incontinence (SUI). Few data exist comparing the success of these two retropubic surgeries. This retrospective cohort study of RA-Burch and RMUS procedures compared the proportion of patients with subjective cure after RA-Burch compared to RMUS at our institution between 2016 and 2020. Subjective cure was defined as reporting no symptoms of SUI at longest follow-up. Chi-square, Fisher's exact, Mann-Whitney U tests, logistic regression, and Kaplan-Meier log-rank tests were used in analyses. The overall cohort of 235 subjects included 47 RA-Burch cases matched 1:4 with 188 RMUS cases. Patients who underwent RA-Burch were younger (p < .01), had lower BMIs (p = .04), and were more likely to have concomitant procedures, including hysterectomy (p < .01). There was no difference in subjective cure at longest follow-up (p = .76). Median follow-up was longer in the RA-Burch group (p < .01). There was no difference in early postoperative complications, EBL, treatment for persistent SUI, or new urge urinary incontinence at longest follow-up. Both groups experienced postoperative urinary retention at a similar rate, although 4 RMUS patients required sling lysis and one patient experienced a mesh exposure. Patients undergoing RA-Burch had significantly longer OR times when no concomitant procedure was performed (p < .01). There were no significant predictors of SUI recurrence when controlling for baseline variables. This study suggests that RA-Burch and RMUS may be equally efficacious for patients with symptoms of SUI desiring surgical management.

Editorial Comment.

No AccessJournal of UrologyAdult Urology21 Mar 2023Editorial CommentThis article comments on the following:Synthetic Mid-urethral Sling for the Treatment of Urinary Incontinence in Women With Neurogenic Lower Urinary Tract Dysfunction: A Multicentric Retrospective Study Sanchita Bose Sanchita BoseSanchita Bose Houston Methodist Hospital, Houston, Texas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003388.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCES 1. . Synthetic mid-urethral sling for the treatment of urinary incontinence in women with neurogenic lower urinary tract dysfunction: a multicentric retrospective study. J Urol.2023; 209(6):000-000. Google Scholar 2. . The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: diagnosis and evaluation. J Urol.2021; 206(5):1097-1105. Link, Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology22 Feb 2023Synthetic Mid-urethral Sling for the Treatment of Urinary Incontinence in Women With Neurogenic Lower Urinary Tract Dysfunction: A Multicentric Retrospective Study Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sanchita Bose Houston Methodist Hospital, Houston, Texas More articles by this author Expand All Advertisement PDF downloadLoading ...