Procedure For Stress Urinary Incontinence Research Articles

Effect of lower urinary tract conditions on surgical outcomes of different suburethral sling procedures for female stress urinary incontinence.

The suburethral sling procedure has been widely used as the first-line treatment for female stress urinary incontinence (SUI). This study retrospectively compared the long-term surgical outcomes and complications between retropubic and transobturator suburethral sling procedures. From 2010 to 2022, a total of 533 women with SUI underwent retropubic pubovaginal sling (PVS) or transobturator tape (TOT) procedures using a synthetic polypropylene mesh with or without concomitant anterior colporrhaphy. All patients underwent preoperative videourodynamic studies, Valsalva leak point pressure (VLPP), and voiding efficiency (VE). The success rate, postoperative complications, overactive bladder symptoms, transvaginal urethrolysis, and repeat procedures were compared among different surgical procedures. Among the patients, PVS was performed in 251 (47.1%) patients and with colporrhaphy in 58 (10.9%), TOT in 174 (32.6%) and with colporrhaphy in 50 (9.4%). The success rate was 87.4% in the PVS group and 75.4% in the TOT group, with or without colporrhaphy (p = 0.001). Urethrolysis was performed in 4.7% of the patients, and repeat suburethral sling procedures were performed in 8.3%. The overall success rate was significantly lower in TOT group, either with high or low VLPP, or with high or low VE. The rate of persistent OAB was significantly higher in TOT group regardless of VLPP or VE, whereas patients with VE < 90% at baseline had a significantly higher rate of postoperative dysuria. TOT procedures had an inferior long-term success rate than PVS procedures for female SUI. Additionally, no differences in the success rate were observed between patients with different bladder functions, high or low VLPP, and high or low VE.

Changes in Stress Urinary Incontinence Symptoms after Pelvic Organ Prolapse Surgery: a Nationwide Cohort Study (FINPOP)

Introduction and hypothesisVarious strategies are employed to manage stress urinary incontinence (SUI) during pelvic organ prolapse (POP) surgery. This study was aimed at facilitating shared decision-making by evaluating SUI symptom changes, staged SUI procedures, and their prognostic factors following POP surgery without concomitant SUI intervention.MethodsWe analyzed 2,677 POP surgeries from a population-based observational cohort, excluding patients with prior SUI surgery. The outcome measures were subjective SUI utilizing the Pelvic Floor Distress Inventory-20 questionnaire and number of subsequent SUI procedures. Multivariable linear models were applied to identify predictors of persistent SUI, procedures for persistent SUI, and de novo SUI. The primary assessment occurred at the 2-year follow-up.ResultsAt baseline, 50% (1,329 out of 2,677) experienced SUI; 35% (354 out of 1,005) resolved, an additional 14% (140 out 1,005) improved, and 5.1% (67 out of 1,308) underwent a procedure for persistent SUI. De novo SUI symptoms developed in 20% (218 out of 1,087), with 3.2% (35 out of 1,087) reporting bothersome symptoms; 0.8% (11 out of 1,347) underwent a procedure for de novo SUI. High baseline symptom severity increased the risk of persistent SUI (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.65–2.53), whereas advanced preoperative apical prolapse decreased the risk (aOR 0.89, 95% CI 0.85–0.93). De novo SUI was more common with advancing age (aOR 1.03, 95% CI 1.01–1.05), baseline urgency urinary incontinence (aOR 1.21, 95% CI 1.06–1.38), and after transvaginal mesh surgery (aOR 1.93, 95% CI 1.24–3.00). It was not dependent on the compartment or preoperative degree of prolapse.ConclusionsIn a pragmatic setting, POP surgery results in a low rate of subsequent SUI procedures.

Midurethral sling position and surgical outcome: A meta-analysis.

There is still ongoing debate as to whether the outcome of the sling is determined by the position of the midurethral sling. In order to evaluate the potential impact of sling position on the outcomes of retropubic and transobturator sling procedures for stress urinary incontinence, it is necessary to conduct further investigations. We conducted a comprehensive search across various electronic databases such as PubMed, EMBASE, MEDLINE. Relevant data were extracted, organized in a table format, and analyzed using RevMan software for further analysis. This review comprised a total of 9 studies. The findings indicate that patients with TVT tape placement in the midurethra exhibited a slightly higher cure rate compared to those with proximal placement. Conversely, tape placement in the midurethra was associated with a significantly higher cure rate compared to distal placement [RR = 0.84, 95% CI (0.74-0.95), P < .05]. In the case of transobturator slings, tape positioning beneath the midurethra or distal urethra yielded better outcomes compared to placement near the bladder neck [RR = 0.74, 95% CI (0.57-0.94), P = .02; RR = 0.61, 95% CI (0.39-0.96), P = .03]. Based on 2D and 3D ultrasound imaging, differences in TVT placement appear to have minimal impact on the cure rate. However, the highest rate of failure after transobturator sling surgery is closely linked to the positioning.

Urinary Tract Infections After Urogynecologic Surgery: Risk Factors, Timeline, and Uropathogens

ABSTRACT Postoperative urinary tract infection (PO-UTI) is seen in 6.4%–32% of stress urinary incontinence (SUI) and/or pelvic organ prolapse (POP) surgeries despite perioperative antibiotic prophylaxis. Postoperative complications associated with PO-UTI include increased mortality and longer hospitalization. Increasing prevalence of resistance to antibiotics and antibiotic stewardship principles necessitate both the improvement of infection prevention strategies and judicious antibiotic prescriptions. Four factors are known to increase PO-UTI risk: (1) recurrent UTI (RUTI) history, (2) preoperative UTI, (3) day-of-surgery UTI, and (4) prolonged postoperative catheterization. This study intended to determine (1) risk factors of PO-UTI and PO-RUTI, (2) preoperative and postoperative UTI temporal distribution, and (3) detected uropathogens in a large database. The study used medical record data of all SUI/POP surgical procedures performed in the Kaiser Southern California Hospital system from January 1, 2008 to December 31, 2016 for women 18 years of age or older. Procedures used Current Procedural Terminology codes for identifying and subcategorizing surgical procedures and their route (SUI or POP; abdominal or vaginal, respectively). The study-wide definition of UTI was as follows: (1) positive standard urine culture of greater than 105 CFU/mL of ≤2 uropathogens, or (2) prescription of urinary antibiotics prescribed for the indication of UTI symptoms. The analysis consisted of 21,063 urogynecologic surgical procedures performed on 20,051 women (33,626 POP and/or SUI procedures), with 22,641 UTI events being diagnosed in 10,091 women. Mean age was 56.9 years, and mean BMI was 29.1. The cohort underwent surgery for only SUI (35.4%), only POP (32.7%), or POP/SUI combined (31.9%). In the 13.5 months postoperatively, 11,976 UTIs were diagnosed in 6733 women. The first month experienced a sharp increase compared with the preoperative year, the second month increased further, and the third month showed leveling of PO-UTI incidence. Prescribed antibiotics captured most UTI events (13,337 or 58.3%). Prescribed antibiotics, in order of most-prescribed to least-prescribed, were as follows: ciprofloxacin (33.7%), cephalexin (21.4%), nitrofurantoin (20.4%), and sulfamethoxazole-trimethoprim (17.6%). The study determined that most PO-UTIs occurred within the first 2 months, with many of these being diagnosed within 2 weeks of surgery. For those patients already having a history of RUTI, RUTI significantly increases in postoperative year 1 when compared with the preoperative year. All patients undergoing SUI procedures had increased PO-RUTI risks compared with their POP-only group peers. Escherichia coli was the most common pathogen found. Risk and event timing were affected by surgical indication: although surgery for only SUI had a lower 6-week PO-UTI risk, it was counterintuitively associated with a higher PO-RUTI risk. Multivariate regression revealed predictable risk factors for PO-UTI: OAB, history of diabetes, history of preoperative UTI within 6 weeks of surgery, history of RUTI, stent and catheter placement. A more confusing finding was the association of a vaginal estrogen prescription with increased short-term PO-UTI risk, possibly related to its use in women with a history of RUTI, but more probably related to the postmenopausal status of many of the women in the dataset. The study recommends preoperative assessment with the purpose of identifying and eliminating UTIs within 6 weeks before surgery, as well as development of protocols for enhanced prophylaxis for women at increased risk such as diabetics and women with preoperative RUTI.

Application of the decisional regret scale (DRS) in men undergoing anti-incontinence procedures for stress urinary incontinence.

Decisional regret (DR) has previously been applied to other urologic issues (hypospadias, prostate cancer). The present study seeks to evaluate certain patient factors that directly correlate to high DR scores in anti-incontinence procedures. Medical records for 119 patients undergoing anti-incontinence procedures between 2009 and 2020 were retrospectively reviewed. Forty-one patients were accessible for telephone follow-up and provided a Decisional Regret Scale (DRS) questionnaire. If patients had both a sling and an artificial urinary sphincter (AUS) placed, questionnaires were administered for each. DRS score was quantified in accordance with prior literature, with scores ranging 0-100. We subdivided patients based on demographics and surgical data, correlating this with DRS score. In 41 patients, 46 procedures (13 slings, 33 AUS) were performed. Thirty-nine (95.1%) men underwent robotic-assisted laparoscopic prostatectomy, and 11 (26.8%) men reported prior pelvic radiation. Post-procedural continence, irrespective of procedure, yielded an average 2±1.56 pads per day (PPD). Mean DRS score across the cohort was 29.78. DRS score was subdivided into mild, moderate, and severe, with majority noting "none to mild" regret (63%), 15.2% reporting moderate and 21.7% severe. Predictors of higher regret included history of radiation (P=0.056), choice of anti-incontinence procedure (P=0.011), and need for surgical revision (P=0.00042). DR was unrelated to race, complete continence, and time to follow-up. DRS has recently been applied to anti-incontinence procedures for male stress incontinence; our study highlights novel findings not previously assessed. Majority of men had minimal regret with a subset that had significant regret-history of radiation, multiple revisions/explant, and those who elected for sling upfront. These results highlight the importance of patient selection and pre-operative counselling.

Impact of Stress Urinary Incontinence After Radical Prostatectomy on Time to Intervention, Quality of Life and Work Status

To characterize the incidence of stress urinary incontinence (SUI) after radical prostatectomy (RP), its treatment, and impact on quality of life (QoL) and work status 1year after RP. Prostate cancer patients treated by RP (1998-2016) were selected from CaPSURE. SUI was defined as any pads per day (ppd) 1 year after RP. SUI procedures were tracked by CPT codes (sling and artificial sphincter). Patients reported work status (full-time, part-time, unpaid), UCLA PCa Index urinary function (UF) and bother (UB) and SF36 Index physical function (PF). Associations of incontinence with UF, UB, and PF and work status changes were assessed (ANOVA). Lifetable estimates and Cox proportional hazards regression evaluated risk of undergoing SUI procedures. 664/2989 (22%) men treated with RP reported SUI at 1 year. More men with SUI had ≥GG2, intermediate to high-risk disease and non-nerve-sparing surgery (all P<.01). Cumulative incidence of SUI procedures was 1.4% at 10years after RP. Age (HR 2.68 per 10years, 95% CI 1.41-5.08) and number of ppd at 1 year (HR 3.20, 95% CI 2.27-4.50) were associated with undergoing SUI procedures. UF declined at 1year after RP, while UB and PF remained stable. UF, UB, and PF were inversely associated with number of ppd (all P<.01). Change in work status was not associated with incontinence or QoL scores. Incontinence affected QoL without impacting work status, suggesting that men with SUI after RP may continue working and go under-treated despite impact on QoL.

Efficacy of Pelvic Floor Ultrasound for Assessing Transobturator Tape Sling Procedure.

Complications after midurethral sling, which require a high degree of clinical suspicion for timely diagnosis, accurate evaluation, and proper intervention, are closely associated with surgical success or failure. This study aimed to evaluate the efficacy and complications of tension-free midurethral sling for stress urinary incontinence (SUI) using pelvic floor ultrasound. This retrospective study included 152 female patients with SUI admitted to the Jinhua Central Hospital between January 2020 and December 2021 who were selected. All patients underwent midurethral transobturator tape sling procedures and were divided into success, voiding dysfunction, overactive bladder, and failure groups according to postoperative efficacy and complications. The pelvic floor ultrasound examination was performed before and after the surgery. The posterior vesicourethral angle difference ( P < 0.01) was significantly lower after the surgery than before the surgery. The rate of bladder neck funneling ( P < 0.01) and the area of bladder neck funneling ( P < 0.01) were smaller after the surgery than before the surgery. The tape-longitudinal smooth muscle distance, the tape-symphysis pubis distance, the sling angle, and the tape-bladder neck/urethra increased successively in the voiding dysfunction, overactive bladder, success, and failure groups. Pelvic floor ultrasound can accurately evaluate the postoperative efficacy and complications of transobturator tape sling procedures for SUI and can reasonably guide the management of complications. Therefore, it is an effective imaging method for postoperative follow-up after tension-free midurethral tape suspension.

MP48-07 NATIONAL TRENDS OF COMMON FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY PROCEDURES: 2016-2019

You have accessJournal of UrologyCME1 Apr 2023MP48-07 NATIONAL TRENDS OF COMMON FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY PROCEDURES: 2016-2019 Connie Wang, Daniel Schoenfeld, Joseph Marte, and Gregory Joice Connie WangConnie Wang More articles by this author , Daniel SchoenfeldDaniel Schoenfeld More articles by this author , Joseph MarteJoseph Marte More articles by this author , and Gregory JoiceGregory Joice More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate national trends in settings and charges of common female pelvic medicine and reconstructive surgery (FPMRS) procedures. METHODS: Common FPMRS procedures were identified by Current Procedural Terminology and International Classification of Diseases (10th Revision) Procedure Coding System codes and classified into 3 categories: 1) stress urinary incontinence procedures (SUI-p) 2) pelvic organ prolapse procedures (POP-p) and 3) overactive bladder procedures (OAB-p). Data from inpatient (IP) and outpatient (OP) encounters for included procedures between 2016-2019 were extracted from the Nationwide Inpatient Sample and Nationwide Ambulatory Surgery Sample from the Healthcare Cost and Utilization Project. Stratified cluster sampling was used to create weighted, national estimates. Student t-tests and multivariable linear regression was performed to compare procedural factors. RESULTS: A total of 893,450 weighted procedures were analyzed, of which 9.3% were performed IP and 90.7% were performed OP. Over the study period, there was a 4.3% increase in total number of procedures, and the proportion performed OP increased from 88.1% to 92.5%. Between 2016-2019, there was a 10.6% and 10.5% increase in SUI-p and POP-p performed OP, respectively. Over the study period, proportion of SUI-p performed OP increased from 96.4% to 99.7%, and proportion of POP-p performed OP increased from 76.5% to 82.8%. 99.9% of OAB-p were performed OP. Charges for SUI-p performed IP were $16,705 higher than those performed OP (p=0.007) and charges for POP-p performed IP were $21,864 higher than those performed OP (p<0.0001). Predictors of SUI-p and POP-p being performed OP included private insurance, fewer co-morbidities, and receiving care at a rural facility or at a center in the Midwest or South. Additionally, SUI-p were more likely to be performed OP for patients < 52 years of age. POP-p were more likely to be performed IP than SUI-p (OR 20.8; 95% CI 20.2 - 21.5), while OAB-p were less likely to be performed IP than SUI-p (OR 0.01; 95% CI 0.01 – 0.02). CONCLUSIONS: An increasing majority of SUI and OAB procedures performed nationwide are performed in OP settings. These procedures performed OP carry less charge than those performed IP and are more likely for younger, healthier patients with private insurance. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e657 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Connie Wang More articles by this author Daniel Schoenfeld More articles by this author Joseph Marte More articles by this author Gregory Joice More articles by this author Expand All Advertisement PDF downloadLoading ...

MP54-10 IMPACT OF URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY ON WORK STATUS, QUALITY OF LIFE AND TIME TO SURGICAL TREATMENT

You have accessJournal of UrologyCME1 Apr 2023MP54-10 IMPACT OF URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY ON WORK STATUS, QUALITY OF LIFE AND TIME TO SURGICAL TREATMENT Avery Braun, Samuel Washington, Janet Cowan, Matthew Cooperberg, Lindsay Hampson, and Peter Carroll Avery BraunAvery Braun More articles by this author , Samuel WashingtonSamuel Washington More articles by this author , Janet CowanJanet Cowan More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , Lindsay HampsonLindsay Hampson More articles by this author , and Peter CarrollPeter Carroll More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stress urinary incontinence (SUI) after radical prostatectomy (RP) can impact quality of life, work status and need for additional surgery. We aim to characterize the cumulative incidence of SUI procedures and report changes in urinary function (UF) and bother (UB), physical function (PF) and work status 1 year after RP. METHODS: Men with prostate cancer (PCa) treated by primary RP (1998-2016) were selected from CaPSURE. SUI was defined as use of any urinary pads per day (ppd) 1 year after RP. SUI procedure was tracked by CPT codes for urinary sling and artificial sphincter. Patients reported work status (full-time paid, part-time paid, unpaid), UF and UB scores (0-100) using UCLA PCa Index and PF using SF36 Index. Associations of incontinence with changes in UF, UB and PF and work status were assessed (ANOVA). Lifetable estimates and Cox proportional hazards regression were used to evaluate risk of undergoing a SUI procedure. RESULTS: Of 2,989 men treated with RP, 664 (22%) reported SUI at 1 year. Mean age was 61 years. More men with SUI had ≥GG2, intermediate to high-risk disease and non-nerve sparing surgery (all p<0.01). Cumulative incidence of SUI procedures was 1.4% at 10 years after RP (0 ppd: 0,3%; 3+ ppd: 12.9%) with median time to intervention of 48 months (IQR 27, 84). SUI procedures comprised of 53% AUS, 24% slings, 9% both and 15% unspecified. Older age (HR 2.68 per 10 years, 95% CI 1.41-5.08, p<0.01) and number of ppd at 1 year (HR 3.20, 95% CI 2.27-4.50, p<0.01) were associated with higher risk of undergoing SUI procedure. UF scores declined significantly from 94 at baseline to 77 at 1 year after RP, while UB and PF remained stable. After RP, UF, UB and PF were inversely associated with increasing number of ppd from 0 to 3+ (all p<0.01). (Figure 1a) Incontinence status (SUI 15% vs no SUI 14%) was not associated with change from paid (FT or PT) to unpaid work at 1 year. QOL scores were not associated with work status. (Figure 1b). CONCLUSIONS: SUI at 1 year after RP may occur in up to 22% of patients; however, 10-year rate of SUI procedure was low at 1.4% with median time to intervention of 48 months. Incontinence affected urinary QOL but did not significantly impact work status. This information suggests that men with SUI after RP may continue to work and go under-treated despite impact on quality of life. Source of Funding: UCSF Goldberg-Benioff Program in Translational Cancer Biology © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e757 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Avery Braun More articles by this author Samuel Washington More articles by this author Janet Cowan More articles by this author Matthew Cooperberg More articles by this author Lindsay Hampson More articles by this author Peter Carroll More articles by this author Expand All Advertisement PDF downloadLoading ...

MP48-16 TRENDS IN STRESS URINARY INCONTINENCE PROCEDURES FROM 2012 TO 2020 FROM THE UDA PROJECT

You have accessJournal of UrologyCME1 Apr 2023MP48-16 TRENDS IN STRESS URINARY INCONTINENCE PROCEDURES FROM 2012 TO 2020 FROM THE UDA PROJECT John Lavelle, Chad Ellimoottil, Ziya Kirkali, Julia S. Barthold, Lei Sandy Ye, Po-Lun Chou, Zhihang Lin, Myrna Cozen, Kyle Buika, and John Hornberger John LavelleJohn Lavelle More articles by this author , Chad EllimoottilChad Ellimoottil More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , Julia S. BartholdJulia S. Barthold More articles by this author , Lei Sandy YeLei Sandy Ye More articles by this author , Po-Lun ChouPo-Lun Chou More articles by this author , Zhihang LinZhihang Lin More articles by this author , Myrna CozenMyrna Cozen More articles by this author , Kyle BuikaKyle Buika More articles by this author , and John HornbergerJohn Hornberger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stress urinary incontinence (SUI) is a major quality of life problem for many people. In women, SUI is associated with pelvic organ prolapse (POP) and in men after a radical prostatectomy. A safety review started in 2011 by the FDA of POP mesh resulted in the 2019 recall. This study reviews the prevalance and procedure trends for SUI between 2012 to 2020. METHODS: Using the 100% Optum® Clinformatics® Data Mart data and 100% national Medicare Fee-for-Service data, we identified subjects claims for urinary incontinence (UI) and any procedures performed for UI. Results reported as mean ± standard deviation. RESULTS: From 2012 - 2020, the mean prevalence of any UI in the 18-64 age group was 37,529 ± 3292 or 0.62% of the population. In the Medicare population (aged 65+), it was 1,439,221 ± 90507, or 5.7% of the group. The Female to Male ratio in the <65 yr group was 2.52:1 and in the 65+ was 5.31:1. The Medicare mean SUI prevalence was 212223 ± 14292 (0.84% population), and the Optum group was 13,179 ± 1,535 (0.22%).38,677 Medicare patients received procedures for UI in 2012. This increased to 54,122 by 2019, falling to 45,667 during COVID. In 2012, 12,286 patients received SUI procedures, which plateaued at 8,670/yr for 2015 to 2019. In 2020, 6508 patients had a SUI procedure. (Breakdown in Figure 1A). 4020 patients with UI aged 18-64 got a procedure in 2012, which decreased by 45% to 2635 in 2019 with a dip for COVID to 2020. The numbers plateaued from 2014 to 2019 at 2500 patients/yr approximately. The SUI patient numbers for this group decreased from 2501 in 2012 to 967 in 2020, plateaued between 2014 and 2019 at 1250 patients/yr approximately. (Breakdown in Figure 1B) There was a 50% decrease in patients getting sling procedures. Patients obtaining artificial urinary sphincter, and injectables remained constant. Men receiving artificial urinary sphincter, slings, and injectables has remained even in the 65+ age group. However, in the 18-64 age group, men obtaining slings decreased. CONCLUSIONS: The claims prevalence for UI has increased in older age and decreased in younger patients. Sling use has decreased in all female patients and younger men. The overall decrease in procedures for SUI, appears partly due to decreased reporting of incontinence claims in the younger population, together decreased Sling procedures in female patients. Source of Funding: NIDDK Contract Number GS-10F-0133S © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e661 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Lavelle More articles by this author Chad Ellimoottil More articles by this author Ziya Kirkali More articles by this author Julia S. Barthold More articles by this author Lei Sandy Ye More articles by this author Po-Lun Chou More articles by this author Zhihang Lin More articles by this author Myrna Cozen More articles by this author Kyle Buika More articles by this author John Hornberger More articles by this author Expand All Advertisement PDF downloadLoading ...

MP71-04 ADJUSTABLE ARTIFICIAL SPHINCTER VICTO IN THE TREATMENT OF URINARY INCONTINENCE: EARLY RESULTS IN A COHORT OF HIGH-RISK CASES IN A PROSPECTIVE SINGLE CENTER STUDY

You have accessJournal of UrologyCME1 Apr 2023MP71-04 ADJUSTABLE ARTIFICIAL SPHINCTER VICTO IN THE TREATMENT OF URINARY INCONTINENCE: EARLY RESULTS IN A COHORT OF HIGH-RISK CASES IN A PROSPECTIVE SINGLE CENTER STUDY Ghazal Ameli, Peter Weibl, Michael Rutkowski, and Wilhelm Huebner Ghazal AmeliGhazal Ameli More articles by this author , Peter WeiblPeter Weibl More articles by this author , Michael RutkowskiMichael Rutkowski More articles by this author , and Wilhelm HuebnerWilhelm Huebner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Victo is an adjustable artificial urinary sphincter (AUS), consisting of three parts which are preconnected. A pressure regulating balloon, a cuff, and a pump, which includes a self-sealing port for adjustment. The objective of the present study is to test the efficiency and practicality of VICTO in the control of stress urinary incontinence (SUI) and to evaluate the short- and long-term complications. METHODS: A total of 32 patients were included between 1/2020 and 4/2022, the trial is still ongoing and estimated end of the clinical trial is May 2025.41% of the patients in this cohort has undergone prior procedures for SUI: sling n=4, ProACT n=4, AMS 800=1, 3 patients had multiple SUI surgeries. 38% of the patients had undergone secondary irradiation therapy. Additionally, 9 patients had undergone procedures for bladder neck pathologies or urethral strictures.All patients underwent artificial urethral sphincter (AUS) implant “VICTO” according to established technique. The mean age was 71.9 years, 41% of the patients had systemic arterial hypertension and 19% diabetes mellitus.Functional urinary outcomes were assessed according to daily pad use and a standardized questionnaire. Data were collected as part of the follow up care of these patients. RESULTS: The reduction in number of pads compared between baseline and Follow-Up was significant (p<0,001). Cure of urinary incontinence was defined as using either 0 or 1 p/d. All the index patients in this cohort (n=7) were cured. In total 64.5% of the patients reported to be dry and were cured by definition. Additionally, 19.4% patients reported improvement of ≥50 % according the PGI-I (Patients Global Impression of Improvement).Two erosions were reported over the FU-period (mean 4.6 months). One infection occurred after traumatic catheterization without deactivation of the device followed by urethral erosion, infection and explantation of the device. Both patients with erosion had previous pelvic irradiation.One explantation was reported at day 2 after implantation, the presumable cause of explantation was unrecognized intra-operative urethral injury and consequently urethral erosion and was excluded from the study. CONCLUSIONS: In this complex group with mostly high-risk patients, all men with uncomplicated SUI (no previous surgeries and no history of irradiation) were cured after device implantation. The overall treatment success was 84 % according PGI-I and 65% according to pad per day usage. Despite the above average number of patients with risk factors for failure in this cohort, the results of the current trial are consistent with the evidence in literature. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1014 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ghazal Ameli More articles by this author Peter Weibl More articles by this author Michael Rutkowski More articles by this author Wilhelm Huebner More articles by this author Expand All Advertisement PDF downloadLoading ...

MP37-05 SATISFACTION WITH DECISION AND DECISIONAL REGRET AFTER MID-URETHRAL SLING AND URETHRAL BULKING INJECTION FOR STRESS URINARY INCONTINENCE

You have accessJournal of UrologyCME1 Apr 2023MP37-05 SATISFACTION WITH DECISION AND DECISIONAL REGRET AFTER MID-URETHRAL SLING AND URETHRAL BULKING INJECTION FOR STRESS URINARY INCONTINENCE Leia Kessler, Michael Schumeister, Dimindra Karki, Melissa Laudano, and Nitya Abraham Leia KesslerLeia Kessler More articles by this author , Michael SchumeisterMichael Schumeister More articles by this author , Dimindra KarkiDimindra Karki More articles by this author , Melissa LaudanoMelissa Laudano More articles by this author , and Nitya AbrahamNitya Abraham More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are currently limited data regarding patient-centered outcomes of satisfaction and decisional regret for treatment of stress urinary incontinence (SUI) in women. The objective of this study was to investigate long-term satisfaction and decisional regret amongst women who underwent mid-urethral sling surgery or urethral bulking injection for SUI. METHODS: This was a retrospective cohort study of patients who underwent a mid-urethral sling or urethral bulking procedure for SUI from 2015 to 2022 at our diverse, urban academic center. Demographic data were collected through chart review and surveys were conducted via telephone calls. Patient satisfaction and decisional regret were measured with the validated modified SDS-DRS scale (Satisfaction with Decision Scale- Decision Regret Scale). On the DRS, a score of 1 correlates with low decisional regret and a score of 5 correlates with high decisional regret. On the SDS, a score of 1 correlates with low satisfaction and a score of 5 correlates with high satisfaction. Descriptive statistics and Wilcoxan rank-sum tests were performed using STATA 15.0 with p<0.05 being significant. RESULTS: Of 97 women who underwent mid-urethral sling surgery called, 68 agreed to participate (70% response rate). The mean time since surgery was 46.7+/-23.11 months. The median score for the SDS was 4.0 (IQR 3.7, 4.8) and the median score on the DRS was 2.0 (IQR 1.2, 2.4). Nine (13%) women experienced surgical complications, which were not significantly associated with SDS (p=0.54) or DRS scores (p=0.54). In comparison, of 60 patients who underwent urethral bulking injection called, 31 agreed to participate (52% response rate). The mean time since surgery was 30.6+/-30.08 months. The median SDS score was 4.0 (IQR 3.5, 4.8) and median DRS score was 2.0 (IQR 1.4, 3.0). Three (10%) women experienced surgical complications, which were not significantly associated with SDS (p=0.17) or DRS scores (p=0.44). CONCLUSIONS: The results of this study show high satisfaction with decision and low decisional regret in women undergoing surgical treatment for SUI. The Satisfaction with Decision and Decisional Regret Scale allows a patient-centered analysis of surgical success that may aid in choosing a treatment option for women considering SUI surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e514 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leia Kessler More articles by this author Michael Schumeister More articles by this author Dimindra Karki More articles by this author Melissa Laudano More articles by this author Nitya Abraham More articles by this author Expand All Advertisement PDF downloadLoading ...

Pelvic ultrasound finding of late-onset bladder erosion after transobturator tape for female stress urinary incontinence: A case report.

Mid-urethral sling is a gold-standard procedure for stress urinary incontinence because of its high efficacy and low complication incidence. Moreover, mesh erosion into the bladder is a rare complication. The 63-year-old patient visited our gynecology clinic with complaints of gross hematuria and was diagnosed with bladder erosion by ultrasound 6 months after transobturator tape procedure. The 2D ultrasound found the sling in the bladder wall perforation, which can lead to the formation of bladder stones. Meanwhile, 3D ultrasound showed the left side of the sling crossed the bladder mucosa at 5 o'clock. The sling and bladder stones were removed by holmium laser. The patient underwent a follow-up pelvic ultrasound at 6 months, which showed no erosion mesh under the bladder mucosa. Pelvic ultrasound could accurately evaluate the location and shape of the tape, which is important for a reasonable surgical plan.

Impact of COVID-19 on surgical procedures for stress urinary incontinence in the Brazilian public health system.

The objective was to characterize the impact of the COVID-19 pandemic on the surgical treatment of female stress urinary incontinence (FSUI) in Brazil. This study was conducted with population-based data from the Brazilian public health system database. We obtained data on the number of surgical procedures for FSUI in 2019 (before the coronavirus disease [COVID-19] pandemic), 2020, and 2021 (during the pandemic) in each of the 27 Brazilian states. We included official Brazilian Institute of Geography and Statistics (IBGE) data on the population, Human Development Index (HDI), and annual per capita income of each state. A total of 6,718 surgical procedures for FSUI were performed in the Brazilian public health system in 2019. The number of procedures was reduced by 56.2% in 2020, and an additional reduction of 7.2% was seen in 2021. The distribution of procedures by state showed important differences, ranging from 4.4 procedures/1,000,000 inhabitants in Paraíba and Sergipe to 67.6 procedures/1,000,000 inhabitants in Paraná (p<0.01) in 2019. The number of surgical procedures was higher in states with a higher HDI (p=0.0001) and per capita income (p=0.042). The decrease in the number of surgical procedures affected the whole country and its rate did not correlate with HDI (p=0.289) or per capita income (p=0.598). The impact of the COVID-19 pandemic on the surgical treatment of FSUI in Brazil was significant in 2020 and persisted in 2021. Access to surgical treatment of FSUI varied according to geographic region, HDI, and per capita income, even before COVID-19.

Cost-effectiveness of urethral bulking polydimethylsiloxane-Urolastic® compared with mid-urethral sling surgery for stress urinary incontinence: A two-arm cohort study.

To investigate the cost-effectiveness of urethral bulking polydimethylsiloxane-Urolastic® (PDMS-U) compared with mid-urethral sling (MUS) surgery for stress urinary incontinence (SUI) at 1-year follow-up. Prospective, two-arm cohort study with 2-year follow-up. International multicentre. Women with moderate to severe SUI. Primary outcome was subjective cure (Patient Global Impression of Improvement). objective cure (negative cough stress test), Urogenital Distress Inventory (UDI-6), complications and re-interventions. Cost-effectiveness outcomes: total costs, quality-adjusted life year (QALY) using IIQ7-scores (Incontinence Impact Questionnaire) and EQ-5D-5L, incremental cost-effectiveness ratio (ICER) and monetary benefit (adjusted for baseline confounders). In all, 131 PDMS-U and 153 MUS surgery patients were treated. Subjective cure rates for MUS surgery and PDMS-U were, respectively: 101/112 (90%) versus 40/87 (46%), adjusted odds ratio (aOR; for age, body mass index [BMI], severity, type of urinary incontinence and previous SUI procedure) was 4.9. Objective cure rates for MUS surgery and PDMS-U were respectively: 98/109 (90%) versus 58/92 (63%), aOR 5.4. Average total costs for PDMS-U and MUS surgery were €3567 and €6688. ICER for MUS surgery cost €15 598 per IIQ QALY and €37 408 per EQ-5D-5L QALY. With a willingness to pay (WTP) of €25 000, MUS has a 84% chance of being cost-effective using IIQ, whereas PDMS-U has a 99% chance of being cost-effective using EQ-5D-5L. MUS surgery is more cost-effective in realising improved disease-specific quality of life (QoL), while PDMS-U is more cost-effective in realising improved generic QoL.

The Role of Pelvic Ultrasound in Evaluating the Success of Tension-free Vaginal Tape (TVT).

This study aims to assess the lack of response to treatment in individuals undergoing mid-urethral sling surgery for stress urinary incontinence (SUI) using ultrasound findings of the pelvic floor. The study included patients who underwent the tension-free vaginal tape (TVT) procedure for stress urinary incontinence within the period spanning from January 2016 to January 2021. The physical examination involved maintaining bladder filling at an average volume of 200-400 mL, and treatment failure was determined by the presence of SUI during the Valsalva maneuver. The study comprised a total of 214 patients, where it was observed during the stress test that 32 patients (25.8%) had an unsuccessful outcome following mid-urethral sling surgery. In the unsuccessful group, the distance of the mesh-posterior urethra was lower (4.09±0.39 vs. 4.91±0.51; p<0.001), the posterior urethrovesical angle was lower when at rest, but the angle increased more significantly during the Valsalva maneuver, and the bladder neck angle was narrower (p<0.001). We obtained lower mean values of mesh-posterior urethral distance in unsuccessful patients compared to those found in the group of cured patients. Pelvic floor ultrasound can predict the success of TVT surgeries but there is as yet little data and there is a need to find in the near future more standard and objective parameters for the diagnosis of urinary incontinence.

Transobturator tape surgery experience: Urodynamic evaluation of 220 patients in a single tertiary center in Turkey

Background/Aim. Stress urinary incontinence (SUI) is the involuntary leakage of urine after increased intraabdominal pressure, and it causes a significant public health problem by reducing the quality of life, causing sexual dysfunction, and increasing the cost of care due to in-creased morbidity. The aim of the study was to investigate the intra? and postoperative results and complication rates of the transobturator tape (TOT) procedures used for SUI treatments in a tertiary center located in central Turkey. Methods. This prospective study analyzed a total of 220 patients undergoing TOT procedures for SUI. The demo-graphic and clinical characteristics, preoperative and post-operative cystometry values, and operative outcome parameters of the study participants were analyzed. Results. While no significant difference was noted between the preoperative and postoperative periods with respect to residual volume (27.09 ? 8.51 mL vs. 26.01 ? 3.51 mL, p = 0.125), there were significant differences in terms of the first urinary urge (142.61 ? 20.25 mL vs. 145.64 ? 20.91 mL, p &lt; 0.001), maximum bladder capacity (423.70 ? 38.43 mL vs. 402.32 ? 39.46 mL, p &lt; 0.001), the Q-tip angle (45.54 ? 5.330 vs. 43.81 ? 6.150, p = 0.001), the maxi-mum flow rate (37.65 ? 11.54 mL/s vs. 24.38 ? 9.26 mL/s, p &lt; 0.001), average flow rate (19.92 ? 9.64 mL/s vs. 14.77 ? 8.71 mL/s, p &lt; 0.001), the number of urinations in the daytime (7.29 ? 1.35 vs. 6.58 ? 1.29, p &lt; 0.001), and the number of urinations at nighttime (1.48 ? 1.01 vs. 0.92 ? 0.83, p &lt; 0.001). Conclusion. The TOT procedure im-proves the quality of life of SUI patients and can reduce morbidity. Nevertheless, additional studies are needed to corroborate our findings and determine the long-term effects.

Urinary Tract Infections After Urogynecologic Surgery: Risk Factors, Timeline, and Uropathogens.

Urinary tract infection (UTI) is a common and potentially avoidable postoperative (PO) adverse event after urogynecologic surgery. Understanding pathophysiology will help prevent the associated morbidity of the disease and treatment of PO-UTI. The objective of this study is to determine the following: (1) risk factors for both PO-UTI and PO recurrent UTI (RUTI) after urogynecologic surgery, (2) temporal distribution of UTI, and (3) uropathogen identification. Women undergoing urogynecologic surgery were retrospectively reviewed. Urinary tract infection was defined by culture or antibiotic prescription for symptoms. Recurrent UTI was defined as occurring outside a 6-week perioperative period. The χ 2 test or Fischer exact and Student t tests or Mann-Whitney U test were used as appropriate. Individual odds ratio (OR), 95% confidence interval [CI], and sequential multivariable logistic regression were calculated. Statistical significance was set at P < 0.05. The 6-week PO-UTI rate after 33,626 procedures was 12.9%. Recurrent UTI increased from 3.7% preoperatively to 4.4% postoperatively ( P < 0.001). A 6-week preoperative UTI and RUTI increased the risk of 6-week PO-UTI (OR, 1.65; 95% CI < 1.26-2.16; P = 0.001 and OR, 2.19; 95% CI, 1.84-2.62; P < 0.001, respectively) and PO-RUTI (OR, 2.95; 95% CI, 2.11-4.11; P < 0.001 and OR, 6.79; 95% CI, 5.61-8.23; P < 0.001, respectively). Compared with pelvic organ prolapse (POP) surgery only, stress urinary incontinence (SUI) surgery (OR 1.57[1.30-1.89]), and combined POP/SUI surgery (OR, 1.36; 95% CI, 1.13-1.63]) increased the risk of PO-RUTI ( P < 0.001). Urinary tract infection within 1 week preoperatively was protective against 6-week PO-UTI (OR, 0.68; 95% CI, 0.48-0.97; P = 0.035). No perioperative factors were protective of PO-RUTI. The PO-RUTI rate in the first year after urogynecologic surgery is low; however, SUI procedures may increase PO-RUTI risk. Potentially, modifiable risk factors for both PO-UTI and PO-RUTI include UTI diagnosis within 6 weeks preoperatively or preoperative RUTI diagnosis. Retesting women the week before surgery to ensure adequate treatment of preoperative UTI may reduce 6-week PO-UTI.

Development of a minimal invasive surgical procedure for stress urinary incontinence

Development of a minimal invasive surgical procedure for stress urinary incontinence

Patterns of Surgical Management of Male Stress Urinary Incontinence: Data From the AUA Quality Registry.

We examined contemporary patterns in treatment of male stress urinary incontinence and identified predictors of undergoing specific surgical procedures. Utilizing the AUA Quality Registry, we identified men with stress urinary incontinence utilizing International Classification of Disease codes and related procedures for stress urinary incontinence performed from 2014 to 2020 utilizing Current Procedural Terminology codes. Characteristics of the patient, surgeon, and practice were included in a multivariate analysis of predictors of management type. We identified 139,034 men with stress urinary incontinence in the AUA Quality Registry, of whom only 3.2% underwent surgical intervention during the study period. Artificial urinary sphincter was the most common procedure with 4,287/7,706 (56%) performed, followed by urethral sling with 2,368/7,706 (31%), and lastly urethral bulking with 1,040/7,706 (13%). There was no significant change by year in volume of each procedure performed during the study period. A large proportion of urethral bulking was performed by a disproportionately small number of practices; 5 high-volume practices performed 54% of the total urethral bulking over the study period. Open surgical procedure was more likely in patients with prior radical prostatectomy, urethroplasty, or care at an academic enter. Urethral bulking was more likely in patients with a history of bladder cancer or care by a surgeon of increasing age or female gender. Utilization of artificial urinary sphincter and urethral sling now exceeds utilization of urethral bulking for male stress urinary incontinence, though some practices continue to perform a disproportionate volume of bulking. Using data from the AUA Quality Registry, we can identify areas for quality improvement to facilitate guideline-adherent care.