BackgroundEctopic ureters (EU) are the main cause of urinary incontinence in juvenile dogs with a continence rate ranging from 22 to 72% reported after surgical correction. The objective of this retrospective preliminary study was to evaluate the usefulness of pre- and postoperative urethral pressure profiles (UPP) in predicting long-term continence in dogs with EU.ResultsUPP were performed in 16 female dogs prior to surgical correction of EU, as well as postoperatively, between 2012 and 2022. Urodynamic parameters included maximal urethral pressure (MUP), maximal urethral closure pressure (MUCP), anatomical profile length (APL), functional profile length (FPL) and integrated pressure (IP). A continence score (CS), defined as 1 = incontinent, 2 = continent with sporadic episodes of incontinence, 3 = continent, was given at the time of pre- and postoperative UPP. Neoureterostomy with dissection of the intramural portion (23 EU) or neoureterocystostomy (3 extramural EU) were performed. Seven dogs were neutered before or during surgical correction. Median preoperative CS was 1 (min 1, max 2). All dogs were continent with a CS of 3 in the immediate postoperative period. Long-term median follow-up time was 24 [8.5–42] months. Recurrence of incontinence occurred in 9 dogs (56.3%). Median time duration without recurrence was 5 months. In the 16 dogs, postoperative FPL values (median 70.5 [56-82.5] mm) were significantly increased compared to preoperative values (median 56.5 [41-72.3] mm) (P = 0.034). In the group of 7 dogs without recurrence of incontinence, IP increased significantly from a preoperative median value of 102 [19–171] cm.cmH2O to a postoperative median value of 132 [67–225] cm.cmH2O (P = 0.016). In dogs without recurrence, ranges of variation between pre- and postoperative MUP and IP values, as well as postoperative MUCP values (median 47.3 [24.5–52] cmH2O, P = 0.026) were significantly higher (P = 0.017 and P = 0.039 respectively). Recurrence hazard of incontinence was neither significantly associated with age, breed, preoperative urodynamic measurements, CS, neutering, or the type of EU.ConclusionsIn our population, preoperative UPP could not be considered as a diagnostic procedure predictive for incontinence recurrence after surgical correction of EU. Our urodynamic findings support potential improvement in urethral tone in female dogs without recurrence of incontinence.

Stress urinary incontinence (SUI) is highly prevalent among adult women and can significantly impact quality of life (QoL), including sexual function (SF). The midurethral sling (MUS) has become the gold-standard intervention for SUI owing to its high efficacy and minimal invasiveness. However, its impact on SF is less well understood. This review is aimed at examining the impact of MUS techniques on SF in women with SUI and outlines evidence-based interventions for managing MUS complications or failure. The PubMed database was searched to identify original, peer-reviewed articles published from 2014 to 2025 that examined changes in SF and treatment options in patients undergoing MUS surgery for SUI. Ninety-eight studies were included in this review. Our analysis found that most studies reported an improvement or preservation of SF following MUS placement. However, surgical outcomes varied depending on the type of sling, follow-up duration, and individual patient characteristics. A subset of patients may also experience postoperative complications such as mesh exposure and recurrent incontinence, requiring further intervention. Treatment options after MUS failure range from conservative approaches, including pelvic floor muscle training and steroid injections, to more invasive surgical interventions such as sling mobilization or removal, urethral bulking injections, and repeat SUI surgeries. Further long-term studies using validated SF instruments are needed to guide clinical decision-making and optimize outcomes for women undergoing MUS surgery.

Midurethral slings are widely used in the treatment of stress urinary incontinence in women. However, little is known about the microbiomes that develop on these implants, their relationship to the urinary and vaginal microbiomes, or their potential role in mesh-related complications. In this study, we characterized the microbiomes of explanted midurethral slings and examined associations with clinical complications. Seventy-four women provided a total of 397 samples, including explanted mesh, urine, and swabs from the vagina and groin or suprapubic skin. Participants were categorized into clinical groups: chronic pain, vaginal mesh exposure, lower urinary tract perforation, or recurrent incontinence (control group). Samples underwent 16S rRNA gene sequencing. The mesh microbiome was dominated by Firmicutes, Proteobacteria, and Actinobacteria, with Enterococcus particularly abundant. Microbial diversity was significantly higher in mesh samples compared to vaginal and skin swabs, but not urine. The mesh microbiome was compositionally distinct from the urinary, vaginal, and skin microbiomes, potentially reflecting vaginal microbiome alterations due to urinary incontinence at the time of implantation. Differences in microbial diversity in mesh and skin samples among women with pain suggest a possible microbial contribution to mesh complications. These findings demonstrate the presence of distinct, site-specific microbial communities on explanted midurethral slings, with potential implications for understanding mesh-related complications.IMPORTANCEStress urinary incontinence commonly affects women, and effective treatment is essential. Midurethral mesh slings have provided effective relief; however, long-term complications such as chronic pain, vaginal mesh exposure, and lower urinary tract perforation have emerged. The pathophysiology of these complications is not well understood but is thought to involve a heightened inflammatory response to mesh implants. The local microbiome may contribute to this inflammation. We have shown that the mesh samples harbored a distinct microbiome and that differences in microbial composition may be associated with mesh complications. Understanding the role of specific bacteria in modulating host responses may offer new insights into the pathogenesis of mesh complications and inform future clinical approaches.

Mid-urethral slings (MUS) have been the standard of care in surgical management of female stress urinary incontinence (SUI) internationally. Complications including pain and erosion has led to a temporary "pause" of their use in the UK and Ireland. We report on our experience to date on patient presentation, operative management, and post-operative outcomes in management of MUS erosion. Review of female patients who had partial MUS removal due to urethral erosion over a 7-year period. Data on patient presentation, operative technique, and post-operative outcomes were collected and collated. A total of 21 patients were identified. Overall, 66% of patients presented with symptoms of urinary tract infection (UTI). Other presentations include overactive bladder symptoms (52%), recurrent incontinence (42%), or dyspareunia (9%). Some patients presented with a combination of these symptoms. Overall, 9 patients had a trans-obturator tape (TOT), 6 had a trans-vaginal tape (TVT), and 4 had unspecified type of MUS. Two patients had 2 previous MUS insertions. Initial operative management with urethroscopy and laser fragmentation in cases with significant MUS calcification was required in 18% (n = 4) of patients. A total of 86% (n = 18) of patients had urethral erosion that required formal urethral repair and a short period with an indwelling catheter. All patients had resolution of their UTI symptoms post procedure. Fifteen patients required further surgical intervention to manage recurrent incontinence after MUS removal. Partial removal of MUS due to urethral erosion improves patient symptoms. However, the majority have recurrence of SUI and require further intervention.

Objective: To present and assess the pubo suburethral suture placement (PSUSP) technique as a surgical treatment option for stress urinary incontinence (SUI) in patients with previous mesh exposure and recurrent incontinence. This technique aims to offer an alternative approach for patients where conventional methods may be contraindicated or have previously failed. The PSUSP procedure involves strategic suture placement to reinforce the pubovaginalis fascia, potentially enhancing structural support and functional outcomes. Case: A 56-year-old woman who had undergone transobturator tape (TOT) surgery 3 years prior presented with SUI. Clinical examination revealed persistent SUI and suburethral mesh exposure. Under spinal anesthesia, partial dissection and removal of the exposed mesh were performed. The vaginal mucosa was dissected from the pubocervical fascia to the pubic bone bilaterally. A zero polyester suture was passed through the retropubic fibrous tissue and the pubovaginalis fascia parallel to the urethra on the left side, and the procedure was mirrored on the right side. Twenty days postoperatively, the patient reported mixed urinary incontinence, and examination revealed local incisional dehiscence, suture detachment, and persistent SUI. A reoperation was conducted using a vertical incision. The vaginal mucosa was re-dissected from the pubocervical fascia, and PSUSP was re-implemented as previously described. The pubovaginalis fascia was repaired before the PSUSP sutures were secured. Postoperative evaluation indicated the resolution of mixed incontinence, with no further complications reported. Conclusion: This case illustrates that PSUSP can be a viable surgical technique for treating SUI in patients with a history of mesh exposure and recurrent incontinence. The reoperation success suggests that PSUSP may provide enhanced support to the pubovaginalis fascia, but further clinical studies are necessary to evaluate its long-term efficacy and safety profile.

To the best of our knowledge, no studies have investigated the withdrawal strategy of pharmacological treatment with solifenacin or mirabegron in children diagnosed with urinary incontinence who have achieved continence on pharmacotherapy. The primary objective is to investigate if abrupt withdrawal versus gradual withdrawal of pharmacotherapy (solifenacin or mirabegron) influences the risk of recurrence of incontinence, assessed by a self-reported 14-day calendar of incontinence episodes. Children aged 5-14 years diagnosed with urinary incontinence, treated with pharmacotherapy of solifenacin or mirabegron and ready for withdrawal, will be randomized 1:1 to either abrupt or gradual withdrawal, according to the medical treatment that the child is receiving. The primary outcome measure is the recurrence of incontinence after withdrawal, 1 month after initiation of withdrawal of the physician-prescribed medication, assessed by a self-reported 14-day calendar of incontinence episodes. In addition, recurrence of incontinence after 3, 6, and 12 months after initiation of withdrawal will be measured. The hypothesis that gradual withdrawal is superior to abrupt withdrawal regarding the risk of recurrence of incontinence will be analyzed by logistic regression. Recruitment began at the end of May 2024 and will continue until 216 patients are included, which is expected by December 2027. As of February 2025, a total of 25 participants are included. The results are expected to influence the withdrawal strategy of pharmacological treatment with solifenacin or mirabegron in children with daytime urinary incontinence. ClinicalTrials.gov NCT06465576; https://clinicaltrials.gov/search?term=NCT06465576. DERR1-10.2196/63226.

V02-04 METHODS OF BLADDER NECK CLOSURE IN WOMEN

Introduction: Women with chronic urethral Foley catheterization can develop a patulous urethra with severe urinary incontinence. Bulking agents and slings offer little relief in this setting. Women who opt for a suprapubic tube or catheterizable channel can have their urethral incontinence addressed with a bladder neck closure. This can be performed transvaginally with a Martius flap or transabdominally with an omental flap. While these techniques have been previously described, to our knowledge there has been no direct video comparison of the indications and methods of the two approaches. The objective of this video is to describe and compare the indications and methods for transvaginal and transabdominal bladder neck closure. Materials and Methods: We define a patulous urethra as one that can accommodate an index finger. Our first case is a 75-year-old woman with neurogenic bladder due to spinal cord injury. She had a chronic urethral Foley catheter and developed a patulous urethra with complete incontinence. She elected for a suprapubic tube and transvaginal bladder neck closure. Our second case is a 29-year-old woman with neurogenic bladder due to relapsing-remitting multiple sclerosis. She had a chronic urethral Foley catheter and developed a patulous urethra with complete incontinence. She opted to proceed with bladder augmentation, catheterizable channel formation, and transabdominal bladder neck closure. Results: Both patients tolerated the procedure well. They had no postoperative complications, no recurrence of incontinence, and no fistula development. Conclusions: Bladder neck closure is a safe and effective procedure for the management of urinary incontinence due to a patulous urethra. We always use a Martius flap for a transabdominal or an omental flap for a transvaginal bladder neck closure to reduce the risk of fistula. We prefer a transvaginal bladder neck closure if the patient is not undergoing a concomitant transabdominal procedure. Acknowledgments: This video was presented at the 2024 American Urology Association conference entitled “Methods of Bladder Neck Closure in Women.” https://doi.org/10.1097/01.JU.0001008636.33664.3e.04 . Patient Consent: Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. All pictures and video footage were used with the written and verbal consent of patients in accordance with University of Minnesota and Internal Review Board policies. Ethics Statement: All procedures were performed in compliance with relevant laws and institutional guidelines. Appropriate approval was obtained from the ethics committee and Institutional Review Board. Informed consent was obtained from all human subjects involved. The work described has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. Music: Music is sourced from https://audionautix.com/ and is not copyrighted material. No authors have a conflict of interest to report. Runtime of video: 7 mins 59 secs.

Midurethral Sling With Concomitant Sacrocolpopexy: Does the Sequence Matter? A Retrospective Cohort Study

Sling surgery is a modern and effective surgical treatment for stress urinary incontinence in women. However, there is insufficient data on the comparative analysis of long-term results and quality of life of patients after various options of such operations. Purpose - to compare the functional results and quality of life of women after two variants of sling operations for stress urinary incontinence. Materials and methods. 84 women with stress urinary incontinence were examined, who were divided into two groups. In the Group I, a plastic free synthetic loop (TVT) was performed, in the Group II - an operation using the transobturator location of the prolene loop (TVT-Obturator - TVT-О). Functional outcomes of treatment and quality of life were assessed 2 years after surgery using the ICIQ-SF questionnaire, the Patient General Impression of Improvement (PGI-I) scale, and the Patient Satisfaction Scale. An objective indicator was the absence of leakage of urine during a cough test. Results. Treatment effectiveness, according to objective criteria, was 87.9% and 67.9% 2 years after TVT and TVT-O surgery, respectively (p=0.045). When evaluating subjective indicators, no statistically significant differences between groups were found, however, according to the ICIQ-SF questionnaire, the frequency of improvement in the quality of life was reliably 1.3 times higher in the case of using the TVT technique (odds ratio 3.33; 95% confidence interval 1.14-9.78). The frequency of urinary incontinence recurrence did not depend on the method of sling operation (p>0.05). Data analysis was carried out using The Statistical Package for Social Sciences. Conclusions. When evaluating the results of treatment 2 years after the intervention, the effectiveness of TVT surgery, according to objective criteria, is statistically significantly higher than the effectiveness of TVT-O surgery, although the latter technique is associated with the absence of bladder etching. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

IntroductionWe performed autologous rectus abdominis fascia sling surgery using Advantage™ following an unsuccessful synthetic midurethral sling.Case presentationAt the age of 76 years, the patient experienced stress urinary incontinence recurrence. A 1‐h pad test resulted in 259 g of leakage. A pressure flow study verified urine leakage while coughing and straining without detrusor overactivity. Abdominal leak point pressure was 10 cmH2O. Autologous rectus abdominis fascia sling surgery was performed using Advantage™. One month postoperatively, a 1‐h pad test resulted in 0 g of leakage.ConclusionWe believe that this method will allow the fascia sling procedure to be performed reliably even if one is unfamiliar with conventional autologous rectus abdominis fascia sling surgery.

Our objectives were to evaluate the Male Stress Incontinence Grading Scale to stratify male patients with stress urinary incontinence for either artificial urinary sphincter or sling using a standing cough test and determine if an emptier bladder at the time of assessment carries increased risk of treatment failure. Retrospective chart review of male patients undergoing sling and artificial urinary sphincter placement. The standing cough test score and bladder scan results were documented at initial evaluation. Forty patients underwent sling and 43 underwent naïve artificial sphincter placement. Median follow-up was 7.11 months. Thirty-six/forty slings had complete incontinence resolution or reduction to a safety pad vs 40/43 after sphincter (90% vs 93%, P = .62). Four sling patients (10%) had persistence or recurrence of incontinence. Cough test scores were similar between sling failure (67% grade 0, 33% grade 1) and success groups (83% grade 0, 3% grade 1, 14% grade 2). Bladder scan mean was 18.5 cc in the sling failure (SD 21.1) and 38.0 cc in the success groups (38.3), with 32% of success patients having bladder scans of 0 cc, and 63% of < 50 cc. Mean for sphincter patients was 45 cc (56.9). Ten patients with scan = 0 and 7 patients with scans < 30 cc demonstrated grade 4 incontinence. Cough test is a noninvasive, reliable tool to assess stress urinary incontinence severity. Our data suggest it is reliable even when bladders are nearly empty and can effectively stratify patients for sling vs artificial urinary sphincter with a high rate of success.

This article gives a current overview of surgical options and limits of surgical post-prostatectomy incontinence (PPI) therapy and reflects the contents of workshop 6 at the ICS meeting in Vienna, Austria 2022.The decision-making process in PPI requires consideration of various dimensions from presentation to determination of treatment. Patient factors include the severity of symptoms, age and health condition, comorbidities, and patient’s expectations. Also important are the type of prior prostate surgery, radiation therapy, and status of cure.Only an accurate diagnosis will lead to the most effective management option being chosen. An accurate history, standardized questionnaires, physical examination, and 24-hour pad-weights are essential. Transperineal ultrasound, urethrocystoscopy with a urethral repositioning test, and multichannel urodynamics are useful in assessing sphincter and bladder function, as well as the anastomotic region after radical prostatectomy.The effect of various treatment options, such as slings, balloons, and artificial hydraulic sphincters can now be evaluated with long-term studies. The most widely used type of sling is the two-arm fixed sling with a dry rate of 58% and overall improvement rate of 83% at 5 years. Prior pelvic irradiation may reduce the long-term success rate. Adjustable devices offer the opportunity of adaptation to a potentially changing degree of incontinence to meet individual patients’ needs. Adjustable male slings support the bulbar urethra with a minimal increase of urethral resistanceThe artificial urinary sphincter (AUS) is the most predictably reliable treatment for men with moderate to severe stress incontinence with social continence rates of 79%. Device revision is required for recurrent incontinence with options including cuff repositioning, downsizing, or transcorporal cuff placement. Alternative hydraulic sphincter systems offer the possibility of postoperative adjustment by changing the intra-device pressure. Recent developments include electrical and remotely controlled devices not yet commercially available. Further factors of the decision-making process are the skills of the surgeon, individual preferences, and product availability.

The purpose of this study was to report the rate of stress urinary incontinence (SUI) recurrence after sling revision, and to determine predictive factors of SUI recurrence. We conducted a retrospective cohort study in a single academic center between 2005 and 2022, of patients who underwent sling revision. Four surgical techniques were used for sling revision (loosening, section, partial, and total excision). The primary endpoint was recurrence of SUI at 3 months postoperatively, and the other outcome of interest was the rate of subsequent anti-incontinence surgical procedure. Sixty-nine patients were included for analysis. SUI recurred in 46.4% of patients. Fifteen patients underwent a subsequent anti-incontinence procedure (21.8%). The time to revision was significantly longer in the group with recurrent SUI (median: 84.5 vs. 44.8 months; p = 0.004). The recurrence rate differed significantly depending on the revision technique: 7.7% after sling loosening, 22.2% after sling section, 60% after partial excision, and 66.7% after complete sling removal (p = 0.001). The risk of SUI recurrence was lower for those whose indication of reoperation was voiding dysfunction (27.3% vs. 66.7%; p = 0.002), and was higher for those who underwent a trans-obturator tap rather than a tension-free vaginal tape revision (68.4% vs. 35.7%; p = 0.02). In multivariate analysis, only the revision technique remained significantly associated with the risk of recurrence of SUI (complete excision vs. section: odds ratio = 4.66; p = 0.04). The risk of SUI recurrence may differ widely according to the techniques used, and it seems that the less extensive the surgical procedure is, the lower the risk is.

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

Risk factors for stress urinary incontinence recurrence after midurethral sling revision

Background &amp; Objectives: Female urinary incontinence is a significant health issue affecting adult women, most suffering from stress incontinence. It affects the quality of life. Recurrence after surgery is difficult for the patients and the surgeon. There is no precise data to show how to treat failed Transobturator tape. Transobturator tape with tension may be an alternative method in applying proper tension in the mid urethra to correct the incontinence. We describe our experience to evaluated outcomes of the second mid-urethral sling with tension to treat recurrent incontinence after the failure of the first mid-urethral sling. Methods: A prospective cohort study was conducted between Oct. 2012 to March 2019. A total of 16 patients with failed Transobturator tape surgery underwent second trans-obturator Mid-Urethral Sling surgery. Preoperative data and postoperative complications were recorded. All patients were followed for one year. Results: Sixteen women after failed Mid-Urethral Sling surgery were evaluated. At a mean follow-up of 7.5 months, the cure rate was 62.5% (10 out of 16) patients. Partial cure (improvement) was achieved in 25% ( 4 patients out of 16) and failure in 2 patients, 12.5%. There were statistically significant improvements after surgery in the Q-tip test and the number of the pads. Conclusion: Repeat Transobturator tape with tension treatment tends to result in good outcomes with a reasonable physician-determined success rate.

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Prevalence and Predictors of Bladder Outlet Obstruction in Women With Chronic Urinary Symptoms and a History of Urethral Sling Surgery.

MP22-06 THE IMPACT OF PROSTATE CANCER DISEASE PROGRESSION AND SALVAGE OR ADJUVANT TREATMENT ON ARTIFICIAL URINARY SPHINCTER DEVICE OUTCOMES