Moderate Incontinence Research Articles

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Stress urinary incontinence (SUI) following radical prostatectomy, transurethral resection of the prostate, and posterior urethroplasty (PU) continues to be a distressing problem with severe impact on quality of life. Although artificial urinary sphincter (AUS) implantation remains the gold standard for incontinence after prostatectomy, morbidity and complications are considerable. 1 Xu YM Zhang XR Sa YL Chen R Fei XF. Bulbourethral composite suspension for treatment of male-acquired urinary incontinence. Eur Urol. 2007; 51 (discussion 1715-6): 1709-1714 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar The male slings (eg AdVance), on the contrary, seem to be less expensive, and complications and morbidity rates are lower. However, an artificial sling is not ideal for patients with previous radiation therapy and urethral surgery. 2 Sturm RM Guralnick ML Stone AR Bales GT Dangle PP O'Connor RC. Comparison of clinical outcomes between “ideal” and “nonideal” transobturator male sling patients for treatment of postprostatectomy incontinence. Urology. 2014; 83: 1186-1188 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar , 3 Cornu JN Sèbe P Ciofu C Peyrat L Cussenot O Haab F. Mid-term evaluation of the transobturator male sling for post-prostatectomy incontinence: focus on prognostic factors. BJU Int. 2011; 108: 236-240 Crossref PubMed Scopus (142) Google Scholar The good and sustainable results of patients with mild or moderate incontinence after PU in our study suggest that adynamic graciloplasty might be a reasonable option for particular patients who are not appropriate for AUS and male slings.

Adynamic Graciloplasty With a Pedicled Gracilis Muscle Flap Wrapped Around Bulbar Urethra for Treatment of Male Acquired Urinary Incontinence

To evaluate the efficacy of adynamic gracilis urethral myoplasty with a pedicled gracilis muscle flap wrapped around bulbar urethra for treatment of male acquired urinary incontinence. Twenty-four patients with acquired urinary incontinence (8 after radical prostatectomy, 7 after transurethral resection of the prostate, and 9 after posterior urethroplasty) were included in our study. Eighteen of these patients (75.0%) had mild to moderate urinary incontinence, and 6 (25.0%) had severe urinary incontinence. All patients received adynamic gracilis urethral myoplasty with a pedicled gracilis muscle flap wrapped around bulbar urethra and had a close follow-up. The mean postoperative maximum urethral pressure after the gracilis muscle wrapped around bulbar urethra was significantly higher than that of the preoperative measurements (P <.05). After a mean follow-up of 31.5 months (6-64 months), 18 patients were cured, 4 patients improved, and 2 patients were considered failures. The total cure rate was 75.0% (18 of 24). Five out of 6 patients with severe incontinence did not have a great success. A pedicled gracilis muscle flap wrapped around bulbar urethra can raise the urethral pressure. Adynamic graciloplasty with a pedicled gracilis muscle flap wrapped around bulbar urethra is a safe and effective surgical option in the treatment of male patients with mild to moderate incontinence, but is not suitable for severe incontinence.

Pelvic Muscle Exercises Using a Home Trainer for Pelvic Muscle Dysfunction: A Case Report

Pelvic muscle exercises can help improve symptoms of pelvic floor muscle dysfunction. This article describes the case of a 66-year-old woman with moderate pelvic organ prolapse (POP) and mild urinary incontinence (UI) who initiated pelvic muscle exercises with the assistance of a novel, at-home trainer equipped with a vaginal sensor and accompanying smartphone app software, the PeriCoach system (Analytica, 2015). After 8 weeks of training with the device, she showed improvements in strength, endurance, and disability, as measured by manual muscle test, electromyography, and Pelvic Floor Disability Index scores. Older women can use biofeedback technology to improve pelvic floor muscle function successfully at home.

Bridging the gap: determinants of undiagnosed or untreated urinary incontinence in women

More than a third of middle-aged or older women suffer from urinary incontinence, but less than half undergo evaluation or treatment for this burdensome condition. With national organizations now including an assessment of incontinence as a quality performance measure, providers and health care organizations have a growing incentive to identify and engage these women who are undiagnosed and untreated. We sought to identify clinical and sociodemographic determinants of patient-provider discussion and treatment of incontinence among ethnically diverse, community-dwelling women. We conducted an observational cohort study from 2003 through 2012 of 969 women aged 40 years and older enrolled in a Northern California integrated health care delivery system who reported at least weekly incontinence. Clinical severity, type, treatment, and discussion of incontinence were assessed by structured questionnaires. Multivariable regression evaluated predictors of discussion and treatment. Mean age of the 969 participants was 59.9 (±9.7) years, and 55% were racial/ethnic minorities (171 black, 233 Latina, 133 Asian or Native American). Fifty-five percent reported discussing their incontinence with a health care provider, 36% within 1 year of symptom onset, and with only 3% indicating that their provider initiated the discussion. More than half (52%) reported being at least moderately bothered by their incontinence. Of these women, 324 (65%) discussed their incontinence with a clinician, with 200 (40%) doing so within 1 year of symptom onset. In a multivariable analysis, women were less likely to have discussed their incontinence if they had a household income < $30,000/y vs ≥ $120,000/y (adjusted odds ratio [AOR], 0.49, 95% confidence interval [CI], 0.28-0.86) or were diabetic (AOR, 0.71, 95% CI, 0.51-0.99). They were more likely to have discussed incontinence if they had clinically severe incontinence (AOR, 3.09, 95% CI, 1.89-5.07), depression (AOR, 1.71, 95% CI, 1.20-2.44), pelvic organ prolapse (AOR, 1.98, 95% CI, 1.13-3.46), or arthritis (AOR, 1.44, 95% CI, 1.06-1.95). Among the subset of women reporting at least moderate subjective bother from incontinence, black race (AOR, 0.45, 95% CI, 0.25-0.81, vs white race) and income < $30,000/y (AOR, 0.37, 95% CI, 0.17-0.81, vs ≥ $120,000/y) were associated with a reduced likelihood of discussing incontinence. Those with clinically severe incontinence (AOR, 2.93, 95% CI, 1.53-5.61, vs low to moderate incontinence by the Sandvik scale) were more likely to discuss it with a clinician. Even in an integrated health care system, lower income was associated with decreased rates of patient-provider discussion of incontinence among women with at least weekly incontinence. Despite being at increased risk of incontinence, diabetic women were also less likely to have discussed incontinence or received care. Findings provide support for systematic screening of women to overcome barriers to evaluation and treatment.

Long-term results of the cutting seton for high anal fistula.

No single procedure for high anal fistula delivers a high cure rate while also completely protecting sphincter function. This paper reports our long-term results with the cutting seton for high fistulae and draws comparisons with advancement flap and ligation of intersphincteric fistula track (LIFT) procedures. A retrospective study of prospectively collected data in consecutive patients undergoing treatment with cutting seton for high cryptoglandular fistulae was carried out. A strict protocol dictated tightening intervals of at least 4 weeks and no muscle division. In 59 patients (male : female = 39:20) followed-up at mean 9.4 years (range 1.7-15.6 years) healing rates, continence (St Mark's score 0-24), patient-perceived overall change in bowel control (-5 to +5), faecal incontinence quality of life (FIQL) and overall patient satisfaction (visual analogue score 0-10) were assessed. Primary and secondary healing rates were 93% and 98%. Mean continence score was 4.1, significantly worse in women than men (median 6, range 0-22 versus median 1, range 0-17; P = 0.006). Seventy-eight per cent of patients had normal continence or minor incontinence (score 0-6), 13.5% moderate incontinence (score 7-12) and 8.5% severe incontinence (score >12). Sixty-three per cent of patients had no change or improved patient-perceived overall bowel control. Mean FIQL scores were high and significantly correlated with continence. Median satisfaction score was 9. Cutting seton for high anal fistula achieved healing in 98% with good continence in the majority, particularly in males, and a high level of patient satisfaction. Multicentre prospective studies are needed to adequately compare cutting seton, flap and LIFT procedures.

Screening occult anal sphincter injuries in primigravid women after vaginal delivery with transperineal use of vaginal probe: a prospective, randomized controlled trial.

Here we aimed to evaluate the incidence of obstetric anal sphincter injuries in spontaneous primigravid deliveries with mediolateral episiotomy beyond 36 gestational weeks. We performed a prospective, randomized controlled study including 201 primigravid women that delivered vaginally. Anal sphincter anatomy and integrity was evaluated before hospital discharge in all cases with transvaginal sonography (5-9MHz) (Siemens Sonoline G50 and Voluson 730 Expert). The vaginal ultrasound probe is placed in the fourchette of the vaginal introitus to obtain the transverse section of the anal sphincter. In the cases with sphincter defect, mean gestational week and second stage of labor were prolonged significantly (p=0.039 and p<0.0001, respectively). The mean perineal body distance in cases with sphincter injury, as detected by sonography, 2.18±0.33cm, is compared to 2.31±2.43cm in cases without injury. There was a significant difference between the two groups (p=0.0142). Shoulder dystocia was significantly higher in cases with sphincter injury, compared to cases without injury (p=0.011). No clinical findings were reported in 11.5% of cases (Sonography findings 1A∓, 1B∓) and 3.5% of cases had clinical and sonographic findings (Sonography findings 2A∓, 2B∓). "Occult tears" were considered as those cases not detected clinically, but detected by sonography (11.5% of all cases). Two months after examination, a moderate incontinence (Wexner continence scale) was found in 71.5% of cases with overt sphincter tear, which was significantly different to the non-overt sphincter tear group. Multiple logistic regression analyses for sphincter injuries identified prolonged second stage of labor and shoulder dystocia as two independent risk factors. Here, we found that only a portion of anal sphincter injuries can be detected after physical examination, with many of cases of "occult tears" escaping notice. These cases of occult anal sphincter injury are detectable by sonography with transperineal use of a vaginal probe. Based on these findings, we propose that this technique is convenient for obstetric, gynecologic and proctologic evaluation of sphincter anatomy.

Stemming the tide of mild to moderate post-prostatectomy incontinence: A retrospective comparison of transobturator male slings and the artificial urinary sphincter.

The AUS remains the gold standard treatment for post-prostatectomy incontinence (PPI), although most patients with mild-moderate PPI prefer a sling without strong evidence of procedural equivalence. This study compares outcomes of 2 procedures for the treatment of mild-moderate PPI. A retrospective review of 124 patients (76 transobturator sling, 48 AUS) with mild-moderate PPI requiring intervention over an 8-year period. The primary outcome was continence. Secondary outcomes included global patient satisfaction, improvement, and complication rates. Mild to moderate incontinence was defined as requiring ≤5 pads/day. There was no significant difference in age (66.2 vs. 68.1 years; p = 0.17) or prostate cancer characteristics for slings and AUS, respectively. AUS patients had higher Charlson comorbidity scores and were more likely to have previous radiotherapy. Median length of follow up was 24 months for slings and 42 months for AUS. There was no difference in continence rates, 88.2% vs. 87.5% (p = 0.79), rate of improvement, 94.7% vs. 95.8% (p = 1.00), or patient satisfaction, 93.4% vs. 91.7% (p = 0.73), for slings and AUS, respectively. Complication rates were equivalent (19.7% vs. 16.7%; p = 1.00), though a significantly higher proportion of complications with AUS were Clavien Grade 3 (0% vs. 75%; p = 0.006). For mild to moderate PPI there is no difference in continence, satisfaction, or improvement rates, between AUS and slings. AUS complications tend to be more severe. Our study supports the use of slings as first-line treatment for mild-moderate PPI.

Comparison of Clinical Outcomes Between “Ideal” and “Nonideal” Transobturator Male Sling Patients for Treatment of Postprostatectomy Incontinence

To review the clinical outcomes of "ideal" vs "nonideal" postprostatectomy stress urinary incontinence (PPI) patients who underwent male sling placement. The medical records of 95 consecutive patients with PPI who underwent male sling insertion (AdVance male sling, American Medical Systems, Minnetonka, MN) were reviewed. Patients were divided into "ideal" vs "nonideal" cohorts. The ideal group consisted of patients with mild to moderate incontinence (<4 pads/day or <300 g daily pad weight), ability to volitionally contract the external urinary sphincter, no history of pelvic radiation or cryotherapy, no history of previous anti-incontinence surgical procedures, the ability to generate a volitional detrusor contraction when voiding, and a postvoid residual urine volume <100 mL. Patients in the nonideal group did not satisfy all these criteria. Significant reductions in daily pad usage and weight were noted in both cohorts. In the ideal patient group, 66 of 72 patients (92%) would undergo the procedure again. Conversely, only 7 of 23 nonideal men (30%) would undergo the procedure again. Preoperative patient selection can influence favorable outcomes after the treatment of PPI with AdVance male slings. Attention to ideal vs nonideal patient characteristics should be used when counseling men considering male sling surgery.

A novel approach to overactive bladder syndrome treatment.

Overactive bladder (OAB) symptoms are among the most bothersome complaints of our elderly patients. They have substantial impact on all aspects of patients’ well–being and reduce their quality of life. This condition affects almost 12% of the adult population of Europe. The prevalence is constantly rising with age and reaches 36% in the group of patients above 75 years of age. The incidence of overactivity related incontinence reaches 28.7% and 50% respectively in men and women [1]. Muscarinic receptor antagonists still constitute the mainstay of the OAB pharmacotherapy. The efficacy of different antimuscarinics is comparable; they relieve symptoms partially and their efficacy is at best moderate. The adverse reaction profiles of muscarinic receptor antagonists used as first line treatment are comparable except for higher oral doses of oxybutynine and propiveryne [2]. The results of clinical trials show really high discontinuation rates – from 4% to 31% in 12 weeks observation. Furthermore, 43% to 81% of patients discontinue their treatment within 30 days, according to the medical claims studies [3]. Professor Kosilov and the co–authors, whose paper appeared in this edition of CEJU address the important clinical problem that is safe and effective treatment of the Overactive Bladder Syndrome (OAB) in the elderly [4]. The Vladivostok team describes the placebo controlled study that analyzes the effects of a novel scheme of treatment with anticholinergic agents (combined high dose pulse anticholinergic therapy) in elderly patients with detrusor overactivity related urinary incontinence. The authors used two compounds with antimuscarinic activity, which are currently not being studied as extensively, as those, having different mechanisms of action. The authors observed a reduction of incontinence events (IE) and urgency episodes lasting until the end of the observation in the group assigned to the double pulse treatment arm in both incontinence severity subgroups. Similar reduction of IE and urgency episodes was observed in patients assigned to single pulse treatment arm, but only in the moderate incontinence severity subgroup. Particularly interesting is why the severtiy of symptoms remains reduced, even after treatment cessation. When the subjects are at least in their sixties and the study drug has relatively narrow therapeutic window, the key question is the safety. The study results revealed a low rate of adverse reactions (AR) – below 12% of patients experienced ARs. These ARs were classified as moderate. The authors provide only an overall percentage of episodes. Taking into account the high doses of study medications and the age of subjects, it is particularly important to show a detailed list of ARs, grouped by treatment arms. Due to intermittent modes of drug administration, it would also be interesting to know the ARs incidence according to the corresponding study phases. The authors claim they showed acceptable tolerance of higher doses of anticholinergics in a previous paper [5]. Unfortunately, the results of this study could be biassed by the patient selection criteria. The next question is why the authors limited the study population to elderly patients with urge incontinence only? Wouldn't it have been safer to choose an idiopathic OAB population not narrowed to those with “wet” OAB in the elderly? The incidence of IE is not the only reliable outcome measure in OAB studies. Invasive urodynamic studies (UDS) were performed at the beginning and the end of the evaluation. UDS results presented in the paper did not reveal much more than the clinical data and the patient reported outcomes. Please, accept this opinion from the point of view of an urodynamics enthusiast. Overall, the authors did a real piece of work trying to look for the new possibilities in OAB treatment. They entered a good number of 313 patients into the prospective placebo controlled study. We are looking forward to see results longer than 6 months and we are also curious what there is behind the prolonged action of anticholinergics.

Transurethral Radiofrequency Collagen Denaturation in the Treatment of Mild to Moderate Female Stress Urinary Incontinence: Six-Month Interim Analysis

Transurethral Radiofrequency Collagen Denaturation in the Treatment of Mild to Moderate Female Stress Urinary Incontinence: Six-Month Interim Analysis

Incontinence urinaire d’effort postopératoire chez l’homme : résultats du traitement par bandelette transobturatrice I-STOP TOMS®

To evaluate the outcome of postoperative male stress urinary incontinence surgery using the I-STOP TOMS(®) sub-urethral sling. Between April 2007 and August 2012, 29 patients had been treated by sub-urethral sling. Stress urinary incontinence was classified as mild, moderate or severe according to the number of pads per day. Patients were also assessed thanks to IQOL, MHU and Ditrovie self-administered questionnaires. Before surgery, 16 patients (55.2%) had mild incontinence, 12 (41.4%) had moderate incontinence and one (3.4%) had severe incontinence. Preoperative median MHU was 9 (5-12); median IQOL was 73 (58-88); and median Ditrovie was 2.7 (2.1-3.3). Three months after surgery, median MHU was 7 (4-9); median IQOL was 85 (75-99); and median Ditrovie was 2.1 (1.6-2.4). Pre- and postoperative questionnaires scores show a significant improvement for IQOL (P=0.014) and Ditrovie (P<0.001). After 3 months, six patients were dry (20.7%), 19 patients had mild incontinence (65.5%) and four had moderate incontinence (13.8%); in résumé 17 patients (58.6%) showed a significant improvement in the number of pads (20.7% dry, 37.9% improved). After a mean follow-up of 24 ± 19.9 months, five patients were dry (17.2%), 20 patients (69%) had mild incontinence and four had moderate incontinence (13.8%). I-STOP TOMS(®) sub-urethral sling improved the level of postoperative stress urinary incontinence. However, the continence rate was weak.

Local excision of low rectal cancer: 12-year follow-up

The last decades have seen an increase in rectal cancer, which mainly affects individuals aged over 40 years [1]. The technique of local excision in the treatment of cancer in the middle and lower third of the rectum is gaining momentum, as opposed to low coloanal anastomosis or abdominoperineal (AP) resection. We report a series of 12 consecutive patients (7 male and 5 female, aged 37 to 65 years) who underwent a local excision of T1 to T3 low rectal cancer during the period 2000–2012 after careful selection according to strict criteria. Abdominoperineal resection was suggested in most cases, but patients strongly refused a permanent stoma. All patients were placed in the Jack-Knife position. A close follow-up was maintained for a period of 10 to 144 months. No major complications were recorded during surgery. The postoperative course for eight patients (72%) was uneventful. One patient died after 48 hours due to sepsis, another patient suffering from myelodysplastic syndrome revealed serious bleeding the 5th postoperative day, an obese (140kgr) female patient developed a rectovaginal fistula that required temporary sigmoidostomy, and one patient under medication for myasthenia Gravis developed moderate faecal incontinence. Eleven patients are currently alive and free of disease for a mean period of 68 months. Pathology reports revealed malignancy (T1–T3) in 11 patients. Three (3) patients received neo-adjuvant therapy preoperative chemoradiation therapy, and another patient received postoperative radiation therapy. Local excision of low rectal cancer in accordance with strict criteria, is a safe technique if skillfully performed. Further investigations and trials should be performed to confirm the safety and advantages of this approach.

Robot-assisted laparoscopic radical prostatectomy after previous open transvesical adenomectomy.

Robot-assisted laparoscopic radical prostatectomy (RALRP) is one of the best treatment for patients with localized prostate cancer. RALRP is currently performed in patients without previous surgical treatment for benign prostatic hyperplasia. This paper presents a successfully performed RALRP after previous open transvesical adenomectomy (TVA). A 68-year-old patient underwent nerve-sparing RALRP for prostate cancer revealed by transrectal ultrasound guided prostate biopsy, 7years after TVA. Postoperatively, a regular diet was allowed on day 1. The Foley catheter was removed on day 7. At 3months' follow-up, the patient complained of moderate stress incontinence but erectile function was responsive to Tadalafil(®). Serum prostate-specific antigen was undetectable. Quality of life was satisfactory. A history of previous prostatic surgery does not appear to compromise the outcome of RALRP. Nerve sparing is still indicated. Long-term follow-up is necessary to define RALRP as a gold standard also in patients with previous TVA.

Re-Adjustable Male Slings

Re-adjustable male slings are well established and should be offered to incontinent men with mild, moderate or severe incontinence. However, they should be able to interrupt their stream. Solely the slight increase of the urethral resistance (10 - 15 cmH20) supporting the smooth muscle component will provide continence for such patients. Argus, Remeex and Atoms allow exactly setting the urethral resistance to a level, which will provide continence thus avoiding obstructive voiding. Implantation may be carried out retropubically (Remeex), via a transobturator route (Atoms) or alternatively (Argus). The success rates after more than one-year follow-up come up to 84%. Intraoperative bladder perforations may occur in 6% - 11%, late complications are infections possibly leading to explantation in 8% - 12%. Postoperative perineal pain and/or numbness may be present.

Surgery for Post-Prostatectomy Incontinence - A Changing Field

The most common cause of male stress urinary incontinence is intrinsic sphincter deficiency secondary to iatrogenic injury during prostate cancer surgery. While conservative management is typically offered during the first 6-12 months, most efficacious therapeutic options are surgical in nature. The most common treatments include periurethral bulking, artificial urinary sphincter, and various male slings. During the last 15 years, innovations in malesling design and technique have resulted in a substantially greater interest in this particular option. With several choices now available to patients, the number of sling surgeries performed each year is steadily increasing. Recent evidence has demonstrated that male slings are most efficacious in men with mild to moderate stress incontinence, no history of pelvic radiation, and without prior artificial sphincter placement. In this population, high efficacy with verylow complication rates can be expected. In men with more severe incontinence, especially following radiotherapy, the artificial urinary sphincter typically offers predictably reliable efficacy, with an acceptably low complication rate. Recent advancements in sling technology may provide improved efficacy even in those with more severe leakage.

Stratification of Postprostatectomy Urinary Function Using Expanded Prostate Cancer Index Composite

To classify the Expanded Prostate Cancer Index Composite (EPIC)-Short Form urinary domain (EPIC-UIN) scores, as part of a validated health-related quality of life instrument after prostate cancer treatment into clinically meaningful functional categories. Using a prospectively maintained database, approved by the institutional review board, of patients undergoing prostatectomy for malignancy, the patient and tumor factors and validated health-related quality of life instruments, including EPIC-UIN and the Incontinence Severity Index (ISI) were retrospectively reviewed. The questionnaires were completed preoperatively, at 3, 6, 9, and 12 months postoperatively, and yearly thereafter. Cutpoints were chosen for the EPIC-UIN scores to correlate with ISI, and statistical analysis querying this correlation was performed. A total of 446 patients completing 764 questionnaires were reviewed. On average, the patients were 59.2 years old with a Gleason score of 6.75. All patients underwent robotic-assisted (n=224) or radical retropubic (n=222) prostatectomy. The range of ISI scores at the prescribed measurement points was "mild" (0-6), "moderate" (7-16), and "severe" (≥17) in 58.9%, 28.9%, and 11.3% of patients, respectively. An EPIC-UIN score of 0-49, 50-69, and 70-100 was chosen to correlate with the ISI score of "severe," "moderate," and "mild," with an agreement of 74.1% (weighted kappa coefficient 0.6541). Severe incontinence and moderate incontinence on the EPIC-UIN were associated with a sensitivity of 74% and 90.6% and specificity of 90.2% and 93.6%, respectively. Categorical EPIC-UIN groups were developed to represent the mild, moderate, and severe incontinence. These categories provided meaningful guides for assessing postoperative urinary incontinence and recovery of urinary function.

Caffeine Intake and Risk of Urinary Incontinence Progression Among Women

To estimate the association between long-term caffeine intake and risk of urinary incontinence (UI) progression over 2 years among women with moderate UI. We conducted a prospective cohort study in 21,564 women with moderate UI enrolled in the Nurses' Health Study and Nurses' Health Study II. Incontinence progression was identified from questionnaires during 2 years of follow-up. Baseline caffeine intake (ie, average intake during the previous year) and change in caffeine intake during the 4 years before baseline were measured using food frequency questionnaires. Odds ratios (ORs) for incontinence progression according to caffeine intake were calculated for each cohort separately, and then for both cohorts combined. The percentage of women with UI progression was similar across categories of baseline level of caffeine intake and change in caffeine intake before baseline. For example, percentages were 21% compared with 22% comparing 450 mg or more to less than 150 mg of caffeine per day (adjusted OR 0.87, 95% confidence interval 0.70-1.08). Comparing women with increased caffeine intake to those with stable caffeine intake, percentages with progression were 22% compared with 20% (OR 1.08, 95% confidence interval 0.95-1.22). Results were similar in separate analyses of urge and stress UI. Long-term caffeine intake over 1 year was not associated with risk of UI progression over 2 years among women with moderate incontinence, although we could not examine acute effects of caffeine. Improved understanding of the effect of caffeine on the bladder is needed to better-advise women with incontinence about caffeine intake. II.

210 PERIURETHRAL INJECTION OF AUTOLOGOUS ADIPOSE-DERIVED STEM CELLS FOR THE TREATMENT OF MALE STRESS URINARY INCONTINENCE: OUTCOME OF A PRELIMINARY CLINICAL TRIAL

You have accessJournal of UrologyStem Cell Research1 Apr 2012210 PERIURETHRAL INJECTION OF AUTOLOGOUS ADIPOSE-DERIVED STEM CELLS FOR THE TREATMENT OF MALE STRESS URINARY INCONTINENCE: OUTCOME OF A PRELIMINARY CLINICAL TRIAL Momokazu Gotoh, Tokunori Yamamoto, Yoshihisa Matsukawa, and Ryohei Hattori Momokazu GotohMomokazu Gotoh Nagoya, Japan More articles by this author , Tokunori YamamotoTokunori Yamamoto Nagoya, Japan More articles by this author , Yoshihisa MatsukawaYoshihisa Matsukawa Nagoya, Japan More articles by this author , and Ryohei HattoriRyohei Hattori Nagoya, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.263AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To report a novel cell therapy using autologous adipose-derived stem cells (ADSCs) for stress urinary incontinence caused by urethral sphincter deficiency and the early outcomes in 2 initial male patients undergoing periurethral injection of ADSCs. METHODS Two male patients with persistent stress urinary incontinence after prostate surgery (radical prostatectomy and holmium laser enucleation of the prostate) received treatment. After liposuction of 250 mL of adipose tissue from the abdomen, we isolated ADSCs from this tissue using the CelutionTM system. Subsequently, the isolated ADSCs and a mixture of stem cells and adipose tissue were transurethrally injected into the rhabdosphincter and submucosal space of the urethra, respectively. Unlike other cell therapy, this treatment is entirely autologous, requires no cell culture, and is performed in the context of a single surgical procedure. Outcomes during a 3-month follow-up were assessed by a 24-hour pad test, a validated patient questionnaire, urethral pressure profile, contrast-enhanced transrectal ultrasonography, and magnetic resonance imaging. The present study was approved by the Ethics Committee of the Nagoya University Graduate School of Medicine and by the Japanese government. RESULTS After injection, urinary incontinence progressively improved during the 3-month follow-up, i.e., decreased leakage volume in a 24-hour pad test. One patient with moderate incontinence (mean leakage amount per day during 4 consecutive days in a 24-hour pad test: 113.3 g) achieved total continence 14 weeks after injection. In another patient, the mean leakage amount per day has been improving from 49.5 to 12.3 g at 12 weeks after injection. In the urethral pressure profile, both maximum urethral closing pressure and functional profile length increased in both patients. Magnetic resonance imaging demonstrated sustained presence of the injected adipose tissue. Enhanced ultrasonography revealed a progressive increase in blood flow to the injected area. No significant adverse events were observed peri- and postoperatively. CONCLUSIONS This preliminary study demonstrated that periurethral injection of autologous ADSCs is a safe and feasible treatment modality for patients with stress urinary incontinence caused by urethral sphincter deficiency. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e87-e88 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Momokazu Gotoh Nagoya, Japan More articles by this author Tokunori Yamamoto Nagoya, Japan More articles by this author Yoshihisa Matsukawa Nagoya, Japan More articles by this author Ryohei Hattori Nagoya, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

515 THREE YEAR FOLLOW-UP OF THE ADVANCE SLING

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy I1 Apr 2012515 THREE YEAR FOLLOW-UP OF THE ADVANCE SLING Ricarda Bauer, Peter Rehder, Francois Haab, Christian Gozzi, and Jean-Nicolas Cornu Ricarda BauerRicarda Bauer Munich, Germany More articles by this author , Peter RehderPeter Rehder Innsbruck, Austria More articles by this author , Francois HaabFrancois Haab Paris, France More articles by this author , Christian GozziChristian Gozzi Brixen, Italy More articles by this author , and Jean-Nicolas CornuJean-Nicolas Cornu Paris, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.587AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The AdVance male sling has shown to be efficacious in studies with a follow-up with a maximum of 2 years for post-prostatectomy incontinence (PPI). However, studies with longer follow-up are lacking. Aim of this study was to assess the longer-term clinical outcome, over three years, after AdVance sling implantation for PPI management. METHODS 156 consecutive patients with PPI were included in a multicentre prospective evaluation. The study was performed in three European tertiary reference centers. Preoperative assessment included evaluation of postvoid residual urine (PVR), uroflowmetry, pad usage, one hour pad-test, quality of life scores (IQOL and ICIQ-UI SF), urethrocystoscopy and urodynamics. The AdVance sling was implanted in all patients according to the same operative technique. At 1, 6, 12 and 36 months the following parameters were evaluated: pad usage, one hour pad-test; uroflowmetry, PVR and quality of life scores. Patients were classified as cured if there was no pad use or only one dry pad for security reasons, as improved if pad reduction was > 50%; all others were considered as failures. Complications of surgery and influence of incontinence severity, age, previous surgery for SUI or adjuvant therapy on outcome was assessed. RESULTS Follow-up over three years was available for 149 patients (three died – not related to the AdVance implantation - and four were lost to follow-up). At 3 years, 53% of patients were cured, 24% were improved and 23% failed. In addition, pad usage was significantly reduced compared with baseline (both p<0.0001). In comparison to the one year data, results were stable. Seven patients received a second treatment for SUI (artificial urinary sphincter or re-do sling). Lower success rates were observed in patients with previous surgical treatment for PPI (64.4% vs.78.3%, p=0.04). Age had no negative impact on cure rate. Cure rate seemed higher in patients with mild or moderate incontinence (<5 pads/day) compared with severe incontinence (>5 pads/day) (80.2% vs. 63.6%) but the results were not significant. Quality of life significantly improved. The most common complications were mild perineal post-operative pain (50%), transient urinary retention (14%), mild dysuria (4.5%), perineal hematoma (3.2%). One sling was explanted due to a symphisitis. CONCLUSIONS The AdVance sling is effective and safe in the three year follow up for treating male SUI after prostate surgery. Complications occurred only in the early postoperative period. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e212 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ricarda Bauer Munich, Germany More articles by this author Peter Rehder Innsbruck, Austria More articles by this author Francois Haab Paris, France More articles by this author Christian Gozzi Brixen, Italy More articles by this author Jean-Nicolas Cornu Paris, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Treatment of Postprostatectomy Male Urinary Incontinence With the Transobturator Retroluminal Repositioning Sling Suspension: 3-Year Follow-up

BackgroundThe AdVance male sling (American Medical Systems, Minnetonka, MN, USA) has been shown to be an efficacious device in short-term studies for postprostatectomy incontinence (PPI), but long-term studies are lacking. ObjectiveExamine the intermediate-term outcome with the AdVance sling for PPI management. Design, setting, and participantsA multicentre prospective evaluation was conducted on consecutive patients treated for PPI in three European tertiary reference centres. InterventionPatients were implanted with the AdVance male sling with no associated surgery. Outcome measurements and statistical analysisMeasurements included daily pad usage, maximum flow rate (Qmax), postvoid residual urine (PVR), the International Consultation on Incontinence Questionnaire–Short Form, the Incontinence Quality of Life questionnaires, and complications of surgery. Paired Wilcoxon signed rank test univariable and multivariable analyses were used. Results and limitationsFollow-up was available for 156 patients for the majority of parameters. Pad usage was significantly decreased compared with baseline at 12 mo and 3 yr (p<0.0001). At 12 mo, 76.9% of patients could be classified as cured or improved; this percentage was maintained at 3 yr (76.8%). Cure rates (58.6% vs 42.3%) and improvement rates (23.2% vs 25.0%) were higher in patients with mild or moderate incontinence compared with severe incontinence. Univariable analysis showed that pretreatment pad usage and severity of incontinence were both significant predictors of success (p=0.0355 and p=0.0420, respectively). However, in multivariable analysis, only pad usage was an independent predictor of success. There were no perioperative or severe postoperative complications. Most complications were Dindo grade I. Seven patients required a second treatment for stress urinary incontinence. There was no worsening over time. Limitations of this study included no comparator group, quality of life questionnaires in only two centres, and no 24-h pad test. ConclusionsThe transobturator retroluminal repositioning sling suspension is effective and safe in the longer term for treating PPI.