Recurrence Of Stress Incontinence Research Articles

Mid-urethral sling revision for mesh exposure-long-term outcomes of two surgical techniques from a comparative clinical retrospective cohort study.

To compare vaginal closure with versus without sling excision in the management of vaginal sling exposure following mid-urethral sling (MUS). Clinical retrospective cohort study. Tertiary urogynaecological centre in Australia. Women with urodynamic stress urinary incontinence (SUI) who had a MUS (n = 2823) during 1999-2017 with a follow-up period up to December 2018. Thirty-three women (1%) had sling exposure and 31 required surgical intervention (1%). Clinical review with analysis of surgical database and patient records. The primary outcome was successful closure and resolution of exposure-related symptoms without the need for re-surgery. Secondary outcomes were repeat procedure and recurrent incontinence following revision. Mean follow up was 103months. Of the 20 women with a primary excision and closure approach, 19 had successful closure. Seven of 11 women with simple vaginal closure without excision needed another surgery for recurrent mesh exposure. Recurrence of stress incontinence did not occur in any of the four who had 'successful' closure without excision. Of those who had sling division/removal without a concomitant stress continence procedure, 32% (7/22) required further surgery. Sling excision and repair have better outcomes with less recurrence of sling exposure compared with simple closure. Following sling removal, one of three women will develop SUI recurrence and require surgery. TWEETABLE ABSTRACT: #Slingexcision &repair leads to less recurrence of exposure versus #simpleclosure for #slingmeshexposure.

04: A retrospective study reviewing the risks related to recurrence of stress incontinence following revision of midurethral sling

04: A retrospective study reviewing the risks related to recurrence of stress incontinence following revision of midurethral sling

Laparoscopic urethrolysis followed by trans-obturator tape sling insertion for long standing voiding dysfunction after Burch colposuspension

This case report describes laparoscopic urethrolysis followed by trans-obturator tape sling insertion for voiding dysfunction after colposuspension. A 50-year-old patient presented with predominant stress incontinence of urine 14 after Burch colposuspension. There was no anterior vaginal wall prolapse on examination and urodynamic assessment confirmed voiding dysfunction in the absence of urodynamic stress incontinence. Clean intermittent self-catheterisation was tried, but failed to improve the patient's symptoms. Laparoscopic urethrolysis was carried out, leading to the relief of voiding dysfunction, but was followed by recurrence of stress incontinence. A trans-obturator tape sling was subsequently inserted with significant improvement in stress incontinence and the patient was discharged.

The Management of Voiding Dysfunction following Mid Urethral Tape Insertion

Objective: No standard regimen has been established for the management of postoperative voiding dysfunction following TVT insertion. This study was designed to compare two different strategies for management of this problem. Methods: This is a retrospective study of women operated on within a tertiary referral unit. Two cohorts were identified: those managed by clean intermittent self catheterization (CISC) during 2006, and those managed by ‘pull-down’ of tape in the immediate post-operative period during 2007. Specific measurements include number of patients with resumption of normal voiding and time taken for resolution of symptoms. Incidence of tape division, recurrence of stress incontinence and development of overactive bladder (OAB) were also measured. Results: The incidence of voiding difficulty following TVT insertion remained the same in 2006 and in 2007. 45.5% of the CISC group resumed normal voiding compared to 100% of the ‘pull-down’ group. The incidence of tape division and reappearance of stress incontinence was 54.5% and 27% respectively in the CISC group compared to none in the ‘pull-down’ group. The CISC group also had higher incidence of OAB. Conclusions: Immediate “pull-down” of tape is an effective way of managing voiding dysfunction following TVT with an excellent rate of symptom resolution without any need of further intervention.

TWO CASES OF BLADDER PROLENE® TAPE EXPOSURE AFTER TVT PROCEDURE

Two cases of bladder exposure of TVT sling material at 23 and 12 months after the implantation are reported. In both cases the urinary problems developed immediately after the TVT procedure and only few millimetres of one arm of the sling were exposed into the bladder. It is assumed therefore that the graft was inserted into the bladder lumen or into the bladder wall during the procedure rather than rejected. The whole sling was removed and both patients were cured of dysuria but in one recurrence of stress incontinence was noted.

Laparoscopic Uterosacral Ligament Suspension for the Prevention of Uterovaginal Prolapse Associated with Burch Colposuspension

Study Objective: To assess the surgical outcomes and postoperative quality of life of concurrent laparoscopic uterosacral ligament suspension (LUSLS) and Laparoscopic Burch Colposuspension (LBC) and evaluate if the addition of LUSLS to LBC could prevent recurrent uterovaginal prolapse.Design: Retrospective chart review of 70 patients who had LBC with prophylactic LUSLS by a single surgeon.Setting: Urban gynaecologic laparoscopy practice of single gynaecologist.Patients: Seventy (70) women undergoing laparoscopic Burch Colposuspension with uterosacral ligament suspension concurrently.11 patients (16%) had previously had a hysterectomy. These patients were then subdivided into an anterior group who had only anterior compartment surgery with BC and LUSLS with (16) and without (16) Total Laparoscopic Hysterectomy (TLH), and a posterior group containing patients who had additional posterior compartment surgery with (14) and without (24) TLH.Intervention: Laparoscopic Burch colposuspension and uterosacral ligament suspension procedures.Measurements and Main Results: Preoperative and postoperative (6wk, 12 month, 24 month and 36 month) POP- Q evaluations were performed by a single examiner and recorded. Pelvic Floor Distress Inventory-SF20 (PFD) was administered postoperatively. Six patients had subsequent surgery representing a reoperation rate of 8.5%. Significant complications occurred in 6 (8.5%) patients with 5 retropubic haematomas and 1 cystotomy associated with TLH. There were 2 (2.8%) reoperations in the anterior group; 0 with no TLH, 2 reoperations with TLH There were 4 (5.7%) reoperations in the posterior group with 2 in the no TLH group and 2 in the TLH group. Mean PFDI scores were low at 8.9 in the posterior group and 7.9 in the anterior group. There was no recurrence of stress incontinence in either group.Conclusion: Prophylactic LUSLS performed with LBC together with site specific repair at the primary surgery offers a very low reoperation rate and good postoperative quality of life. It does not appear to interfere with the proven success rate of LBC and is easy to perform. Study Objective: To assess the surgical outcomes and postoperative quality of life of concurrent laparoscopic uterosacral ligament suspension (LUSLS) and Laparoscopic Burch Colposuspension (LBC) and evaluate if the addition of LUSLS to LBC could prevent recurrent uterovaginal prolapse. Design: Retrospective chart review of 70 patients who had LBC with prophylactic LUSLS by a single surgeon. Setting: Urban gynaecologic laparoscopy practice of single gynaecologist. Patients: Seventy (70) women undergoing laparoscopic Burch Colposuspension with uterosacral ligament suspension concurrently.11 patients (16%) had previously had a hysterectomy. These patients were then subdivided into an anterior group who had only anterior compartment surgery with BC and LUSLS with (16) and without (16) Total Laparoscopic Hysterectomy (TLH), and a posterior group containing patients who had additional posterior compartment surgery with (14) and without (24) TLH. Intervention: Laparoscopic Burch colposuspension and uterosacral ligament suspension procedures. Measurements and Main Results: Preoperative and postoperative (6wk, 12 month, 24 month and 36 month) POP- Q evaluations were performed by a single examiner and recorded. Pelvic Floor Distress Inventory-SF20 (PFD) was administered postoperatively. Six patients had subsequent surgery representing a reoperation rate of 8.5%. Significant complications occurred in 6 (8.5%) patients with 5 retropubic haematomas and 1 cystotomy associated with TLH. There were 2 (2.8%) reoperations in the anterior group; 0 with no TLH, 2 reoperations with TLH There were 4 (5.7%) reoperations in the posterior group with 2 in the no TLH group and 2 in the TLH group. Mean PFDI scores were low at 8.9 in the posterior group and 7.9 in the anterior group. There was no recurrence of stress incontinence in either group. Conclusion: Prophylactic LUSLS performed with LBC together with site specific repair at the primary surgery offers a very low reoperation rate and good postoperative quality of life. It does not appear to interfere with the proven success rate of LBC and is easy to perform.

Methods and results of urethrolysis

Although occurring with somewhat less frequency now than historically reported, outlet obstruction after incontinence surgery continues to be a source of postoperative patient dissatisfaction and therapeutic dilemma. Several techniques have been described that fall under the rubric of urethrolysis, including sling incision, sling lysis with explantation, and formal vaginal or retropubic urethrolysis (incision and disruption of bladder neck and urethral fibrosis). Surgical approaches have included vaginal, retropubic, or combined techniques with or without the use of adjunctive steps such as graft interposition. However, evidence emanating from reports of these varied techniques has been incomplete due to variability in outcomes presentation, lack of longevity of follow-up, or problematic study design. Nonetheless, the bulk of clinical evidence supports the efficacy of urethrolysis as an intervention for outlet obstruction after stress incontinence surgery. However, persistent irritative bladder symptoms remain bothersome for some women and, in addition, the recurrence of stress incontinence also may complicate the technique of urethrolysis. Management of these potential adverse outcomes also has been inconsistent, with some authorities routinely performing repeat incontinence surgery at the time of urethrolysis and others preferring to assess continence status after convalescence from urethrolysis. The differences among the types of urethrolysis and the results of each type are reviewed in this article in light of evolving definitions of outlet obstruction, diagnosis, and definition in women.

Release of Tension-Free Vaginal Tape for the Treatment of Refractory Postoperative Voiding Dysfunction

In Brief OBJECTIVE To report our experience with surgical release of tension-free vaginal tape (TVT) for the treatment of persistent post-TVT voiding dysfunction. METHODS A total of 1175 women underwent TVT placement for treatment of genuine stress urinary incontinence and/or intrinsic sphincter deficiency over a 2-year period. Additional procedures and vaginal repairs were performed as indicated. Among these patients, 23 women (1.9%) had persistent voiding dysfunction (urinary retention, incomplete bladder emptying, or severe urgency or urge incontinence) refractory to conservative management. This cohort underwent a simple vaginal TVT release procedure, performed on an outpatient basis. Preoperative characteristics, intraoperative, and postoperative details were assessed by review of operative notes, medical records, and office notes. Continence status was assessed using subjective and objective information. RESULTS Mean age was 67 years (range 46–86 years), and the mean interval between TVT placement and release was 17.3 weeks (range 2–69 weeks; median 8.6 weeks). For the release procedure, there were no intraoperative complications, and all patients were discharged on the day of surgery. All cases of impaired emptying were completely resolved, and all cases of irritative symptoms were resolved (30%) or improved (70%) by 6 weeks. Fourteen (61%) patients remained continent 6 weeks after the release procedure, six (26%) were improved over baseline, and three patients (13%) had recurrence of stress incontinence. CONCLUSION Refractory voiding dysfunction after TVT is a relatively uncommon situation and can be successfully managed with a simple midline release procedure. In most cases, the release procedure does not compromise overall improvement in symptoms of stress incontinence. Persistent post–tension-free vaginal tape voiding dysfunction is effectively treated with a simple vaginal release procedure, without unduly compromising continence benefits.

Release of tension-free vaginal tape for the treatment of refractory postoperative voiding dysfunction

OBJECTIVE: To report our experience with surgical release of tension-free vaginal tape (TVT) for the treatment of persistent post-TVT voiding dysfunction. METHODS: A total of 1175 women underwent TVT placement for treatment of genuine stress urinary incontinence and/or intrinsic sphincter deficiency over a 2-year period. Additional procedures and vaginal repairs were performed as indicated. Among these patients, 23 women (1.9%) had persistent voiding dysfunction (urinary retention, incomplete bladder emptying, or severe urgency or urge incontinence) refractory to conservative management. This cohort underwent a simple vaginal TVT release procedure, performed on an outpatient basis. Preoperative characteristics, intraoperative, and postoperative details were assessed by review of operative notes, medical records, and office notes. Continence status was assessed using subjective and objective information. RESULTS: Mean age was 67 years (range 46–86 years), and the mean interval between TVT placement and release was 17.3 weeks (range 2–69 weeks; median 8.6 weeks). For the release procedure, there were no intraoperative complications, and all patients were discharged on the day of surgery. All cases of impaired emptying were completely resolved, and all cases of irritative symptoms were resolved (30%) or improved (70%) by 6 weeks. Fourteen (61%) patients remained continent 6 weeks after the release procedure, six (26%) were improved over baseline, and three patients (13%) had recurrence of stress incontinence. CONCLUSION: Refractory voiding dysfunction after TVT is a relatively uncommon situation and can be successfully managed with a simple midline release procedure. In most cases, the release procedure does not compromise overall improvement in symptoms of stress incontinence.

Long-Term Subjective Results of Marshall-Marchetti-Krantz Procedure

Objective: Retrospective, subjective evaluation of results of suprapubic vesicourethropexy (Marshall-Marchetti-Krantz procedure) for stress urinary incontinence. Material: A total number of 81 patient records operated between 1980 and 1994 at our institution were reviewed and questionnaires were mailed to them to estimate the success rate, period of continence, current complaints and patient satisfaction. Patients with primary incontinence constituted 73% of this group, the remainder of 27% being recurrent or persistent incontinence. Results: The response rate was 75% (60 cases) and this group was evaluated. Mean postoperative time was 9.9 (2–15) years at the time of assessment. Mean duration of continence was 78.5 months and was not influenced by prior hysterectomy or parity. Weak correlation was found between patients’ age and continence period. It was similar in patients operated in their 5th and 6th decades of life and was shorter in the 7th decade. Additional sutures placed between the anterior bladder wall and rectus fascia (Lapides modification) resulted in a longer continence period. Cure rates decreased with time and were 81, 77, 57 and 28% after 6, 12, 60 and 120 months respectively. In the incontinent group, 34% of patients described leakage degree as lesser than preoperatively and 65% required protection. As many as 90% of continent and 62% of incontinent women evaluated their urinary system status as better than preoperatively. 90% of continent and 69% of incontinent women would repeat surgery again. Conclusions: This procedure is characterized by a high 81% early postoperative success rate that decreases with time. Despite recurrence of stress incontinence, one third of patients declare lesser incontinence degree and do not require protection.

Semicircular, transurethral bladder neck resection in therapy of the overcorrected bladder neck

We report 4 cases of severe urinary obstruction after abdominal stress incontinence procedures in women. The operative procedure consisted in transurethral resection of the obstructive, overcorrected dorsal bladder neck. After resection of the highly elevated bladder neck between the 3- and 9-o'clock position in the dorsal lithotomy position, the patients were able to regain a normal micturition without residual urine. There was no recurrence of stress incontinence.

Surgical results and urodynamic studies 10 years after retropubic colpourethrocystopexy.

Retropubic colpourethrocystopexy has been shown to be associated with good immediate cure rate in treating female urinary stress incontinence. Urodynamic data is often lacking in follow-up studies. This study presents long-term results 8-12 years after operation. Between 1979-1982, 72 women suffering from genuine stress incontinence underwent a colpourethrocystopexy. Follow-up was done 1989-1990. Each patient had a complete urodynamic evaluation preoperatively and at the follow-up. Mean age at operation was 46.2 years and follow-up was done on average 9.4 years later (8-12 years). 71% were postmenopausal at the time of follow-up. Surgical cure rate was 90.3%, 9.7% (seven patients) were considered failures. Five of the seven patients had experienced much improvement. A number of patients showed a decrease in one or more urodynamic parameter without a recurrence of stress incontinence. The bladder neck was incompetent in 38 (52.8%) of the patients, 31 of the 38 patients were still continent. Retropubic colpourethrocystopexy should be considered the primary operation for the treatment of female stress incontinence. Cure rate and postoperative evaluation cannot be judged by urodynamic parameters only, as some of the continent women showed a decrease in one or more urodynamic parameters that are considered important for continence. Bladder neck competence is not necessary for postoperative continence.

Readjusting the loop tension for resolving postoperative urination difficulties and recurrent stress incontinence after stamey suspension of the vesical neck

Excessive tension of the vesical neck sutures produces postoperative urinary retention or difficulties in urination after anti-stress urinary incontinence operations. We have demonstrated that these complications after the Stamey operation and its modifications can be resolved by readjusting the suspending loops to an adequate tension under local anesthesia, since these operations use non-absorbable monofilament loops for the suspension of the vesical neck. The technique was also applied for the correction of insufficient suspension which caused persistent or recurrent stress incontinence after these operations. The procedure was performed for 7 patients with postoperative difficulties in urination, and for 7 with postoperative recurrence of stress incontinence, and all of them recovered normal urination without stress incontinence. These procedures have been performed successfully even 27 months after a Stamey operation. These cases suggest that a recurrence of stress incontinence, even several years after the Stamey operation, can be cured with our procedure, as long as the supporting tissue of the suspending loops is not damaged.

Mental factors influencing recurrence of stress incontinence

At a recent follow-up of 51 women operated on for stress incontinence, there was an astonishingly high discrepancy between symptoms claimed by the patients and signs found by the physician. To examine the influence of certain mental factors on the recurrence of stress incontinence, the patients in the above-mentioned follow-up were tested with the Eysenck Personality Inventory test and the Sabbatsberg Depression Self-rating Scale test. The women with symptoms but no objective signs of stress incontinence showed a higher degree of both neuroticism and depression than the women of perfect health. Thus, in this group, it may be a question of aggravation of symptoms, which cannot be helped by a reoperation. Instead, these women might need psychiatric attention to relieve their psychosomatic symptoms.