Persistent Urinary Incontinence Research Articles

LeFort Colpocleisis: Unmet Expectations about Correction of Urinary Symptoms Are Related to Disappointment and Regret

ABSTRACT Introduction and Hypothesis: The aims of this study were to define long-term anatomic outcome, satisfaction rate, and reasons for disappointment and regret in a group of patients with advanced pelvic organ prolapse who underwent LeFort colpocleisis (LFC). Materials and Methods: This was a retrospective, single-center, cohort study including consecutive patients who underwent LFC from 2007 to 2021. All patients had surgery involving vaginal hysterectomy and anti-incontinence procedure where clinically indicated. All patients were examined 3 months after surgery. A cross-sectional telephone survey was performed in 2022 using the Patient Global Impression of Severity (PGI-S), Patient Global Impression of Improvement (PGI-I), and Patient Global Impression of Change (PGI-C) questionnaires, as well as the Decision Regret Scale. Student’s t-test, Fisher’s Chi-square test, and univariable logistic regression analysis were carried out. Results: One hundred and forty-one patients (mean age 74.95 ± 6.25 years) were included. The mean preoperative POP Quantification C/D point was +6 (±2.7). In 86 (60.99%) patients, a hysterectomy and in 56 (39.71%), a mid-urethral synthetic sling was performed. At 3-month follow-up, there was one prolapse recurrence (0.71%) and no case of regret of sexual function loss. In the long term, 28 patients died, and 69 patients were interviewed through telephone (follow-up 61.65 months). The mean PGI-S, PGI-I, and PGI-C scores were 1.42 (±0.81), 1.93 (±1.45), and 5.91 (±1.69) respectively, and no patient declared regret about vaginal intercourse loss. Preoperative and postoperative persistent or de novo mixed UI appeared to be related to decreased satisfaction and regret post-LFC (P = 0.0021). Conclusion: LFC is a valuable, easy-to-perform technique with long-lasting results and decreased postoperative anti-incontinence rates. However, de novo or persistent urinary incontinence appears to be related to decreased satisfaction rates.

Multiple urogenital abnormalities and urine incontinence in a sexually ambiguous goat (Capra aegagrus hircus)

AbstractA 6‐month‐old, phenotypic, male Nigerian dwarf goat presented after bilateral abdominal gonadectomy for persistent urinary incontinence. Physical examination revealed a caudally positioned cliteropenis with an abnormally enlarged urethral opening. Abdominal ultrasound and computed tomography revealed a fluid‐filled structure dorsal to the urinary bladder. The structure was removed by caudal midline laparotomy. Communication between the structure and proximal urethra was confirmed in surgery. Unexpected separation of the structure from the urethra in surgery necessitated normograde catheterisation through a cystotomy to pull a catheter retrograde into the bladder. Histopathology confirmed the structure as a hypoplastic uterus. The goat regained normal urine continence following surgery.

Placement of an artificial urethral sphincter in 8 male dogs with urethral diverticulum.

Urethral diverticulum (UD) is a poorly defined anomaly consisting of an outpouching of the urethra. Management without surgical resection is not previously reported in dogs. Report the outcome of male dogs presented for urinary incontinence with UD treated with an artificial urethral sphincter (AUS). Eight client-owned dogs with UD treated with an AUS. Multicenter retrospective study. Medical records from male dogs with urinary incontinence were reviewed. diagnosis of a UD by retrograde cystourethrography, cystoscopy, abdominal ultrasonography or contrast computed tomodensitometry (CT) or a combination of these modalities, AUS placement, and at least 1 follow-up. Urinary continence score (UCS) was attributed retrospectively. Median UCS at presentation was 1/5. A contrast cystourethrogram was diagnostic in 8/8 dogs. All diverticula were saccular, and 7/8 were within the prostatic urethra and 1/8 extended up to the membranous urethra. A congenital origin was suspected in 7 dogs and acquired in 1. Concurrent anomalies included renal dysplasia or chronic pyelonephritis (n = 4), bilateral cryptorchidism (n = 3), and pelvic urinary bladder (n = 3). All dogs were poorly/moderately responsive to phenylpropanolamine. Artificial urethral sphincter placement resulted in improvement in continence in all dogs with a median UCS of 4/5 (5/5 in 2/8 dogs, 4/5 in 5/8 dogs, 3/5 in 1/8 dogs). Urethral diverticulum should be considered in male dogs with persistent urinary incontinence not responding to medical management. Artificial urethral sphincter placement is an effective therapeutic option that improved continence scores in all dogs.

Midurethral Sling Mesh Exposure Confers a High Risk of Persistent Stress Urinary Incontinence.

The objective was to investigate the relationship between mesh exposure and persistent stress urinary incontinence (SUI) post-midurethral sling (MUS) surgery. Extensive data collection including patient demographics, obstetric history, existing medical conditions, previous surgeries, and surgical outcomes, encompassing both perioperative and postoperative complications. Out of 456 patients who underwent the MUS procedure within the specified period, the persistence of SUI was noted in 6.4% of cases. Mesh exposure was observed in 8.8% of these cases. Notably, 25% of patients with mesh exposure suffered from persistent SUI, in stark contrast to 4.6% of those without mesh exposure (p < 0.0001). Further, multivariate analysis indicated that patients with mesh exposure had an approximately 6.5-fold increased likelihood (95% CI: 2.71-15.44) of experiencing persistent SUI compared with those without mesh exposure. Mesh exposure is a significant independent risk factor for persistent SUI post-MUS surgery. Patients with mesh exposure are about 6.5 times more prone to persistent SUI than those without. Although mesh exposure is typically managed with expectant measures, vaginal estrogen or mesh excision, current evidence does not support surgical revision of MUS affected by mesh exposure or additional incontinence procedures during mesh excision.

The Potential of Non-ablative Erbium (YAG) Laser Treatment for Complications After Midurethral Sling Surgery: A Narrative Review.

Midurethral sling (MUS) surgery, using tension-free vaginal tape and transobturator tape, has been widely adopted for the treatment of stress urinary incontinence (SUI). However, postoperative complications, including persistent urinary incontinence, mesh exposure, and pain, have become problematic, and surgical treatments for these complications face challenges, such as invasiveness, treatment-resistant cases, and recurrence. This review provides an overview of the current evidence regarding these complications and the potential of vaginal non-ablative erbium (YAG) laser (VEL) treatment as a minimally invasive option with low risk of complications. Studies have suggested the effectiveness of VEL treatment, performed using devices such as IncontiLase (SP Dynamis; Fotona d.o.o., Ljubljana, Slovenia), for persistent urinary incontinence after MUS surgery, pain following mesh removal, and asymptomatic mesh exposure. VEL treatment is expected to be a new treatment option for complications following MUS surgery; however, further large-scale comparative trials are required to verify its efficacy and safety and to establish criteria for its indications. Appropriate assessment of the indications and provision of sufficient information to patients is important when presenting VEL as a treatment option.

Pathological Insights on Polypropylene Mesh Complications From Laparoscopic Sacrocolpopexy: A Case Series.

Background The use of polypropylene mesh in laparoscopic sacrocolpopexy (LSC) is a common treatment for pelvic organ prolapse (POP). Despite its widespread application, postoperative complications such as mesh pain and infection sometimes necessitate the removal of the mesh. However, it remains unclear in which cases mesh removal is warranted. Our research focused on the pathological changes at the sacral fixation point of the mesh. We sought to evaluate the pathological alterations of the sacral mesh removed through an innovative approach of transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Methods This retrospective study included nine patients who underwent mesh removal surgery at the Yokosuka Urogynecology and Urology Clinic in 2023. Extraction surgery was performed using vNOTES with the GelPoint Access Platform (Applied Medical JAPAN HEADQUARTERS, Tokyo, Japan). Non-ablative Erbium YAG and Neodymium YAG lasers (RenovaLase, SP Dynamis; Fotona d.o.o., Ljubljana, Slovenia) were utilized for persistent stress urinary incontinence, fecal incontinence, vaginal erosion, and bleeding after surgery. Patients were categorized based on mesh fixation conditions, including unintended mesh overlap (Group I), excessive traction (Group II), and signs of mesh aging (Group III). This categorization helped to understand the distinct pathological outcomes associated with each condition. Results Pathological findings from the mesh removed via vNOTES varied significantly across the groups. In Group I, characteristic large vacuole formation and accumulation of atypical giant cells were observed, attributed to mesh overlap. Group II presented with vacuole formation, fiber degradation, and tissue destruction as a result of excessive mesh traction. In Group III, the aging of the mesh was marked by cracks in the surrounding tissues and granuloma formation. These detailed observations provide crucial insights into the underlying causes of mesh-related pain and other complications, highlighting the complexity of bodily responses to mesh implants. Conclusion This study demonstrated the effectiveness of vNOTES for polypropylene mesh removal in patients with post-LSC complications, resulting in significant pain reduction. Pathological analysis revealed that mesh-related issues stem from the surgical techniques, mesh properties, and long-term bodily reactions. These findings provide valuable insights for improving mesh design and POP treatment strategies. Despite the technical challenges, vNOTES is recommended for mesh removal in patients with pain. Additionally, the combination of UEL, VEL, targeted laser irradiation, AEL, and Nd:YAG laser treatments showed promising results in managing post-mesh removal complications such as stress urinary incontinence, vaginal erosion, bleeding, and fecal incontinence, offering hope for improved patient outcomes.

Laser excision of urethral mesh erosion: a 10-year experience.

To review our 10-year experience with laser excision for urethral mesh erosion (UME) of mid-urethral slings (MUS). Following Institutional Review Board approval, the charts of female patients with endoscopic laser excision of UME were retrospectively reviewed. Demographics, clinical presentation, surgical history, pre- and post-operative Urinary Distress Inventory-6 scores and quality of life ratings, operative reports, and outcomes were obtained from electronic medical records. UME cure was defined as no residual mesh on office cystourethroscopy 5-6months after the final laser excision procedure. From 2011 to 2021, 23 patients met study criteria; median age was 56 (range 44-79) years. Twenty (87%) had multiple prior urogynecologic procedures. Median time from MUS placement to presentation with UME-related complaints was 5.3 [interquartile range (IQR) 2.3-7.6] years. The most common presenting symptom was recurrent urinary tract infection (rUTI) (n = 10). Median operating time was 49 (IQR 37-80) minutes. Median duration of follow-up was 24 (IQR 12-84) months. Fourteen (61%) required more than 1 laser excision procedure for UME. Although 5 were asymptomatic (22%), new (n = 5) or persistent (n = 8) urinary incontinence was the most common symptom on follow-up (57%). UME presenting symptoms are highly variable, necessitating a high index of suspicion in patients with a history of MUS, especially in the case of rUTI. Endoscopic laser excision is a minimally invasive, brief, safe, outpatient procedure with a high UME cure rate.

Persistent and De Novo Stress Urinary Incontinence After Minimally Invasive Sacrocolpopexy.

Data on stress urinary incontinence (SUI) after minimally invasive sacrocolpopexy (SCP) with or without midurethral sling placement are limited. The aim of the study was to determine the incidence of SUI after minimally invasive sacrocolpopexy. This was a secondary analysis of 2 randomized clinical trials of participants undergoing SCP. Participants completed symptom assessment and urodynamic testing. Participants underwent SCP with or without midurethral sling placement. Preoperatively, participants were defined as having symptomatic SUI, occult SUI, or no SUI. Participants completed the Pelvic Floor Distress Inventory-20 at 6 and 12 months postoperatively and were categorized as having persistent SUI in the setting of symptomatic or occult SUI or de novo SUI. Eighty-one participants were included. Sixty-one participants met inclusion criteria for the persistent SUI analysis: 42 participants with symptomatic SUI and 19 participants with occult SUI. There were 20 participants in the de novo SUI group. The overall incidence of persistent SUI was 26.2% (95% confidence interval [CI], 15.8%-39.1%) with 33.3% (95% CI, 19.6%-49.6%) of symptomatic and 10.5% (95% CI, 1.5%-33.1%) of occult participants. Bothersome symptoms were defined as "moderately" or "quite a bit" bothered postoperatively. Of participants with symptomatic SUI, 14.3% participants were bothered and no participants underwent retreatment. No patient with occult SUI was bothered; however, 1 patient underwent retreatment. The incidence of de novo SUI was 45% (95% CI, 23.1%-68.5%). No patient in the de novo SUI group was bothered or underwent SUI treatment. Approximately 1 in 4 participants reported persistent SUI. Almost 50% reported de novo SUI. However, few participants were bothered or underwent treatment.

Persistent urinary incontinence in female Golden Retrievers following laser ablation of intramural ectopic ureters may be associated with the presence of historical urinary tract infection.

To identify predictive factors for postoperative continence in female Golden Retrievers following cystoscopic-guided laser ablation of intramural ectopic ureters (CLA-EU). 41 client-owned female entire Golden Retrievers with uni- or bilateral intramural ectopic ureter(s) were retrospectively enrolled. Patients were diagnosed with ectopic ureters with a combination of ultrasonography and cystoscopy. CLA-EU was performed for all dogs so that each ureteral opening was considered to be in an appropriate position by a single operator. All dogs had short-term follow-up 4 weeks and long-term follow up > 10 weeks after the procedure via telephone, which included urinary continence scoring. Clinical factors and ultrasonographic and cystoscopic findings from initial presentation were evaluated to identify predictive factors for postoperative continence. Short-term urinary continence was achieved in 46.3% of dogs with no additional medical therapies. Presence of historical urinary tract infections prior to CLA-EU (OR, 0.130; 95% CI, 0.020 to 0.621; P = .018) was negatively correlated and ureteral dilatation (OR, 34.260; 95% CI, 1.813 to 2,143; P = .043) was positively correlated with likelihood of urinary continence. Long-term urinary continence was achieved in 63.4% of dogs, and presence of historical urinary tract infections was negatively prognostic (OR, 0.173; 95% CI, 0.023 to 0.856; P = .048). Female Golden Retrievers undergoing CLA-EU have similar outcomes to those reported for other mixed-breed cohorts with > 30% of dogs failing to regain urinary continence. Historical urinary tract infections were significantly associated with both short- and long-term urinary continence in our population.

Using a stress reservoir to improve urine leakage after artificial urinary sphincter implantation.

Although the longest efficacy record, some patients report about urinary leakage during higher intra-abdominal pressure after Artificial Urinary Sphincter (AUS) implantation. To improve the continent results, we placed in addition to the occluding cuff and the pressure regulating balloon, in a second procedure a stress-relief reservoir in lower abdomen, for additional passive pressure transmission to the occluding cuff. In this retrospective monocentric data analysis between 2011 and 2018, 80 patients with persistence incontinence after AUS implantation were included. Stress-relief reservoir was indicated in 12 patients with involuntary leakage of urine, that occurred when intra-abdominal pressure raised. In all 12 cases, the stress reservoir was easily implanted and there were no intraoperative complications. In a mean follow-up time of 53months, the pad per day usage (p/d) improved from 3 (± 1.2) to 1.7 (± 1.5) (p = 0.001). Two patients with multiple previous abdominal surgeries used an equal number of pads after SRR; however, an improvement during physical exertion was reported. Continence situation was evaluated with a questionnaire and was rated as "excellent", "good", or "satisfactory" by 11 (92%) patients. The persistence of urinary incontinence after AUS is a challenging topic. Implantation of a stress reservoir in carefully selected patients with urinary leakage during higher intra-abdominal pressure is minimally invasive and offers new options to improve the proven long-term record of AUS. Certainly, more investigations are needed to determine the clinical relevance of this approach.

Predictors of Long-Term Urinary Incontinence After Robot-Assisted Laparoscopic Prostatectomy.

Urinary incontinence is a major complication after radical prostatectomy. We analyzed the predictors of urinary incontinence after robot-assisted radical prostatectomy. One hundred twenty-one patients, whose urinary continence status was evaluable at 3 months, 6 months, and 12 months after robot-assisted radical prostatectomy, were included from October 2016 to September 2021. Data were retrospectively collected from electronic medical records. The continence status was evaluated by interviewing the patients about the number of urinary pads used per day. We compared the patients' age, body mass index, prostate volume, membranous urethral length on preoperative magnetic resonance imaging, surgeon experience, and pathological findings between patients with and without regained continence at 12 months after robot-assisted radical prostatectomy. The urinary continence rates were 30%, 57.8% and 79.3% at 3 months, 6 months, and 12 months, respectively, after robot-assisted radical prostatectomy. Twelve months after robot-assisted radical prostatectomy, 96 patients had regained continence and did not require urinary pads, whereas 25 patients had persistent urinary incontinence and required urinary pads. Membranous urethral length and surgeon experience were significantly different between patients with and without regained continence at 12 months after robot-assisted radical prostatectomy (P=0.05). However, no significant differences existed in age, body mass index, prostate volume, and pathological findings between patients with and without regained continence at 12 months after robot-assisted radical prostatectomy. Membranous urethral length and surgeon experience are predictors of urinary incontinence after robot-assisted radical prostatectomy. Measuring the membranous urethral length is recommended before performing the operation.

Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation.

This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS). Data from our institutional AUS database spanning the period from 2009 to 2020 were retrospectively analyzed. The number of pads per day was determined, a standardized quality of life (QoL) questionnaire and the International Consultation on Incontinence Questionnaire (ICIQ) were administered, and postoperative complications according to the Clavien-Dindo classification were analyzed. Out of 477 patients who received AUS implantation during the study period, 25 (5.2%) underwent cuff downsizing (median age, 77 years; interquartile range [IQR], 74-81 years; median follow-up, 4.4 years; IQR, 3-6.9 years). Before downsizing, SUI was very severe (ICIQ score 19-21) or severe (ICQ score 13-18) in 80% of patients, moderate (ICIQ score 6-12) in 12%, and slight (ICIQ score 1-5) in 8%. After downsizing, 52% showed an improvement of >5 out of 21 points. However, 28% still had very severe or severe SUI, 48% had moderate SUI, and 20% had slight SUI. One patient no longer had SUI. In 52% of patients, the use of pads per day was reduced by ≥50%. QoL improved by >2 out of 6 points in 56% of patients. Complications (infections/urethral erosions) requiring device explantation occurred in 36% of patients, with a median time to event of 14.5 months. Although cuff downsizing carries a risk of AUS explantation, it can be a valuable treatment option for selected patients with persistent or recurrent SUI after AUS implantation. Over half of patients experienced improvements in symptoms, satisfaction, ICIQ scores, and pad use. It is important to inform patients about the potential risks and benefits of AUS to manage their expectations and assess individual risks.

A narrative review: evaluation and surgical management of persistent and recurrent urinary incontinence after previous surgical treatment.

Urinary incontinence after prostate treatment is associated with significant morbidity and impact on quality of life. Stress urinary incontinence can be treated by insertion of a urethral sling or artificial urinary sphincter. Persistent or recurrent urinary incontinence after such treatment can be frustrating and require specific evaluation and approach to management to optimize chance of successful outcomes and patient satisfaction whilst avoiding further patient morbidity. The aim of this review is to outline the evaluation and management of persistent and recurrent urinary incontinence in men after previous surgical treatment for stress urinary incontinence by way of narrative review. A literature review was performed using PubMed, MEDLINE, and Google Scholar between 2010 to 2023. The search strategy included the following MeSH terms: device, men, urinary incontinence, persistence, recurrence, and revision. A total of 140 English-language articles were identified and reviewed; 68 articles were considered relevant to the aims and the findings have been outlined in this narrative review. There are many approaches currently practiced by surgeons in continence revision surgery. There is not clear consensus regarding optimum revision strategy for persistent and recurrent incontinence post urethral sling and artificial urinary sphincter insertion. Whilst small observational studies have reviewed different surgical approaches, there is a paucity of high volume comparative data from which to draw conclusions. However, there have been recent studies enabling a paradigm shift in the understanding of incontinence post artificial urinary sphincter insertion that may lead to improved revision strategies in future. There are various surgical modalities used to manage incontinence following urethral sling and artificial urinary sphincter insertion. There is currently no clear consensus on the optimal surgical technique for persistent or recurrent urinary incontinence after surgery. Further comparative studies would be beneficial to help guide surgeons as to which revision approaches would be suitable for select patients.

Uterus Masculinus with a Patent Urethral Communication Documented with Positive Contrast Computed Tomography.

A 9 mo old male Labrador retriever presented for investigation into persistent urinary incontinence. Abdominal ultrasound and retrograde urethrocystogram with computed tomography documented a uterus masculinus (UM), which was confirmed on histopathology after surgical removal. A connection between the UM and the urethra was present, documented by positive contrast retrograde urethrocystography and confirmed with surgery. Typically, in the literature, UM are blind ending, and there are only a few case reports that demonstrate an assumed connection. This case has demonstrated a patent connection between the UM and the urethra, which should be considered a differential diagnosis for persistent urinary incontinence and urinary tract infection in juvenile male dogs.

Mesh Exposure After Midurethral Sling Procedures Confers a High Risk of Persistent Stress Urinary Incontinence [ID: 1373885

INTRODUCTION: Stress urinary incontinence (SUI) affects between 4% and 35% of adult women. Midurethral slings (MUSs) are the gold standard for the treatment of SUI. Mesh exposure has been reported in 4.7–16.4% of patients who undergo MUS. It is unclear whether mesh exposure portends an increased risk of persistent SUI. The purpose of this study was to determine whether mesh exposure is associated with MUS failure/persistent SUI. METHODS: This was a retrospective cohort study from December 1, 2015 to January 1, 2022, of all patients who had a MUS procedure at a large community hospital. The primary outcome was persistent SUI at the 12-week postoperative appointment after MUS in patients with and without mesh exposure. RESULTS: A total of 456 patients underwent MUS procedure. The incidence of persistent SUI and mesh exposure was 6.4% and 8.8%, respectively. Twenty-five percent of patients with mesh exposure experienced persistent SUI, compared with 4.6% of patients without mesh exposure (P&lt;.0001). In univariable analysis, mesh exposure and postmenopausal status were associated with persistent SUI while asthma was associated with mesh exposure. In logistic regression, persistent SUI was 6.5 times higher in patients with MUS mesh exposure compared to those without mesh exposure (adjusted odds ratio 6.46, 95% CI 2.71–15.44). CONCLUSION: Mesh exposure is an independent risk factor for persistent SUI. Patients with mesh exposure are approximately seven times more likely to experience persistent SUI compared to patients without mesh exposure. Currently, there is insufficient evidence to recommend surgical revision of MUSs complicated by mesh exposure, and further studies are warranted.

Kidney Transplantation After Multiple Urinary Tract Conversion with an Ileal Conduit: A Case Report

Kidney transplantation (KTx) after urinary tract conversion surgery is extremely difficult due to several complications. In our case, KTx was performed after multiple operative procedures, including diversion urethrostomy. The patient was a 46-year-old woman with a right atrophic kidney, an ectopic opening of the left ureter, and urethral dysplasia since birth. The patient underwent a right nephrectomy, left ureteral sigmoidostomy, Stamey surgery, augmentation ileocystoplasty, and left ureteroileostomy. Thereafter, she underwent nephrostomy, ileal conduit diversion, open sigmoid colectomy, and total cystectomy because of persistent urinary incontinence, sigmoid colon cancer, and recurrent cystitis. Her renal function gradually deteriorated, and hemodialysis was initiated. Before the KTx, she underwent laparoscopic left nephrectomy, an intraperitoneal adhesion debridement, and left ileal conduit resection. We dissected the left ileal conduit in the abdominal cavity and penetrated the anorectal side of the free ileal conduit into the wall of the right side of the abdomen. Thereafter, a kidney from a living donor was transplanted into the right iliac fossa through the existing right ileal conduit when the patient was 46 years old. The allograft function was stable without rejection for 2 years. We report the case of a patient who underwent multiple urethral modifications followed by ileal conduit transfer and living donor KTx, which progressed without major postoperative complications.

POST-PROSTATEKTOMİ İNKONTİNANSTA İNTRİNSİK SFİNKTER DİSFONKSİYONU DIŞINDAKİ NEDENLER DE AKILDA BULUNDURULMALIDIR

Objective: This study aims to determine the causes of urinary incontinence and accompanying bladder pathologies in patients with persistent incontinence 12 months after radical prostatectomy.&#x0D; Methods: Thirty-four patients who underwent open radical retropubic prostatectomy (RRP) due to localized prostate cancer and incontinent after surgery between January 2015 and December 2020 and underwent urodynamic study (UDS) were retrospectively reviewed. All UDSs were performed according to the ICS protocol of good urodynamic practice and assessed by the same doctor. Patients were assessed by demographic and clinical parameters including age, body mass index (BMI), comorbidity, preoperative PSA level, prostate volume (PV), transrectal prostate biopsy Gleason score, clinical stage, pathological ISUP grade, pathological stage, lymph node positivity, international consultation on incontinence questionnaire-short form and subjective questionnaire for daily pad use.&#x0D; Results: Urodynamic studies showed that 29 patients (85.2%) had intrinsic sphincter deficiency (ISD). Nine (26.4%) of 29 patients with ISD had a secondary diagnosis of overactive bladder (OAB), impaired detrusor contractility (IDC) and OAB+IDC 9 (11.6%), 4 (11.6%), 1 (2.9%), respectively. Nineteen patients (55.8%) had a sole diagnosis of ISD, whereas 15 patients (44.1%) had another primary diagnosis or a secondary diagnosis other than ISD. &#x0D; Conclusion: Although ISD is the most common cause of persistent urinary incontinence in patients after radical prostatectomy, it should be taken into account that overactive bladder and impaired detrusor contractility are also accompanied by a significant proportion of patients.

Longitudinal analysis of persistent stress urinary incontinence after radical prostatectomy and time to definitive surgical treatment: Data from CaPSURE.

347 Background: Persistent urinary incontinence (UI) after radical prostatectomy (RP) can have significant impact on quality of life, return to work and need for additional surgery. We aim to characterize the long-term cumulative incidence of incontinence procedure and report changes in urinary function (UF), urinary bother (UB), and work status from time of RP to 1 year postop. Methods: Participants treated by primary RP (1990-2020) for prostate cancer enrolled in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry of 43 US urologic practices. UI was defined as self-reported use of &gt;1 pad per day at 1 year after RP. UI procedure was tracked with CPT codes for urinary sling and artificial urinary sphincter (AUS). Participants reported work status (full-time paid, part-time paid, unpaid) and urinary scores (0-100) using UCLA Prostate Cancer Index. Associations of incontinence with changes in urinary scores (t-test) were assessed. Lifetable estimates and Cox proportional hazards regression were used to evaluate the risk of undergoing a UI surgical procedure, with model adjustment for pre-treatment age and urinary dysfunction, surgical characteristics, and post-surgical radiation. Results: Of 5742 men treated with primary RP, 641 (11%) reported UI as defined above at 1 year post-RP. Mean age was 61 years. A larger proportion of individuals with UI underwent open RP (93% vs 7%) and non-nerve sparing (62% vs 38%). At 1 year post RP, score decline in UF (-42.6 vs -11.7) and UB (-25.5 vs -2.7) were significantly worse in the incontinent group (all p&lt;0.01). Cumulative incidence of incontinence procedures was 1.4% at 10 years with median time to UI-redirected procedure of 36 months (IQR 12, 74) after RP. Incontinence procedures comprised 52.4% AUS, 15.8% sling, 6.3% both, and 25.4% unspecified. UI (HR 10.6,95%CI 6.3-17.9), older age (per decade, HR 2.0, 95% CI1.3-3.0), history of voiding dysfunction (HR 6.1,95% CI 2.9-12.8) and receipt of radiation (adjuvant or salvage) (HR 2.4, 95% CI1.2-4.8)) were associated with undergoing incontinence procedure. Conclusions: UI at 1 year after RP may occur in up to 11% of surgical recipients. However, the rate of intervention remained low with 1.4% of the total cohort undergoing an incontinence procedure within 10 years. Incontinence affected urinary quality of life. Median time to UI procedure was 36 months. This information suggests that a significant number of men may have long – term, untreated incontinence and even those who undergo procedures to manage it may not have it in a timely fashion.

Latest Evidence on Post-Prostatectomy Urinary Incontinence.

A radical prostatectomy is frequently used as the first-line treatment for men with prostate cancer. Persistent urinary incontinence after surgery is one of the most severe adverse events. We report the results of a comprehensive literature search focused on post-prostatectomy urinary incontinence (PPI), performed by a panel of experts on non-neurogenic lower urinary tract symptoms. The data on the prevalence and timing of PPI are very heterogeneous. The etiology of PPI can be multifactorial and mainly dependent on patient characteristics, lower urinary tract function or surgical issues. The medical history with a physical examination, the use of validated questionnaires with a voiding diary and pad tests are determinants in identifying the contributing factors and choosing the right treatment. Lifestyle intervention and urinary containment are the most frequently used strategies for the conservative management of PPI, while antimuscarinics, beta-3 agonists and duloxetine (off-label) are drugs indicated to manage PPI with a concomitant overactive bladder. Surgical therapies for the management of post-prostatectomy SUI include non-adjustable trans-obturator slings in men with mild-to-moderate incontinence and an artificial urinary sphincter in men with moderate-to-severe incontinence.

Midterm postoperative results of mid-urethral slings. Role of ultrasound in explaining surgical failures.

Surgical treatment for stress urinary incontinence (SUI) with mid-urethral sling (MUS) is considered to have a high success rate. However, between 5% and 20% of MUS fail, with inadequate surgical implantation being a possible cause of SUI persistence or recurrence. Misplacement of a MUS can be determined by pelvic floor ultrasound (PF-US). The aim of this study was to investigate the role of PF-US in patients with persistent or recurrent urinary incontinence(UI) symptoms after MUS surgery for SUI with a midterm follow-up. A historical cohort study including women undergoing MUS surgery for SUI between 2013 and 2015 was designed. The primary outcome was to correlate the sonographic parameters of MUS with SUI cure (negative International Continence Society-Uniform Cough Stress Test, Incontinence Questionnaire-Short Form < 5 points and no symptoms of SUI), at 5years postsurgery. Secondary outcomes were changes of maximum urethral closure pressure (MUCP) and symptoms of urgency urinary incontinence (UUI) at 1 and 5 years after surgery. Eighty-seven patients (80 transobturator-MUS, 7 retropubic-MUS) were included. At 5 years all patients referred improvement of UI and objective cure of SUI was demonstrated in 81.2%. The MUS was sonographically correct in 67 (98.5%) of the 68 patients with cure of SUI. The MUS was considered incorrectly placed in only 4 (28.6%) of the 14 patients with noncured SUI. MUCP decreased from 61.9 to 48.8 cmH2 O at 5 years of follow-up (p < 0.01) and up to 53% of women had UUI symptoms after surgery, with a nonsignificant decrease compared to baseline. Patients cured of SUI had sonographically correct MUS by PF-US. Less than one-third of cases of SUI persistence or recurrence after MUS surgery could be explained by a sonographically incorrect sling. Low urethral resistance and/or UUI symptoms could help to explain the remaining failures. Complete functional and anatomic studies, including urodynamics and PF-US, should be performed before deciding on the next management strategy in patients with SUI persistence or recurrence after MUS.