Recurrent Stress Urinary Incontinence Research Articles

Midterm Efficacy and Complications of Readjustable Midurethral Sling (Remeex System) in Female Stress Urinary Incontinence With Recurrence or Intrinsic Sphincter Deficiency

To evaluate the efficacy, complications, and managements of the readjustable midurethral sling (Remeex system) for the treatment of recurrent stress urinary incontinence (SUI) after previous anti-incontinence surgeries or intrinsic sphincter deficiency (ISD). Between March 2008 and February 2012, 102 women, who presented with previous failed surgery or ISD, were treated with the Remeex system at 4 different institutions. We retrospectively reviewed medical history, physical examination, urodynamic study, postvoiding residual volume, and/or 1-hour pad test of the patients. Surgical outcomes were evaluated using the Severity Index for Urinary Incontinence. The degree of patient satisfaction was assessed, and all complications were classified according to the modified Clavien classification system. After a mean follow-up of 27.6 months (range, 14-56 months), 91 patients (89.2%) were cured and 6 patients (5.9%) were improved. The patient's satisfaction rate was 87.2% (89 of 102 patients). Overall, 41 patients (40.2%) experienced 53 complications; 15 patients (14.7%) presented de novo urgency, which was properly managed with anticholinergics, and 14 patients (13.7%) underwent delayed sling readjustment for recurrent SUI (n = 13) and urinary retention (n = 1) during follow-up. Among 6 patients (5.9%) with wound infection, 4 patients were successfully treated by daily dressing with antibiotics, and 2 patients underwent removal of the Remeex system owing to intractable infection. Most complications were classified as grade 1 (54.8%) or 2 (15.1%) and were successfully treated with minimal conservative measures. The Remeex system is a valuable adjunct for recurrent SUI after previous anti-incontinence surgeries or ISD, considering most complications are Clavien grade I or II.

P.1.f.011 Neonatal exposure to a leptin antagonist impairs immune function and cytokine release in young male and female rats

Those patients who failed to achieve continence after a procedure aimed to correct it, require a special attitude and precise management due to the sophisticated anatomical and functional field of interest. The purpose of the present study was to assess long-term clinical efficacy and evaluate the frequency and severity of any complications related to recurrent stress urinary incontinence treatment with a non-absorbable bulking agent periurethral injections.Between February 2012–September 2013, 66 patients with recurrent stress urinary incontinence were treated with Urolastic in the tertiary referral gynecologic department. The efficacy of the procedure was assessed objectively at each follow-up visit, scheduled at two, six weeks and 3, 6, 12 and 24 months after primary procedure. Material was injected under local anesthesia according to the manufacturer’s instructions, at 10, 2, 4 and 8 o’clock positions with 0.5–1.25 ccm per spot. Statistical analyses were performed with Statistica package version 8.0 (StatSoft Inc., Tulsa, OK, USA). A p value <0.05 was considered statistically significant.Objective success rate at 24 months was found in 32.7% of patients, including 22.4% patients who were completely dry. The efficacy of Urolastic, when considering the intention to treat, is 24.2% and 16.7%, respectively. In 4.5% patients an oval shaped material was found inside the bladder. Overall, complications were observed in 17 (25.8%) patients.Although only 30% of patients will benefit from Urolastic injection on the long-term basis it seems to be a safe procedure in the treatment of recurrent stress urinary incontinence.

The value of surgical release after obstructive anti-incontinence surgery: An aid for clinical decision making.

To present satisfaction rates after surgical release of obstructive anti-incontinence surgery, to look for predictive factors for outcome and to define the optimal moment to perform the surgical release. We reviewed the charts of 87 women at first, second, and last follow-up at a median of 2 (0.5-7), 4 (2-12), and 108 (29-156) months after surgical release. Obstruction was defined as urinary retention, straining to void after overcorrected anti-incontinence treatment or urodynamic bladder outlet obstruction. Patients' satisfaction was assessed using a 4 point Likert scale. Satisfaction rates at first, second, and last follow-up were 66% (n = 54/82), 54% (n = 37/69), and 74% (n = 43/58) respectively. Postoperatively, patients complained about overactive bladder (OAB) symptoms in 37% (n = 30/81) and SUI in 28% (n = 23/81) at first follow-up and in 41% (n = 28/68) and 27% (n = 18/68) at second follow-up for OAB symptoms and stress urinary incontinence (SUI) respectively. When surgical release was performed more than 180 days after original surgery, less SUI (P = 0.008) was reported. When performed within 70 days in patients without pre-operative OAB symptoms, less post-operative OAB symptoms (P = 0.05) were reported. Surgical release can be very successful in relieving obstruction due to bladder outlet obstruction (BOO) after anti-incontinence surgery. Persistent OAB symptoms and recurrent SUI are the main reasons for being dissatisfied. To lower the odds for recurrent SUI, surgical release should be performed more than 180 days after original surgery. Patients without pre-operative OAB symptoms are at higher risk of developing post-operative OAB symptoms when treatment is delayed more than 70 days.

Is obstruction an issue after adjustable sling insertion for recurrent stress urinary incontinence?

Is obstruction an issue after adjustable sling insertion for recurrent stress urinary incontinence?

Minimum 1-year results of mesh spiral-sling procedure in managing refractory and primary disabling stress urinary incontinence.

We present our minimum 1-year results with a mesh spiral-sling procedure (MSSP) for managing refractory and disabling stress urinary incontinence (SUI) in women. Thirty-four women were treated with MSSP between 2007 and 2011. Six had incomplete data and were excluded from analysis. Study cohort comprised 21 women with refractory (mean number of previous surgeries 2.2; range 1-6) and seen with primary disabling SUI. All patients had marked intrinsic sphincter deficiency (ISD) with a Valsalva leak-point pressure (VLPP) <60 cm H2O. Preoperative workup included assessing the impact of voiding symptoms using the International Consultation on Incontinence Questionnaire--Short Form (ICIQ-SF), estimating the daily number of pads, and urodynamic studies. Preoperative and postoperative findings were compared using the Wilcoxon signed-rank test. Intraoperative unilateral bladder-neck perforation occurred in two women during dorsal urethrolysis. With a mean follow-up of 26 months (range 12-48), SUI was cured in 71.4% of patients. Distal urethral reconstruction with vaginal mucosal flaps was performed in two patients with short urethral length (<2.5 cm) due to recurrence of SUI 10 months after MSSP. Mean ICIQ-SF score decreased from 19.4 ± 3.6 preoperatively to 7.3 ± 2.8 postoperatively (p = 0.001). Mean daily pad number decreased from 5.2 preoperatively to 1.2 postoperatively (p = 0.02). Urethral or vaginal erosion was not observed in any case during follow-up. Using spiral slings may be a viable option in managing refractory and disabling SUI.

A cost-effectiveness analysis of conservative versus surgical management for the initial treatment of stress urinary incontinence

We sought to determine whether conservative or surgical therapy is more cost effective for the initial treatment of stress urinary incontinence (SUI). We created a decision tree model to compare costs and cost effectiveness of 3 strategies for the initial treatment of SUI: (1) continence pessary, (2) pelvic floor muscle therapy (PFMT), and (3) midurethral sling (MUS). We identified probabilities of SUI after 12 months of use of a pessary, PFMT, or MUS using published data. Parameter estimates included Health Utility Indices of no incontinence (.93) and persistent incontinence (0.7) after treatment. Morbidities associated with MUS included mesh erosion, retention, de novo urge incontinence, and recurrent SUI. Cost data were derived from Medicare in 2012 US dollars. One- and 2-way sensitivity analysis was used to examine the effect of varying rates of pursuing surgery if conservative management failed and rates of SUI cure with pessaries and PFMT. The primary outcome was an incremental cost-effectiveness ratio threshold <$50,000. Compared to PFMT, initial treatment of SUI with MUS was the more cost-effective strategy with an incremental cost-effectiveness ratio of $32,132/quality-adjusted life year. Initial treatment with PFMT was also acceptable as long as subjective cure was >35%. In 3-way sensitivity analysis, subjective cure would need to be >40.5% for PFMT and 43.5% for a continence pessary for the MUS scenario to not be the preferred strategy. At 1 year, MUS is more cost effective than a continence pessary or PFMT for the initial treatment for SUI.

Long-term durability, functional outcomes, and factors associated with surgical failure of tension-free vaginal tape procedure.

The cure rate of tension-free vaginal tape (TVT) appeared to decrease overtime, with an associated increased in the stress urinary incontinence (SUI) recurrence rate. We evaluated the long-term durability and functional outcomes of TVT and identified the risk factors that may affect recurrence. Eighty-eight patients, who were cured of SUI 6 months after undergoing TVT, were followed-up for at least 12 years. At post-operative, the patients were evaluated with a Severity Index for Urinary Incontinence questions regarding cure, patient's satisfaction, goal achievement, 3-day voiding diary with urinary urgency scale, uroflowmetry, and complications. Cure rates decreased from 96.6 % at 1-year post-surgery to 83.0 % at 5 years and that the cure rates between 5 and 12 year were similar (83.0 vs. 79.6 %). Valsalva leak point pressure (VLPP) < 60 H(2)O was the only independent factor that predicted recurrence (p = 0.011; hazard radio 5.31). At last follow-up, 39.2 and 70.0 % of patients were free of urgency and urgency incontinence, respectively; and de novo urgency and urgency incontinence developed in 40.5 and 17.2 % of these patients, respectively. Age was the only factor that predicted freedom from overactive bladder (OAB) symptom. There was a significant reduction in the maximal flow rate from 23.3 ± 9.0 ml/s pre-operation to 18.8 ± 6.7 ml/s at 12 years post-operation. TVT is an effective long-term treatment for SUI, although the cure rate may decrease with time. A low VLPP was predictive of SUI recurrence, and patients showing no OAB symptoms tended to be younger.

Management of recurrent stress incontinence following a sling.

Management of recurrent or persistent stress urinary incontinence (RSI) following primary insertion of a synthetic midurethral sling (MUS) remains a challenge for the urologist since no consensus is available to favor one treatment over another. Complete workup should be carried out, including cystoscopy, urodynamics and potentially a pelvic floor ultrasound as a diagnostic adjunct. Various surgical options have been described for RSI, apart from another MUS, including tightening of or shortening a previously placed MUS, a mini-sling, a salvage spiral sling, a colposuspension, the ACT® system, an artificial urinary sphincter or ultimately a urinary diversion. Treatment depends ultimately on the experience and the expertise of the surgeon but it appears most reasonable to offer a repeat MUS (retropubic or transobturator), a pubovaginal sling or bulking agents to women with RSI. Appropriate counseling of patients to set realistic outcomes is key as it may be more practical to aim more for symptomatic improvement than cure.

Results of tension-free vaginal tape for recurrent stress urinary incontinence after unsuccessful transobturator tape surgery.

The aim of this study was to evaluate cure rate and mid-term results of tension-free vaginal tape for recurrent stress urinary incontinence after failed transobturator tape surgery. Between January 2006 and December 2011, 42 women were enrolled in this study. Patient characteristics and operating parameters were recorded, and any complications were noted. All patients were followed up for at least 24 months after the second surgery. The Incontinence Impact Questionnaire and the Urinary Distress Inventory were used to identify satisfaction level. The mean age of the patients was 49.07 ± 8.6 years, and median period between transobturator surgery and the tension-free vaginal tape procedure was 12.8 (range 9.2-17.8) months. The cure rate was 83.3% and 76.2% at the first- and second-year follow-up visits, respectively. Intraoperative complications were transient and slight. Bladder injury in five patients and subcutaneous hematoma above the pubis in two patients were the most serious complications, but they were managed conservatively. We found the scores of the Incontinence Impact Questionnaire and Urinary Distress Inventory to be significantly lower at follow-up, compared to the preoperative assessment. De novo urgency was the most common complaint at follow-up and occurred in 11.9% of the women. We suggest that tension-free vaginal tape is a feasible surgical option for recurrent stress urinary incontinence. Further studies with larger patient numbers and longer follow-up periods are needed to support this finding.

B18 - Comparison of three surgical approaches for the treatment of female recurrent stress urinary incontinence

B18 - Comparison of three surgical approaches for the treatment of female recurrent stress urinary incontinence

Treatment of recurrent stress urinary incontinence in women: comparison of treatment results for different surgical techniques.

IntroductionThere is still no consensus on which surgical technique is the most effective for female recurrent stress urinary incontinence after the initial surgery.AimTo compare the long-term treatment outcomes of Burch colposuspension operation, transobturator tape implantation (TOT) and tension-free vaginal tape (TVT) procedures performed for female recurrent stress urinary incontinence after the initial surgery.Material and methodsA retrospective study was performed on 45 women operated on for recurrent stress urinary incontinence after the initial surgery. Depending on the surgical approach, the patients were divided into three groups: group I (n = 19) – Burch colposuspension operation, group II (n = 16) – TOT, and group III (n = 10) – TVT operation was performed. The treatment results were assessed using the UDI-6 (Urogenital Distress Inventory) and IIQ-7 (Incontinence Impact Questionnaire) short form questionnaires. We included one additional question: Is the patient satisfied with the treatment outcome? We classified the urinary continence results after surgery as good when patients were cured or improved, and as bad when the treatment failed.ResultsGood urinary continence results were observed in 84.2% of patients in group I, 93.8% of patients in group II, and 90% of patients in group III. 68.4% of patients in group I, 81.3% of patients in group II, and 90% of patients in group III were satisfied with the treatment outcomes.ConclusionsBurch colposuspension operation, TOT and TVT procedures performed for the female recurrent stress urinary incontinence treatment are effective and show similar good urinary continence results and similar number of patients satisfied with the treatment outcomes.

Midurethral Slings for the Treatment of Stress Urinary Incontinence

INTRODUCTION: The objective of this study was to report on long-term outcomes after midurethral sling for treatment of stress urinary incontinence (SUI). METHODS: We identified women who underwent midurethral sling procedures (retropubic, transobturator, or mini-slings) from January 1, 2002, through December 31, 2011, at Mayo Clinic, Rochester. The primary outcome was reoperation for recurrent SUI (treatment failure). Patients who had follow-up less than 12 months were excluded. We also reported on reoperation rate for complications. Kaplan-Meier curves were used to calculate the cumulative failure rate and 95% confidence intervals (95% CI). RESULTS: During the study, 1,877 women had a midurethral sling procedure including 1,365 (72.7%) retropubic slings, 254 (13.5%) transobturator slings, and 258 (13.7%) mini-slings. The mean age was 57.9 ± 13.6, 96% were white, median parity was 3 (range, 0 to 9), mean body mass index was 29.9 ± 6.5 kg/m2, and the median follow-up was 10 years (range, 1 to 12 years). The 5-year reoperation rate for stress UI was 4.4% (95% CI 3.4–5.4) (Table 1). There were significantly lower rates of failure among women who underwent the retropubic sling compared with those who had transobturator or mini-sling (P = .002) (Fig. 1). One hundred twelve patients (6%) required surgery as a result of a complication, 89 (6.5%) in the retropubic sling group, 10 (3.9%) in the transobturator sling group, and 13 (5%) in the mini-sling group. These complications were: urinary retention (n = 64), mesh erosion (n = 36), and others (n = 12).CONCLUSIONS: We provide long-term data about risk of reoperation for SUI and complications that can aid preoperative patient counseling.

MP75-19 STRESS URINARY INCONTINENCE OUTCOMES FOLLOWING TRANSVAGINAL SLING INCISION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology II1 Apr 2014MP75-19 STRESS URINARY INCONTINENCE OUTCOMES FOLLOWING TRANSVAGINAL SLING INCISION Lara MacLachlan, Justin Ellett, Kelly Johnson, Gini Ikwuezunma, Michelle Koski, Ross Rames, Ahmed El-Zawahry, and Eric Rovner Lara MacLachlanLara MacLachlan More articles by this author , Justin EllettJustin Ellett More articles by this author , Kelly JohnsonKelly Johnson More articles by this author , Gini IkwuezunmaGini Ikwuezunma More articles by this author , Michelle KoskiMichelle Koski More articles by this author , Ross RamesRoss Rames More articles by this author , Ahmed El-ZawahryAhmed El-Zawahry More articles by this author , and Eric RovnerEric Rovner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2392AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Mid-urethral slings (MUS) have been commonly used in the operative management of stress urinary incontinence (SUI). Unfortunately, many women suffer from complications following MUS surgery that may necessitate a subsequent surgery such as a transvaginal sling incision (TVSI). The objective of this study is to assess the SUI outcomes following TVSI. METHODS A retrospective review of patients who underwent TVSI from 2007 to 2013 was conducted. Indications for the surgery included bladder outlet obstruction (BOO), pelvic pain, dyspareunia, transvaginal exposure of mesh and erosion of mesh into the urinary tract. SUI at baseline and at 3 months follow-up was assessed. SUI was defined as any patient-reported symptoms of SUI, or demonstration of SUI on physical exam, or urodynamic examination. RESULTS A total of 167 patients underwent TVSI with the most common indication being BOO (67.7%). Of the entire cohort, 88/167 (52.7%) had no SUI at baseline and following TVSI 26.1% of these patients had SUI at 3 months follow-up. Of the 113 patients with BOO at presentation, 67 (59.3%) patients had no SUI at baseline and 16/67 (23.9%) patients had SUI at 3 months follow-up. 17/39 (43.6%) patients with transvaginal mesh exposure had no SUI at baseline and 23.5% of these patients had SUI following TVSI. Of the 23 patients with mesh erosion into the urinary tract, 11 (47.8%) patients had no SUI at baseline and 6/11 (54.5%) patients had SUI at 3 months. Of the 66 patients with pelvic pain, 10/30 (33.3%) patients had SUI following TVSI who did not have SUI at baseline. Of the 78 patients with dyspareunia, 10/34 (29.4%) who did not have SUI at baseline had SUI following TVSI. There were 46 patients with SUI and BOO at baseline and following TVSI, 21 patients (45.7%) continued to have SUI at 3 months. Of the 33 patients with SUI and no BOO at baseline, concomitant slings were done on 5 patients at the time of TVSI (2 MUS and 3 autologous pubovaginal slings (aPVS). One patient with concomitant MUS had SUI at 3 months and no patient with a concomitant aPVS had SUI at 3 months. 19 patients have undergone subsequent SUI surgery or bulking injection (11 aPVS, 3 MUS, 2 bladder neck closures, and 3 bulking agents). CONCLUSIONS For patients who do not have SUI at baseline, recurrent SUI following TVSI is not commonly seen. However, for those patients with mesh erosion into the urinary tract or SUI at presentation, recurrent/persistent SUI is seen in over 50% of patients. This knowledge can be used in counseling patients who undergo TVSI. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e881 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Lara MacLachlan More articles by this author Justin Ellett More articles by this author Kelly Johnson More articles by this author Gini Ikwuezunma More articles by this author Michelle Koski More articles by this author Ross Rames More articles by this author Ahmed El-Zawahry More articles by this author Eric Rovner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD33-10 OUTCOMES AND PREDICTORS OF REOPERATION AFTER SLING RELEASE SURGERY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology I1 Apr 2014PD33-10 OUTCOMES AND PREDICTORS OF REOPERATION AFTER SLING RELEASE SURGERY Marisa Clifton, Sherif A. El Nashar, Deborah Lightner, and Daniel Elliott Marisa CliftonMarisa Clifton More articles by this author , Sherif A. El NasharSherif A. El Nashar More articles by this author , Deborah LightnerDeborah Lightner More articles by this author , and Daniel ElliottDaniel Elliott More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2293AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lower urinary tract symptoms are well-documented complications of sling placement and can occur in 5-20% of patients. Urethrolysis is a common procedure utilized to relieve these symptoms. We aimed to report on the outcomes after sling release surgery and to evaluate the predictors of reoperation. METHODS A retrospective review of 143 consecutive female urethrolysis procedures at the Mayo Clinic from January 1, 2000 through August 1, 2012 was performed. Only patients who underwent primary sling placement prior to urethrolysis were included. The clinical features and outcomes of this cohort were recorded. Survival analysis and regression modeling were utilized to calculate the cumulative reoperation rate and detect potential predictors of reoperation after sling release surgery. RESULTS During our study duration, 93 women had sling release after sling placement. Eight had initial transobturator slings, 47 had autologous or cadaveric pubovaginal slings (A/C-PVS) and 38 had synthetic retropubic slings. Indications for sling release included de novo urge in 13(14%), obstruction in 76 (82%) and infections in 4 (4%). The mean age (SD) of patients at the time of sling release was 58.1 (13.2) years with a mean followup after sling release of 39.3 (range, 1 to 124) months. During followup, 22 (24%) women required an additional surgery for persistent or de novo symptoms with a 5 year cumulative reoperation rate of 26.3 % (95%CI 15.8, 36.9). Reoperation for recurrent stress urinary incontinence occurred in 13 (14%) patients and included A/C-PVS in 7, synthetic sling in 2, and bladder neck bulking injection in 4. Reoperation for persistent obstructive symptoms occurred in 9 (10%) patients and included repeat sling release in 3, InterStim placement in 2, Botox injection in 2, and urethral dilation in 2 patients. At last follow up, 28 (32%) patients were taking anticholinergic medication and 18 (21%) required continued intermittent catheterization. In the 76 women who had sling release for obstructive symptoms, those with excision or complete removal tended to have lower reoperation rates (6 /35 or 17%) compared to those who had sling incision (10/41 or 24%)(P=0.44). CONCLUSIONS One in four women who had sling release surgery required an additional operative procedure within 5 years. Patients who had sling incision for obstructive symptoms tended to require reoperation more frequently than those who had excision or complete removal of their sling. This information is invaluable during patient counselling prior to proceeding to sling release surgery. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e844 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Marisa Clifton More articles by this author Sherif A. El Nashar More articles by this author Deborah Lightner More articles by this author Daniel Elliott More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Cost Effectiveness Analysis of Conservative versus Surgical Management for the Initial Treatment of Stress Urinary Incontinence

Objective We sought to determine whether conservative or surgical therapy is more cost effective for the initial treatment of stress urinary incontinence (SUI). Study Design We created a decision tree model to compare costs and cost effectiveness of 3 strategies for the initial treatment of SUI: (1) continence pessary, (2) pelvic floor muscle therapy (PFMT), and (3) midurethral sling (MUS). We identified probabilities of SUI after 12 months of use of a pessary, PFMT, or MUS using published data. Parameter estimates included Health Utility Indices of no incontinence (.93) and persistent incontinence (0.7) after treatment. Morbidities associated with MUS included mesh erosion, retention, de novo urge incontinence, and recurrent SUI. Cost data were derived from Medicare in 2012 US dollars. One- and 2-way sensitivity analysis was used to examine the effect of varying rates of pursuing surgery if conservative management failed and rates of SUI cure with pessaries and PFMT. The primary outcome was an incremental cost-effectiveness ratio threshold Results Compared to PFMT, initial treatment of SUI with MUS was the more cost-effective strategy with an incremental cost-effectiveness ratio of $32,132/quality-adjusted life year. Initial treatment with PFMT was also acceptable as long as subjective cure was >35%. In 3-way sensitivity analysis, subjective cure would need to be >40.5% for PFMT and 43.5% for a continence pessary for the MUS scenario to not be the preferred strategy. Conclusion At 1 year, MUS is more cost effective than a continence pessary or PFMT for the initial treatment for SUI.

A Comparison of Risk Factors for Recurrent Stress Urinary Incontinence Surgery in Patients with and without a History of Tobacco Abuse

A Comparison of Risk Factors for Recurrent Stress Urinary Incontinence Surgery in Patients with and without a History of Tobacco Abuse

Therapieoptionen der rezidivierenden oder persistierenden Belastungsharninkontinenz

After synthetic sling procedures, up to 16 % of women and 45.5 % of men complain about a persistent or recurrent stress urinary incontinence (SUI). Currently, randomized studies comparing the different treatment modalities of persistent or recurrent SUI are lacking. There are data of retrospective studies investigating the efficiency of synthetic slings and the artificial urinary sphincter AMS 800® in men. Synthetic slings can be applied in patients with mild SUI and without prior radiation of the pelvic region. The AMS 800® is the treatment of choice in patients with severe SUI or previous radiation.In women with persistent and recurrent SUI, the efficiency of colposuspensions, autologous and synthetic slings as well as the AMS 800® has been investigated in retrospective studies. Due to comparable cure rates and a faster postoperative recovery, synthetic slings are now superseding colposuspensions and autologous slings. Excellent success rates after AMS 800® implantation have been described for both genders; nonetheless, postoperative complications and revisions as well as the requirement of dexterity of the patients should be taken into account. Data about the efficiency of adjustable slings, the ACT® and newer artificial urinary sphincter devices like Flow-Secure® and Zephyr® ZSI 375 in the treatment of persistent and recurrent SUI is lacking.

Long-term effects of simulated childbirth injury on function and innervation of the urethra

Pudendal nerve and external urethral sphincter (EUS) injury during vaginal delivery are risk factors for stress urinary incontinence (SUI). Although most patients with short-term postpartum SUI regain continence within 1 year, they have a higher predisposition to develop recurrent SUI years later, suggesting a possible mechanistic relationship. In contrast, animal models generally recover spontaneously and have not been studied much in the long term. The aim of this study was to investigate the long-term effects of simulated childbirth injury in rats. Thirty-four Sprague-Dawley female rats underwent sham injury or pudendal nerve crush and vaginal distension (PNC + VD), a simulated childbirth injury. Nine weeks later, leak point pressure (LPP) and EUS electromyography (EMG) were recorded simultaneously. The pudendal nerve was harvested for histological analysis. EUS neuromuscular junctions (NMJs) and their innervation were qualitatively assessed using immunofluorescence. A t-test was used to compare quantitative outcomes between groups, with P < 0.05 indicating a significant difference. There was no significant difference in LPP or EUS EMG amplitude or firing rate between the two groups. Nonetheless after PNC + VD, NMJs in the EUS were diffuse and were innervated by tortuous and multiple axons, demonstrating that reinnervation of the EUS was still in progress. Although continence function recovered 9 weeks after simulated childbirth injury, innervation of EUS was not complete at this time point, suggestive of persistent neurogenic deficiency which when compounded by the effects of aging may lead to a delayed recurrence of SUI in this animal model with increased age.

Long-term Outcome of the Readjustable Sling Procedure for Female Stress Urinary Incontinence With Intrinsic Sphincter Deficiency or Recurrence

PurposeWe evaluated the long-term outcome of a readjustable midurethral sling system (Remeex) in the treatment of recurrence of stress urinary incontinence (SUI) after surgical treatment or SUI with intrinsic sphincter deficiency (ISD).Materials and MethodsThis study included 19 patients who underwent the Remeex procedure with a mean of 45.6 months of follow-up. The patients had responded to a telephone questionnaire. Thirteen patients had ISD, four patients had SUI recurrence, and two patients had both. The questionnaire included subjective cure and satisfaction surveys and also recommended surgery to some patients.ResultsThe mean patient age was 69.1 years (range, 50-85 years), the mean parity was 2.79 times (range, 2-5 times), and the mean follow-up period was 45.6 months (range, 21-72 months). The long-term follow-up cure rate was 79%, the improvement rate was 21%, and the fail rate was 0%. The long-term follow-up "very satisfactory" rate was 26.3%, the "satisfactory" rate was 73.7%, and the "usual" and "unsatisfactory" rates were both 0%. In addition to these results, 16 patients (84.2%) would recommend the Remeex procedure to other patients with SUI recurrence or ISD. After the procedure, four patients had urinary retention, three patients had difficulty emptying, and one patient had SUI recurrence. Furthermore, all of the patients subsequently endured sling readjustments.ConclusionsAfter long-term follow-up, the Remeex system showed good cure rates and subjective satisfaction rates that were similar to the results found at the 1-year follow-up, and minimal complications were reported. Therefore, the Remeex system is effective in treating patients with SUI recurrence or ISD.

Treatment of recurrent stress urinary incontinence after failed minimally invasive synthetic suburethral tape surgery in women

Treatment of recurrent stress urinary incontinence after failed minimally invasive synthetic suburethral tape surgery in women