Mild Stress Urinary Incontinence Research Articles

The use of hyaluronic acid based bulking agent for stress urinary incontinence in women: A prospective controlled study

Background. Paraurethral injection of bulking agents in women is one of the minimally invasive technologies for the treatment of stress urinary incontinence (SUI). The effectiveness and safety of this method depend on the properties of injected substance. Aim. To evaluate the results of paraurethral injections of 1,4-butanediol diglycidyl ether crosslinked high-density hyaluronic acid (EsteFILL® intim) in the treatment of SUI in women of reproductive and perimenopausal age. Materials and methods. We examined 18 patients aged 45.8±5.0 years with mild SUI in combination with grade I–II genital prolapse. After general clinical and special studies (urination diaries, King and PISQ-12 questionnaires, cough test, complex urodynamic study, urethrovesical segment and pelvic floor ultrasound with compression elastography) paraurethral injection of 4.0 ml EsteFILL® intim drug was performed. The results of therapy were studied 1 and 6 months after the procedure. Results. It was found that the injection of the drug contributed to an increase in the stiffness of paraurethral tissues by 1.5 times within 6 months after injection. According to the results of elastography before treatment, the average value of the strain ratio of paraurethral tissues of the proximal posterior wall of the urethra was 0.66±0.46 (0.42–0.91), after 1 and 6 months – 0.99±0.45 (0.76–1.23) and 1.00±0.36 (0.78–1.22) respectively; p=0.009 and 0.018. The effectiveness of EsteFILL® intim drug in the treatment of mild SUI in women after 1 and 6 months according to the results of a cough test was 88.2 and 71.4%, according to urination diaries – 88.9 and 66.7% respectively. During the entire observation period the patients noted a decrease in the degree of discomfort due to SUI and an improvement in the quality of life. Conclusion. Paraurethral injection of EsteFILL® intim drug helps to increase the stiffness of the urethra supporting structures in patients with SUI. This method of treating SUI is effective for women of reproductive and perimenopausal age with mild severity disease, who do not plan surgical treatment, are interested in achieving a quick result of therapy and are informed that the effect decreases over time after the procedure.

Long-term efficacy and safety of a bioresorbable polycaprolactone-based injectable in female stress incontinence

A fully bioresorbable polycaprolactone (PCL)-based bulking agent was evaluated for safety and efficacy in female patients with mild to moderate stress urinary incontinence (SUI) who attempted and failed prior pelvic floor muscle training. A total of 44 adult female subjects with mild or moderate SUI (median age 60 and 57, respectively) were treated by transurethral sub-mucosal injection. Safety was evaluated at 6-, 12-, and 24-month follow-up visits. Efficacy was assessed at the same intervals with the Stamey grading system (SGS). SGS improvement was shown in both the mild and moderate SUI groups. At 24 months, most participants were continent: 78.1% in the mild SUI group and 66.7% in the moderate SUI group. All participants in the moderate SUI group showed an improvement in the SGS grade, and most participants were continent. The study shows that the PCL-based bioresorbable bulking agent treatment seems to be a safe and effective treatment option for women with mild to moderate SUI who attempted and failed prior pelvic floor exercises.

Effect of home-based core exercises on postpartum stress urinary incontinence during COVID-19 pandemic in Jeddah city: a randomised control trial

IntroductionIntroduction. Postpartum stress urinary incontinence affects many women worldwide; it may exist during pregnancy or postpartum with a risk of permanence increasing five years later. This study aimed to determine the effect of home-based core exercises on postpartum stress urinary incontinence during the COVID-19 pandemic, in Jeddah city.MethodsRandomised control trial was conducted on 26 postpartum women aged 25–40 years with mild or moderate grade stress urinary incontinence and a body mass index (BMI) less than 30 kg/m2. Participants were randomly divided into two equal groups (A & B). Group A performed home-based core exercises and pelvic floor muscle training for twenty-four sessions three times weekly for eight weeks; each session lasted 30 minutes. Group B performed home-based PFMT only. The assessment of pelvic floor muscles (PFMs) was measured with the Modified Oxford Grading Scale, while the 1-hour pad test and International Consolation on Incontinence questionnaire-short form (ICIQ UI- SF) total score served to assess incontinence severity before and after treatment.ResultsThe results showed a significant improvement in PFMs strength and endurance in both groups and there was a highly significant difference between groups, favouring the study group (A). There was a highly significant difference between the groups in the 1-hour pad test and ICIQ-SF total score, favouring the study group (A).ConclusionsHome-based core exercises for postpartum SUI women were an effective method to improve PFMs strength and endurance and minimise SUI symptoms.

Possibilities of elastography in the diagnosis of stress urinary incontinence in women

BACKGROUND:Stress urinary incontinence in women is a widespread disease. It can occur in women of reproductive age, while progressing and disrupting the quality of life. Ultrasound elastography allows for evaluating the stiffness of the urethral supporting structures and can help in studying the pathophysiology of stress urinary incontinence and in diagnosing its mild forms for timely initiation of therapy and preventing the development of severe forms of the disease.
 AIM:The aim of this study was to improve the diagnosis of mild stress urinary incontinence in women using ultrasound compression elastography of the ureterovesical junction.
 MATERIALS AND METHODS:We examined 25 women with mild stress urinary incontinence (main group) and 15 patients without urinary incontinence (control group) of reproductive and perimenopausal age. The diagnosis of stress urinary incontinence was confirmed during a comprehensive urodynamic study. To assess the urethral mobility and determine the stiffness of the supporting structures, a 2D ultrasound examination was performed with compression elastography of the ureterovesical junction using Voluson E6 and E10 ultrasound systems equipped with a transvaginal probe (GE Healthcare, USA). Four areas of interest in the paraurethral region of the proximal and middle urethra were examined. The obtained elastograms were used to evaluate the color characteristics and strain ratio of the areas of interest in three dimensions, the average values being calculated.
 RESULTS:The strain ratios in all studied areas of the paraurethral region had no significant relationship with age and were lower in patients with stress urinary incontinence compared to control values (p 0.01). Urethral hypermobility (mobility: mean urethral α angle rotation of 40 degrees) was identified in 84% of women with stress urinary incontinence. According to the results of correlation analysis, the strain ratios in the three areas of interest had a significant negative relationship with changes in the urethral α angle rotation. The ROC analysis showed that the stiffness values of the paraurethral region of the proximal posterior wall of the urethra are the most significant parameters for the diagnosis of stress urinary incontinence. The threshold value of the strain ratio for diagnosing stress urinary incontinence was determined to be less than or equal to 0.85 (sensitivity 96.0%; specificity 86.7%;p 0.001).
 CONCLUSIONS:Ultrasound compression elastography of the ureterovesical junction is a new non-invasive technique that can improve the accuracy of diagnosing stress urinary incontinence in women. It is advisable to use the technique in women with mild stress urinary incontinence who are planned for conservative treatment to confirm the diagnosis and monitor therapy.

Remote pelvic floor muscle training in the treatment of stress urinary incontinence in women

BACKGROUND: Stress urinary incontinence in women is a common condition that can develop at a young age and, even with mild severity, disrupts the quality of life. The first line of treatment for stress urinary incontinence is pelvic floor muscle training, which is the most effective in biofeedback mode. The low effectiveness of self-study is often associated with irregular and incorrect exercise.
 AIM: The aim of this study was to evaluate the effectiveness of remote pelvic floor muscle training using the Tyulpan laser vaginal simulator under medical supervision in the treatment of mild and moderate stress urinary incontinence in women of reproductive and perimenopausal age, and to develop a predictive model for evaluating the effectiveness of treatment by this method.
 MATERIALS AND METHODS: We examined 48 patients aged 41.3 6.8 years (2655) with complaints of mild to moderate stress urinary incontinence. After general clinical and special studies (analysis of seven-day urination diaries, Kings questionnaire and Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire (PISQ-12), urethrovesical segment ultrasound examination), a remote course of treatment was started using the Tyulpan laser vaginal simulator under medical supervision via videoconference for 35 patients within three months. The participants were re-examined one, three and four to six months after the start of the pelvic floor muscle training course.
 RESULTS: The training course was fully completed by 25 participants. After one month of remote pelvic floor muscle training, according to urination diaries, a decrease in the number of stress urinary incontinence episodes was noted by 64.0% of patients and the absence of stress urinary incontinence episodes by 28.0% of patients (p 0.001); after three months of remote pelvic floor muscle training, by 32.0% and 68.0% of patients, respectively (p 0.001). A negative cough test after one month was detected in 62.5% of the participants (p = 0.002) and, after four to six months with the continuation of independent pelvic floor muscle training, in 81.9% of patients (p = 0.003). According to the ROC-analysis, the absence of stress urinary incontinence episodes was predicted when the amplitude of the simulator laser beam was greater than or equal to 90 cm (sensitivity 84.0%, specificity 96.0%; p 0.001). Distance learning under medical supervision had a positive impact on the quality of life and relationships with a partner and improved the womens psychological well-being (p 0.001).
 CONCLUSIONS: Remote pelvic floor muscle training is effective in women of reproductive and perimenopausal age with mild to moderate stress urinary incontinence who are able to contract their pelvic floor muscles and perform regular exercises. The effectiveness of the training course is 68.0% according to urination diaries and 81.9% according to the cough test. The absence of stress urinary incontinence episodes is predicted when the amplitude of the simulator laser beam is greater than or equal to 90 cm.

(446) Synchronous Surgical Management of Erectile Dysfunction and Stress Urinary Incontinence: A Systematic Review and Meta-analysis of Reoperation Rates

Abstract Introduction The efficacy, safety, and postoperative outcomes of synchronous surgery for concomitant erectile dysfunction (ED) and stress urinary incontinence (SUI) remain unclear. Objective We performed a systematic review and meta-analysis to evaluate the available synchronous surgical approaches for concomitant ED and SUI and to assess the reoperation rates compared to asynchronous surgery and surgery only for ED or SUI. Methods We searched PubMed, Cochrane Library, and Embase databases until June 2022 for relevant studies. Based on data availability, we performed a meta-analysis of odds ratios (ORs) comparing reoperation rates after synchronous surgery in patients with concomitant ED and SUI versus asynchronous surgery, as well as surgery solely for ED or SUI (PROSPERO: CRD42022326941). Results We included 18 studies in the systematic review (16,517 patients) and 5 in the meta-analysis. Comparing synchronous implantation of penile prosthesis and artificial urinary sphincter (AUS) versus asynchronous surgery, no statistically significant differences were observed in the reoperation rates [OR:0.98, 95% confidence interval (CI): 0.52-1.84, I2:0%). Comparing synchronous implantation of both penile prosthesis and AUS versus implantation of only a penile prosthesis or an AUS, combined surgery was associated with higher reoperation rates (OR:2.02, 95%CI: 1.29-3.16, I2:36% and OR:1.7, 95%CI: 1.25-2.32, I2:0%, respectively). Synchronous surgery led to high satisfaction rates and significant improvement in ED and SUI. Evidence for the combination of penile prosthesis with a male sling or the ProACT device is low, but data suggests it may be safe and effective. The synchronous placement of a Mini-Jupette sling and penile prosthesis represents a promising treatment modality for the correction of ED and mild SUI and/or climacturia. Conclusions Synchronous penile prosthesis and AUS implantation appears safe and effective in patients with severe ED and SUI. Further high-quality studies are mandatory to strengthen the current scarce evidence for synchronous surgery in patients with ED and SUI. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Cynosure, Coloplast, Clarus Therapeutics, Antares Pharma, Acerus

(291) Long-term Assessment of the Safety and Efficacy of the Mini-Jupette Sling: 5-year Follow-up of the Original Series

Abstract Introduction Climacturia has been reported in up to 64% of patients following radical prostatectomy (RP). In 2017, a prospective multicenter, multinational, investigational pilot study was conducted examining outcomes using a novel surgical technique, the Mini-Jupette sling, for the management of men with post-RP erectile dysfunction (ED) and climacturia and/or minimal stress urinary incontinence (SUI). We sought to report the 5-year outcomes from this original cohort. Objective To assess long-term safety and efficacy of the mini-jupette sling in the treatment of ED and concomitant mild SUI and/or climacturia Methods We identified patients who were enrolled in the previous multicenter study with post-RP ED and climacturia and/or mild SUI (2 ppd) and underwent IPP insertion with simultaneous placement of a Mini-Jupette sling. Data including current ppd, improvement in climacturia, complications, need for revision of IPP or additional urinary incontinence surgery, and date of most recent follow-up were collected. Results Of the original 38 patients, 5 have since died and 10 were lost to follow-up with 23/38 (61%) patients available for evaluation of long-term outcomes. The average follow-up time was 59 months (SD= 8.8) with a mean age of 69 years (SD= 6.8). Most patients (n=21, 91%) had subjective improvement of SUI and climacturia. One patient with persistent bothersome incontinence underwent artificial urinary sphincter (AUS) placement in 2018 with no complications, while the other is still considering a repeat procedure due to minor but persistent SUI. The mean ppd decreased from 1.4 preoperatively to 0.3 at a mean 5 years of follow-up. Most patients reported satisfaction in their urinary symptoms with 91% and 73% reporting improvement in SUI and climacturia respectively, compared to 86% and 93% respectively in the original series. One (4.3%) patient had an IPP revision for pump malfunction. There were no device infections reported. Conclusions The Mini-Jupette sling appears to be a safe and effective procedure with durable improvements in SUI and climacturia at 5 years of follow-up. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus, Intuitive Surgical, Fidalis, Hims & Hers Health Inc

Modified lumbo-pelvic exercise to alleviate mild stress urinary incontinence in middle-aged females

Urinary incontinence is one of the common clinical problems of females passing middle age. Traditional pelvic floor muscle training to alleviate urinary incontinence is too dull and unpleasant. Therefore, we were motivated to purpose a modified lumbo-pelvic exercise training incorporating simplified dancing components with pelvic floor muscle training. The objective of this study was to evaluate the 16-week modified lumbo-pelvic exercise program that incorporated dance and abdominal drawing-in maneuvers. Middle-aged females were randomly assigned into the experimental (n = 13) and control (n = 11) groups. Compared to the control group, the exercise group significantly reduced body fat, visceral fat index, waistline, waist-hip ratio, perceived incontinence score, frequency of urine leakage, and pad testing index (p < 0.05). In addition, there were significant improvements in pelvic floor function, vital capacity, and muscle activity of the right rectus abdominis (p < 0.05). This indicated that the modified lumbo-pelvic exercise program can promote benefits of physical training and alleviate urinary incontinence in middle-aged females.

Long-term assessment of the safety and effectivity of the mini-jupette sling: 5-year follow-up of the original series.

In 2017, a prospective multicenter, multinational, investigational pilot study was conducted examining outcomes using a novel surgical technique, the Mini-Jupette sling, for the management of erectile dysfunction (ED) patients with climacturia and/or minimal stress urinary incontinence (SUI) after prostate procedures. Climacturia has been reported in up to 64% of patients following radical prostatectomy (RP). We sought to report the 5-year outcomes from this original cohort to assess long-term safety and effectivity of the mini-jupette sling in the treatment of ED and concomitant mild SUI and/or climacturia. This is a single-arm, multicenter, retrospective, observational study. We identified patients who were enrolled in the previous multicenter study with post-RP ED and climacturia and/or mild SUI- 2 PADS PER DAY (PPD) and underwent inflatable penile prosthesis (IPP) insertion with simultaneous placement of a mini-jupette sling. Data were collected including current PPD, subjective improvement in climacturia/SUI, complications, need for revision of IPP or additional urinary incontinence surgery, and date of most recent follow-up. SPSS was used for statistical analysis. Of the original 38 patients, 5 have since died and 10 were lost to follow-up with 23/38 (61%) patients available for evaluation of long-term outcomes. The average follow-up time was 59 months (SD =8.8) with a mean age of 69 years (SD =6.8). Most patients (n=21, 91%) had subjective improvement of SUI and climacturia. One patient with persistent bothersome incontinence underwent artificial urinary sphincter (AUS) placement in 2018 with no complications, while the other is still considering a repeat procedure due to minor but persistent SUI. The mean PPD decreased from 1.4 preoperatively to 0.4 at a mean of 5 years of follow-up. Most patients reported satisfaction in their urinary symptoms with 91% and 73% reporting improvement in SUI and climacturia respectively, compared to 86% and 93% respectively in the original series. One (4.3%) patient had an IPP revision for pump malfunction. There were no device infections reported. The mini-jupette sling appears to be a safe and effective procedure with durable improvements in SUI and climacturia at 5 years of follow-up.

MP62-12 PARIETEX MINI MALE SLING FOR STRESS URINARY INCONTINENCE AT THE TIME OF THREE PIECE PENILE PROSTHESIS: TECHNIQUE AND OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP62-12 PARIETEX MINI MALE SLING FOR STRESS URINARY INCONTINENCE AT THE TIME OF THREE PIECE PENILE PROSTHESIS: TECHNIQUE AND OUTCOMES Shirin Razdan, Alexandra Siegal, and Robert Valenzuela Shirin RazdanShirin Razdan More articles by this author , Alexandra SiegalAlexandra Siegal More articles by this author , and Robert ValenzuelaRobert Valenzuela More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Male stress urinary incontinence (SUI) and climacturia are often comorbid with erectile dysfunction (ED) post prostatectomy. While the inflatable penile prosthesis (IPP) is the gold standard surgical option for ED, there are many surgical options for male SUI as well as climacturia including bulking agents, Virtue® male sling, AdVance™ male sling, mini Jupette with IPP, and artificial urinary sphincter (AUS). We present our technique and outcomes for mini male sling (MMS) with IPP insertion for mild SUI and climacturia using a hydrophilic monofilament polyester mesh. METHODS: After obtaining IRB approval, a retrospective review of all IPPs performed by a single high volume surgeon was performed. Those men who underwent IPP insertion with concomitant MMS were analyzed. The technique of MMS placement involves measurement of an approximately 5x3cm Parietex™ mesh (Covidien, MN) and overlying this ventrally over the bulbar urethra. The Parietex™ mesh includes a hydrophilic absorbable collagen film to minimize tissue reaction and risk of erosion. The lateral edges of the mesh are sutured to the 3- and 9 o’clock positions on the left and right corporal bodies, respectively, using a nonabsorbable, braided suture in an interrupted fashion. Mesh is sutured just proximal to the corporotomy sites. Tightness of mesh was measured using the proximal end of a Debakey forceps, with ease of passage when IPP deflated and inability to pass forceps when IPP inflated indicative of proper sizing. RESULTS: A total of 63 men underwent IPP with MMS between January 2018 and October 2022. All patients had ED after radical prostatectomy. Average patient age was 67 years old, and average IPP size was 21cm with 1cm rear tip extender (RTE). A total of 59 men had SUI, with average pad per day (PPD) of 1.5. Twenty-five men with SUI had comorbid climacturia, and 4 men had preoperative climacturia without SUI. Average PPD post IPP with MMS was 0.1. Of the 29 men with preoperative climacturia, only one did not have resolution of his symptoms post MMS. There was only one reported complication of acute urinary retention requiring temporary foley catheter placement. Two patients required subsequent AUS insertion for persistent SUI. There were no reported cases of infection or mesh erosion. CONCLUSIONS: The hydrophilic Parietex™ mesh is a safe, easy to use, nonreactive, and effective material for mini male sling insertion at the time of IPP placement for men with ED and mild/moderate SUI or climacturia. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e866 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shirin Razdan More articles by this author Alexandra Siegal More articles by this author Robert Valenzuela More articles by this author Expand All Advertisement PDF downloadLoading ...

Long-term efficacy of the pelvic floor muscle rehabilitation for women with stress urinary incontinence.

Stress urinary incontinence is a common disease with many therapeutic ways, but it lacks long-term follow-up. This study aims to conduct a retrospective study on the long-term efficacy of women with mild and moderate stress urinary incontinence after pelvic floor rehabilitation treatment for 3-years so as to provide a more effective treatment plan for this disease. Data were collected from 279 female patients, who were diagnosed with stress urinary incontinence at the Pelvic Floor Rehabilitation Center of the Third Xiangya Hospital of Central South University from January 2017 to January 2019. All patients received health education and were instructed to perform Kegel exercises for 20 min daily at home. According to the treatment pattern, patients were divided into 3 groups as A, B, and C. Group A (n=94) received pelvic floor biofeedback, electrical stimulation and electroacupuncture; Group B (n=99) received pelvic floor biofeedback and electrical stimulation; Group C (n=86) only got pelvic floor function examinations and did not receive any pelvic floor treatment. The pelvic floor functional examinations included a pelvic floor electrophysiological test, pelvic organ prolapse quantitive examination (POP-Q), and stress urinary incontinence severity assessment. All patients were followed up with questionnaire consisting of the International Committee on Urinary Incontinence Questionnaire-Short Form (ICI-Q-SF) and the Quality of Life questionnaire of Urinary Incontinence (I-QOL) before and after the treatment, as well as at 1-, 2-, and 3-years after the treatment (5 times in total). Among the patients who received the treatment, 43 returned to the hospital, including 21 in group A (Group Areturn) and 22 in group B (Group Breturn). Pelvic floor electrophysiological test and POP-Q were performed on the 2 groups. For the leakage rate at the end of the treatment and the following 1-, 2-, and 3-years: Group A<Group B<Group C, and the recurrence rate of their leakage remained stable after 2 to 3 years of the treatment (P<0.05). Meanwhile, there was no significant difference in the I-QOL scores between Group A and Group B at the end of the treatment (P>0.05), but the I-QOL scores of Group A and Group B were much higher than that in Group C (both P<0.05). On the other hand, the I-QOL scores at 1-, 2-, and 3-years after the treatment were Group A>Group B>Group C (all P<0.05). In addition, the ICI-Q-SF scores at the end of the treatment and 1-, 2-, and 3-years after the treatment were Group A<Group B<Group C (P<0.05). There was also a significant effect of delivery on I-QOL and ICI-Q-SF scores after the treatment (P<0.05). Besides, the production method also had an impact on the ICI-Q-SF scores after the treatment (P<0.05). The results of the re-evaluation showed that there was no significant difference in the anterior vaginal wall prolapse score (point Aa) between Group A return and Group Breturn at the end of the treatment, but 3 years later, the score of anterior vaginal wall prolapse in Group Areturn was less than that in Group Breturn (P<0.05). Besides, no significant difference was found in the pelvic floor muscle strength between Group A return and Group Breturn at the end of the treatment (P>0.05). While the pelvic floor muscle strength in Group Areturn was much higher than that in Group Breturn (P<0.05) after 3 years of the treatment. What's more, the pelvic floor muscle potential in Group Areturn was much higher than that in Group Breturn (both P<0.05) at the end of the treatment and after 3 years of the treatment. Compared with pelvic floor biofeedback and electrical stimulation for stress urinary incontinence, electroacupuncture combined with pelvic floor electrical stimulation and biofeedback reveal more remarkable short-term efficacy and more stable long-term efficacy, which can significantly improve the quality of life in female patients.

The Risk Factor Associated with Stress Urinary Incontinence (SUI) Severity: a Cross-Sectional Multi-centered Study

Background: Stress urinary incontinence is defined as involuntary loss of urine on effort or exertion or with coughing or sneezing. SUI affects as many as 75% of older women, 44-57% of middle-aged, and 25% of young women. Risk factors include age, parity, vaginal birth, menopause, obesity, body mass index, diabetes, hysterectomy, chronically increased abdominal pressure, genetic factors, physical activity level, smoking, diet, and family history. Our purpose was to determine which risk factors are associated with the severity of stress urinary incontinence using a 1-hour pad test. Method: This cross-sectional multicentered study was performed on 178 women who complained of incontinence and had completed QUID for SUI. We collected data using a pad test, and we classified those women into two main groups, women with mild SUI with 1-hour pad test results 1-10 g and women with moderate and severe SUI with 1-hour pad test results more than 10 g. We use Phi and Cramer’s V to calculate the effect size of each risk factor. Results: There were 20 women with moderate and severe SUI, and 158 had mild SUI. We analyzed the risk factors associated with moderate-severe SUI women and found that age (p=0.03), perineometer result (p = 0.04), and level of education (p=0.02) are statistically significant. Conclusion: The severity of stress urinary incontinence is related to age, perineometer result, and level of education.

Vaginale Lasertherapie – Mythen und Fakten

The current guideline "Female Urinary Incontinence" of the working group of scientific medical professional associations (AWMF) comprises arecommendation about the optional use of vaginal laser therapy in patients with mild to moderate stress urinary incontinence (SUI). Since to date there is no corresponding recommendation within the European Association of Urology (EAU) guidelines, the scientific evidence of the AWMF recommendation is evaluated. On the basis of limited data, both available laser systems (Erbium:YAG and CO2) seem to work equivalently in patients with mild SUI. The problematic comparability of studies with different definitions of incontinence, severity classifications, outcome parameters, and consideration of diverse etiological aspects is addressed. After thorough consideration of the available prognosticator research, aprofile of an ideal laser candidate is developed for proper patient selection. This profile includes younger age, normal body mass index, sufficient estrogenization status, pure stress urinary incontinence due to urethral hypermobility, and urine loss of < 8 g during a1 h pad test.

Changes and debates in male stress urinary incontinence surgery practice patterns: a contemporary review.

Surgery plays a crucial role in the definitive management of male stress urinary incontinence (SUI). The most utilized and well-studied surgical options include the artificial urinary sphincter (AUS) and the male sling (MS). The AUS has long been considered the "gold standard" and more versatile option in this space, showing effectiveness in mild, moderate, and severe SUI cases, whereas the MS is preferred in cases of mild to moderate SUI. Not surprisingly, and importantly, much of the published literature on male stress incontinence has focused on determining the "ideal" candidate for each procedure and identifying which clinical, device-specific, and patient factors play an important role in the objective and subjective success rates. There are, however, more granular, and sometimes debatable, topics to assess regarding the real-life practice patterns of male SUI surgery. The aim of this clinical practice review is to examine current trends of several of these topics including: AUS vs. MS utilization, the prevalence of outpatient procedures, 3.5 cm AUS cuff use, preoperative urine studies utilization, and intraoperative and postoperative antibiotics. As with many things in surgery, dogma rather than evidence-based medicine can significantly influence everyday clinical decision making. We seek to highlight which practice patterns in male SUI surgery are changing and/or being challenged and debated.

Developing a Clinical Care Guideline on Pelvic Floor Muscle Training for Women with Mild Stress Urinary Incontinence

&lt;p&gt;臨床上壓力性尿失禁常使用的評估診斷工具，可能造成輕度尿失禁症狀被低估而未適當治療，使病患仍受困擾。台灣健保制度完善，利用手術治療中、重度壓力性尿失禁病患，卻沒有對骨盆底肌強化訓練如何治療輕度壓力性尿失禁進行明確規範。本文發展流程為選定主題、建構問題、系統性文獻查證，根據16篇實證文獻擬定此指引，經由德菲法共識確認，隨後以AGREE II進行外部評估，結果為強烈建議使用，發展出指引範圍包含三個構面：指引的範圍界定5項，壓力性尿失禁評估診斷2項和處置建議5項。透過會議使醫師及專科護理師間達成共識；團隊成員教育訓練；建立檢核表，標準化評估處置流程，使輕度壓力性尿失禁婦女在身心完整評估下，適切接受骨盆底肌強化訓練。由於專科護理師跨醫療護理的角色功能，更能將此指引整合落實，使輕度壓力性尿失禁病患的照護更完整與持續。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;The commonly used evaluation and diagnostic tools for clinical stress urinary incontinence may lead to underestimation of mild symptoms. Therefore, leaving patients with long-term distress when prop-erly treatment is not provided. Taiwan has a well-established health insurance system, of which sur-gery is used to treat patients with moderate to severe stress urinary incontinence, but there is no clear regulation on the use of pelvic floor muscle training to treat mild stress urinary incontinence. Through the selection of topics, construction of issues and comprehensive literature review, this guideline was developed based on 16 empirical studies. The content of this guideline was later confirmed by the Dephi method and was strongly recommended for application after externally evaluated by AGREEII. The scope of this guideline includes three facets: 5 items for scoping, 2 items for the assessment and diagnosis of stress urinary incontinence, and 5 items for treatment. Through meetings, consensus was reached between physicians and nurse practitioners; team members were educated and trained; a checklist was established to standardize the evaluation and treatment process, so that women with mild stress urinary incontinence could appropriately receive pelvic floor muscle training after a com-plete physical and mental evaluation. Since nurse practitioner plays an important role in medical care, this guideline can be integrated and implemented to comprehensively improve the care of patients with mild stress urinary incontinence.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Efficacy and Complications of the Re-Adjustable Male Sling System for Stress Urinary Incontinence after Radical Prostatectomy.

The aim of this study was to investigate the outcomes of re-adjustable male slings in pa-tients with postoperative stress urinary incontinence (SUI) following radical prostatectomy (RP). We retrospectively analyzed 18 patients with SUI following RP for prostate cancer, who were treated with re-adjustable male slings from January 2016 to December 2021. The clinical outcomes were evaluated based on daily pad usage and urodynamic studies, both preoperatively and post-operatively. The degree of SUI was categorized as either mild, moderate, or severe. Success was defined as no more pad use or significantly decreased pad use. Complications were classified ac-cording to the Clavien-Dindo system. The mean age of patients was 70.4 ± 5.9 years, and 61.1% of cases were diagnosed as locally advanced prostate cancer. Mild, moderate, and severe SUI were reported as 33.3%, 50.0%, and 16.7%, respectively. The average daily pad use after RP was 3.3 pads and there was a significant reduction in the number of daily pads used after the re-adjustable male sling procedure (3.3 vs. 1.3; p = 0.002). Overall, the operation was considered successful in 11 pa-tients (61.1%), 1 case showed improvement (5.6%), and it was considered unsuccessful in 6 patients (33.3%). Impressively, in the severe incontinence subgroup (three patients), one (33.3%) had im-provement and one (33.3%) had success. Transient perineal discomfort after the operation was the most common complaint. However, two patients had severe complications with bowel injury during sling implantation (Clavien-Dindo grade III). The re-adjustable male sling system was an efficient surgical treatment option for post-RP SUI, even in a locally advanced disease dominant population. One should pay attention to the complication of bowel perforation during surgery.

Synchronous Surgical Management of Erectile Dysfunction and Stress Urinary Incontinence: A Systematic Review and Meta-Analysis of Reoperation Rates.

The efficacy, safety, and postoperative outcomes of synchronous surgery for concomitant erectile dysfunction (ED) and stress urinary incontinence (SUI) remain unclear. We performed a systematic review and meta-analysis to evaluate the available synchronous surgical approaches for concomitant ED and SUI and to assess the reoperation rates compared to asynchronous surgery and surgery only for ED or SUI. We searched PubMed, Cochrane Library, and Embase databases until June 2022 for relevant studies. Based on data availability, we performed a meta-analysis of odds ratios (ORs) comparing reoperation rates after synchronous surgery in patients with concomitant ED and SUI versus asynchronous surgery, as well as surgery solely for ED or SUI (PROSPERO: CRD42022326941). We included 18 studies in the systematic review (16,517 patients) and 5 in the meta-analysis. Comparing synchronous implantation of penile prosthesis and artificial urinary sphincter (AUS) versus asynchronous surgery, no statistically significant differences were observed in the reoperation rates [OR:0.98, 95% confidence interval (CI): 0.52-1.84, I2:0%). Comparing synchronous implantation of both penile prosthesis and AUS versus implantation of only a penile prosthesis or an AUS, combined surgery was associated with higher reoperation rates (OR:2.02, 95%CI: 1.29-3.16, I2:36% and OR:1.7, 95%CI: 1.25-2.32, I2:0%, respectively). Synchronous surgery led to high satisfaction rates and significant improvement in ED and SUI. Evidence for the combination of penile prosthesis with a male sling or the ProACT device is low, but data suggests it may be safe and effective. The synchronous placement of a Mini-Jupette sling and penile prosthesis represents a promising treatment modality for the correction of ED and mild SUI and/or climacturia. Synchronous penile prosthesis and AUS implantation appears safe and effective in patients with severe ED and SUI. Further high-quality studies are mandatory to strengthen the current scarce evidence for synchronous surgery in patients with ED and SUI.

Первый опыт применения имплантируемого объемообразующего материала «Сферо®ГЕЛЬ» при стрессовом недержании мочи у женщин.

Introduction. Among minimally invasive technologies for the treatment of stress urinary incontinence (SUI) in women, a special place is occupied by the method of paraurethral administration of bulking agents (BA). Recently, great attention has been paid to the new generation of natural biopolymers with a set of unique qualities that allow using the body's own resources to restore damaged tissues. Heterogeneous implantable gel (JSC «BIOMIR service», Russia) belongs to such BA. Objective: to evaluate the efficacy and safety of transurethral administration of BA «Sphero®GEL» LONG (SGL) in women with SUI. Materials and methods. The open prospective study included 20 women with mild or moderate SUI, aged 41-76 years, who underwent one/two transurethral implantation of SGL into the submucosal and muscular layers after clinical and urodynamic examination. Results. According to the preliminary survey, mild SUI was detected in 13 (65%) women, and moderate SUI – in 7 (35%). Initial data: visual analog scale (VAS) – 7.7 ± 2.0; quality of life (QOL) – 3.3 ± 1.2; maximum urine flow rate (Qmax) – 20.5 ± 5.3 ml/s; post-void residual urine volume (PVR) – 7.0 ± 2.1 ml; voided volume (VV) – 297.2 ± 65.6 ml; maximal cystometric capacity (MCC) – 312.1 ± 83.3 ml; maximum urethral closure pressure (MUCP) – 48.4 ±11.9 cm H2O; functional urethral length (FUL) – 20.3 ± 8.2 mm; one-hour PadTest 8.2 ± 1.9 g. Two weeks after the introduction of SGL, the satisfactory effect was detected in 17 women (85%) 6 of them (30%) were completely dry. The need for SGL additional administration occurred in 11 women (55%), which was fulfilled. There was an improvement in key parameters compared to the initial data 3 and 6 months after treatment: VAS index significant decrease by 70.1 and 63.6%; increase of MUCP by 8.9 and 7.9%; increase of FUL by 14.3 and 18.2%; statistically significant decrease of PadTest weight by 61.0 and 53.7%; improvement of QOL by 60.6 and 48.5%, respectively. There was a slight decrease in Qmax – by 11.2 – 8.3%. Changes in other indicators did not exceed normal values. When evaluating the results after 6 months in 17 patients (85%), the effect of treatment and the quality of life were assessed as satisfactory: according to PadTest results urine loss was less than 5 g. Moreover, in 11 cases (55%) urinary incontinence disappeared, so the full effect was achieved. There was no satisfactory effect in 3 women (15%), they were offered surgical treatment of SUI. Long–term results up to 12 months were followed in a group of 9 women with a good effect of SGL implantation. The dynamics of the main indicators a year after implantation was: 52.8% decrease according to VAS; 41.1% decrease according to PadTest; 48.3% of QOL improvement. SUI was also absent after a year of observation. Request for SGL re-administration was received from 3 of 8 women with unsatisfactory result, although their urine loss did not exceed 5 g per hour. No complications were observed during the SGL implantations. After the procedure urinary retention and the need for catheterization were not observed in any of patients. Allergic reactions, pain, severe hematuria, infection, tissue erosion at the injection site of SGL, as well as bladder overactivity «de novo» were not observed. Conclusion. The first experience of using the implantable heterogeneous volume-forming material SGL in women with mild and moderate SUI has confirmed the high efficiency of the technology, no worse than other samples of BA, with a high safety profile exceeding many of them. It is necessary to continue clinical research in this direction in order to implement the method into wide practice, also as part of import replacement activities.

Impact of E2 and FSH levels on the severity of Stress Urinary Incontinence (SUI) in menopausal women

HIGHLIGHTS 1. E2 and FSH levels in menopausal women are thought to have relationship with stress urinary incontinensia (SUI).2. It was found that E2 and FSH levels had no significant relationship with SUI severity in menopausal women. ABSTRACT Objectives: This study aimed to analyze the relationship between E2 and FSH levels in menopausal women with the severity of Stress Urinary Incontinence (SUI) at Ulin Hospital, Banjarmasin, Indonesia. Materials and Methods: This study used an analytic observational method with cross-sectional design in menopausal women diagnosed with Urinary Incontinence (UI) from October 2020 - March 2021. The independent variables were E2 and FSH levels. The dependent variable was the severity of SUI in menopausal women. The severity of SUI was determined by the Incontinence Severity Index (ISI) scoring. Data were analyzed by Spearman correlation. Results: The subjects who met the criteria were 25 women. The results showed the prevalence rate of SUI was 5.8% with E2 and FSH levels of mild SUI (14.25 pg/mL and 49.70 mIU/mL), moderate (7.91 pg/mL and 54.13 mIU/mL), and severe (9.14 pg/mL) and 70.97 mIU/mL). The number of severity levels of mild SUI was 44%, moderate SUI was 48%, and severe SUI was 8%. Most patients with SUI aged &gt;60 years, multipara, normal body mass index (BMI), duration of menopause &lt;10 years, menarche &lt;15 years, Intrauterine Device (IUD) contraception, and delivered with spontaneous vaginal delivery. There was no significant relationship between E2 levels and the severity of SUI with a p-value of 0.084 and a correlation coefficient of -0.353. There was no significant relationship between FSH level and severity of SUI with a p-value of 0.367 and a correlation coefficient of 0.189. Conclusion: There was no significant relationship between E2 and FSH levels and the severity of SUI in menopausal women. It is necessary to do research on other factors that influence the high severity of SUI in menopausal women.

Using mini-jupette slings to treat post radical prostatectomy urinary incontinence: Foreplay incontinence, climacturia, and stress incontinence

ABSTRACT Introduction and Objective The Mini-Jupette has been successfully used concomitantly with inflatable penile prostheses (IPP) to treat erectile dysfunction (ED), climacturia and stress urinary incontinence (SUI) secondary to radical prostatectomy (RP). This is the largest single surgeon report of the original Andrianne Mini-Jupette sling and IPP placements in men with ED and climacturia, mild SUI and/or foreplay incontinence. Methods This was a retrospective study on a prospectively managed database of 32 patients who underwent IPP and Mini-Jupette placement using Tutoplast® cadaver pericardium graft by a single surgeon between July 2016 and February 2020. Patients were surveyed pre- and post-operatively and asked to score the severity of their foreplay incontinence (FI), climacturia, and SUI from 0 (“dry”), 1 (“1 drop”), 2 (“few drops”), 3 (“small dribble”), or 4 (“squirt of urine”). Patient surveys were compared pre- to post-operation using Fisher's exact test. Results Of the 32 men, 27 (84%) had FI, 26 (81%) with climacturia, and 27 (27%) with SUI (Table 1). At a mean follow-up of 17.9 months, FI (p&amp;lt;0.001), climacturia (p&amp;lt;0.001), and SUI (p&amp;lt;0.001) all significantly improved (Table 2). FI improved in 78.9% (15/19) and resolved in 47.4% (9/19); climacturia improved in 82.3% (14/17) and resolved in 64.7% (11/17); SUI improved in 71.4% (15/21) and resolved in 57.1% (12/21). Sexual Health Inventory for Men (SHIM) scores significantly improved from 5.0 to 23.8 (p&amp;lt;0.001) for the entire group. Three patients (9.4%) required an artificial urethral sphincter (AUS) for the management of persistent incontinence. One patient underwent IPP revision due to foreskin irritation and another experienced pump-related issues. Conclusions The Mini-Jupette in tandem with an IPP is a safe and effective treatment option for men with severe ED experiencing sexually related incontinence as well as SUI post-RP. This is the first report of IPP placement with a Mini-Jupette sling successfully treating foreplay incontinence. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Antares Pharma, Clarus Therapeutics, Coloplast, Promescent, Viome).