Negative Pad Research Articles

Pelvic Floor Muscle Training for Urinary Incontinence with or without Biofeedback or Electrostimulation in Women: A Systematic Review.

To determine the effectiveness of pelvic floor muscle training (PFMT) with or without biofeedback or electrostimulation in reducing urinary incontinence and pelvic floor muscle con-traction in non-pregnant women with urinary incontinence. Methods: The following electronic databases were searched: PubMed, Cochrane Central, ClinicalTrials.gov, EU Clinical Trials Register, and sources from NICE, FDA, EMA, and SMC (articles only in English, 2000–2021). Search terms were: urinary incontinence, pelvic floor muscle training or exercises, biofeedback, electrostimulation. We used the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for this systematic review. Relevant articles were selected, data were extracted, and quality was assessed. Data were extracted in predesigned form, followed by narrative synthesis. Results: Following the search, 15 RCTs were retrieved using the strict inclusion and exclusion criteria, assessing 2441 non-pregnant women with urinary incontinence. Of the 15 studies, 7 were low risk, 5 were medium risk, and 3 were high-risk studies. Of the 2441 patients, 970 were in PFMT, 69 were in extracorporeal magnetic innervation (ExMi) or with PFMT + BF, 30 were in electrostimulation (ES), 21 were in whole body vibration training (WBVT), 23 were in pelvic floor muscle + abdominal muscle therapy (PFM + AMT), 326 were in PFMT + biofeedback, 93 were in vaginal cones (VC), 362 were in PFMT + education, 318 were in education, and 229 were in control groups. The most often measures employed were pad tests, bladder diary, and questionnaire on the quality of life. Stress, urge and mixed urinary incontinence were studied. In all RCT, PFMT significantly reduced urinary incontinence, essentially SIU and MUI, when compared with the control group before and after treatment. Overall, out of 997 PFMT or PFMT + education patients, 504 patients (50.5%) showed improvement in urinary incontinence, and 218 became continent (21.8%) (negative pad test). In total, 62% of patients significantly reduced their urinary incontinence or cured it and improved their pelvic floor muscle contraction. All other physiotherapist techniques also significantly reduced urinary leakages, e.g., vaginal cones, biofeedback, ExMI, and WBVT when compared with the control group. There were no significant differences between these methods in reducing the severity of urinary incontinence. Conclusion: PFMT alone or with bio-feedback or electrostimulation was effective in reducing urinary incontinence and improving pelvic floor muscle contraction. PFMT when compared with other interventions such as bio-feedback, VC, and WBVT did not show significant differences but was superior to the control group. RCT studies with similar parameters used for measuring the outcomes need to be included.

Use of polyvinylidene fluoride in treatment of female stress urinary incontinence: Efficacy and safety of midurethral slings: 24-month follow-up results.

To evaluate the safety and efficacy rate of polyvinylidene fluoride (PVDF) slings in the treatment of female stress urinary incontinence (SUI). A prospective pilot study was conducted with women with SUI who underwent PVDF slings. Data regarding subjective (International Consultation on Incontinence Questionnaire - Urinary Incontinence [ICIQ-UI] and International Consultation on Incontinence Questionnaire - Overactive Bladder [ICIQ-OAB]) and objective (stress test and bladder diary) outcomes and complication rates were evaluated. Primary outcomes were objective (negative pad and stress test) and subjective (no leakage episodes) success after a median follow-up of 24 months. PVDF slings demonstrated a high level of satisfaction with objective cure (transobturator 90% compared with retropubic 100%, P = .90), urgency to urinate, frequency of de novo incontinence (transobturator 90% compared with retropubic 80%, P = .85), ability of physical and sexual activity (transobturator 90% compared with retropubic 100%, P = .90). The multivariate logistic regression model for satisfaction was associated with overall treatment success (odds ratio [OR] = 3.55, 95% confidence interval [CI] 2.32-6.1), greater reduction in ICIQ-UI (OR = 0.85; 95% CI 0.78-1.85) and ICIQ-OAB (OR =0.99; 95% CI 0.89-1.78). The total Female Sexual Function Index (FSFI) score for both groups was 19.3 ± 1.2 and 20.7 ± 1.8, statistically significant when compared with perioperative FSFI score 16.7 ± 1.1 and 17.6 ± 1.4 (P < .001). PVDF mid-urethral slings are safe with clinically efficacies at 3, 6, 12, and 24-month follow-up for the treatment of SUI. The high level of satisfaction seen after PVDF sling procedures is associated with objective improvement of SUI and fewer slings related complications. Further studies using larger sample sizes with longer and comparative clinical follow-up are required.

Theoretical investigation of the effect of offset loads on the static characteristics of a multi-pad adjustable bearing geometry

ABSTRACT An adjustable or controllable form of bearing geometry embodying four multiple pads circumferentially positioned around the journal is presented in this study. The proposed pad geometry has a novel feature to undergo radial and tilt adjustments in both inward and outward directions from the reference position. The adjustability principle of bearing pads helps to attain a controlled bearing operation in the clearance spaces. This paper investigates the effect of offset loads on the steady-state characteristics of a four-pad adjustable bearing. A modified film thickness equation is applied to take account of the radial and tilt pad adjustments in the theoretical analysis. Variation in fluid film pressures and static characteristics is analysed for different pad adjustment conditions and offset load positions. From the comparative study, superior static performance is obtained for bearing operated with an offset load of χ/α = 0.45 and negative pad adjustment configurations than compared with central load condition.

Prevalence of Peripheral Arterial Disease among End Stage Renal Disease Patients

Abstract Background Patients with End Stage Renal Disease are more susceptible to develop Peripheral Arterial Disease. so, screening is helpful for early diagnosis. Objectives The aim of this study is to screen and calculate the prevalence of asymptomatic patients on regular hemodialysis for presence of PAD. Aim of Study The aim of this study is to screen and calculate the prevalence of asymptomatic patients on regular hemodialysis for presence of PAD. Patients and Methods The study included 100 asymptomatic patients on regular hemodialysis and below 60 years old to be screened for presence of PAD. Patients who refused the test, above 60 years old, or diabetic have been excluded from the study. All selected patients have been subjected to complete history taking, full clinical examination including extremities examination, Lab workup including; CBC, liver function test, kidney function test, A1C level, lipid profile, Resting 12 lead ECG, Echocardiography to assess systolic function, valvular disease, and resting SWMA, and ABI assessment using the Doppler. Patients then were divided into two groups; control group who has negative PAD with ABI &amp;gt; 0.9 and study group who has PAD with ABI ≤ 0.9. Results It was found that the prevalence of PAD among ESRD patients is 26%. Regarding the laterality; 21% had bilateral PAD and the rest 5% had unilateral disease. The results showed that females had statistically significant higher risk of developing PAD that males. 55% of patients were females and the other 45% were males. 36.4% of females studied had positive ABI but only 13.3% of studied males found positive for PAD. The p value was 0.017. The study showed also that A1C level in patients who have no diabetes carries statistically significant results. The mean A1C level for the study group was 5.56 ± 0.70 and the control group was 4.92 ± 0.73. The p value was 0.000. The A1C level cut off value was &amp;gt; 5.3. This means that patients who have A1C &amp;gt; 5.3 should be paid more attention and be screened because they have higher risk to develop PAD. Conclusion Renal impairment is an important risk factor for developing PAD in absence of traditional risk factors such as DM, hypertension, or dyslipidemia. Prevalence of PAD was 26% in our study. ABI is a simple non-invasive modality of screening for PAD. Females are at higher risk to develop PAD than males by ∼ 2.7 fold. Although diabetes is absent, A1C level &amp;gt; 5.3 is significantly correlating with the risk of PAD.

Does Previous Pelvic Organ Prolapse Surgery Influence the Effectiveness of the Sub-Urethral Sling Procedure?

Pelvic organ prolapse (POP) often co-occurs with stress urinary incontinence. There is no consensus on whether prolapse repair and anti-incontinence surgery should be performed concomitantly or separately, in a two-step manner. The present study evaluated the effects of the tension-free vaginal tape (TVT) procedure in patients who had previously undergone pelvic floor repair (study group), compared to women who underwent TVT insertion only (control group). The study group comprised 84 patients who underwent the TVT procedure but had previously also undergone surgical POP repair. The control group consisted of 250 women in whom the TVT was inserted. The primary objective was to compare the objective cure rate and the secondary objective was to compare the subjective cure rate in both groups. Negative pad test was achieved in over 91% in both groups. Objective and subjective cure rates were compared, as well as complication rates. Significant improvement was observed in the postoperative 1-h pad test in all patients. In all patients, we observed significant improvement in the quality of life, with no differences between the groups. No differences were found in the occurrence of postoperative urinary retention, urgency and frequency of daytime micturition, or vaginal erosion between the groups. The current results demonstrate that the two-step approach to pelvic reconstruction and anti-incontinence surgery is as safe and effective as primary TVT implantation.

Analysis on the steady state performance of a multi pad externally adjustable fluid film bearing

PurposeThis study aims to investigate the performance characteristics of an externally adjustable bearing with multiple pads in steady state conditions. The proposed adjustable bearing geometry can effectively control the hydrodynamic operation in bearing clearances by adjusting the pads in radial and tilt directions. These pad adjustments have a significant role in improving the bearing characteristics such as load capacity, attitude angle, side leakage, friction variable and Sommerfeld number, which will be analysed in this paper.Design/methodology/approachThe adjustable bearing is designed with circumferentially spaced four bearing pads subjected to similar radial and tilt adjustments. Tilt angles are applied along the leading edges of bearing pads. A modified film thickness equation is used to incorporate the pad adjustments and accurately predict the variation in film profile. Finite difference approximation is adopted to solve the Reynolds equation and discretize the fluid film domain.FindingsFor negative radial and tilt adjustments, higher hydrodynamic pressures are generated in bearing clearances, which increases the bearing load capacity at different eccentricity ratios. From comparative analysis for different pad adjustments, superior bearing performance is observed for bearing pads under negative radial and negative tilt adjustments.Originality/valueThis research presents a detailed theoretical approach to analyse the performance capability of a four pad adjustable bearing geometry, which is not available in literatures. Improved bearing performances with negative pad adjustments can attract bearing designers to implement the proposed adjustability-bearing concept in rotating machineries.

Treating Women With Urinary Incontinence and Overactive Bladder

Introduction: Pelvic floor Muscle Training (PFMT) commonly used physical therapy for Female Overactive bladder (OAB) and stress urinary incontinence (SUI). However some women has difficulty to understand and comply to PFMT. Our aim is to evaluate the effectiveness of Transpelviner Magnetic Stimulation (TPMS) as a replacement for PFMT. Materials and Methods: A prospective observational study on 53 women with SUI or OAB, were assessed objectively using cough stress test, bladder diary, one hour pad test, perineometry and validated questionnaires. Then, all of them received 10 courses of individualized TPMS therapy over five weeks. Reassessments were done after five weeks and six months of initial treatment. The outcomes were measured by severity index, negative pad test, muscle power, numbers of leaking episodes, daytime frequency and nocturia, negative cough stress test and improvement in specific quality of life questionnaires (QOL) Results: Frequency of micturition in OAB showed reduction from 100% at baseline to 12.5%,(p=0.053) after five weeks and 25%,(p=0.345) after six months. While, SUI reducedfrom 100% to 17.2(0.052) and 27.6% (p=0.826) after six months. Urgency OAB reduced from 100% to 12.5% and SUI reduced from 100% to 41.4%. It appears that after five weeks of treatment, all participants improved in their severity index (75%) followed by OAB (55.6%). However the percentage dropped six months later which was 50% and 12.5%, respectively. These results were consistent for perineal muscles power, one hour pad test and QOL score. Conclusion: TPMS shows significant effectiveness to treat OAB and SUI. However, bigger study is required to compare it with PFMT in treating urinary symptoms.

Urolastic®, a new bulking agent for treatment of stress urinary incontinence: a systematic review and meta-analysis

The aim of the present systematic review and meta-analysis was to assess the effectiveness and safety of injections of the new bulking agent Urolastic® in the treatment of patients with stress urinary incontinence (SUI). A systematic search was carried out to select observational and experimental studies on Urolastic® in female patients with SUI. Three different databases, Pubmed, the Cochrane Central Register of Controlled Trials, and Scopus, were used to retrieve scientific articles published from their inception to 31 January 2018. Eight full texts were evaluated but only five were selected for the qualitative and quantitative analyses. Duration of follow-up after Urolastic® injections was significantly heterogeneous, ranging from 6 to 24months. Secondary injections were needed in 16.7%-35.0% of the treated patients. The pooled proportion of secondary injections was 20% (95% CI: 15%-24%; I2: 0%). Subjective improvement, measured by different means (i.e., patient global impression of improvement PGI-I score) was only assessed by 40% of the selected papers and was > 80% in two cohorts. The objective treatment success was evaluated by four (80.0%) papers and was achieved in all cohorts with a wide proportional range: from 32.7% (i.e., patients without objective SUI symptom cough tests and with a negative pad test) to 67.0%. Its pooled proportion was 57% (95% CI: 38%-75%; I2: 82.3%). Urolastic® showed effectiveness in patients with SUI during a follow-up period of 6-24months.

Clinical value of negative pressure vacuum cushion combined with thermoplastic body membrane in radiotherapy for Wilms tumor in children

Objective To investigate the clinical value of negative pressure vacuum cushion combined with thermoplastic body membrane in radiotherapy for Wilms tumor in children. Methods A total of 42 pediatric patients with Wilms tumor who received radiotherapy after surgery were enrolled in the study and were randomly divided into two groups according to the fixation positions: group A and group B. During radiotherapy, the patients in group A were fixed with negative pressure vacuum cushion, and those in group B were fixed by negative pressure vacuum cushion combined with thermoplastic body membrane. The setup errors, short-term effects, adverse reactions, and prognosis were compared between the two groups. Results Group B showed significantly lower translational errors and rotational errors, as well as significantly higher rates of ≤3 mm and ≤5 mm errors, compared with the group A (P=0.04, 0.04, 0.04, 0.03, 0.00, 0.04, 0.04, 0.00, 0.04). Group B also showed significantly higher complete remission rates and response rates than group A (P=0.02, 0.04). There were no significant differences in the adverse reaction rates (P=0.75) and the overall survival (OS) rates at 2 and 3 years (P=0.68, 0.74) between the two groups. Group A had the MPTV values in left-right (LR) direction (x-axis), superior-inferior (SI) direction (y-axis), and anterior-posterior (AP) direction (z-axis) being 5.74 mm, 5.93 mm, and 5.94 mm, respectively, and group B had the MPTV values at LR, SI, and AP directions being 4.21 mm, 5.71 mm, and 4.61 mm, respectively. Conclusions In the radiotherapy positioning for Wilms tumor in children, fixation limbs with negative pressure vacuum cushion combined with thermoplastic body membrane effectively reduces the setup errors and improves the effect of radiotherapy, so it holds promise for clinical application. Key words: Wilms tumor/radiotherapy; Vacuum negative pressure pad; Thermoplastic body membrane; Treatment effect; Adverse reaction

Use of a postoperative pad test to identify continence status in women after obstetric vesicovaginal fistula repair: a prospective cohort study.

Determine whether a 1-hour pad test at discharge can identify continence status within 120days of obstetric vesicovaginal fistula (VVF) repair. Prospective cohort study. Fistula Care Centre in Lilongwe, Malawi. Women with VVF who underwent repair between January 2012 and December 2014. Data on demographics, obstetric history, physical exam findings, operative management, postoperative findings, and follow up evaluations were collected on women with VVF repair. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and a receiver operating curve (ROC) were calculated to assess the utility of using a discharge pad test at three thresholds to identify women likely to be continent at follow up. After VVF repair, 346 women had a 1-hour pad test performed at the time of hospital discharge and completed follow up within 120days of repair. Of these, 79.8% (n=276) were completely continent, whereas 20.2% (n=70) had some degree ofincontinence. The sensitivity and specificity of a negative 1-hour pad test at predicting continence is 68.1% and 82.9%, respectively. With this prevalence, a negative pad test at a 1.5-g threshold demonstrates a high predictive value (PPV=94.0%, 95% CI 90.0-96.9) in detecting women with continence after repair. At the 1.5-g threshold, a negative pad test at discharge identifies 94% of women who will remain continent after VVF repair. Adding the pad test to fistula care can identify women who are likely to remain continent and may not need further therapies in settings where resources are limited and follow up after repair is difficult. A negative pad test after repair is associated with continued continence at follow up.

Fraktursonografie im Kindesalter

X-rays are the standard imaging procedure for the diagnosis of pediatric long bone fractures. Recent studies show that ultrasound (US) imaging is also qualified to diagnose pediatric long bones fractures. Thus, the diagnosis and decision-making for the treatment of metaphyseal forearm fractures in children can be performed by solely using US. The sonographic fat pad sign has been proven to be a useful primary screening tool for pediatric elbow injuries. If there is a negative fat pad sign, a fracture is unlikely and taking additional radiographs is dispensable at this time. If there is a positive fat pad sign, a fracture is likely and radiographs should be taken. US is also useful to exclude subcapital humeral fractures and to estimate fracture displacement. If a fracture of the subcapital humerus is present, additional radiographs are necessary to avoid overlooking of pathologic fractures. For reliable sonographic fracture diagnosis in childhood, a detailed history und exact clinical examination are required.

Randomized controlled trial comparing TVT-O and TVT-S for the treatment of stress urinary incontinence: 2-year results

The aim was to compare the efficacy and safety of single-incision sling TVT-Secur (TVT-S) and transobturator midurethral sling (TVT-O) for the treatment of stress urinary incontinence (SUI) over 2 years' follow-up. This is a randomized controlled trial in which women with SUI were randomly assigned to have either TVT-O (n = 56) or TVT-S (n = 66). Exclusion criteria included: voiding dysfunction, detrusor overactivity, and pelvic organ prolapse beyond the hymen. The primary outcomes were objective and subjective cure rates at a follow-up visit at 24 months, defined as a negative stress test and pad test as well as absence of self-reported SUI symptoms. Secondary endpoints included quality of life assessment using the King's Health Questionnaire (KHQ), and complication and reoperation rates. Analysis was performed using intention to treat, and statistical significance was fixed at 5% (p < 0.05). Statistical methods used were Mann-Whitney, Student's t, Chi-squared, Fisher's, ANOVA, and McNemar's tests. The groups were similar regarding demographic and clinical preoperative parameters. Objective cure rates for TVT-S and TVT-O groups were 77.3% and 83.6%, while subjective cure rates were 75.7% and 80.3% respectively, with no statistically significant differences between the techniques. There was a significant improvement in all KHQ domains in both groups (p < 0.001). A few complications were observed in our study. The most common perioperative complication was thigh pain associated with TVT-O, while the long-term one was tape exposure observed in 5.3% of TVT-O and in 7.5% of TVT-S cases. The efficacy of the TVT-S was similar to that of the TVT-O after 2 years' assessment. This cohort will continue to be followed in order to maintain commitment to contributing data on long-term results.

Effect of the direct current on microstructure, tensile property and bonding strength of pure silver wires

In the microelectronics assembly and packaging industry, the wire bonding has become an important process to connect lead frames and pads. In the past, gold and copper were the main materials of wire bonding. However, the cost of gold wires is getting higher nowadays and yet wire bonding cannot be wholly replaced by copper wire; thus silver wires become a novel bonding material in recent years. The reliability test of wires was a static method; this study leads electrical current into the wires to estimate the structural changing and interface properties of Al pads (positive and negative pad). After leading 90% critical fusing current density (CFCD) into a 23μm silver wire, some grains of silver wire had grown up and formed into equal-diameter grains (EDG). After the current test, the fracture position of bonded wires moved from heat affect zone (HAZ) of electric flame-off (EFO) to the neck of HAZ. Otherwise, the current test would reduce the tensile strength of wire. The bonding strength of the positive pad was lower than that of the negative pad. The intermetallic compound (IMC) of bonding interface was AgAl2.

Treatment Success of Retropubic and Transobturator Mid Urethral Slings at 24 Months

Longer term comparative efficacy information regarding transobturator and retropubic mid urethral slings is needed. We report 24-month continence rates, complications and symptom outcomes from a randomized equivalence trial. Primary outcomes were objective (negative stress test, negative pad test and no re-treatment for stress urinary incontinence) and subjective (no self-report of stress urinary incontinence symptoms, no leakage episodes on 3-day bladder diary and no re-treatment for stress urinary incontinence) success at 24 months. The predetermined equivalence margin was ± 12%. Of 597 randomized participants 516 (86.4%) were assessed. Objective success rates for retropubic and transobturator mid urethral slings were 77.3% and 72.3%, respectively (95% CI for difference of 5.1% was -2.0, 12.1), and subjective success rates were 55.7% and 48.3%, respectively (CI for difference of 7.4% was -0.7, 15.5). Neither objective nor subjective success rates met the prespecified criteria for equivalence. Patient satisfaction (retropubic 86.3% vs transobturator 88.1%, p = 0.58), frequency of de novo urgency incontinence (retropubic 0% vs transobturator 0.3%, p = 0.99) and occurrence of mesh exposure (retropubic 4.4% vs transobturator 2.7%, p = 0.26) were not significantly different. The retropubic mid urethral sling group had higher rates of voiding dysfunction requiring surgery (3.0% vs 0%, p = 0.002) and urinary tract infections (17.1% vs 10.7%, p = 0.025), whereas the transobturator group had more neurological symptoms (9.7% vs 5.4%, p = 0.045). Objective success rates met the criteria for equivalence at 12 months but no longer met these criteria at 24 months. Subjective success rates remained inconclusive for equivalence. Patient satisfaction remained high and symptom severity remained markedly improved. Continued surveillance is important in women undergoing mid urethral sling surgery.

Urodynamic Changes Associated with Successful Stress Urinary Incontinence Surgery: Is a Little Tension a Good Thing?

To identify urodynamic changes that correlate with successful outcomes after stress urinary incontinence (SUI) surgery. Six-hundred fifty-five women were randomized to Burch colposuspension or autologous fascial sling as part of the multicenter Stress Incontinence Surgical Treatment Efficacy Trial. Preoperatively and 24 months after surgery, participants underwent standardized urodynamic testing that included noninvasive uroflowmetry, cystometrogram, and pressure flow studies. Changes in urodynamic parameters were correlated to a successful outcome, defined a priori as (1) negative pad test; (2) no urinary incontinence on 3-day diary; (3) negative cough and Valsalva stress test; (4) no self-reported SUI symptoms on the Medical, Epidemiologic and Social Aspects of Aging Questionnaire; and (5) no re-treatment for SUI. Subjects who met criteria for surgical success showed a greater relative increase in mean Pdet@Qmax (baseline vs 24 months) than women who were considered surgical failures (P = .008). Although a trend suggested an association between greater increases in bladder outlet obstruction index and outcome success, this was not statistically significant. Other urodynamic variables, such as maximum uroflow, bladder compliance, and the presence of preoperative or de novo detrusor overactivity did not differ with respect to outcome status. Successful outcomes in both surgical groups (Burch and sling) were associated with higher voiding pressures relative to preoperative baseline values. However, concomitant changes in other urodynamic voiding parameters were not significantly associated with outcome.

1164 TWENTY-FOUR-MONTH OUTCOMES OF RANDOMIZED EQUIVALENCE TRIAL OF RETROPUBIC AND TRANSOBTURATOR MIDURETHRAL SLINGS (TOMUS)

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy1 Apr 20111164 TWENTY-FOUR-MONTH OUTCOMES OF RANDOMIZED EQUIVALENCE TRIAL OF RETROPUBIC AND TRANSOBTURATOR MIDURETHRAL SLINGS (TOMUS) Michael Albo, Heather Litman, Gary Lemack, Holly Richter, Toby Chai, Kimberly Kenton, Stephen Kraus, Larry Sirls, Halina Zyczynski, Peggy Norton, Ann Gormley, and John Kusek Michael AlboMichael Albo San Diego, CA More articles by this author , Heather LitmanHeather Litman Watertown, MA More articles by this author , Gary LemackGary Lemack Dallas, TX More articles by this author , Holly RichterHolly Richter Birmingham, AL More articles by this author , Toby ChaiToby Chai Baltimore, MD More articles by this author , Kimberly KentonKimberly Kenton Maywood, IL More articles by this author , Stephen KrausStephen Kraus San Antonio, TX More articles by this author , Larry SirlsLarry Sirls Royal Oak, MI More articles by this author , Halina ZyczynskiHalina Zyczynski Pittsburgh, PA More articles by this author , Peggy NortonPeggy Norton Salt Lake City, UT More articles by this author , Ann GormleyAnn Gormley Hanover, NH More articles by this author , and John KusekJohn Kusek Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.774AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transobturator and retropubic midurethral slings (TMUS and RMUS) are common surgical techniques for women with stress urinary incontinence (SUI), but their longer-term comparative efficacy is unknown. We assessed 24-month outcomes in a randomized equivalence trial of TMUS and RMUS. METHODS Primary outcomes were objective and subjective SUI cure rates at 12 and 24 months after surgery; 12-month outcomes were reported previously. Objective cure was defined as a negative stress test, negative pad test and no retreatment. Subjective cure was defined as no self-reported SUI symptoms, no leakage episodes on 3-day bladder diary and no retreatment. An equivalence margin of +/- 12% was established a priori. The primary analysis for equivalence was per protocol (assigned surgery performed); all other analyses were intention-to-treat. Secondary outcomes included persistent or de novo urge incontinence; voiding dysfunction and mesh complications; patient satisfaction, and scores on Urinary Distress Inventory (UDI) and Incontinence Impact Questionnaire (IIQ). RESULTS 516 (88.5%) of 583 randomized participants who received the assigned surgery completed the 24-month assessment. Mean age was 53 + 11 years. Objective success rates for RMUS and TMUS were 77.3% and 72.3%, respectively (95% CI for difference of 5.1%: -2.0, 12.1%). Subjective success rates were 55.7% and 48.3% (CI for difference of 7.4%: -0.7, 15.5%). The statistical test for equivalence was inconclusive for both objective and subjective success. No differences were noted between the groups with regard to patient satisfaction (RMUS 86.3% vs. TMUS 88.1%, p=0.58), change in total UDI scores (RMUS 100 vs. TMUS 107, p =0.13), change in total IIQ scores (RMUS 125 vs. TMUS 124, p=0.89), de novo urge incontinence (RMUS 0% vs. TMUS 0.3%, p= 0.99), persistent urge incontinence (RMUS 14.1% vs. TMUS 12.7%, p=0.63) or mesh exposure (RMUS 1.3% vs. TMUS 0.7%, p=0.41). Similar to findings at 12 months, the RMUS group had higher rates of voiding dysfunction requiring surgery (3.0% vs. 0%, p=0.002) and urinary tract infections (17.1% vs. 10.7%, p=0.025), and the TMUS group had a higher rate of neurologic symptoms (4.4% vs. 9.4%, p=0.023). CONCLUSIONS Although objective outcomes of RMUS and TMUS were equivalent at 12 months, 24-month objective and subjective cure rates did not meet predefined criteria for equivalence. Patient satisfaction remained high and symptom severity remained markedly improved compared to baseline for both groups. No additional differences in adverse events were identified. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e467 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Albo San Diego, CA More articles by this author Heather Litman Watertown, MA More articles by this author Gary Lemack Dallas, TX More articles by this author Holly Richter Birmingham, AL More articles by this author Toby Chai Baltimore, MD More articles by this author Kimberly Kenton Maywood, IL More articles by this author Stephen Kraus San Antonio, TX More articles by this author Larry Sirls Royal Oak, MI More articles by this author Halina Zyczynski Pittsburgh, PA More articles by this author Peggy Norton Salt Lake City, UT More articles by this author Ann Gormley Hanover, NH More articles by this author John Kusek Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Retropubic versus Transobturator Midurethral Slings for Stress Incontinence

Midurethral slings are increasingly used for the treatment of stress incontinence, but there are limited data comparing types of slings and associated complications. We performed a multicenter, randomized equivalence trial comparing outcomes with retropubic and transobturator midurethral slings in women with stress incontinence. The primary outcome was treatment success at 12 months according to both objective criteria (a negative stress test, a negative pad test, and no retreatment) and subjective criteria (self-reported absence of symptoms, no leakage episodes recorded, and no retreatment). The predetermined equivalence margin was +/-12 percentage points. A total of 597 women were randomly assigned to a study group; 565 (94.6%) completed the 12-month assessment. The rates of objectively assessed treatment success were 80.8% in the retropubic-sling group and 77.7% in the transobturator-sling group (3.0 percentage-point difference; 95% confidence interval [CI], -3.6 to 9.6). The rates of subjectively assessed success were 62.2% and 55.8%, respectively (6.4 percentage-point difference; 95% CI, -1.6 to 14.3). The rates of voiding dysfunction requiring surgery were 2.7% in those who received retropubic slings and 0% in those who received transobturator slings (P=0.004), and the respective rates of neurologic symptoms were 4.0% and 9.4% (P=0.01). There were no significant differences between groups in postoperative urge incontinence, satisfaction with the results of the procedure, or quality of life. The 12-month rates of objectively assessed success of treatment for stress incontinence with the retropubic and transobturator approaches met the prespecified criteria for equivalence; the rates of subjectively assessed success were similar between groups but did not meet the criteria for equivalence. Differences in the complications associated with the two procedures should be discussed with patients who are considering surgical treatment for incontinence. (ClinicalTrials.gov number, NCT00325039.)

Pelvic floor muscle training in female stress urinary incontinence: comparison between group training and individual treatment using PERFECT assessment scheme

Pelvic floor muscle training (PFMT) is a treatment for stress urinary incontinence (SUI) that can be done individually or in a group. The aim of this study was to compare these two types of treatment. Sixty women 30 to 75 years old with SUI were randomly assigned to participate in the two groups. They were evaluated before and after the treatment with the Oxford grading system, pad test, voiding diary, and the King's Health Questionnaire. Both groups experienced significant reductions in urinary leakage as measured by the pad test and bladder diary. A negative pad test was observed in about 50% of patients in both groups. There were statistically significant improvements in both muscle strength and quality of life. When the groups were compared, there were no differences in the results between them. Individual treatment and group PFMT appear to be equally effective for improving SUI.

Irritative symptoms are the main predictor of satisfaction rate in women after transobturator tape procedures

A study was performed to assess the satisfaction rate (SR) after transobturator procedures in pad negative women. All patients were asked to complete Urogenital Distress Inventory (UDI) questionnaire. SR after the procedure was estimated by means of VAS scale. Two groups were formed (group 0, 100% SR; group 1, <100% SR) and compared by means of Student t test and Chi-square test. Predictors of SR were tested by linear regression model. Data was available for 168 women. The mean follow-up was 18.4 weeks, a negative pad test was observed in 153 patients (91.1%). Less than 100% SR was observed in 83 (54.2%) women with negative pad test. SR was significantly predicted by total UDI and irritative UDI score after surgery (p < 0.001), the later bearing also greatest negative impact on QoL (p < 0.001). Irritative symptoms are the main reason for dissatisfaction of patients with surgical outcome.

Eleven years prospective follow-up of the tension-free vaginal tape procedure for treatment of stress urinary incontinence

The aim of this study was to evaluate the long-term effectiveness and safety of the tension-free vaginal tape (TVT) procedure. In a Nordic three-center prospective observational cohort study, 90 women with primary stress incontinence had a TVT operation performed in local anesthesia. Assessment included a 24-h pad test, a stress test, physical examination, and a visual analog scale for assessing the degree of bother. Patient's global impression of cure was obtained, and condition specific quality of life questionnaires were used. Seventy-seven percent of the initial cohort of 90 women and 89% of those alive and capable of cooperating were assessed 11.5 years after the TVT operation. Ninety percent of the women had both a negative stress test and a negative pad test being objectively cured. Subjective cure by patients global impression was found in 77%, 20% being improved and only 3% regarded the operation as a failure. No late-onset adverse effects of the operation were found, and no case of tape erosion was seen. The TVT procedure is safe and effective for more than 10 years.