Mild Stress Urinary Incontinence Research Articles

Seguimiento a largo plazo del cabestrillo AdVance®/AdVanceXP®. ¿Qué piensa el cirujano?, ¿qué piensa el paciente?

ObjectivesTo analyse the safety, efficacy and quality of life of patients with male stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdvanceXP® slings. Patients and methodThe study included 92 patients with stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdVanceXP® sling between May 2008 and December 2015. A perineal repositioning test was performed in all cases with sphincter coaptation of≥1.5cm. Mild stress urinary incontinence was defined as the use of 1-2 absorbers/24h; moderate was defined as 3-5 absorbers/24h; and severe was defined as more than 5 absorbers/24h. Healing was defined as the total absence of using pads; improvement was defined as a reduction>50% in the number of pads; and failure was defined as a reduction<50, no improvement or worsened incontinence. Check-ups were conducted at 3, 12 and 36 months after the surgery. We employed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for the quality of life index. The complications are listed according to the Clavien-Dindo classification. ResultsThe degree of preoperative incontinence was mild in 23.9%, moderate in 67.4% and severe in 8.7% of the patients. The mean use of preoperative pads was 3.1 (range 1-6, 95% CI). The mean preoperative ICIQ-SF score was 16.5 (15-20). Sphincter coaptation≥1.5cm using the perineal repositioning test was present in 87 patients (94.6%). The mean follow-up from insertion of the sling was 42.1 months. Some 89.1% of the patients were healed at 3 months, 70.7% were healed at 12 months, and 70.4% were healed at 36 months. The ICIQ-SF score at 3, 12 and 36 months showed significant improvement (P<.001) compared with the preoperative score. ConclusionsThe Advance® and AdvanceXP® system are effective over time in terms of urinary continence and patient satisfaction.

Review of traditional Chinese medicine in treatment of stress urinary incontinence

Stress Urinary Incontinence (SUI) has a higher incidence in middle-aged and elderly women. At present, for mild and moderate SUI patients, the treatment of kegel practice or combined with TCM ,and acupuncture, acupoint application or pelvic floor muscle exercise show benefit effect. This article summarized the etiology and pathogenesis of SUI, TCM therapy, integrated traditional Chinese and Western Medicine, in recent years, in order to provide reference for the treatment of the disease and the further study. Key words: Urinary incontinence, stress; Traditional Chinese medicine therapy; Review

The TiLOOP® Male Sling: Did We Forejudge

Introduction: To evaluate the safety and efficacy of the TiLOOP® male sling (pfm medical, Cologne, Germany) used in the treatment for male stress urinary incontinence (SUI). Material and Methods: We retrospectively evaluated a total of 34 patients with a TiLOOP® male sling. Perioperative complication rates were assessed and validated questionnaires were prospectively evaluated to assess quality of life and satisfaction rate. Outcome and complication rates were analysed by using descriptive statistics. Correlation of continence outcome and risk factors was performed with the chi-square test. A p value below 0.05 was considered statistically significant. Results: The majority of patients (70.6%) were diagnosed with mild or moderate male SUI. During surgery, one instance (2.9%) of intraoperative urethral injury was observed. There were no immediate postoperative complications. The mean follow-up time was 44.6 months. An improvement of male SUI was reported by 61.9% of the patients and 38.1% reported no change according the Patient Global Impression of Improvement. The mean perineal pain score was 0.5 according to the international index of pain. Conclusions: The TiLOOP® is a safe treatment option for male SUI in our cohort with a low complication rate. However, the functional outcome of the TiLOOP® was inferior when compared to the outcome of the AdVance® male sling.

Improving Male Sling Selectivity and Outcomes—A Potential Role for Physical Demonstration of Stress Urinary Incontinence Severity?

IntroductionWe reviewed our 9-year experience with AdVance™ Male Sling System cases to determine clinical features associated with treatment success and to refine procedure selectivity. We hypothesized that preoperative physical demonstration of stress urinary incontinence by the standing cough test improves patient selection for male sling surgery. MethodsRetrospective review of primary AdVance sling surgeries between 2008 and 2016 was performed. Patients without standing cough test results were excluded from study. Success was defined as 1 pad per day or less postoperatively and no further intervention. Standing cough test was performed during preoperative consultation and objectively graded using the MSIGS (Male Stress Incontinence Grading Scale). ResultsOf the 203 male patients who underwent sling placement 80 (39%) experienced treatment failure during a median followup of 63.5 months. From 2008 to 2016 the proportion of AdVance slings performed as a surgical treatment modality for stress urinary incontinence decreased from 66% to 13%. Increasing selectivity correlated with greater treatment success. Success was greater among men using 2 pads per day or less preoperatively (77% vs 36%, p <0.0001), having physical findings of mild stress urinary incontinence (MSIGS grade 0-2 on standing cough test, 67% vs 26%, p <0.0001) and without a history of radiation (64% vs 41%, p=0.02). In combination, men without prior radiation with mild stress urinary incontinence and favorable standing cough test were “ideal patients” with an 81% success rate. Incremental increases in pad per day use (OR 1.8 per pad, p <0.0001) and MSIGS grade (OR 1.7 per grade, p=0.005) were independently associated with treatment failure. ConclusionsIncreasing selectivity has improved sling outcomes for men with stress urinary incontinence. Ideal sling candidates have not received radiation therapy, and have history and physical findings suggestive of mild stress urinary incontinence.

Predictors of sexual function in women with stress urinary incontinence

To assess female sexual function (SF) in different grades of urodynamic stress urinary incontinence (SUI), with/without pelvic organ prolapse (POP); to investigate associations between clinical data and pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ) scores. A cross-sectional study was conducted in sexually active women (130 with SUI and 126 controls). Stamey score and POP quantification (POP-Q) were used. Urogynecological examinations were performed; all participants completed PISQ. Multivariable linear regression was used to identify negative SF predictors. SF was lower in the study group (P < 0.001), in moderate (P < 0.001), and severe SUI (P < 0.02) versus controls, in each particular domain and total PISQ-score (total score: 83.8 ± 14.8, 80.8 ± 14.5, 84.5 ± 11.1 vs 95.7 ± 10.3, respectively). Women with mild SUI had better SF in physical and partner-related domains compared to moderate SUI (33.6 ± 6.1 vs 30.7 ± 6.4, P < 0.02; 18.8 ± 2.9 vs 17.3 ± 3.3, P = 0.02, respectively). Age correlated with PISQ-scores in behavioral/emotive (r = -0.24, P = 0.006), and partner-related domains (r = -0.28, P = 0.002), and total PISQ-score (r = -0.2, P = 0.02); menopausal status with partner-related domain (r = -0.32, P = 0.000) and total PISQ-score (r = -0.19, P = 0.029); menopause duration with physical domain (r = 0.17, P = 0.045); SUI stage only with PISQ scores in physical domain (r = -0.22, P = 0.014). No correlations were found between BMI, parity, number of vaginal deliveries, POP-Q stages, with PISQ results. Age in the SUI group and controls (β = -0.18, P < 0.05) and BMI in controls (β = -0.26, P < 0.01) were independent predictors of impaired SF. Different SF predictors were found in SUI women and controls. Impaired SF was confirmed in SUI women compared to controls, with more severe SUI corresponding to lower SF.

Long-term effect of thermoablative fractional CO2 laser treatment as a novel approach to urinary incontinence management in women with genitourinary syndrome of menopause

Introduction and hypothesisThe aim of this study was to evaluate the long-term effect of thermoablative fractional CO2 laser (TACO2L) as an alternative treatment for early stages of stress urinary incontinence (SUI) in postmenopausal women with genitourinary syndrome of menopause.MethodsA total of 161 postmenopausal patients (age 53.38 ± 5.1 years, range 45–65 years) with a clinical diagnosis of mild SUI were prospectively enrolled in the study. Patients received one treatment with TACO2L every 30–45 days, each treatment comprising four sessions, followed in all patients by a yearly treatment session at 12, 24 and 36 months. SUI was evaluated using the International Continence Society 1-h pad test and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before and after TACO2L treatment.ResultsTACO2L treatment was associated with a significant improvement in ICIQ-UI SF scores and 1-h pad weight test at 12 months (both p < 0.001), 24 months (both p < 0.001) and 36 months (both p < 0.001). Improvements were maintained for up to 36 months without the need for any further intervention. The results were confirmed by significant histological changes related to trophic restoration of the vagina, responsible for extrinsic and intrinsic mechanisms involved in urinary continence.ConclusionsOur results suggest that TACO2L is an efficient and safe novel treatment strategy in patients with mild SUI. Further investigation to confirm the long-term results presented here is still warranted.

Salvage Robotic-assisted Laparoscopic Radical Prostatectomy: Experience with 14 Cases.

To report the outcomes of salvage robot-assisted radical prostatectomy (S-RaRP). Fourteen patients underwent S-RaRP. The mean initial prostatic-specific antigen level was 14.3 ng/ml and mean Gleason score was 6.93. Initial definitive treatment was external irradiation in 11 cases, cyberknife in two, and high-intensity focused ultrasound in one. Time from definitive treatment to S-RaRP was a mean of 36.5 months. The mean console time was 134.9 min and blood loss was 99.6 ml. Stage pT2N0, T3N0, and T3N1 were found in eight, four, and two cases, respectively. A positive surgical margin was found in 21.4% (3/14) of the patients. The continence rate was 71.4% (10/14). Mild stress urinary incontinence (one or two pads/day) was noted in 28.6% (4/14) of patients. Biochemical recurrence-free status was noted in 11 (78.5%) patients with a mean follow-up of 32.4 months. S-RaRP is feasible with a low complication rate, good continence rate, and an acceptable potency rate. The short-term oncological outcomes are encouraging.

Treatment of Stress Urinary Incontinence in Neurological Patients With an Injectable Elastomer Prosthesis: Preliminary Results

Many treatment options for stress urinary incontinence are difficult to apply to neurological patients. Urolastic is a new agent that is primarily indicated for women with mild stress urinary incontinence or men after prostate surgery. In this report, we present a series of 5 cases describing the first use of Urolastic to treat neurological patients. All patients were evaluated with a voiding diary and the use of auxiliary devices as the main indicators of continence. The median operative time was 30.8 minutes, and no complications were observed. Of the 5 patients, 4 reported improved incontinence: 2 switched from diapers to small pads, while the other 2 patients were able to discontinue urinary condom use. The only instance of treatment failure occurred in a patient with a low-compliance bladder. The advantages of this procedure appear to include a soft-cuff effect, reversibility, and minimal invasiveness. However, a future randomized study would be necessary to validate this treatment option.

Sexuality and erectile function after implantation of an Adjustable Transobturator Male System (ATOMS) for urinary stress incontinence. A multi-institutional prospective study.

To investigate erectile function and sexuality before/after implantation of the ATOMS device including continence outcome, pain perception and co-morbidities. We collected data from 34 patients (2010-2014) who were provided with an ATOMS implant due to mild or moderate stress urinary incontinence (SUI) after radical prostatectomy (RPE), transurethral resection (TURP) or radiotherapy. Previous failed implants were no contraindication. Sexuality was evaluated with the International Index of Erectile Function (IIEF-5). The Visual Analog Scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used to analyse pain perception. Results regarding continence, influence of co-morbidities and drug intake were interpreted. IIEF-5 score increased 6 months after ATOMS implantation with a mean difference of 2.18 (Cl: 1.22, 3.14), p &lt; 0,001). Non-sexually active patients had the greatest benefit. However, 50% of patients achieved a mean IIEF-5 of 10.1 and 38% of patients reported a new onset of sexual activity at follow up (mean IIEF-5 score of 12.9). This is in accordance with reduced SUI and absence of persistent pain syndrome. Overall success rate regarding 24h pad-use was 88% (no pad rate 38%). Previous failed implants did not influence results but diabetes, obesity and drug intake (beta-blockers, antidepressants) led to poorer outcomes. Sexuality and erectile function improves significantly 6 months after ATOMS implantation. We postulate that reduced SUI (also during sexual activity) and absence of chronic pain are the improving factors. ATOMS should be offered to men with mild to moderate SUI who are interested in regaining their erectile function and sexual activity.

Reconstruction of Female Urethra with Tubularized Anterior Vaginal Flap.

Female urethral injury is a rare disease. Causes of urethral injuries are prolonged obstructed labour, gynaecological surgeries like vaginoplasty and post traumatic urethral injuries. The present study was conducted to evaluate outcome of female urethral reconstruction using tubularized anterior vaginal wall flap covered with fibroadipose martius flap and autologous fascia sling in patients with urethral loss. Aim of study was to evaluate outcome of reconstruction of female urethra with tubularized anterior vaginal flap. Retrospective analysis of all the patients with complete urethral loss was done from August 2008 to July 2015. Total seven patients were included in study. All patients presenting with total urethral loss were included. These patients were treated with tubularized anterior vaginal flap. Neourethra was covered with Martius labial flap and autologous fascia lata or rectus abdominis fascia sling. Most common cause of urethral loss was obstructed labour (57.1%). Postoperatively patients were assessed for continence, urine flow rate, ultrasound for upper urinary tract and post void residue. Mean operative time was 180 minutes (160-200 minutes) and Intraoperative blood loss was 220ml (170-260 ml). Mean postoperative hospital stay was eight days (seven to nine days) Mean post surgery maximum urine flow rate was more than 15ml/sec (6.7-18.2ml/sec) and mean post void residual urine was 22.5ml (10-50ml). Median follow-up time was 35 months. All patients were catheter free and continent post three weeks of surgery except one patient who developed mild stress urinary incontinence. One patient developed urethral stenosis which was managed by intermittent serial urethral dilatation. Female neourethral reconstruction with tabularized anterior vaginal flap and autologous pubovaginal sling is feasible in patients of total urethral loss with success rate of approximately 86%. It should be considered in patients of complete urethral loss with adequate healthy vaginal tissue.

Severe complications and failures of incontinence surgery using the Remeex® adjustable tension sling (external mechanical regulator)

ObjectivesSince 1999, we have performed implantations of Remeex® adjustable prosthetics as rescue treatment for complex or persistent stress urinary incontinence (SUI) after failure of other surgical treatments (Burch colposuspension, Marshall-Marchetti-Krantz (MMK) or tension-free transvaginal tape [TVT] until 2003 and transobturator tape [TOT] since 2003). We present the results of our series, which include cases with severe complications. Material and methodRetrospective study of women diagnosed with complex or refractory SUI who underwent Remeex® implantation between October 1999 and December 2013. In 5 cases, we conducted cystocele correction in the same operation as the placement of the Remeex®. ResultsSixty women, with a mean age of 66.87 years (range 39–85), underwent operations. The procedure was successful in 68.33% of the cases. The failures consisted of the following: 10% of the women had mixed urinary incontinence (UI) with multiple bladder diverticula; 8.33% had mild SUI; and 13.33% had urgency urination without UI. Thirty-five percent required adjustments. We recorded 3 cases with severe complications: disabling severe UI in a patient who underwent multiple operations, massive pelvic hemorrhage in a patient undergoing standard antiplatelet therapy and infected vaginal calculi measuring 7cm on an extruding Remeex thread in a paraplegic patient 4 years after the implantation. ConclusionsRemeex® is an effective and safe procedure for achieving continence in cases of complex or refractory SUI, although it is not exempt from severe complications. Following rigorous protocols can help detect complications and treat them in a timely manner.

Complicaciones graves y fracasos de la cirugía de incontinencia mediante cabestrillo de tensión regulable Remeex® (regulador mecánico externo)

ObjectivesSince 1999, we have performed implantations of Remeex® adjustable prosthetics as rescue treatment for complex or persistent stress urinary incontinence (SUI) after failure of other surgical treatments (Burch colposuspension, Marshall-Marchetti-Krantz (MMK) or tension-free transvaginal tape [TVT] until 2003 and transobturator tape [TOT] since 2003). We present the results of our series, which include cases with severe complications. Material and methodRetrospective study of women diagnosed with complex or refractory SUI who underwent Remeex® implantation between October 1999 and December 2013. In 5 cases, we conducted cystocele correction in the same operation as the placement of the Remeex®. ResultsSixty women, with a mean age of 66.87 years (range 39-85), underwent operations. The procedure was successful in 68.33% of the cases. The failures consisted of the following: 10% of the women had mixed urinary incontinence (UI) with multiple bladder diverticula; 8.33% had mild SUI; and 13.33% had urgency urination without UI. Thirty-five percent required adjustments. We recorded 3 cases with severe complications: disabling severe UI in a patient who underwent multiple operations, massive pelvic hemorrhage in a patient undergoing standard antiplatelet therapy and infected vaginal calculi measuring 7cm on an extruding Remeex thread in a paraplegic patient 4 years after the implantation. ConclusionsRemeex® is an effective and safe procedure for achieving continence in cases of complex or refractory SUI, although it is not exempt from severe complications. Following rigorous protocols can help detect complications and treat them in a timely manner.

V2-06 SKENE'S GLAND CYST EXCISION

You have accessJournal of UrologyFemale Voiding Dysfunction1 Apr 2015V2-06 SKENE'S GLAND CYST EXCISION Philippe Zimmern and Gary Lemack Philippe ZimmernPhilippe Zimmern More articles by this author and Gary LemackGary Lemack More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.331AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To review our experience with the long-term outcome after Skene's gland cyst excision METHODS A surgical database of all procedures performed by two surgeons at one institution was reviewed for Skene's gland cyst excision. Data extracted from an electronic medical record or medical charts were presenting symptoms, pre-operative evaluation, site of excision, peri-operative complications, and clinical outcomes. Technique of surgical excision is presented in the attached movie, and includes cystoscopy, dissection of cyst wall from the floor of the urethra with scissors or bovie on low setting, distal urethroplasty as indicated, complete removal of the cyst wall, and primary vaginal wall closure. Urethral Foley catheter is left indwelling for 3–5 days afterwards and sexual function is resumed after completion of vaginal healing. RESULTS From 2001 to 2013, ten women were studied. Mean age was 45 (range: 29 to 66). Presenting symptoms were: dyspareunia (4), urinary tract infections (4), vaginal mass (1) and voiding dysfunction (1), with half of women having more than one presenting symptoms. Evaluation included an MRI in all women, and a voiding cystourethrogram in 5 to exclude a urethral diverticulum. Skene's gland cyst was observed on the left (5) or right (5) sides, with no cases being bilateral. No peri-operative complications were reported. All procedures were done on an outpatient basis. A distal meatoplasty was done in 2 women, and a urethral dilation in another 2. Mean follow-up was 3.5 years (range 3 to 96 months). One woman died of unrelated cause (stroke). Four women had mild stress urinary incontinence in follow-up years, one requiring pelvic floor therapy, the others simple observation. Two have been treated for occasional urinary tract infections. One underwent a distal urethroplasty 6 years later after a failed urethral dilation. Eight of ten women who were sexually active remained sexually active post-operatively. CONCLUSIONS Excision of Skene's gland cyst is a safe procedure with acceptable long-term functional outcomes. Excision of a Skene's gland cyst is: a. A frequent vaginal procedure due to the large incidence of this condition b. A bloody procedure possibly requiring blood transfusion c. A delicate operation that can lead to distal urethral wall damage and possible meatoplasty (∗) d. Similar to a urethral diverticulum removal and requiring closure of the urethral ostium e. Likely to recur even after complete excision of the gland linings © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e99 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philippe Zimmern More articles by this author Gary Lemack More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Descriptive cross sectional study on prevalence, perceptions, predisposing factors and health seeking behaviour of women with stress urinary incontinence.

BackgroundStress urinary incontinence (SUI) leads to considerable physical and psychological morbidity. The highest prevalence reported was found in Caucasian Americans (range 23% -67%) and the lowest in Singaporean females (4.8%). The study assessed the prevalence, perceptions, predisposing factors and health seeking behaviour of women with SUI in an Asian setting which may have different sociocultural implications.Methods400 consecutive women >20 years of age attending the outpatient department of a tertiary care hospital in Sri Lanka, for non-urinary conditions were studied over a 3 week period using an interviewer administered questionnaire. SUI was diagnosed on clinical history alone when leakage of urine occurred either with coughing, sneezing, walking or lifting heavy objects. The severity was graded using the Finnish Gynaecological Society’s Urinary Incontinence Severity Score (UISS). Data were analysed using SPSS version 20. Odds ratios were calculated using univariate and multivariate analysis.ResultsNinety three (23.33%) had SUI and only 12 (12.9%) had sought treatment. The prevalence among women >50 years of age was 34.71% ( n = 121) compared to 18.28% (n = 279) in those ≤50 years. 25 (26.88%) had mild SUI, 66 (70.97%) moderate and 2 (2.15%) severe as per UISS. SUI was perceived as an illness by 210 (52.5%). SUI was significantly associated with pregnancy, parity, vaginal delivery, complicated labour, diabetes mellitus, chronic cough, constipation and faecal incontinence (p < 0.05).Among those affected main reasons for not seeking medical advice included; being embarrassed (n = 27, 33.33%), not knowing that it is remediable (n = 23, 28.40%), perceiving SUI to be a normal consequence of childbirth (n = 19, 23.46%) and having to attend to needs of the family (n = 12, 14.81%). None who had been pregnant (n = 313) had received advice on postnatal pelvic floor exercises. SUI interfered with social activities (71;76.34%), sexual function (21; 22.58%) and resulted in despair (67; 72.09%). It was associated with clinically diagnosed candidiasis (50; 53.76%) and soreness in the perineal region (49; 52.69%).ConclusionsSUI is a common and neglected gynaecological problem with poor healthcare seeking behaviour. Community based education may help to minimize the occurrence and improve the quality of life of those affected.

Reply

Although the degree of stress urinary incontinence (SUI) can range from mild to severe, men with mild post prostatectomy incontinence (PPI) are the largest group seeking treatment in most urologic practices. The retroluminal sling has enjoyed popularity as a well-established sling for the treatment of mild SUI, and it is therefore offered to most men with lower amounts of urinary leakage. Similarly, the artificial urinary sphincter is generally recognized as the most predictably successful treatment for men with SUI who have received adjuvant external beam radiotherapy and is therefore commonly offered to such men.

Therapieoptionen der rezidivierenden oder persistierenden Belastungsharninkontinenz

After synthetic sling procedures, up to 16 % of women and 45.5 % of men complain about a persistent or recurrent stress urinary incontinence (SUI). Currently, randomized studies comparing the different treatment modalities of persistent or recurrent SUI are lacking. There are data of retrospective studies investigating the efficiency of synthetic slings and the artificial urinary sphincter AMS 800® in men. Synthetic slings can be applied in patients with mild SUI and without prior radiation of the pelvic region. The AMS 800® is the treatment of choice in patients with severe SUI or previous radiation.In women with persistent and recurrent SUI, the efficiency of colposuspensions, autologous and synthetic slings as well as the AMS 800® has been investigated in retrospective studies. Due to comparable cure rates and a faster postoperative recovery, synthetic slings are now superseding colposuspensions and autologous slings. Excellent success rates after AMS 800® implantation have been described for both genders; nonetheless, postoperative complications and revisions as well as the requirement of dexterity of the patients should be taken into account. Data about the efficiency of adjustable slings, the ACT® and newer artificial urinary sphincter devices like Flow-Secure® and Zephyr® ZSI 375 in the treatment of persistent and recurrent SUI is lacking.

Study on concomitant surgical correction of pelvic organ prolapse and TVT-O for treatment of stress urinary incontinence

To investigate the necessity, safety and efficacy of transobturator tension-free vaginal tape (TVT-O) for treatment of stress urinary incontinence (SUI) during transvaginal corrective operation of pelvic organ prolapse (POP). From Jan. 2005 to Dec. 2010, 92 patients undergoing transvaginal pelvic reconstruction surgery for correction of POP concomitant TVT-O for treatment of SUI in Department of Obstetrics and Gynecology affiliated to Beijing Chaoyang Hospital as concomitant surgery group were enrolled in this retrospective study matched with 90 patients with mild SUI without SUI surgery as non-concomitant surgery group and 120 patients without SUI as control group.Variable clinical index, clinical efficacy and complications were compared among those three groups. Compared with those in the other two groups, the mean age [(62 ± 11) years] was lower (P = 0.007,0.038), the operation time only slightly increased (12.8 min and 12.9 min respectively) significantly in concomitant TVT-O group. The bleeding loss and the length of staying hospital after operation all exhibited no significant differences within three groups (P > 0.05). The effective rate for SUI was 96.7% (89/92) in concomitant TVT-O group, corrective operation of POP was ineffective for 74.4% (67/90) SUI, 9.2% (11/120) patients presented new SUI in the patients without SUI preoperatively. TVT-O is a simple, safe and effective method in the treatment of SUI, which is more suitable for performing simultaneously during the corrective operation of POP.Efficacy of SUI correction was limited in those patients undergoing only pelvic reconstructive surgery. However, a preventive anti-incontinence procedure is not recommended because of the lower incidence in POP patients without SUI preoperatively.

Coadministration of low-dose serotonin/noradrenaline reuptake inhibitor (SNRI) duloxetine with α 2-adrenoceptor blockers to treat both female and male mild-to-moderate stress urinary incontinence (SUI)

Female urinary incontinence is a relatively common disorder affecting women in different age groups, with significant prevalence amounts of stress-related subtype (stress urinary incontinence, SUI). Various neurotransmitters/neuromodulators - particularly both the glutamatergic and GABA-ergic ones - are involved in micturition/urinary continence nerve centre-based control, where Onuf's nucleus plays an important functional role under the adiuvant serotoninergic/ noradrenergic influences. To outline, deriving them from the literature review, the SUI therapeutic implications of SNRI (serotonin-noradrenaline reuptake inhibitors) particularly of the duloxetine, though displaying its full therapeutic dose (40 mg twice/day)-related side effects and, therefore, highlighting recent issues concerning novel drug administration modalities to avoid such adverse events. EMERGING KNOWLEDGES: Intriguing studies in SUI animal models have shown that co-administration of duloxetine low dose with α 2-adrenoceptor antagonists - given the α 2-adrenoceptor inhibition-induced enhancement of duloxetine effectiveness on the urethral rhabdospincter-can avoid the duloxetine-related adverse events though perspectively reaching, in perspective translational clinical applications, the awaited beneficial effects for women suffering from intrinsic rhabdosphincter deficiency-based mild-to-moderate SUI as well as, in men, to treat post-prostatectomy mild SUI.

Adjustable male sling: our experiences with placement of adjustable male sling, including a case of exstrophy-epispadias: initial report.

To present our experience of using an adjustable male sling, Argus® (Promedone SA; Cordoba, Argentina), in patients with stress urinary incontinence (SUI), and report its success, extension of indications, and management of complications. We retrospectively evaluated Argus implantation results in 17 patients, including 15 post prostatectomy incontinence, one exstrophy-epispadias, and one neurogenic bladder patient. Of 17 patients, 12 had severe (more than 5 pads daily) and 5 had moderate SUI (2 to 5 pads daily). Seven patients had history of previous surgeries. Patients were evaluated pre-operatively with urodynamic study and cystoscopy. After median follow-up of 11.8 months (range, 3 to 22 months), 9 patients were continent, 7 had mild SUI (1 pad daily), and one had the device removed due to perineal and bladder symptoms. Argus adjustment was done in 10 out of 17 patients; 8 tightening and 2 loosening. In a totally incontinent exstrophy-epispadias patient with a history of multiple bladder surgeries, continence was achieved after device readjustment. In a patient with neurogenic bladder with a history of cystoplasty, severe SUI changed into a moderate sporadic SUI. In 2 patients, prosthesis infection occurred, which was managed with antibiotics without the need for Argus explantation. Argus is a simple and good device to control incontinence in men. It may also be used in exstrophy-epispadias patient who is not a candidate for urinary sphincter implantation. Infection complication may be managed conservatively. To the best of our knowledge, this is the first report of successful Argus implantation in exstrophy-epispadias patient.

Efficacy of a new pelvic muscle exercise for the treatment of female stress urinary incontinence

Objective To evaluate the efficacy of a new pelvic muscle gymnastic exercise in the treatment of stress urinary incontinence (SUI).Methods Prospectively,we randomly recruited 60 cases with mild and moderate SUI.We use ICI-Q-SF,pad Test and urodynamics to assess the degree of incontinence,volume of leakage,maximum urethral pressure and functional urethral length before and after intervention.Results The ICI-Q-SF score,volume of leakage,maximum urethral closure pressure and functional urethral length in study group before treatment were 11.6 ±4.2,(5.9 ±2.2) ml,(39.4 ± 12.5) cm H2O and (2.5 ±1.2) cm.The indicators in control group were 10.3 ±2.2,(5.8 ±1.3) ml,(41.3 ±8.9) cm H2O and (2.1 ± 0.5) cm respectively.There was no significant difference between the 2 groups (P ＞ 0.05).The ICI-Q-SF score,volune of leakage and maximum urethral closure pressure in study group after treatment were 7.7 ± 2.7,(1.8 ± 1.2) ml and (65.9 ± 8.9) cm H2O,which were significantly improved than the values of10.1 ±2.1,(5.7 ± 1.1) ml and (44.6 ±9.5) cm H2O in control group (P ＜0.05).Conclusions The new pelvic muscle exercise may play an important role in the treatment of mild and moderate SUI.Therefore,it could be recommended to the patients with mild and moderate SUI. Key words: Urinary incontinience, stress; Pelvic muscle exercise