Recurrent Stress Urinary Incontinence Research Articles

The impact of pregnancy and childbirth on stress urinary incontinence in women previously submitted to mid-urethral sling: A systematic review and metanalysis.

There is no guideline or clinical consensus concerning the mid-urethral sling (MUS) operation for stress urinary incontinence (SUI) and future pregnancies. The aim of this systematic review and metanalysis is to evaluate the impact of pregnancy and of delivery on SUI in women who previously sustained a MUS surgery. We performed a systematic review and meta-analysis, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, and selected seven publications for inclusion in the analysis. Recurrence of SUI after childbirth in women previously submitted to MUS was 22% (95% confidence interval [CI]: 18.0%-26.0%; I2 = 0%) while the reintervention rate for SUI the 5% (95% CI: 2.0%-8.0%; I2 = 47.34%) in the included studies. There was not statistically significant difference between women who delivered (both vaginally and by caesarian section) or not after MUS in SUI recurrence (RR 1.01, 95% CI 0.73-1.40; p = 0.96 and I2-test of 41% p = 0.18) and in SUI reintervention (RR 1.45, 95% CI 0.91-2.30; p = 0.12 and I2-test of 0% p = 0.38) with homogeneity among studies. There was no difference between women who delivered vaginally or by caesarian section both for recurrence of SUI (RR 1.24, 95%CI 0.77-2.01; p = 0.37 and I2-test of 0% p = 0.60) and reintervention (RR 1.61, 95% CI 0.76-3.42; p = 0.22 and I2-test of 0% p = 0.47). BMI ≥ 30 kg/m2, urinary incontinence (UI) before and during pregnancy emerged as risk factors for postpartum UI relapse. Childbirth do not affect SUI relapse or reintervention in women previously submitted to MUS. In the same population of patients, no difference was highlighted concerning the mode of delivery for the outcome SUI relapse or reintervention. Previous MUS surgery may not be an appropriate indication for cesarean birth in subsequent pregnancy.

Sonography as a Diagnostic Tool in Midurethral Sling Complications: A Narrative Review.

Despite the established safety and efficacy of midurethral slings (MUS), which are the current gold standard treatment for stress urinary incontinence (SUI), the potential for postoperative complications remains a significant concern for both healthcare professionals and patients. Meanwhile, sonography has emerged as a significant diagnostic tool in urogynecology, and one of the applications of this imaging modality may be the evaluation of complications arising from MUS procedures. This review, based on a comprehensive literature search, focuses on the use of pelvic floor ultrasound (US) in the context of MUS complications. It includes analyses of randomized controlled trials, prospective, and retrospective studies, covering preoperative and postoperative investigations, to assess complications such as persistent and recurrent SUI, urinary retention and obstructive voiding, de novo urgency/overactive bladder, vaginal exposure, sling erosion, pain, and hematoma. The review critically examines the existing literature, with a particular focus on recent publications. Despite the variability in findings, it appears that for each of the discussed complications, the application of pelvic floor US can significantly support the diagnostic and therapeutic process. The paper also identifies potential future directions for the development of US applications in diagnosing MUS complications.

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

The objective is to determine if the timing of midurethral sling (MUS) placement has an impact on the recurrence rate of stress urinary incontinence. We conducted a retrospective cohort study of patients who underwent robot sacrocolpopexy (RSC) with MUS placement at a large community hospital. Our data demonstrated that there was no significant difference in stress urinary incontinence recurrence when the MUS was placed before or after the RSC (15% vs. 11%, P = 0.41, respectively). We concluded that physician preference may dictate surgical approach to sequence of retropubic MUS placement at the time of RSC.

Quality of life outcomes after transobturator tape full removal surgeries: A monocentric experience

AbstractObjectiveThe objective of this study is to describe a standardised technique of full TOT removal with groin dissection and to report clinical improvement, satisfaction, safety and long‐term functional, quality of life (QoL) and sexual QoL outcomes.Materials and methodsA retrospective review enrolling all women who had full TOT removal, in a tertiary referral centre from May 2017 to November 2020. Functional outcomes, satisfaction and QoL were assessed using a bespoke composite questionnaire (UDI‐6, EQ‐5D‐5L and ICIQ‐S) with additional questions on sexual QoL. Secondary outcomes were post‐operative recurrent stress urinary incontinence (SUI) and complication rate according to the Clavien‐Dindo classification.ResultsFull TOT removal using a vaginal approach and bilateral groin/para‐labial incisions was performed in 67 patients. Chronic pelvic pain was the main indication for mesh removal (51% of cases, n = 34). QoL questionnaires were answered by 43 patients. The satisfaction rate was high 86% (n = 37), and 81% (n = 35) of the patients considered the surgery successful. Seventy per cent (n = 30) of patients returned to having a sexual life after surgery. Recurrent SUI was reported in 32% (n = 14) of cases. The complication rate was 10% (7/67), all of them Clavien–Dindo ≤2.ConclusionDespite a high rate of postoperative bothersome SUI, full TOT removal with bilateral groin dissection improves pain and QoL. It is associated with a high overall satisfaction rate and an acceptable rate of complications.

An assessment of the relationship between urethral hypermobility as measured by ultrasound and the symptoms of stress urinary incontinence in primiparous women 9-18 months postpartum.

The aim of the study was to estimate the relationship between bladder neck hypermobility as assessed by ultrasound and the occurrence of stress urinary incontinence as measured with the UDI-6 questionnaire in primiparous women 9-18 months postpartum. The study included 100 women 9-18 months after their first delivery, 19% of whom (study group) presented with urethral hypermobility. Ultrasound was used to determine the position and mobility of the bladder neck in order to assess the urethral hypermobility. A vector of ≥15 mm was defined as urethral hypermobility. Symptoms of stress urinary incontinence were assessed using question 3 of the UDI-6 questionnaire, in which the presence of symptoms was defined as a response rated from 1 to 4. We demonstrated a statistically significant relationship between urethral hypermobility and the symptoms of stress urinary incontinence with a statistical significance level of p <0.002. Stress urinary incontinence is a common disorder in women, the pathophysiology of which is not fully understood. It has adverse effects on the quality of life, perception of one's own body and sexual function. Impairment of urethral fixation may play an important role in the pathophysiology of this common form of urinary incontinence. The study showed that urethral hypermobility, as assessed by ultrasound, contributes to stress urinary incontinence, as measured with the UDI-6 score. Although stress urinary incontinence is a multifactorial disorder influenced by anatomical changes and congenital anatomical features, it is easily diagnosed. Suburethral slings are an effective surgical technique; however, the incidence of postoperative voiding dysfunction or recurrent stress urinary incontinence is 10-20%. Therefore, an assessment of anatomical changes in stress urinary incontinence may help individualize the surgical strategy.

Autologous rectus abdominis fascia sling surgery following unsuccessful synthetic midurethral sling

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.

(373) Economic Benefits of Patient Care for Prostate Cancer Survivors with Stress Urinary Incontinence and/or Erectile Dysfunction: A Physician Reimbursement Analysis

Abstract Introduction Reconstructive urological procedures play a vital role in enhancing the satisfaction and quality of life of patients with prostate cancer (PCa) following radical prostatectomy (RP). Providing comprehensive postoperative care for common side effects of post-RP, including stress urinary incontinence (SUI) and erectile dysfunction (ED), may result in a greater number of patients with PCa receiving needed consultations and therapies. This analysis sought to explore the potential economic benefits of offering men’s health consultations and reconstructive care for PCa survivors. Objective This study quantified the relative value units (RVUs) generated from providing patient care to PCa survivors covered by Medicare Fee-for-Service who may experience SUI and/or ED due to RP. Methods This physician reimbursement analysis was based on typical patient care pathway scenarios for patients at risk of developing SUI or ED post-RP. Current Procedural Terminology (CPT) codes were utilized to identify and describe the care provided to patients in each scenario, leading to an artificial urinary sphincter (AUS) or male sling for SUI and/or an inflatable penile prosthesis (IPP) for ED. The 2023 CMS Physician and Clinical Laboratory Fee Schedule and Medicare reimbursement rates were used to obtain the most recent RVUs and reimbursement for each CPT. RVUs represent the value assigned to a service or procedure performed by a physician and are used to capture the relative cost values associated with patient care. For each scenario, we reported the total RVUs, which include work, non-facility or facility, and malpractice RVUs, and the total physician reimbursement. The 2023 Physician Conversion Factor was used to calculate the Medicare physician reimbursement. The Medicare physician reimbursement was used as a conservative estimate. Results The four clinical pathway scenarios were patients who did not experience recurrent SUI or ED (no recurrent SUI/ED), patients who only experienced SUI (only SUI), patients who only experienced ED (only ED), and patients who experienced both SUI and ED (SUI + ED). For the no SUI/ED scenario, the total RVUs from providing patient care were 5.26 RVUs, resulting in $205 in physician reimbursement. For the only SUI scenario, the total RVUs were 56.20 RVUs with an average of $1,996 in physician reimbursement for those receiving AUS and 55.54 RVUs with an average of $1,974 in physician reimbursement for those receiving male sling. For the only ED scenario, the total RVUs were 42.51 RVUs, resulting in $1,550 in physician reimbursement. For the SUI + ED scenario, the total RVUs were 98.71 RVUs with an average of $3,547 in physician reimbursement for those receiving AUS and 98.05 RVUs with an average of $3,524 in physician reimbursement for those receiving male sling. Conclusions This study justified the economic benefits of expanding patient care to men who underwent RP for PCa and provided urology practice insight into the potential physician reimbursement when PCa survivors were seen by reconstructive urologists. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Exploring the Challenges of Using Minimal Invasive Surgery to Treat Stress Urinary Incontinence: Insights from a Retrospective Case-Control Study

Stress urinary incontinence (SUI) is a significant global health issue that particularly affects females, leads to notable societal and economic challenges and significantly affects the quality of life. This study focuses on the comparative analysis of two established surgical interventions, tension-free vaginal tape (TVT) and transobturator tape (TOT), at a single center and applied to 455 women suffering from SUI, with a mean follow-up period of 102 ± 30 months for TVT and 80.4 ± 13 months for TOT. Our findings indicate that, in comparison to TVT, the TOT procedure demonstrates fewer early and late post-operative complications in patient outcomes (1.41% vs. 17.64% and; 5.66% vs. 12.74%, both respectively). However, the TVT procedure shows a modestly favorable outcome in the risk of recurrence of SUI, compared to TOT (0% vs. 3.7%); the TOT procedure has also proven to be more effective in alleviating of urgency symptoms, although not at a statistically significant level (p = 0.072). Univariable and multivariable analysis of factors that predict late complications showed that only obesity can predict a worse outcome [OR]: 1.125 CI 95%: 1.105–1.533, p = 0.037), when adjustments are made for symptoms presented before surgery and procedure type. While both methods are safe and effective, the choice between them should be based on the specific characteristics of each case.

Continence Is Not Affected after Sling Revision with Transvaginal Tape Elongation for Post-Sling Voiding Dysfunction.

Voiding dysfunction (VD) after sling operation is not uncommon. Sling revisions by incision/excision are usually effective; however, they may result in recurrent stress urinary incontinence (SUI). We aimed to evaluate continence status after an innovative sling revision procedure that preserves the integrity of the sling. Patients who underwent either a single-incision (AJUST) or a trans-obturator (TVT-O) mid-urethral sling were studied. Transvaginal tape elongation (i.e., sling midline incision and mesh interposition) was performed on patients with post-sling VD. Factors that may affect recurrent SUI were investigated by statistical analyses. Of 119 patients, 90 (75.6%) (45 AJUST and 45 TVT-O) were available for long-term (median 9; 8-10 years) follow-up. A significantly higher rate (17.2% vs. 3.3%, p = 0.014) of VD was noted after AJUST (N = 10) than after TVT-O (N = 2). After sling revision, four (33%) of the 12 cases reported recurrent SUI, which was not significantly different (p = 1.000) from the rate (37%, 29/78) of patients who did not undergo sling revision. Further statistical analyses revealed no significant predisposing factors affecting the recurrence of SUI. Surgical continence did not seem to be affected by having had sling revision with transvaginal tape elongation for post-sling VD.

Detrusor underactivity and complicated stress urinary incontinence: a cross-data study.

It is still uncertain whether detrusor underactivity (DUA) influences the outcomes of women undergoing surgery for stress urinary incontinence (SUI). Even less evidence is available about women with complicated stress urinary incontinence (C-SUI). The aim of the study was to assess outcomes of middle urethral sling (MUS) placement according to the type of SUI, and the impact of DUA on uncomplicated SUI (U-SUI) and C-SUI functional and surgical results. The study was conducted among patients undergoing MUS. The population was divided into 4 groups: 1: C-SUI with DUA; 2: C-SUI without DUA; 3: U-SUI with DUA; and 4: U-SUI without DUA. Women were qualified for the DUA group if they met one of the Jeong, Abarbanel and Marcus, BVE, and PIP1 Griffiths criteria. Post-operative functional outcomes and differences in POUR rate, de novo overactive bladder syndrome (OAB), and SUI recurrence were examined. 142 women took part in the study, of whom 97 completed the 2-year follow-up. DUA was found in 54.6% (53/97) of patients. C-SUI was prevalent also in the no-DUA group (59.1%). Post-operative ICIQ-FLUTS improved more in the no-DUA patients compared to the DUA women. Post-operative Qmax was statistically significant higher the in no-DUA than in the DUA population. After surgery, neither the PVR nor the PVR ratio differed in the DUA and the no-DUA patients. C-SUI and U-SUI patients showed a POUR rate of 15.6%-12.1%, de novo OAB 12.5%-3%, tape incision 3.1%-3%, and SUI recurrence 4.6%-3%, respectively. The impact of pre-operative DUA on the outcomes of patients undergoing MUS was negligible, even in C-SUI cases. DUA women with SUI, even if complicated, should not be excluded from this kind of surgery.

Serious complications and recurrences after retropubic vs transobturator midurethral sling procedures for 2682 patients in the VIGI-MESH register

BackgroundMidurethral slings are the gold standard for treating stress urinary incontinence, but their complications may raise concerns. Complications may differ by the approach used to place them. Objective(s)To compare serious complications and reoperations for recurrence after midurethral sling procedures by the retropubic and transobturator routes for female stress urinary incontinence. Study DesignThis analysis covers patients included in the French multicenter VIGI-MESH register since February 2017 who received a midurethral sling for female stress urinary incontinence by the retropubic or transobturator route, excluding single-incision slings. Follow-up continued to October 2021. Serious complications (Clavien-Dindo classification ≥ Grade III) imputable to the midurethral sling and reoperations for recurrence were compared by Cox proportional hazard models including any associated surgery (hysterectomy or prolapse) and a frailty term to consider the center effect. Baseline differences were balanced by propensity score weighting. Analyses using the propensity score and Cox models were adjusted for baseline differences, center effect, and associated surgery. Results1830 participants received a retropubic sling and 852 a transobturator sling in 27 French centers, placed by 167 surgeons. The cumulative two-year estimate of serious complications was 5.8% (95% CI 4.8%-7.0%)) in the retropubic group and 2.9% (95% CI, 1.9%–4.3%) in the transobturator group, that is, after adjustment, half that of the retropubic group (adjusted HR 0.41; 95% CI 0.3-0.6). The cumulative two-year estimate of reoperation for recurrence of stress urinary incontinence was 2.7% (95% CI 2.0-3.6) in the retropubic group and 2.8% (95% CI 1.7-4.2) in the transobturator group, with risk of revision for recurrence higher in the transobturator group after adjustment (adjusted HR 1.9; 95% CI 1.2-2.9); this surplus risk disappeared after exclusion of the patients with a previous surgery for stress urinary incontinence. ConclusionsThe transobturator route for midurethral slings is associated with a lower risk of serious complications but a higher risk of surgical reoperation for recurrence than the retropubic route. Despite the large number of surgeons involved, these risks were low. The data are therefore reassuring.

Which parameters, related to the female urethra and pelvic floor, determine therapy selection for recurrent female stress urinary incontinence: ICI‐RS 2023?

AbstractIntroductionThe evidence basis for therapy selection in women who have failed primary stress urinary incontinence (SUI) surgery is limited. The ICI‐RS group discussed the available data at its meeting in June 2023, particularly the anatomical characteristics as assessed using magnetic resonance imaging (MRI) and ultrasound (US) modalities, functional characteristics associated with storage and voiding urodynamic assessment, as well as the patient characteristics that might influence outcomes. This paper summarizes the evidence base that supported these discussions and offers the basis for research proposals for future groups.MethodsA literature search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was performed, and the data is presented. Research questions are based on the knowledge gaps highlighted.ResultsPossible MRI parameters that may influence outcomes were striated urethral sphincter volume, bladder and proximal urethral funneling, pubo‐urethral ligament integrity, distance of the bladder neck below the pubococcygeal line, posterior urethra‐vesical angle, and bladder neck to levator ani distance. US parameters included sling distance to the urethral lumen and pubis, sling position, bladder neck mobility, and lateral arm asymmetry, twisting, or curling. Urodynamic parameters included detrusor overactivity, Valsalva leak point pressure, maximum urethral closure pressure, and bladder outlet obstruction. Important patient parameters included body mass index, age, and previous interventions.ConclusionsIdentifying and quantifying causative factors in patients with recurrent SUI, that allow clinicians to modify subsequent treatment choices and techniques may help reduce treatment failure and complications. Formulating algorithms is the next step in optimizing patient counseling, surgical selection, and healthcare allocation.

Recurrence of stress urinary incontinence in women treated with transobturator suburethral mesh: 9-year follow-up

Objectives: The recurrence of SUI after surgery with TO represents a frequent complication whose etiology has not been clarified. Our study aims to establish the SUI recurrence rate in patients operated on at our center as well as to analyze the possible factors associated with the risk of recurrence, during a 9-year follow-up. Methods: Prospective descriptive observational study, conducted at the Hospital Clínico Universitario de Valladolid, between January 2012 and March 2021, including 133 patients. Results: Our study describes a recurrence rate of SUI after TO of 12%, with a statistically significant relationship (p 0.009) between the year of postoperative follow-up and the risk of recurrence. The risk of recurrence at 9 years was related to advanced age, macrosomic delivery, and multiparity. Conclusions: We must identify those patients whose risk factors allow us to anticipate a torpid evolution, considering therapeutic alternatives, for example, in young women or who have not completed their reproductive desire.

Postoperative outcomes and urodynamic findings after continence mesh removal.

To analyze urodynamics findings and patient-reported outcomes after removal of a mid-urethral mesh because data regarding outcomes following mesh removal vary in different studies, and mesh removal itself may have risks. Women who were referred to the Female Pelvic Medicine and Reconstructive Surgery Department of University College London Hospital and underwent vaginal removal of a continence mesh between January 2014 and January 2020, were included. Patient clinical data and results of video-urodynamics investigations performed 4 months after mesh removal were collected and analyzed retrospectively. In all, 204 patients were included in the study. After mesh removal, 80.5% of patients reported recurrent stress urinary incontinence (SUI), 10.1% reported prolapse symptoms, 8% reported voiding dysfunction and 2.9% reported overactive bladder (OAB) symptoms. Video-urodynamics investigations confirmed the presence of SUI (67.6%), mixed urinary incontinence (14.3%), detrusor overactivity (DO) (6.8%) and voiding dysfunction in one patient. In two women a urethral stricture was described, and 10 women were deemed to have a significant cystocele. Recurrence of SUI was the most frequent finding after continence mesh removal, both symptomatically and objectively. Women seldom reported OAB symptoms, but urodynamics showed evidence of DO despite this. On the other hand, voiding dysfunction was often reported but less often proven on urodynamics.

Risk factors for stress urinary incontinence recurrence after midurethral sling revision.

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.

Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation.

This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS). Data from our institutional AUS database spanning the period from 2009 to 2020 were retrospectively analyzed. The number of pads per day was determined, a standardized quality of life (QoL) questionnaire and the International Consultation on Incontinence Questionnaire (ICIQ) were administered, and postoperative complications according to the Clavien-Dindo classification were analyzed. Out of 477 patients who received AUS implantation during the study period, 25 (5.2%) underwent cuff downsizing (median age, 77 years; interquartile range [IQR], 74-81 years; median follow-up, 4.4 years; IQR, 3-6.9 years). Before downsizing, SUI was very severe (ICIQ score 19-21) or severe (ICQ score 13-18) in 80% of patients, moderate (ICIQ score 6-12) in 12%, and slight (ICIQ score 1-5) in 8%. After downsizing, 52% showed an improvement of >5 out of 21 points. However, 28% still had very severe or severe SUI, 48% had moderate SUI, and 20% had slight SUI. One patient no longer had SUI. In 52% of patients, the use of pads per day was reduced by ≥50%. QoL improved by >2 out of 6 points in 56% of patients. Complications (infections/urethral erosions) requiring device explantation occurred in 36% of patients, with a median time to event of 14.5 months. Although cuff downsizing carries a risk of AUS explantation, it can be a valuable treatment option for selected patients with persistent or recurrent SUI after AUS implantation. Over half of patients experienced improvements in symptoms, satisfaction, ICIQ scores, and pad use. It is important to inform patients about the potential risks and benefits of AUS to manage their expectations and assess individual risks.

The transvaginal mesh class action: a tertiary teaching hospital experience of all mid-urethral sling procedures performed between 1999 and 2017.

Class action against Ethicon (J&J), manufacturer of transvaginal mesh devices, including mid-urethral slings (MUS), was brought to the Federal Court of Australia in 2016 by Shine Lawyers. As a result, subpoenas to all hospitals and networks were received, which overrode patient privacy concerns. This medical record search allowed a complete audit and communication with patients to offer clinical review. This enabled a review of complications, readmission and re-operation for women who underwent a MUS for stress urinary incontinence. A cohort study of women who underwent MUS treatment for stress urinary incontinence (SUI) at a single tertiary teaching hospital between 1999 and 2017 was carried out. The main outcome measures were the rate of readmission and re-operation following MUS procedures. These include voiding dysfunction managed by sling loosening or sling division, mesh pain or exposure managed by mesh removal and reoperation for recurrent stress urinary incontinence. Between 1999 and 2017, a total of 1,462 women were identified as having a MUS; of these, 1,195 (81.7%) had full patient records available. Voiding dysfunction requiring surgical intervention with sling loosening or division was 3%, excision for mesh exposure was 2%, and partial or complete excision for pain was 1% at a median of 10 years from index surgery. The reoperation rate for recurrent stress urinary incontinence was 3%. This audit of all MUS procedures performed at a tertiary centre confirms an overall low rate of readmission for complications and recurrent SUI surgery; this justifies its continued availability with appropriate informed consent.

Cystoscopic removal of transvaginal mesh: Long-term outcomes.

This study's aim is to evaluate the long-term quality of life and functional outcomes following cystoscopic excision of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) mesh extruded into the urinary tract in women. A retrospective chart review was performed of all cases of cystoscopic removal of extruded mesh at our high-volume tertiary care centre between April 2013 and August 2021. Postoperative patient-reported outcomes were collected via questionnaires: Urogenital Distress Inventory Short Form (UDI-6), EQ-5D-5L Visual analogue scale, ICIQ-Satisfaction (ICIQ-S) and additional questions regarding postoperative sexual function. During the study period, 27 women with a median age of 61 years (45-87) underwent cystoscopic mesh removal surgery using either Ho-YAG laser (56%) or bipolar loop resection (44%). The most common presentation of mesh extrusion was recurrent urinary tract infections (67%). Other presenting complaints were pain (41%), urinary urgency ± incontinence (41%) and voiding difficulties (18%). Long-term follow-up outcomes from 20 patients (median follow-up: 24 months) showed that mesh removal was rated successful by 80%, and 100% would choose to have the surgery again if in the same situation. Recurrent SUI was reported by 45% of respondents, and urinary urge incontinence was found in 50%. For patients who answered the sexual function questions, 50% reported improved sexual function postmesh removal (6/12). Cystoscopic removal of extruded female SUI and POP mesh is associated with high patient satisfaction and low morbidity in appropriately selected patients at 2-year median follow-up. A patient-centred shared decision-making process is essential in counselling patients regarding options and expected outcomes following mesh removal surgery.

(143) Hostile Field: Surgical Management Strategies After Multiple Explants of Artificial Urinary Sphincters

Abstract Introduction Placement of artificial urinary sphincters (AUS) is the gold standard treatment for moderate to severe stress urinary incontinence in men. Erosion, infection, and mechanical malfunction of the AUS are well known complications that require removal of the device. Replacement of AUS after several explants represents a surgical challenge and is performed by a minority of urologists. Objective We describe our experience with management of complex cases after multiple AUS complications. Methods Retrospective review of patients who underwent artificial urinary sphincter (AUS) removal after prior device explantations. Surgical and clinical data was collected, including demographic characteristics, indication for AUS explantation, number of prior AUS, presence of an IPP, and surgical outcomes and complications. Descriptive statistics were used for both categorical and nominal variables. Results Between 2017 and 2021, 8 patients presented with recurrent stress urinary incontinence (SUI) with a history of AUS with or without explant. 2 patients presented with one prior AUS, 1 patient with two prior, 4 patients with 3 prior AUS, and 1 patient with 4 prior AUS. 5/8 patients achieved &amp;gt;90% continence following one revision. The remaining patients underwent cuff downsizing. 1 patient failed multiple revisions and required urethral ligation with permanent suprapubic tube placement (SPT). Patient history and surgical course is summarized in Table 1. Conclusions AUS placement after multiple explants presents a surgical challenge. It is associated with a higher rate of complications and need for explant. It is however feasible and safe, and can provide resolution of incontinence to the majority of patients. In patients with a devastated urethra where additional AUS does not seem feasible a urinary diversion or urethral ligation with SPT may be a satisfactory alternative. Disclosure No

MP71-09 WHICH REVISION STRATEGY IS THE BEST FOR NON-MECHANICAL FAILURE OF MALE ARTIFICIAL URINARY SPHINCTER?

You have accessJournal of UrologyCME1 Apr 2023MP71-09 WHICH REVISION STRATEGY IS THE BEST FOR NON-MECHANICAL FAILURE OF MALE ARTIFICIAL URINARY SPHINCTER? Tiffany Cousin, Benoit Peyronnet, Imad Bentellis, Sami Lasri, Fayek Taha, Nicolas Hermieu, Adrien Boileau, Augustin Zelmar, Clément Ciolek, Alexandre Dubois, Priscilla Léon, Jean-Francois Hermieu, Thibault Brierre, Xavier Gamé, Thibault Tricard, Christian Saussine, Pierre Lecoanet, Adrien Vidart, Franck Bruyère, Jean-Nicolas Cornu, Hervé Monsaint, Xavier Biardeau, and Grégoire Capon Tiffany CousinTiffany Cousin More articles by this author , Benoit PeyronnetBenoit Peyronnet More articles by this author , Imad BentellisImad Bentellis More articles by this author , Sami LasriSami Lasri More articles by this author , Fayek TahaFayek Taha More articles by this author , Nicolas HermieuNicolas Hermieu More articles by this author , Adrien BoileauAdrien Boileau More articles by this author , Augustin ZelmarAugustin Zelmar More articles by this author , Clément CiolekClément Ciolek More articles by this author , Alexandre DuboisAlexandre Dubois More articles by this author , Priscilla LéonPriscilla Léon More articles by this author , Jean-Francois HermieuJean-Francois Hermieu More articles by this author , Thibault BrierreThibault Brierre More articles by this author , Xavier GaméXavier Gamé More articles by this author , Thibault TricardThibault Tricard More articles by this author , Christian SaussineChristian Saussine More articles by this author , Pierre LecoanetPierre Lecoanet More articles by this author , Adrien VidartAdrien Vidart More articles by this author , Franck BruyèreFranck Bruyère More articles by this author , Jean-Nicolas CornuJean-Nicolas Cornu More articles by this author , Hervé MonsaintHervé Monsaint More articles by this author , Xavier BiardeauXavier Biardeau More articles by this author , and Grégoire CaponGrégoire Capon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Persistence or recurrence of stress urinary incontinence (rSUI) after artificial urinary sphincter (AUS) implantation may be secondary to mechanical failure (MECA), whose management is standardized, or to non-mechanical failure (NOMECA). In NOMECA, rSUI have for long been assumed to result from urethral atrophy. Its existence is now debated. As the pathophysiology of NOMECA is not elucidated, the most appropriate management remains unclear. We aimed to compare the several revision techniques for NOMECA of AUS in men. The primary endpoint was the complete continence status three months after revision for NOMECA. Secondary outcomes were complications, explantation-free and reoperation-free survivals. METHODS: NOMECA was defined as persistence or recurrence of stress urinary incontinence (SUI), with normally functioning device, no erosion, infection or loss of fluid in the pressure regulating balloon. The exclusion criteria were neurogenic SUI, revision or explantation for other causes. From 1991 to 2022, 143 AUS revision for NOMECA including 99 cuff DOWNSIZING, 10 cuff repositioning (RELOC), 13 TANDEM-CUFF placement, 18 cuff changing (CHANGE), 3 increasing balloon pressure (BALLOON-UP) were performed in 10 centers. The BALLOON-UP patients were not included in comparative analysis due to small sample size. All components could be changed during the revision. Patients were then categorized in complete vs. partial change of the device. RESULTS: The three-month complete continence rates was 70,8% with a statistically significant difference between RELOC (100%) and DOWNSIZING (69.5%) (p=0.04). Complete change of the device was significantly associated with complete continence status at three months (83.3% vs. 63.3%; p=0.01) even in multivariate analysis (OR=2.7; CI95%:1.1-7.1; p=0.03). Complication rate at 30 days was very low (0.01%). Median follow up was 80 months. For the whole cohort, estimated 5-year reoperation-free and explantation-free survival were respectively 63.4% and 75.9%, with no significant difference between groups (p=0.16; p=0.30). Estimated five-year explantation-free and reoperation-free survivals were significantly longer in the complete AUS change group (82.2% vs. 69.6%; p=0.03; 71.2% vs. 58.2%; p=0.047). CONCLUSIONS: AUS revision for prSUI due to NOMECA yields satisfactory outcomes regardless of the technique used. We observed better functional outcomes when repositioning the new cuff on the urethra. Change of all AUS components may improve functional outcomes, explantation-free and reoperation-free survivals. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1017 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tiffany Cousin More articles by this author Benoit Peyronnet More articles by this author Imad Bentellis More articles by this author Sami Lasri More articles by this author Fayek Taha More articles by this author Nicolas Hermieu More articles by this author Adrien Boileau More articles by this author Augustin Zelmar More articles by this author Clément Ciolek More articles by this author Alexandre Dubois More articles by this author Priscilla Léon More articles by this author Jean-Francois Hermieu More articles by this author Thibault Brierre More articles by this author Xavier Gamé More articles by this author Thibault Tricard More articles by this author Christian Saussine More articles by this author Pierre Lecoanet More articles by this author Adrien Vidart More articles by this author Franck Bruyère More articles by this author Jean-Nicolas Cornu More articles by this author Hervé Monsaint More articles by this author Xavier Biardeau More articles by this author Grégoire Capon More articles by this author Expand All Advertisement PDF downloadLoading ...