Recurrent Urinary Incontinence Research Articles

Invasive neurostimulation in neuro-urology: state of the art

Modulation or stimulation of the nerves supplying the lower urinary tract is a possible treatment option for dysfunction of the lower urinary tract, pelvic floor and rectum if conservative or minimally invasive treatment approaches fail. This overview shows the possibilities and limitations of sacral neuromodulation, sacral deafferentation with sacral anterior root stimulation and conus deafferentation.Sacral neuromodulation (SNM) is a procedure for the treatment of refractory pelvic floor dysfunction of various origins (idiopathic, neurogenic or post-operative), such as overactive bladder, non-obstructive retention and faecal incontinence. A particular advantage of SNM is the possibility of prior test stimulation with a high prognostic value. The procedure is minimally invasive, reversible and associated with relatively low morbidity rates.Following the introduction of MRI-compatible SNM systems, there has been renewed interest in the treatment of neurogenic bladder dysfunction. A recent meta-analysis reports similar success rates as in the idiopathic patient population.Sacral deafferentation with implantation of a sacral anterior root stimulator (SARS/SDAF) is an excellent therapeutic option for patients with spinal cord injury, which can significantly improve the quality of life of those affected and, in addition to treating neurogenic lower urinary tract dysfunction, can also have a positive effect on neurogenic bowel dysfunction, neurogenic sexual dysfunction or autonomic dysreflexia. If conservative or minimally invasive treatment fails, it is crucial for the success of this procedure to consider SDAF/SARS at an early stage in order to avoid irreversible organic damage.Conus deafferentation (KDAF) is a less invasive surgical treatment option for patients with spinal cord injury for whom sacral deafferentation would be indicated but who would not benefit from the simultaneous implantation of a sacral anterior root stimulator. In principle, these patients also have the option of being subsequently treated with an extradural implant and thus utilising the advantages of anterior root stimulation. Indications for KDAF are autonomic dysreflexia, therapy-refractory detrusor overactivity, recurrent urinary tract infections, urinary incontinence and spasticity triggered by detrusor overactivity. With KDAF, we have a safe and efficient procedure with great potential for improving the spectrum of paraplegiological and neuro-urological treatment.

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.

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.

Second Suburethral Sling Implantation for the Recurrent Urinary Incontinence after Radical Prostatectomy when First Sling Surgery was Non-Effective: Case Report

Stress urinary incontinence is a complication after radical prostatectomy. The suburethral sling implantation operation is often performed for mild to moderate male urinary incontinence after radical prostatectomy. There are non-adjustable suburethral slings that are effective up to 73.7% and adjustable slings that are effective up to 92%. We present a case report of a 62-year-old man who underwent radical prostatectomy due to prostate cancer in 2018 and experienced moderate degree urinary incontinence. After non-effective conservative treatment in 2020-02-27, the suburethral transobturator sling implantation was performed in another hospital, but it did not yield effective results. After further examinations in 2023-03-25, an adjustable ATOMS system suburethral male sling implantation was performed and it was effective. 2023-05-03 ATOMS system was adjusted and after this there was no urinary incontinence. ATOMS system is an effective surgical method for the treatment of male recurrent urinary incontinence or for cases where the initial sling implantation has failed.

A robot-assisted laparoscopic revision of an artificial urinary sphincter in a patient with spinal cord injury.

This step-by-step article demonstrates our approach to robot-assisted laparoscopic revision of a bladder neck sited artificial urinary sphincter (AUS) for a spinal cord injured patient. The bladder neck location of an AUS in the spinal cord injured demographic is ideal to minimise urethral complications and urinary tract infections, whilst the transabdominal approach reduces the risk of wound breakdown that can occur via the typical perineal incision for AUS insertion. The accompanying video will guide viewers as to our minimally invasive technique for cuff revision in the event of secondary surgery for recurrent urinary incontinence.

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.

Отдаленные результаты применения субуретральной петлевой пластики с контролем натяжения в лечении недержания мочи.

Introduction. Urinary incontinence is a disease that significantly reduces the quality of life in patients. Suburethral loop plasty is still the gold standard for the treatment of stress urinary incontinence, which is highly effective, but also has a number of possible postoperative complications. The purpose of this article is to evaluate the long-term results (after 4 years), the effectiveness and safety of the use of suburethral loop plasty with tension control. Materials and methods. Currently, there is no single way to adjust the tension of the hinge during its installation. At the Department of Urology of A.I. Yevdokimov Moscow State University of Medicine and Dentistry developed a device to control the tension of the loop, presented in the form of a self-absorbable pad (damper layer) located in the middle of a synthetic prosthesis. A prospective, comparative, randomized study that began in 2018 showed a high efficacy and safety profile for this device. When analyzing the results 1 year after the operation, the effectiveness of surgical treatment was 96%, the rate of postoperative complications in the form of infravesical obstruction was 2%, de novo urgency in the study group was 6%. In this study, we assessed long-term mid-term outcomes (over 4 years) through a telephone survey and filling in validated questionnaires (Urogenital distress inventory – UDI-6, Incontinence Impact Questionnaire – IIQ-7) among patients who underwent suburethral loop plasty with a loop tension control device. Results. The average score on the UDI-6 survey was 1.22 ±0.81, and 1.2±0.77 on the IIQ-7 survey. After a telephone survey after 48 months, there was a slight increase in scores, when compared with the results of the survey 12 months after surgical treatment, but not statistically significant (p>0.05). In the analysis of individual clinical cases after 48 months, 10 patients noted worsening of symptoms. Of these, 6 patients noted a recurrence of urinary incontinence when coughing, physical activity. Accordingly, the subjective effectiveness of surgical treatment over a 4-year follow-up period was 88%. Conclusions. Efficacy and safety data, in the medium-term follow-up of patients after suburethral loop plasty with tension control, are comparable to world data. However, further monitoring of patients in the long term is required.

A narrative review: evaluation and surgical management of persistent and recurrent urinary incontinence after previous surgical treatment.

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

Risk factors for stress urinary incontinence recurrence after midurethral sling revision

Risk factors for stress urinary incontinence recurrence after midurethral sling revision

Our experience of surgical treatment of recurrent urinary incontinence in women after the installation of a synthetic implant

BACKGROUND: The article presents data on the frequency of recurrence of urinary incontinence in women after the installation of a synthetic implant, as well as methods for the surgical elimination of this pathology. The described urogynecological problem is relevant and widespread.
 MATERIALS AND METHODS: The results of surgical treatment of 16 women with pelvic organ prolapse and recurrent urinary incontinence after sling operations are presented. All patients underwent laparoscopic colpovesicosuspension.
 RESULTS: In the postoperative period positive dynamics was noted during the examination using the POP-Q system and the results of the questionnaire using the ICIQ-SF questionnaire, which was observed throughout the follow-up period of 12 months. Complications in the immediate and long-term postoperative period were not identified. For the entire period of observation of the patients, recurrence of prolapse was not observed in any case.
 CONCLUSION: The proposed method of surgical treatment of recurrence of urinary incontinence in women with mesh implants is effective and safe.

Urethral diverticulum and periurethral cyst: symptoms, diagnostics, treatment and outcome.

Objectives. In order to contribute to better diagnostic and treatment, we compared the symptomatology, diagnostics, treatment and outcome in women with a urethral diverticulum or a periurethral cyst. Methods. We performed a retrospective extraction of data from medical records including 70 women with a urethral diverticulum or a periurethral cyst, operated at our department from January 2010 until December 2013. Fischer’s exact test and t-test were used for statistical analyses. Results. In total, 31 women were diagnosed with a diverticulum and 39 with a periurethral cyst. Women with a diverticulum had significantly more often voiding pain (45 % vs 8 %, p=0.001), urethral/vaginal pain (45% vs 15 %, p=0.01), recurrent urinary tract infection (23 % vs. 5 %, p=0.01), urinary incontinence (45 % vs. 21 %, p=0.04), and urethral discharge (39 % vs. 15 %, p=0.03) compared to women with a periurethral cyst. The only symptom less frequent in the diverticulum group was a bulky feeling (42 % vs. 74 %, p=0.01). In the diverticulum group, 87% had resections and 13% marsupialization, while in the cyst group 59 % had resections and 41 % marsupialization (p=0.02). In the diverticulum group four (13%) experienced recurrence compared to none in the cyst group (p=0.03). Furthermore, one patient referred as a diverticulum had urethral cancer. Conclusions. Urethral diverticula and periurethral cysts should be considered in women with lower urinary tract symptoms and pain. Urethral diverticula are more complicated to diagnose and to treat. Tweetable abstract: Urethral diverticula and periurethral cysts should be considered in women with lower urinary tract symptoms and pain

Midterm postoperative results of mid-urethral slings. Role of ultrasound in explaining surgical failures.

Surgical treatment for stress urinary incontinence (SUI) with mid-urethral sling (MUS) is considered to have a high success rate. However, between 5% and 20% of MUS fail, with inadequate surgical implantation being a possible cause of SUI persistence or recurrence. Misplacement of a MUS can be determined by pelvic floor ultrasound (PF-US). The aim of this study was to investigate the role of PF-US in patients with persistent or recurrent urinary incontinence(UI) symptoms after MUS surgery for SUI with a midterm follow-up. A historical cohort study including women undergoing MUS surgery for SUI between 2013 and 2015 was designed. The primary outcome was to correlate the sonographic parameters of MUS with SUI cure (negative International Continence Society-Uniform Cough Stress Test, Incontinence Questionnaire-Short Form < 5 points and no symptoms of SUI), at 5years postsurgery. Secondary outcomes were changes of maximum urethral closure pressure (MUCP) and symptoms of urgency urinary incontinence (UUI) at 1 and 5 years after surgery. Eighty-seven patients (80 transobturator-MUS, 7 retropubic-MUS) were included. At 5 years all patients referred improvement of UI and objective cure of SUI was demonstrated in 81.2%. The MUS was sonographically correct in 67 (98.5%) of the 68 patients with cure of SUI. The MUS was considered incorrectly placed in only 4 (28.6%) of the 14 patients with noncured SUI. MUCP decreased from 61.9 to 48.8 cmH2 O at 5 years of follow-up (p < 0.01) and up to 53% of women had UUI symptoms after surgery, with a nonsignificant decrease compared to baseline. Patients cured of SUI had sonographically correct MUS by PF-US. Less than one-third of cases of SUI persistence or recurrence after MUS surgery could be explained by a sonographically incorrect sling. Low urethral resistance and/or UUI symptoms could help to explain the remaining failures. Complete functional and anatomic studies, including urodynamics and PF-US, should be performed before deciding on the next management strategy in patients with SUI persistence or recurrence after MUS.

Usefulness of videourodynamic study in the decision-making of surgical intervention and bladder management for neurogenic lower urinary tract dysfunction among patients with myelomeningocele.

Neurogenic lower urinary tract dysfunction (NLUTD) is common among children with myelomeningocele (MMC). If NLUTD is not appropriately managed, recurrent urinary tract infection (UTI) can persist and may affect upper urinary tract function. This study investigated the usefulness of videourodynamic study (VUDS) in the urological management of MMC. We retrospectively analyzed 57 patients with MMC who underwent VUDS and received urological treatments at the hospital, including surgeries, minimally invasive therapies, and conservative management. The baseline VUDS parameters of patients who received different treatments were evaluated, and the treatment outcomes of the different treatment subgroups were compared. There were 29 male and 28 female patients with a mean age of 24.1 ± 15.9years upon enrollment. Patients had dysuria or urinary retention (n = 42, 73.7%), urinary incontinence (n = 40, 70.2%), recurrent UTI (n = 35, 61.4%), hydronephrosis (n = 27, 47.4%), and vesicoureteral reflux (n = 26, 45.6%). VUDS revealed detrusor sphincter dyssynergia in 32 (56.1%) patients, bladder neck dysfunction in 13 (22.8%), and intrinsic sphincter deficiency in 20 (35.1%). Among them, 21 (36.8%) received surgical intervention, 17 (29.8%) minimally invasive therapy, and 19 (33.3%) conservative management. After a mean follow-up of 8.5years, the incidence rates of recurrent UTI (61.4% vs 31.6%, p = 0.001), hydronephrosis (47.4% vs 14.0%, p < 0.0001), urinary incontinence (70.2% vs 35.1%, p < 0.0001), and vesicoureteral reflux (45.6% vs 21.1%, p < 0.001) decreased. The overall global response assessment rate was 73.7%, and patients who underwent surgery had the best rate (90.5%). The predictive value of bladder compliance for treatment selection was > 20.5ml/cm H2O. VUDS can be used to comprehensively assess lower and upper urinary tract dysfunction among patients with MMC. To improve NLUTD and prevent complications, minimally invasive therapies or surgical procedures should be recommended to patients with MMC who have low bladder compliance.

MP52-08 ARTIFICIAL URINARY SPHINCTER CUFF DOWNSIZING IMPROVES CONTINENCE AND PATIENT SATISFACTION IN CASES OF SUB-CUFF ATROPHY

You have accessJournal of UrologyCME1 May 2022MP52-08 ARTIFICIAL URINARY SPHINCTER CUFF DOWNSIZING IMPROVES CONTINENCE AND PATIENT SATISFACTION IN CASES OF SUB-CUFF ATROPHY Kevin Krughoff, Brent D. Nosé, and Andrew C. Peterson Kevin KrughoffKevin Krughoff More articles by this author , Brent D. NoséBrent D. Nosé More articles by this author , and Andrew C. PetersonAndrew C. Peterson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002627.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The management of suspected artificial urinary sphincter (AUS) sub-cuff atrophy remains controversial and clinical outcomes remain underreported. Our objective was to examine the impact of cuff downsizing on patient reported outcomes and pad use in cases of sub-cuff atrophy. METHODS: We reviewed our prospectively collected, institutional approved QI database from 2011 to 2021. IRB approval was obtained for the analysis. At our institution, the AUS is routinely filled with contrast solution and imaged radiographically upon initial activation for a baseline. This allows for better delineation between device failure or sub-cuff atrophy during standard multimodal workup of recurrent urinary incontinence with serial AP Pelvis radiography. Patients are seen on a routine basis following activation. Sub-cuff atrophy was diagnosed with serial AP pelvis films indicating atrophy, cystoscopy, assessment of symptom scores and pad use, and history and physical examination. Patients with post-prostatectomy incontinence who underwent cuff downsizing after the diagnosis of sub-cuff atrophy were included for analysis. Repeated measures T-tests were used to assess change in validated survey instruments, subjective outcomes measures and pad use. RESULTS: Over this time-period, 842 AUS devices were placed, 623 new and 219 revisions. Of these, 30 underwent cuff downsizing following a diagnosis of sub-cuff atrophy as determined by the appearance of more fluid in the cuff versus baseline on AP pelvis film, cystoscopy with incomplete coaptation, patient interview and questionnaires, and evaluation of number pads used per day. The initial AUS was in place for a median of 668 days (292, 1601) prior to the diagnosis of sub-cuff atrophy. Median follow up duration after cuff downsizing was 3561 days (2247, 4704). At time of most recent assessment, 23 (73.3%) of downsized cuffs remained in place, 2 (6.6%) were revised for mechanical failure, 2 (6.6%) for further atrophy and 3 (10.0%) for erosion. Following downsize, 96.7% reported subjective improvement and 92.0% experienced a decrease in pad count, with a median decrease of 2 and mean decrease of 2.21 (± 1.45) pads per day (p<0.01). Of those who completed the AUA Symptom Score before and after downsize, 82% experienced an improvement on the bother index score (mean decrease 1.63 ± 1.74, median 1, p=0.01). CONCLUSIONS: Cuff downsizing improves continence control and patient satisfaction in cases of multimodal diagnosed sub-cuff atrophy. Source of Funding: Boston Scientific Fellowship Grant © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e889 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Krughoff More articles by this author Brent D. Nosé More articles by this author Andrew C. Peterson More articles by this author Expand All Advertisement PDF DownloadLoading ...

Outcomes of 25 female dogs treated for ectopic ureters by open surgery or cystoscopic-guided laser ablation.

To report outcomes after the correction of ectopic ureter (EU) by open surgery or cystoscopic-guided laser ablation (CLA) in female dogs. Retrospective study from 2011 to 2018. Twenty-five female dogs. Data collected included signalment, clinicopathologic data, procedural data, complications, and short-term and long-term outcomes. Complications were graded as minor or major if a surgical revision was required. Continence status was scored subjectively (1=completely incontinent to 10=fully continent). Fifteen dogs had bilateral EU and 24 had intramural EU (iEU). Open surgical correction included 13 neoureterostomies, 2 neocystoureterostomies, and a combination of these in 2 dogs. Eight dogs underwent CLA. Eighteen dogs experienced minor complications (72%), and 2 experienced major complications (8%). One-month postoperative continence was achieved in 20/25 (80%) dogs (median score of 10). Incontinence recurred at a median time of 24.9months in 5 dogs but responded to medical treatment. Overall, dogs remained continent for 66 months (median) and 22/25 (88%) dogs achieved continence with adjunction of medical/surgical treatment in incontinent ones. Fewer minor complications and postoperative recurrences of incontinence were documented after CLA than neoureterostomy (P < .01 and P < .05). Ectopic ureter correction by open surgery or CLA resulted in a subjectively good prognosis, most dogs reaching continence within a month of surgery, although incontinence occasionally recurred in the long term. CLA was associated with fewer complications and incontinence recurrences than neoureterostomy. Cystoscopic-guided laser ablation should be preferred to correct iEU to prevent short-term complications and the recurrence of incontinence. Further studies should investigate the cause of postoperative recurrence of urinary incontinence.

Urethral Exposure of Mid-urethral Sling: Diagnosis, Management and Functional Outcomes

ObjectiveTo identify symptoms leading to urethral mesh exposure diagnosis, describe the surgical management and evaluate post-operative functional and urodynamic outcomes. Materials and MethodsRetrospective observational monocentric study of 15 patients treated by mid-urethral sling removal for urethral exposure, between December 2005 and February 2021, in a pelviperineology centre. ResultsFifteen patients were included. The mean time to diagnosis of urethral exposure was 43 months. This diagnosis delay was caused by a non-specific symptomatology. Surgical management consisted of partial removal of the eroded mid-urethral sling fragment by vaginal approach in all cases, with low peri-operative morbidity. At 3 months follow-up, 87% of the patients had stress urinary incontinence vs 54% at 2 years. 13 patients had a urodynamic assessment after their mid-urethral sling removal, they all had sphincter insufficiency with a urethral closure pressure lower than 30 cm H2O. Nine patients underwent a second urinary incontinence management procedure, leading to 77% of complete remission and 23% of partial improvement. ConclusionClinical presentation of urethral erosion after mid-urethral sling is heterogeneous. Surgical management is complex; after a good preoperative evaluation, a two-step management strategy including minimally invasive mid-urethral sling removal and treatment of recurrent urinary incontinence leads to good results with 77% of patients cured. Sphincter insufficiency is one of the mechanisms that may explain the high rate of stress urinary incontinence after urethral mesh erosion surgery.

Can urethral re-bulking improve the outcomes of a prior urethral bulking?

Aims:To analyze the outcomes of urethral re-bulking in the treatment of female stress urinary incontinence.Materials and Methods:We performed a multicenter observational retrospective study, which included all consecutive patients treated with urethral re-bulking for the treatment of persistent stress or mixed urinary incontinence after a previous urethral bulking. Objective outcomes were evaluated with the 24 h pad-test, while PGI-I questionnaires were administered to evaluate subjective outcomes. Clinical outcomes were assessed before re-bulking procedure and at last follow-up. Mann–Whitney’s U test was used for subgroup analysis. Shapiro-Wilk’s tests were used as normality tests.Results:In total, 62 patients who underwent urethral re-bulking between 2013 and 2020 in a multicenter setting were included. Most patients did not reach complete continence after the first procedure (n = 56) while the remainder reported recurrence of urinary incontinence after initial benefit. Median age at surgery was 66 (IQR: 55-73). Median overall follow-up was 30 months (IQR: 24-41). Median time occurred between the first procedure and reintervention was 12 months (IQR: 7-27). Bulking agents for the re-bulking procedures were bulkamid(n = 56), macroplastique(n = 4), and Prolastic(n = 2). A statistically significant reduction of median 24 h pad test from 100 g(IQR: 40-200) to 35 g(IQR: 0-120) was observed (p = 0.003). Dry rate after rebulking was 36.6%, while 85.4% patients declared themselves ‘very much improved’ or ‘much improved’ (PGI-I 1-2). Very few low-grade complications were observed (n = 4). A single case of major complication occurred.Conclusions:Urethral re-bulking can be an effective technique for the treatment of stress urinary incontinence refractory to a previous urethral bulking and can determine a cumulative benefit after the first procedure.

ATOMS (Adjustable Transobturator Male System) Is an Effective and Safe Second-Line Treatment Option for Recurrent Urinary Incontinence after Implantation of an AdVance/AdVance XP Fixed Male Sling? A Multicenter Cohort Analysis.

(1) Background: This study examined outcomes of second-line ATOMS implantation after failure of the fixed male sling (FMS) AdVance/AdVance XP. (2) Methods: A retrospective multicenter cohort analysis was carried out in men implanted with an ATOMS between 2011 and 2020 after failure of an AdVance/AdVance XP. Success was assessed on the basis of objective (dryness, 0–1 pad/24 h or >20 g/24 h pad test) and subjective results (PGI-I). We performed the Wilcoxon rank sum test, Fisher’s exact test, logistic regression, and multivariate analysis. (3) Results: The study included 88 patients from 9 centers with a mean age of 71.3 years. No Clavien–Dindo > II complications occurred within the first 3 months after ATOMS implantation. A total of 10 cases (9%) required revision in the ensuing clinical course. After a mean follow-up of 42.5 months, 76.1% achieved social continence, and 56.8% used no pads at all. Mean urine leakage/24 h dropped from 422 g (3.9 pads) to 38 g (0.69 pads) and the mean ICIQ-SF decreased from 16.25 to 5.3 (p < 0.0001). PROMs (patient-reported outcome measures) showed improvement in 98.9% of cases, and 63.6% gave a “very much better” PGI-I rating. Multivariate analysis identified a lower probability of achieving maximum satisfaction for the following factors: the AdVance XP as first-line therapy (OR 0.35), a lower ICIQ-SF question 1 (OR 0.26), status post-irradiation (OR 0.14), and more severe pain prior to ATOMS implantation (OR 0.51). (4) Conclusions: Implantation of an ATOMS is an effective and safe second-line treatment option for recurrent urinary incontinence after implantation of an AdVance/AdVance XP sling. High patient satisfaction was demonstrated in a long-term follow-up.

Symptom Resolution and Recurrent Urinary Incontinence Following Removal of Painful Midurethral Slings

To evaluate pain improvement and recurrent stress incontinence (SUI) following painful synthetic midurethral sling (MUS) removal. We conducted a retrospective review of patients who underwent synthetic MUS removal at our institution from 2009-2016 for the indication of pain. We recorded sling type (transobturator vs retropubic), complete vs partial removal, and presenting symptoms. Postoperative pain improvement was categorized as resolved (pain resolved, requiring no further therapy), improved (pain less bothersome, may require further therapy), or unresolved (no/minimal improvement, requiring further management). Recurrent incontinence and further reconstructive procedures were assessed. 87 patients (49 complete and 38 partial removal) with pain as the primary indication for removal were included. Median age at intervention was 54 years with median follow-up of 8 months. Overall, pain improved or resolved in 78.1% of cases. Complete removal was associated with significantly greater percentage of pain resolution (63.3%) compared to partial removal (26.3%) (P=0.002) regardless of sling type. No significant differences in recurrent SUI were noted in complete vs partial removal. Additional reconstructive procedures were performed in 28 patients, most commonly sling placement, with no significant difference in complete (20.4%) vs partial (28.9%) removal groups (P=0.36). The overall complication rate was low (5.7%), a majority of which were transfusions (4.6%). Following MUS removal, most patients experienced resolution or improvement of pain. Complete sling removal was associated with significantly greater percentage of pain resolution compared to partial removal in both retropubic and transobturator slings. Rates of recurrent SUI and reintervention for SUI were not related to the extent of sling removal.

Transvaginal closure of urinary bladder opening and Mitrofanoff technique in a neurologically impaired female with chronic indwelling catheter: a case presentation

BackgroundChronic catheterization remains the only attractive option in specific circumstances, especially in neurologically impaired patients. Complications produced by the indwelling catheters, like patulous urethra and bladder neck destruction, usually lead to severe incontinence and significant nursing difficulties. Here, we describe a rare case, a urinary bladder opening representing massive and extensive destruction of the urethra and bladder sphincter due to an indwelling catheter.Case presentationWe present a 46-year-old paraplegic woman complaining of recurrent febrile urinary tract infections and severe urinary incontinence. She suffered from persistent malodorous urine and skin breakdowns from constant urine leakage. The vaginal examination revealed extensive destruction of the urethra and a 10 cm opening permitting the urinary bladder wall to prolapse into the vagina. The patient underwent a combined surgical approach; a transvaginal bladder closure with anterior colporrhaphy and a Mitrofanoff procedure to ensure a continent stoma for future clean intermittent self-catheterization (CISC). The patient is compliant with CISC and, remains continent twelve years after surgery.ConclusionThis case demonstrates that in the era of CISC, there are still neurologically impaired females suffering from rare but critical adverse effects of indwelling catheters. The urethra and bladder neck erosion represent a demanding treatment assignment. The Mitrofanoff procedure for continent stoma and the transvaginal closure of urinary bladder opening produced a lifesaving potential treatment.