Pure Stress Incontinence Research Articles

Patients with transobturator tape: a retrospective observational study of ten-year follow-up

Stress urinary incontinence (SUI) may result from intrinsic sphincter weakness or urethral hypermobility brought on by weakened muscles in the pelvic floor that sustain the urethra and bladder. The amount of mid-urethral support is increased by the mid-urethral tape's function to serve as an anchored pubo-urethral neo-ligament. This study's objective is to assess the safety and effectiveness of transobturator tape (TOT) for SUI after a 10-year follow-up period. There were 103 patients included in this retrospective observational single-arm research. Only 95 participants were included in the trial since 8 patients were lost to follow-up. Patients who had TOT between 2010 and 2013 were monitored until December 2022. The effectiveness of the tape was assessed at 10 years for both early and late surgical problems in the patients. Those diagnosed with SUI were 52.27 years old on average (standard deviation ±8.48). 24% of patients (n=21) experienced mixed urinary incontinence (MUI), compared to 79.61% (n=82) of patients who had just pure stress incontinence. At 10 years, the success rate in our research was 97.09%. Demand incontinence was healed in 57.14% (n=12) of the 21 MUI patients. 7.69% of de novo urgency was noted (n=7). There were no significant side effects including mesh erosion, bladder and intestine perforation, or vascular hemorrhage. Excellent patient satisfaction was rated in 43% of cases (n=44), good in 54% of cases (n=56), and low in 3% of cases (n=3). At 10 years, TOT for SUI shows an impressive cure rate and excellent effectiveness. When the treatment is carried out by experienced hands, there are no significant difficulties.

Urinary incontinence during pregnancy – of predictive value?

Objective: Primary objective was to find the prevalence of urinary incontinence during pregnancy by its type and see how predicative it was of urinary incontinence in the long term. Associated risk factors were identified as secondary objectives. Method: Antenatal clinics provide opportunistic screening for diseases of the breast, the heart or even the mind. Preventive gynaecological issues could also be addressed likewise. It was felt worth investigating the prevalence of urinary incontinence during pregnancy without undue harassment to the patients by way of a few routinely directed questions about urinary incontinence.This information is rarely volunteered due to embarrassment. 867 women attending antenatal clinics led by the author at teaching hospital Peradeniya, in 2007 and 2008 were interviewed during pregnancy and those incontinent were followed up post-partum at 6 weeks,one and two years till 2010. Patients were inquired regarding the predominant type of incontinence, when the symptoms were mixed(stress and urge both). Results: Of the 867 women analysed, 209 (24%) had some form of urinary incontinence. 110 (52%) of those affected had pure or predominant stress, and 15 (7%) pure or predominantly urge incontinence. The rest 41% had a mixed picture. 154 were still incontinent at 6 weeks post-partum. The proportion of the type of incontinence had changed. 97 (63%) had pure or predominantly stress incontinence, 6 (3.9%) had pure or predominantly urgency and the 33.1% had a mixed picture. 47 of them still complained of some degree of incontinence at the end of one year despite interventions of pelvic floor exercise (PFE),for urodynamic stress incontinence or mixed symptoms. The patterns were even more stress predominant. 33(70%). 2 patients (4.2%) had pure urgency and the rest 12 (25.5%) had a mixed pattern. End of 2 years only 43 patients of those incontinent at 1year were traceable at least over the telephone. Only 23 complained of persistence of the problems. Of the 23 with symptoms at 2 years, 2 were pregnant again. 18 (78%) had pure SI and the rest 5 (22%) had a mixed picture. This indicated that pure stress incontinence tended to persist more than urge incontinence probably indicating some form of permanent damage to the pelvic floor. Older and women of higher parity were found to be more affected again indicating possibility of such injury. Conclusions: The finding that of the initial 209 women who leaked urine during pregnancy 23 remained incontinent at the end of 2 years (11%), is evidence that incontinence during pregnancy is of some predictive value in finding those likely to have long term incontinence.The symptoms of stress incontinence persisted despite PFE. This places doubts on benign physiological and hormonal change theories which is discussed alongside these findings. Incontinence during pregnancy maybe a useful indicator of injury sustained to the pelvic floor providing early warning for trouble ahead with the sphincter mechanism. Questions about urinary incontinence as a routine during antenatal consultations may be a worthwhile exercise. This would take only a very short time and should be encouraged as a higher percentage would have remained incontinent had PFE not been initiated as an ethical intervention.

Five-Year Follow-up in Patients with Transobturator Tape - A Retrospective Observational Study.

Background:Stress urinary incontinence (SUI) could be due to urethral hypermobility due to the weakening of the pelvic floor muscles which support the urethra and bladder or the intrinsic sphincter deficiency. The mid-urethral tape acts as an anchored pubo-urethral neo-ligament thus increasing the level of mid-urethral support. The purpose of this study is to evaluate the safety and efficacy of transobturator tape (TOT) for SUI at 5 years of follow-up.Materials and Methods:This was a retrospective observational single-arm study of 40 patients. Ten patients were lost to follow-up; hence, only 30 patients were included in the study. Patients who underwent TOT from 2010 to 2012 were followed up till December 2017. Patients were evaluated for early and late postoperative complications and efficacy of the tape at 5 years.Results:The mean age of the patients with SUI was 48.07 (standard deviation ± 9.38). About 76.66% (n = 23) of patients had only pure stress incontinence, whereas 23.3% of patients (n = 7) had mixed urinary incontinence (MUI). The cure rate in our study was 93.33% at 5 years. Out of the seven patients with MUI, urge incontinence was cured in 71.42% (n = 5). De novo urgency was observed in 6.6% (n = 2). No major complications such as bladder and bowel perforation, vascular hemorrhage, or mesh erosion were seen. Patient satisfaction was graded as excellent in 46.66% (n = 14), good in 30% (n = 9), and poor in 23% (n = 7).Conclusion:TOT for stress incontinence has a high cure rate and very good efficacy at 5 years. No major complications are seen when the procedure is performed by expert hands.

Complications and Success Rate in Women Undergoing Burch Colposuspension for Urinary Stress Incontinence

Our goal was to study the success rates and peri-operative and post operative complications of Burch colposuspension in women having urinary stress incontinence. The study was performed in the department of gynaecology and obstetrics, MTI Hayatabad Medical Complex, MTI Lady Reading Hospital and a private set in Peshawar. Peri and postoperative outcomes were reviewed in 54 patients who underwent Burch Colposuspension from 2012 to 2017. All operations were performed by a single experienced surgeon and patients were followed post procedure for 18-24 months. Prior to the procedure, urodynamic studies were performed on 34 patients, while others showed signs of pure stress incontinence, so they did not require urodynamic studies. Urodynamics of 28 women showed genuine stress incontinence while six showed mixed stress incontinence. 10 patients underwent additional procedures along with Burch Colposuspension, mostly posterior colporrhaphy in 6 patients. The complication rate was relatively low, with 14.8% of patients experiencing voiding difficulties and 11% experiencing Denovo detrusor instability. Burch Colposuspension is a safe surgical treatment for genuine stress incontinence.

Urethral sphincter volume and urodynamic diagnosis.

To compare urethral sphincter measurements in women with different urodynamic diagnoses using three-dimensional transperineal ultrasound (TPU). Women with lower urinary tract dysfunction having urodynamic studies (UDS) were prospectively recruited to this study. A detailed history and vaginal examination were conducted. Saline cystometry was performed and the women were divided into groups according to their urodynamic diagnosis, which were nondiagnostic urodynamics (NUDS), pure detrusor overactivity (PureDO), pure urodynamic stress incontinence (PureUSI) and mixed urinary incontinence (MUDS). Three-dimensional TPU was performed to measure total urethral sphincter volume, striated sphincter volume, core volume, sphincter length and maximum cross-sectional area. The ultrasound measurements were compared with the diagnostic urodynamics. One hundred fifty women were included in the study. There were 37, 53, 22 and 38 women in the groups of NUDS, PureDO, PureUSI and MUDS respectively. The average striated sphincter volumes in these groups were 1.84ml, 2.24ml, 1.32ml and 1.98ml respectively. There was no difference in average age, body mass index or presence of prolapse in these groups. All measurements were larger in the PureDO and smaller in the PureUSI group compared with the NUDS group. The measurements in the MUDS group were larger than in the NUDS group and smaller than in the PureDO group but this difference was not statistically significant. The urethral sphincter of women with PureDO is larger than in women with PureUSI. The value in women with MUDS was between the two. The size of the urethral sphincter appears to be related to the pathophysiology.

SC116 - Long-term efficacy of artificial urinary sphincter for pure stress and mixed incontinence: Multi-institutional analysis

SC116 - Long-term efficacy of artificial urinary sphincter for pure stress and mixed incontinence: Multi-institutional analysis

Patient-reported outcomes and urodynamic findings in men with persistent lower urinary tract symptoms following robot-assisted radical prostatectomy.

To evaluate the patient-reported outcome measures (PROMs) and urodynamic findings in men seeking intervention for lower urinary tract symptoms (LUTS) after robotic-assisted radical prostatectomy (RARP) in a regional referral center for continence surgery. Consecutive men with post-RARP LUTS, who were referred for specialist evaluation and urodynamics between December 2012 and October 2017, were evaluated. Men were invited to complete the International Consultation on Incontinence Questionnaire on Male Lower Urinary Tract Symptoms Long Form (ICIQ-MLUTS) pre-operatively and at 6, 12 and 18 months post-RARP. In total 64/860 (7.4%) men post-RARP were referred for specialist evaluation. There was a significant increase in total ICIQ-MLUTS and bother scores at 6, 12 and 18 months compared with the baseline in these men (P < 0.001 and P < 0.05, respectively). Urodynamics identified 41/64 (64%) had urodynamic stress incontinence (USI) only, 2/64 (3%) had detrusor overactivity (DO) only and 11/64 (17%) had a combination of USI and DO. Of those referred to a continence specialist 29/64 (45%) underwent a continence procedure. Patients with bothersome LUTS post-RARP have higher baseline ICIQ-MLUTs scores and significant worsening of total scores at all time points compared with the baseline. Routine use of PROMs may identify patients at risk of bothersome symptoms after RARP and prompt earlier referral for further management of their LUTS. Urodynamic evaluation revealed that the most common finding was pure stress incontinence but the range of urodynamic diagnoses highlights the need to perform urodynamics before making treatment decisions for men with LUTS post-RARP.

AUTHOR REPLY

Thank you for the insightful feedback on our study evaluating exchange of the artificial urinary sphincter (AUS) pressure regulating balloon. We agree it would be beneficial to know more of the details regarding the nature of incontinence (recurrent vs persistent) and the etiologies of the prior AUS explants, which was not obtained in 64% of the cohort. Of note, however, there was no significant difference in erosion rates, perhaps the most morbid outcome, between those with a prior AUS implant/explant and those who underwent pressure regulating balloon exchange with a virgin AUS. Further, it is important to emphasize that this procedure is beneficial in a very select cohort, ideally the nonirradiated patient with pure stress incontinence lacking urethral atrophy. Despite the efficacy demonstrated by our study, there is certainly a need for multi-institutional, prospective studies evaluating this management option for post AUS incontinence.

Stress Urinary Incontinence Management in the Patient With Overactive Bladder

Mixed urinary incontinence is a common diagnosis that has significant impact on patient quality of life and can be more bothersome to patients compared to pure stress incontinence. Given the complexity of concomitant stress incontinence and overactive bladder symptoms, mixed urinary incontinence can often present as a clinically challenging scenario for treating physicians across different subspecialties and primary care medicine. In this review, we discuss the importance of a judicious evaluation and the utility of deciphering stress-predominant versus urge-predominant urinary incontinence in patients with concomitant symptoms. The temporal relationship between stress incontinence and urgency symptoms has been explored in recent literature. Although a common pathway has been alluded, characterization of the predominant symptom is essential in treating this difficult diagnosis. As suggested in recent guidelines, emphasis should be placed on setting appropriate patient goals of care and discussing treatment expectations in order to best optimize patient satisfaction and patient-reported treatment success. Risks, benefits, and alternatives for both stress urinary incontinence and overactive bladder treatment options should be reviewed, yet there is lack of a standardized approach in the literature. We outline a sequential algorithm to help guide patient counseling, management, and appropriate expectations for treatment of mixed urinary incontinence.

Overactive Bladder Symptoms after Transobturator Sling Surgery for Pure Stress Urinary Incontinence: A Cross-Sectional Comparative Study

Introduction: Transobturator tape (TOT) surgery has been associated with increased overactive bladder (OAB) although much controversy exists. Methods: In a cross-sectional study, women who underwent TOT surgery for pure stress incontinence (Monarc^TM) answered the 6 questions of the symptom bother (SB) subscale of the OAB questionnaire – short form (OABq-SF) and an additional question regarding whether symptoms began after surgery. Women with SB score over the 4th quartile (≥30/100) were reassessed after a longer follow-up. Patients from primary care were recruited as controls. Results: We recruited 213 patients (135 in the TOT group and 78 age-adjusted controls). The mean age of operated patients was 58.7 ± 10.1 years with a mean follow-up of 25.9 ± 13.2 months. OABq-SF SB scores did not differ between the TOT group and controls (respectively, 18.5 ± 30 and 15.5 ± 6.7, p = 0.202). A total of 48% patients reported no relationship between symptoms and surgery. Highly symptomatic operated patients were reassessed after a longer follow-up (46.3 ± 10.6 months). The mean score in the second follow-up (n = 25) was not statistically different from the first assessment (46.4 ± 22.7 and 58.1 ± 19.8, p = 0.059). Conclusions: Women who underwent TOT surgery did not show increased OAB SB scores when compared to controls. Our study suggests that OAB symptoms may thus be present but overlooked during initial clinical assessment.

Does the diagnosis of detrusor overactivity affect the long-term prognosis of patients treated with a retropubic midurethral sling?

There are few long-term studies on the midurethral sling (MUS) procedure in patients with preoperative detrusor overactivity (DO) and there is debate regarding the usefulness of preoperative cystometry. This study was designed to provide long-term efficacy and safety data for the Advantage MUS and to compare the outcomes in patients with pure urodynamic stress incontinence (USI) with the outcomes in patients with mixed USI and DO. This was a retrospective consecutive case series study of 100 patients with USI (USI-only group) matched to a consecutive group of a further 100 patients with preoperative USI and DO (mixed group) treated with a retropubic MUS. Outcomes were assessed using the King's Health Questionnaire and Patient Global Impression of Improvement questionnaire. After a mean follow up of 6years more patients in the USI-only group described themselves as "very much better" or "much better" (86% USI-only group vs. 57% mixed group; p = 0.007). Quality of life was improved at 6years from baseline in both groups. Patients in the mixed group were more likely to complain of urgency (69% vs. 42%; p = 0.0007) which was more likely to be severe (34% vs. 10%; p = 0.004). A repeat MUS procedure was needed in 1% of patients and 0.6% needed surgical removal of the MUS for persistent troublesome pain. This study suggests that the preoperative diagnosis of DO affects the long-term patient-perceived outcome of the MUS procedure. However, most patients have significant long-term improvement in quality of life.

Is It Possible to Predict Urodynamic Stress Urinary Incontinence in Women with Minimal Diagnostic Evaluation?

Objectives: To determine whether it is possible to predict urodynamic stress urinary incontinence (uSUI) in women with minimal diagnostic evaluation. Materials and Methods: Medical records of 2,643 female incontinent patients were reviewed and 301 women were eligible for this study. The positive predictive values (PPV), sensitivity, specificity and negative predictive values (NPV) for uSUI and uSUI with or without detrusor overactivity (DO), and DO patients of pure SUI symptom (group 1), combination of pure SUI symptom and positive provocative stress test (+PST; group 2) and combination of pure SUI symptom, +PST and absence of overactive bladder symptoms (group 3) were calculated for each group. Results: Mean age was 51.03 years (22-88). PPV, sensitivity and specificity values for uSUI with or without DO of group 3 were 100, 7.4, and 100%, while these values for pure uSUI were 93.3, 9.3, and 99.3%, respectively. Interestingly, none of the patients in groups 2 and 3 had DO. Conclusions: Our results show that it was possible to predict uSUI with high accuracy using minimal diagnostic evaluation in a group of female patients with pure stress incontinence symptoms +PST while it was also possible to eliminate DO accurately in this group of patients.

Cost-Effectiveness of Urodynamics Testing in Women With Predominant Stress Incontinence Symptoms

INTRODUCTION: The objective of this study was to determine the cost-effectiveness of urodynamic testing in women who have either pure stress incontinence or mixed incontinence with predominant stress incontinence. METHODS: A decision analysis model was used based on recent randomized controlled data. Costs and complications were based on literature and Medicare. Sensitivity analysis (one-way) was used. RESULTS: In patients with pure stress urinary incontinence or mixed urinary incontinence, opting for immediate midurethral sling placement was both less costly and more effective (dominated) than performing urodynamic testing and subsequently individualizing treatment decisions if history and urodynamics were discordant. One-way sensitivity analysis showed to achieve a cost of adding urodynamic testing to less than $5,000 per subjective cure, the subjective cure rate would have to increase from 71.2% to 79.5%. Alternatively, if the cost of urodynamic testing was decreased from $350 to free, it would still not be cost-effective because of the lower subjective cure rate in this population. CONCLUSION: In women who have either pure stress incontinence or mixed incontinence with predominant stress incontinence, urodynamic testing does not add effectiveness in subjective treatment outcomes but does add cost.

MP33-07 SUCCESS OF AUTOLOGOUS PUBOVAGINAL SLING FOLLOWING FAILED MIDURETHRAL SLING

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy I1 Apr 2014MP33-07 SUCCESS OF AUTOLOGOUS PUBOVAGINAL SLING FOLLOWING FAILED MIDURETHRAL SLING Jaclyn Milose, Chang He, John Stoffel, Quentin Clemens, and Anne Pelletier Cameron Jaclyn MiloseJaclyn Milose More articles by this author , Chang HeChang He More articles by this author , John StoffelJohn Stoffel More articles by this author , Quentin ClemensQuentin Clemens More articles by this author , and Anne Pelletier CameronAnne Pelletier Cameron More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.958AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is no consensus on the management of stress incontinence status post failed synthetic midurethral sling. It has generally been our practice to perform autologous pubovaginal slings (APVS) however little empirical work has been performed to assess the efficacy. METHODS 108 patients underwent APVS with rectus fascia following one or more failed synthetic midurethral sling from 2000 to 2012. Mean follow up of 14.3 months. RESULTS Mean age for the patient population was 55.7 years. 46 of our 108 patients (42%) had a prior retropubic synthetic sling, 45 (41.7%) had prior transobturator sling, 5 (4.6%) had prior bone anchored sling, 5 (4.6%) had prior unspecified midurethral sling and 4 (3.7%) had prior minisling. 85 patients (78.7%) had only 1 incontinence procedure prior to APVS while 15 (13.9%) had 2, 7 (6.5%) had 3, and 1 (0.9%) patient had 4 prior procedures. 35 (32.4%) of the patients required mesh removal prior to their APVS while 26 (24.1%) had mesh removed simultaneously with APVS. Primary indication for mesh removal included vaginal exposure in 31.7%, pain in 26.8%, retention in 22.0% and urethral erosion or fistula in 15.5%. Preoperative diagnosis was pure stress incontinence (SUI) in 32 patients (29.6%), mixed incontinence in 64 (59.3%), and complex stress incontinence with urethral diverticulum or urethrovaginal fistula/urethral mesh erosion in 12 (11.1%). In the subgroup with Michigan-Incontinence Symptom Index scores (n=66) stress subdomain scores improved from 9.8 pre-op to 3.4 post op (p=0.045). Urgency incontinence (UI) subdomain improved from 8.6 pre-op to 5.5 post op (p=0.017). 93.8% had improvements of their SUI defined as a reduction of 2 points or more on the stress subdomain with 57.6% having cure of their SUI. 62.5% had improvements of their UI defined by a reduction of 2 points. Of our entire patient population 43 (39.8%) had cure with no incontinence, 20 (18.5%) had significantly improved SUI, 32 (29.6%) had cure of their SUI but persistent urge incontinence, 6 (5.5%) patients had no improvement, and 7 (6.5%) de novo urge incontinence. The rate of retention following APVS was 12% (13/108) with 4 patients requiring urethrolysis. On univariate analysis patients with a mesh excision did not have worse outcomes than patients with mesh not removed. Patients with pure SUI were significantly more likely to be cured (56.3%) than those women with pre-operative mixed or complex incontinence (32.9% p=0.032) CONCLUSIONS In this complex population APVS is very effective in the management of SUI following failure of a synthetic midurethral sling. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e340 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jaclyn Milose More articles by this author Chang He More articles by this author John Stoffel More articles by this author Quentin Clemens More articles by this author Anne Pelletier Cameron More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Correlation Between Cystometric Volumes, ATP Release, and pH in Women With Overactive Bladder Versus Controls

Bladder stretch has been implicated in the development of the sensations associated with urgency in women with overactive bladder (OAB). It is well established that bladder stretch causes release of ATP from urothelial cells. Some investigators have hypothesized that ATP release may modulate initial afferent sensation in OAB patients whose main symptom is urinary urgency. Animal studies conducted in vitro showed that, in addition to stretch, urine acid was a potent stimulant of ATP release. Moreover, in a human study, women with detrusor overactivity had significantly lower urinary pH than a control. It is possible that increased urine acidity could contribute to urgency, possibly through release of ATP. This study tested the hypothesis that ATP plays an important role in women with OAB characterized by symptoms of urgency and that low urine pH in these patients may be associated with symptoms of frequency and/or urgency. The correlation between ATP release, urine pH, and urodynamic parameters was investigated in women with OAB characterized by small bladder volumes at first desire to void (FDV) and maximal cystometric capacity (MCC). All subjects had symptoms of frequency/urgency (mild bladder pain syndrome). Routine cystometry was performed in a consecutive series of 246 women aged 28 to 87 years. Control subjects were 69 women with normal bladder function or with pure urodynamic stress incontinence without urge symptoms, voiding dysfunction, or urinary infection. A sample of the voided urodynamic fluid was collected and stored at 20°C. ATP was measured using bioluminescence. A catheter urine specimen was collected for measurement of pH. Linear regression analysis was used to test correlations between ATP and urine pH. Patients with voiding dysfunction, urinary tract infection, and detrusor overactivity were excluded from the study. There was a strong inverse correlation between ATP concentration in voided urodynamic fluid and FDV (r2 = 0.25; P = 0.01) in OAB patients (n = 25). In contrast, no such correlation was seen for MCC or in control subjects. In women with OAB, but not control subjects, a significant inverse correlation (r2 = 0.16; P = 0.047) was found between ATP concentration in voided urodynamic fluid and urinary pH. However, no correlation between urine pH and MCC occurred in patients with OAB. These data suggest that ATP is an important factor in patients with OAB for initial perception of need to urinate, which often produces the symptom of urgency/frequency. Increasing ATP concentration in patients with OAB (at FDV) was directly related to the increasing acidity of the urine.

Assessment of the Impact of Male Urinary Incontinence on Health-Related Quality of Life: A Population Based Study.

To assess the impact of male urinary incontinence on health-related quality of life by population based study. A two-stage systematic sampling method was adopted. A total of 5830 men participated in this survey. Face -to-face interviews were used to collect data. Urinary incontinence and symptom bother were measured with the Urogenital Distress Inventory-6 (UDI-6). General health-related quality of life (QoL) was measured using EQ-VAS, which evaluates the respondent's self-rated health on a vertical visual analogue scale. The age-adjusted prevalence of Korean male UI was 5.5%. Incontinent men reported higher score of UDI-6 and lower score of EQ-VAS than continent men. Men with mixed urinary incontinence reported significantly lower QoL than men with pure stress or urge incontinence. Urinary incontinence affects men's QoL negatively. In particular, mixed urinary incontinence has the greatest impact on QoL.

726 TVT-O for the treatment of pure urodynamics stress incontinence in females: Efficacy and adverse events at 5 years follow-up

726 TVT-O for the treatment of pure urodynamics stress incontinence in females: Efficacy and adverse events at 5 years follow-up

When Are Urodynamics Indicated in Patients with Stress Urinary Incontinence?

Despite technical and procedural advances in urodynamics over the past decade, the role of urodynamics in women with stress urinary incontinence (SUI) remains controversial. Many of these advancements have been the result of multicentric studies in the United States, such as the UITN and PFDN, which will be highlighted in this article. It appears to be the consensus that urodynamics may not be needed in pure stress incontinence. Urodynamics can be valuable in unmasking stress urinary incontinence in prolapse, although its impact on the ultimate management of occult incontinence remains debated. This article reviews the indications for urodynamic testing in women with SUI but will exclude more complex conditions such as mixed or recurrent incontinence which are outside the scope of this review.

Évaluation prospective d’un dispositif de rééducation périnéale à domicile dans l’incontinence urinaire d’effort féminine

ObjectivesTo study the objective and subjective effectiveness of transvaginal electrical stimulation for treatment of female pure genuine stress incontinence. Patients and methodsThis was a multicenter prospective trial including 207 patients with genuine stress incontinence who used the stimulator for 10weeks. Similar pre-treatment and post-treatment assessments included both validated symptom severity index and health-related quality of life. ResultsObjective evaluation showed a significant improvement in 65.7% of subjects with stress incontinence. All domains of quality of life improved significantly after treatment (P=0.0001) and rate of satisfactory was 84.7%. There were no statistical differences between the two stimulators. Discussion and conclusionPelvic floor electrical stimulation seems to be effective in treating female genuine stress incontinence and could be considered first-line therapy.

Bandas suburetrales libres de tensión transobturatriz in-out: indicación y resultados asociados

ObjectiveTo describe the characteristics of treated patients and assess the results obtained. Subjects and methodsAll patients (n=162) who underwent this technique between June 2005 and December 2010 at the Hospital de Fuenlabrada were included. ResultsThe mean age was 51.64 years, mean body max index was 28.92kg/m2 and the mean number of vaginal deliveries was 2.31. Urodynamic diagnosis was performed in 96.3%, with findings of pure stress incontinence in 68.5%, mixed incontinence and stress incontinence in 25.9%. Intraoperative complications occurred in 3.1%. Mesh erosions were found in 1.2%. The overall objective cure rate was 92% and the subjective cure rate was 80.3%. ConclusionsThe complications rate was low and all complications were resolved. Cure rates were highly satisfactory both in pure stress urinary incontinence and in mixed urinary incontinence with a predominance of stress incontinence. Urodynamic studies before surgery allow good surgical indications and guide postsurgical prognosis.