Pubovaginal Sling Research Articles

Management of Occult Urinary Incontinence with Prolapse Surgery.

The purpose of this paper is to review (1) the epidemiology and pathophysiology of pelvic organ prolapse (POP) and occult stress urinary incontinence (SUI), (2) examine the data on combined operative management of POP and occult SUI, (3) discuss the approaches to clinical decision making, and (4) present future therapies. Prospective data on many approaches to concomitant treatment of prolapse and occult stress urinary incontinence, such as minimally invasive sacrocolpopexy and midurethral sling, or older approaches that have regained favor among patients and clinicians wishing to avoid synthetic mesh, such as native tissue prolapse repair and pubovaginal sling, are limited. Safe durable treatments with absorbable graft materials that promote a beneficial host response are intriguing but may be far from clinical implementation. Stem cell therapy for the treatment of stress urinary incontinence has demonstrated benefit in phase I/II trials but has not been studied in the setting of concomitant treatment of occult SUI with POP surgery and remains in the preclinical phase for the treatment of POP. A personalized approach to concomitant SUI surgery that incorporates individual risk assessment as well as informed patient preferences likely optimizes the risk/benefit ratio and patient satisfaction. Novel therapies, including graft materials and cellular therapies that stimulate a regenerative response, may improve or maintain continence outcomes while mitigating risk and alter the approach to both POP and SUI surgery.

Exploring stress urinary incontinence outcomes after sling excision for perforation or exposure.

This study assessed stress urinary incontinence (SUI) outcomes after sling excision for urinary tract perforation or vaginal exposure, and compared the outcomes of concomitant versus staged autologous fascia pubovaginal sling (AFPVS). A retrospective chart review of all patients who underwent midurethral sling (MUS) excision for urinary tract perforation or vaginal exposure at a tertiary referral center between 2010 and 2015 was performed. Therapeutic strategies were categorized as concomitant AFPVS, staged AFPVS, and no anti-incontinence procedure. In all, 32 patients were included for analysis: 13 with vaginal tape exposure (40.6%) and 19 with urinary tract tape exposure (59.4%). In patients who had SUI prior to sling excision (43.8%), the rate of resolved or improved SUI postoperatively was higher in the concomitant AFPVS group than in those who underwent sling excision alone (83.3% vs 12.5%, respectively; P = 0.03). Of 18 patients with no SUI prior to sling excision, 12 experienced recurrent SUI after sling removal (66.7%). The rate of recurrent SUI was lower in patients with vaginal MUS exposure than urinary tract MUS perforation, but this did not reach statistical significance (57.1% vs 72.7%, respectively; P = 0.63). The rates of resolved SUI after AFPVS were comparable in patients with concomitant and staged AFPVS (66.7% vs 71.4%, respectively; P = 0.99). Many patients with MUS perforations or exposures will have SUI at initial presentation or develop SUI after removal of the synthetic sling. The decision to perform a concomitant AFPVS or to stage the surgical management of SUI can be individualized.

Long-term unexpected single polyprolene suture complication following traditional pubovaginal sling: Suprapubic skin fistula

Long-term unexpected single polyprolene suture complication following traditional pubovaginal sling: Suprapubic skin fistula

Re: Updated Systematic Review and Meta-Analysis of the Comparative Data on Colposuspensions, Pubovaginal Slings, and Midurethral Tapes in the Surgical Treatment of Female Stress Urinary Incontinence.

Re: Updated Systematic Review and Meta-Analysis of the Comparative Data on Colposuspensions, Pubovaginal Slings, and Midurethral Tapes in the Surgical Treatment of Female Stress Urinary Incontinence.

Autologous rectus fascia sling for treatment of stress urinary incontinence in women: A review of the literature.

Stress urinary incontinence (SUI) is common in the adult females. Surgical treatment options include synthetic mid-urethral sling (MUS), autologous sling, bulking agents, and Burch colposuspension. The autologous pubovaginal sling (PVS) has re-emerged in response to complications of synthetic MUSs and FDA communications regarding the use of vaginal mesh. This resulted in patients' fear related to vaginal mesh and drop in number of patients seeking surgical treatment of SUI. PVS has re-emerged as an option for treatment of primary SUI. The aim of this review is to familiarize, disseminate information, and share tips for the practicing female pelvic surgeons related to the practice of the autologous fascia sling. We reviewed the literature related to the autologous sling. We used the following data bases and search engines: GoPubMed (Transinsight), Cochrane reviews (Wiley Interscience), google scholar (google), and Scopus (Elsevier). Because it is the most commonly investigated and utilized, we focused on the autologous rectus fascia sling. We also focused on the retropubic sling approach because the literature on transobturator rectus fascia sling is sparse. Out of 307 articles related to the subject found, 22 articles were included and the rest were excluded. ARFS is a valid primary method of treatment for female SUI. Also, it is used in particular indications such as patients with intrinsic sphincter deficiency (ISD), prior pelvic irradiation, failed and/or complicated synthetic MUS, and violated urethral lumen.

PO637 Cardiac Chamber Enlargement Is Associated With More Significant Mitral Regurgitation In Children Screened For Rheumatic Heart Disease

The impact of surgery for stress urinary incontinence (SUI) on female sexual function has received attention in the medical literature, but not in a structured manner.To assess the most recent evidence on the impact of surgical management for female SUI on female sexual function.The review and meta-analysis of available articles published in Medline, Cochrane, LILACS, SCOPUS, Web of Science, CINHAL, and EMBASE included prospective randomized and non-randomized studies that assessed patients who underwent surgical treatment for UI through 2 validated questionnaires: the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Female Sexual Function Index (FSFI).The following terms were searched: (urinary incontinence OR female OR woman OR women) AND (suburethral slings OR transobturator tape* OR transobturator suburethral tape OR trans-obturator tape* OR urethral sling* OR midurethral sling* OR mid-urethral sling* OR “standard midurethral slings” OR tensionless vaginal tape* OR mini sling* OR Burch* OR “Burch colposuspension” OR “urologic surgical procedures” OR “tension-free vaginal tape” OR pubovaginal sling) AND (sexual behavior OR “Female Sexual Function Index” OR FSFI OR sexual function OR “Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire” OR PISQ-12).1,043 articles were retrieved; 9 studies were included for qualitative analysis and 4 were included for meta-analysis. 25 articles were excluded because they used questionnaires other than the FSFI and PISQ-12. Meta-analysis of 2 studies composed of 411 women who underwent to retropubic and transobturator sling intervention and completed the PISQ-12 questionnaire showed an increase in sexual function of 2.40 points after transobturator compared with retropubic sling intervention (95% CI = −2.48 to −2.32; I2 = 35%, P < .00001). However, 2 other studies composed of 183 women comparing the same techniques, but using the FSFI, did not show a statistically significant difference (95% CI = −1.77 to 3.78; I2 = 0%, P = .48).The impact of UI surgery on sexual function is uncertain because of the imprecision of the effect and inconsistency among studies. Only limited evidence on the impact of the transobturator vs the retropubic sling was found.Bicudo-Fürst MC, Borba Leite PH, Araújo Glina FP, et al. Female Sexual Function Following Surgical Treatment of Stress Urinary Incontinence: Systematic Review and Meta-Analysis. Sex Med Rev 2018;6:224–233.

Long-term outcomes of anti-incontinence surgery and subsequent transvaginal sling incision for urethral obstruction.

The suburethral sling procedure has been widely used as the first-line treatment for stress urinary incontinence (SUI) in women. Although the success rate is high, difficult urination and urine retention can occur in a small portion of patients. A transvaginal sling incision can solve this problem but recurrent SUI may occur. This study investigated the long-term outcomes of women who underwent the pubovaginal sling (PVS) procedure and subsequent transvaginal sling incision for urethral obstruction. We retrospectively reviewed the voiding conditions of women who underwent transvaginal sling incision owing to bladder outlet obstruction after the PVS procedure over the past two decades. Urodynamic study was performed before and after each operation. The patients' Global Impression of Improvement (PGI-I) and quality of life index (QoL-I) due to urinary symptoms were used for outcome evaluation. Among 405 women who underwent PVS procedure, 14 (3.5%) underwent subsequent transvaginal sling incision. The main symptoms were severe dysuria, followed by urinary retention or severe wound discomfort. The average interval between the two operations was 147.6 ± 353.6 days (range 3~1,344). The mean follow-up time after sling incision was 91.1 ± 50.7months. At follow-up, 12 patients (85.7%) could maintain urinary continence whereas 2 had urgency incontinence. Ten patients (71.4%) were satisfied with their quality of life postoperatively. Transvaginal sling incision is effective for urethral obstruction after PVS procedure. Voiding dysfunction after PVS could be resolved via sling incision. Most patients could maintain urinary continence and reported good satisfaction.

Management of Recurrent Stress Urinary Incontinence After Failed Mid-Urethral Sling Placement

Our objective is to review the current literature on recurrent stress urinary incontinence after mid-urethral sling placement, focusing on evidence-based management considerations for this complex clinical problem. Conservative, minimally invasive surgical therapies are currently available for management of persistent or recurrent SUI after a previous mid-urethral sling (MUS). Our review of the literature does not show a clear benefit of one approach over others and emphasizes that the ideal management for these complex patients should be determined using an individualized approach with a detailed discussion of patient symptoms, past surgical history, and goals. For symptomatic patients who are surgical candidates and desire intervention, trans-urethral bulking agents, repeat retropubic (RP) MUS, or salvage autologous pubovaginal (PV) sling appear to be the most well-described management strategies.

An Internet-based survey to evaluate the comfort and need for further pubovaginal sling training.

The pubovaginal sling (PVS) dates to the 1940s as an efficacious surgical treatment for stress urinary incontinence (SUI). Recently, it has been replaced by the midurethral sling (MUS). Since 2008, international regulatory agencies increased regulation and issued warnings on vaginal mesh for repair of pelvic organ prolapse (POP), which has led to increased scrutiny of the MUS. Thus, the need for surgical comfort with PVS is resurfacing. We sought to evaluate the surgical practice patterns among international urogynecologists for the treatment of SUI and identify whether a need and interest for more training exists. We developed a short, Internet-based survey for members of the International Urogynecological Association (IUGA). Descriptive analyses, binomial and multivariate logistic regressions were calculated to determine significant associations. Among 556 members who responded to the survey, 72% did not offer PVS in practice. Among those who did, there was as significant relationship between offering PVS and practicing in the United States, board-certification in urogynecology, PVS exposure in training, increasing number of PVS performed during training, and comfort with PVS. Members interested in further PVS training were younger, less comfortable with PVS, performed fewer PVS, or had no exposure in training. Most IUGA members do not offer PVS in clinical practice. As would be expected, members who performed more PVS in training and were more comfortable with PVS were likely to offer it to patients. Our results highlight a learning gap, especially among younger providers who are not comfortable with PVS and desire further training in this procedure.

Transvaginal Cystocele Repair Using Tension-free Polypropylene Mesh (Tension-free Vaginal Tape)

Urinary incontinence is one of the most common diseases, 25% of women between 18 and 80 years suffer from it. Urinary incontinence can be described as accidently loss of small amounts of urine. The solution involves a surgical procedure, such as sling procedures and bladder neck suspension procedures. The methods of surgical interventions have evolved due to a minimum period of hospitalization (sling, TVT), or performing laparoscopic surgery instead of the classical Burch surgery. Studies reviled that the most effective interventions are those which restore the urethra by retro pubic urethropexy, pubovaginal sling and synthetic mid-urethral slings. This type of surgery has currently the highest success rate (85-90% on 5 years after surgery), and the lowest relapse rate. In our study we obtained the same success rate for the TVT procedure.

Bladder neck placement of a synthetic polypropylene sling for the treatment of stress urinary incontinence.

Pubo-vaginal sling placed at the bladder neck is the gold standard treatment for stress urinary incontinence (SUI). The synthetic mid-urethral sling (MUS) is now widely used, as morbidity rates with this technique are substantially reduced. This is an initial report on long-term outcomes of a polypropylene sling (PPS) placed in the traditional bladder neck location. A retrospective analysis of all patients who underwent PPS insertion at our institution between 2006 and 2014 was conducted. Patient and urodynamic demographics were recorded. Subjective and objective measures of success were determined by postoperative pad usage and validated incontinence questionnaires. A total of 170 patients were followed for a median of four years (range 1-8). The mean age was 51 years (±10). Subjective response was assessed in 57% of patients; the overall subjective cure rate was 85.3% (n=145), subjective improvement rate was 4.1% (n=7), and the subjective failure rate was 10.6% (n=18). The mean Urogenital Distress Inventory (UDI)-6 score was 6.5 (±5.6) out of a maximum score of 24 and the Incontinence Impact Questionnaire (IIQ)-7 score was 5.5 (±6.3) out of a maximum score of 28. There was no significant difference in objective outcome measures in those with an abdominal leak-point pressure (ALPP) < or >60 cmH2O. Bladder neck placement of a PPS resulted in cure rates of 85% in this series. SUI secondary to intrinsic sphincter deficiency (ISD) and urethral hypermobility were treated with equal success. Bladder neck PPS placement has a role in the treatment of SUI. Our data may well reassure rectus fascia sling (RFS) surgeons who wish to take advantage of faster postoperative recovery using the less invasive PPS placed at the bladder neck.

An Overview of Surgical Treatment for Female Stress Urinary Incontinence

We aimed to present an overview of recent data on the proven surgical techniques for female stress urinary incontinence (SUI) including their efficacy, safety, and adverse events. Surgical treatment of female SUI is the mainstay of urogynecological surgery, with two accepted gold standard techniques: Burch colposuspension and synthetic midurethral slings (MUS). Thorough understanding of the historical evolution of the surgical techniques before and after the introduction of integral theory is important. This theory enhances our comprehension for the continence mechanism of MUS, which are currently the level 1, grade A, recommended anti-incontinence procedures in all recent guidelines. However, in cases with specific contraindications, mesh surgery should be avoided. Burch colposuspension and autologous rectus fascia pubovaginal sling (RF PVS) procedures are the recommended surgical techniques with level 1 evidence in such cases and should be performed after a complete evaluation. Urethral bulking agents and artificial sphincters are the other options for severe and complicated cases. Because each surgical intervention for female SUI has inherent advantages and risks of complications, selection of the optimal surgical technique should be based on the risk-benefit ratio for every patient. Comprehension of recent data derived from systematic meta-analyses and latest guidelines and knowledge of the safety, long-term efficacy, and possible adverse events of all currently accepted surgical techniques for female SUI provide an insight to properly counsel women and to select the optimal individualized anti-incontinence surgery.

MP23-09 COMPARISON OF POSTOPERATIVE CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES IN THE UROLOGIC PATIENT WITH A SUPRAPUBIC CATHETER VERSUS TRANSURETHRAL CATHETER

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2018MP23-09 COMPARISON OF POSTOPERATIVE CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES IN THE UROLOGIC PATIENT WITH A SUPRAPUBIC CATHETER VERSUS TRANSURETHRAL CATHETER Jason Warncke, Brittan Sutphin, John Hohenmeyer, E. David Crawford, and Brian Flynn Jason WarnckeJason Warncke More articles by this author , Brittan SutphinBrittan Sutphin More articles by this author , John HohenmeyerJohn Hohenmeyer More articles by this author , E. David CrawfordE. David Crawford More articles by this author , and Brian FlynnBrian Flynn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.741AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary tract infections (UTIs) are the most common type of healthcare-associated infection. Among UTIs acquired in the hospital, 75% are catheter-associated urinary tract infections (CAUTI). CAUTI has gained much attention, as in 2008 Medicare regulations ceased reimbursement for costs related to nosocomial CAUTIs. Traditional teaching has been that suprapubic catheters (SPC) are associated with less risk of CAUTI than transurethral catheters (TUC). However, studies directly comparing the CAUTI rate in patients with SPC versus TUC are lacking, particularly in the postoperative Urologic patient. Thus, in this study we aim to compare the CAUTI rate with SPC versus TUC in the postoperative Urologic patient. METHODS We retrospectively reviewed and compared the medical records of 354 patients over a 5-yr period that underwent Urologic surgery. The SPC group consisted of patients that underwent SPC placement at the time of concomitant autologous rectus fascia pubovaginal sling (PVS) by a single surgeon (BJF). SPC placement was accomplished using the T-Spec device from Swan Valley Medical. The TUC group consisted of patients that underwent TUC placement using an 18 Fr Foley at the time of open radical prostatectomy (RP) by a single surgeon (EDC). Patients without a SPC or TUC and patients with both were excluded from the study. The primary outcome of comparison was the CAUTI rate (defined by the 2017 CDC guidelines) between the SPC and TUC cohorts. A Fisher’s exact test was performed to determine if the difference in CAUTI rate between the two cohorts was statistically significant (p<0.05). RESULTS 252 patients were included, including 145 (57.6%) in the SPC group and 107 (42.5%) in the TUC group, mean age 54.5 and 61.5 yrs, respectively. The mean catheter duration at the time of CAUTI for the SPC and TUC groups were 21.3 and 16.0 days, respectively (p=0.79). The mean catheter duration for the TUC group with and without CAUTI was 25.4 and 14.7 days, respectively (p=0.14). The overall CAUTI rate when catheter duration was less than 15 days compared to greater than 15 days was 3.3% and 5.0%, respectively (p=0.39). The CAUTI rate for the SPC group was 2.1% versus the TUC group 7.5% (p=0.039; OR 3.82). CONCLUSIONS In this study of postoperative Urologic patients, SPC was found to have a statistically significant lower rate of CAUTI when compared to TUC. This information may help guide providers when choosing the appropriate bladder drainage modality for their patients, particularly in the postoperative Urologic setting. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e284 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jason Warncke More articles by this author Brittan Sutphin More articles by this author John Hohenmeyer More articles by this author E. David Crawford More articles by this author Brian Flynn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

33: Robotic excision of pubovaginal sling

33: Robotic excision of pubovaginal sling

Volume at First Leak Is Associated With Sling Failure Among Women With Stress Urinary Incontinence.

Stress urinary incontinence at a low bladder volume is a clinically observed phenomenon that is not well studied with regard to treatment outcomes. The primary aim of our study was to determine if the volume at first leak is associated with sling outcome. This is a retrospective cohort study evaluating whether urodynamic stress urinary incontinence observed at low volumes is associated with sling failure using the Synthetic Derivative database. Sling failure was defined as (1) undergoing a subsequent surgery for stress incontinence (eg, urethral bulking agent, repeat sling) or (2) leakage that was subjectively worse or unchanged from baseline. Sling success was defined as subjective improvement in incontinence or being dry. Intrinsic sphincter deficiency was defined as maximum urethral closure pressure 20 cm H20 or less or abdominal leak point pressure less than 60 cm H20. Outcome data were available for 168 of 206 women who underwent a sling after urodynamic testing from 2006 to 2014. Of the 168 women, 80 were transobturator, 79 were retropubic, 8 lacked data regarding the approach to the midurethral sling, and 1 was an autologous pubovaginal sling. Similar failure rates were seen for transobturator (10%) and retropubic slings (7.6%). Preoperative urodynamic parameters, such as cystometric capacity and intrinsic sphincter deficiency, were similar among failed and successful slings. For every additional 50 mL in bladder volume at first leak (SUIvol), there was a 1.6 increased odds of having a successful sling (odds ratio, 1.576; 95% confidence interval, 1.014-2.450; P = 0.04). There was no statistically significant association between maximum urethral closure pressure, abdominal leak point pressure, body mass index, age, sling type, or whether a prior anti-incontinence procedure had been performed and sling success. Bladder volume at first leak is a strong predictor of sling failure.

Female Sexual Function Following Surgical Treatment of Stress Urinary Incontinence: Systematic Review and Meta-Analysis.

The impact of surgery for stress urinary incontinence (SUI) on female sexual function has received attention in the medical literature, but not in a structured manner. To assess the most recent evidence on the impact of surgical management for female SUI on female sexual function. The review and meta-analysis of available articles published in Medline, Cochrane, LILACS, SCOPUS, Web of Science, CINHAL, and EMBASE included prospective randomized and non-randomized studies that assessed patients who underwent surgical treatment for UI through 2 validated questionnaires: the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Female Sexual Function Index (FSFI). The following terms were searched: (urinary incontinence OR female OR woman OR women) AND (suburethral slings OR transobturator tape* OR transobturator suburethral tape OR trans-obturator tape* OR urethral sling* OR midurethral sling* OR mid-urethral sling* OR "standard midurethral slings" OR tensionless vaginal tape* OR mini sling* OR Burch* OR "Burch colposuspension" OR "urologic surgical procedures" OR "tension-free vaginal tape" OR pubovaginal sling) AND (sexual behavior OR "Female Sexual Function Index" OR FSFI OR sexual function OR "Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire" OR PISQ-12). 1,043 articles were retrieved; 9 studies were included for qualitative analysis and 4 were included for meta-analysis. 25 articles were excluded because they used questionnaires other than the FSFI and PISQ-12. Meta-analysis of 2 studies composed of 411 women who underwent to retropubic and transobturator sling intervention and completed the PISQ-12 questionnaire showed an increase in sexual function of 2.40 points after transobturator compared with retropubic sling intervention (95% CI=-2.48 to-2.32; I2= 35%, P<.00001). However, 2 other studies composed of 183 women comparing the same techniques, but using the FSFI, did not show a statistically significant difference (95% CI=-1.77 to 3.78; I2= 0%, P= .48). The impact of UI surgery on sexual function is uncertain because of the imprecision of the effect and inconsistency among studies. Only limited evidence on the impact of the transobturator vs the retropubic sling was found. Bicudo-Fürst MC, Borba Leite PH, Araújo Glina FP, etal. Female Sexual Function Following Surgical Treatment of Stress Urinary Incontinence: Systematic Review and Meta-Analysis. Sex Med Rev 2018;6:224-233.

Surgical Treatment of Female Stress Urinary Incontinence: Pubovaginal Slings

Autologous tissue has been used for pubovaginal sling construction for over a century. Compared with synthetic materials, fascial harvest carries additional and expected morbidity. However, by the nature of its definition, the use of autologous tissues is not associated with a significant immunogenic or any foreign body response. Randomized controlled trials have demonstrated and confirmed the durability of these procedures when compared with both colposuspensions and synthetic midurethral sling procedures. In light of the recent FDA warning regarding the use of synthetic materials for stress incontinence and pelvic organ prolapse surgery, the role of the autologous sling may be more prominent going forward. As such, the autologous pubovaginal sling remains a standard of care for the management of female stress urinary incontinence. This review contains 6 figures and 30 references Key words: autologous rectus fascia, complications, outcomes, pubovaginal sling, randomized controlled trials, stress urinary incontinence

Re: Comparison of Retropubic Synthetic Mid-Urethral Slings to Fascia Pubovaginal Slings following Failed Sling Surgery.

Re: Comparison of Retropubic Synthetic Mid-Urethral Slings to Fascia Pubovaginal Slings following Failed Sling Surgery.

An in-house Composix™-based pubovaginal sling trial for female stress urinary incontinence: Five-year comparative followup to tension-free and transobturator vaginal tapes.

We compared the efficacy of three slings in the long-term treatment of stress urinary incontinence (SUI): tension-free vaginal tape (TVT), vaginal tape-obturator (TVT-O), and an in-house two-layered polypropylene mesh with a submicronic polytetrafluoroethylene (Composix™). Our primary endpoint was the objective measurement of continence (24-hour pad test). Secondarily, we measured the satisfaction and complication rates. This prospective, non-randomized study included 128 patients with SUI. Preoperative evaluation included medical history, physical exam, 24-hour pad test, Urinary Incontinence Quality of Life Scale (IQOL), FPSUND, and global satisfaction questionnaires. Patients were followed at one month postoperative, biannually for two years, and then annually for a total of five years. Followup visits included a focused questionnaire, physical exam, satisfaction questionnaire, 24-hour pad test, IQOL, and FPSUND questionnaires. Composix, TVT, and TVT-O groups included 60, 34, and 34 patients, respectively. No significant differences were found in baseline characteristics except for the pad test. Length of catheterization was the only immediate operative significant parameter (Composix 4.7 days vs. TVT 1.1 days vs. TVT-O 2.6 days; p=0.03). The entire cohort had significant improvements in their IQOL, FPSUND, and pad test at one and four years (p<0.01). The cohort-wide 24-hour pad test average weight was 30.4 g preoperatively vs. 5 g at 12 months (p<0.00001) (Composix 37 to 5 g, TVT 83 to 4 g, and TVT-O 55 to 5 g). The Composix group had a higher number of minor complications (Clavien I, II) and secondary procedures. This single-surgeon cohort with five-year followup demonstrated a large improvement and maintenance of continence in all three surgical groups. The Composix-based sling provided comparable continence outcomes at a fraction of the cost; however, its increased morbidity and higher complication rate raise concerns over future use.

Outcomes of treatment of stress urinary incontinence associated with female urethral diverticula: A selective approach

To assess surgical outcomes of concomitant treatment of SUI at time of transvaginal urethral diverticulectomy (TVUD) based on a selective approach. Following Institutional Review Board (IRB) approval, we identified patients with a UD and SUI who underwent TVUD between July 2004 and January 2016. SUI was documented before and after surgery using subjective and objective parameters. Autologous pubovaginal slings (APVS) were used selectively based on surgeon and patient preference. A total of 61 patients underwent surgical treatment of urethral diverticula; 39 patients with UD and concomitant SUI. Mean age was 53 years. Mean follow-up was 16.2 months. There were 24 patients (62%) with SUI that underwent concomitant APVS. There was resolution of SUI in 20 of 24 patients (83%) who underwent a simultaneous APVS compared to 8 of 15 patients (53%) who underwent TVUD without APVS. Surgery resulted in the improvement or resolution of the majority of preoperative symptoms including recurrent urinary tract infection (UTI) (82% vs 15%), dyspareunia (64% vs 8%), and urgency (56% vs 13%) (preoperative vs postoperative). Female UD is often associated with SUI. Concomitant surgical treatment of UD and SUI often results in satisfactory control of bothersome SUI as well as other urinary symptoms such as UTI, dyspareunia and urgency. Treatment of SUI with APVS when undergoing TVUD is feasible with satisfactory outcomes.