Severe Stress Urinary Incontinence Research Articles

The AdVance™ male sling: does it stand the test of time?

Introduction There is minimal data published on the longevity of the transobturator retrobulbar male sling (AdVance™). We aimed to determine the efficacy, the complication rate and need for salvage SUI surgery in the medium to long term for male sling insertion. Materials and methods We performed a retrospective review of all patients undergoing male sling insertion at a single centre between 2009 and 2018. Data on patient demographics, pre and post-operative International Consultation on Continence Questionnaire – Urinary Incontinence (Short Form) (ICIQ-UI(SF)) scores and 24 h pad usage were collected. Success was calculated as a combination of the cured rate (0–1 security pad use) and the improved rate (>50% reduction in pad usage). Data was also collected on complications, patient satisfaction as well as need for further SUI surgery. Results A total of 91 patients underwent male sling insertion in the period specified; median follow up was 69 months. Success rates at 3 months in mild SUI, moderate SUI and severe SUI groups were 96, 86 and 80%, respectively. In the medium to long term, this drops to 65, 62 and 47%, respectively. The overall rate of artificial urinary sphincter (AUS) implantation was 15%. Common complications included groin pain (3%), infection (3%), urinary retention (10%) and de novo overactive bladder (OAB) (11%). The only factor predicting success or failure was pre-operative ICIQ-UI(SF) score. Conclusions AdVance™ male sling success rates deteriorate from 89% at 3 months to 61% at 5 years. The risk of complications is low and, for the most part, transient. Sling insertion remains a reasonable treatment option for male patients suffering with stress urinary incontinence (SUI).

Continence and Complication Rates of Artificial Urinary Sphincter Devices (AMS 800) for Parkinson and Stroke Patients with Incontinence after Prostate Surgery: Retrospective Analysis of a Prospective Database

Objectives: The artificial urinary sphincter (AUS) is the gold standard treatment for severe stress urinary incontinence (SUI). According to the literature, patients suffering from Parkinson’s disease (PD) or stroke (ST) show adverse continence outcomes after prostate surgery and, therefore, constitute a challenging cohort for continence surgery. However, little is known with respect to the results of AUS surgery in these patients. A retrospective analysis of our institutional, prospectively maintained AUS database aims to address this aspect with a focus on surgical and functional outcomes. Methods and Patients: All data of patients with an AUS implantation were prospectively collected in our database since 2009. The AUS was implanted according to a standardized protocol and activated at 6 weeks postoperatively at our institution. Further follow-up (FU) consisted of pad-test, uroflowmetry, residual urine, and radiography as well as a standardized questionnaire including the Incontinence Quality of Life questionnaire (I-Quol) and International Consultation on Incontinence questionnaire (ICIQ-SF) and is scheduled at 6 and 24 months and every 2 years thereafter. Patients received a preoperative urodynamic evaluation (UD). Patients with normal voiding and storage function were considered for AUS implantation. All patients performed a preoperative test for manual dexterity. Patients with a history of ST or PD were grouped and compared to nonneurological patients. Primary/secondary endpoints of the study were complications/continence. Results: 234 patients were available for analysis. The median FU was 24 months (interquartile range 7–36). Twenty-four patients (10%) had a neurological history (PD and ST). Neurological patients showed significantly worse outcomes regarding continence (objective/subjective/social continence; p = 0.04/p = 0.02/p = 0.1). Significant differences concerning explantation rates were not observed (p = 1). Kaplan-Meier analysis showed no significant difference regarding explantation-free survival (log-rank p = 0.53). Conclusion: AUS implantation shows significantly worse continence rates for neurological patients, despite the fact that all patients showed normal UD results and sufficient manual dexterity. Although neurological patients showed worse outcomes for continence, AUS implantation seems to be a safe and viable treatment for patients with a history of neurological disease.

Outcomes of laparoscopic artificial urinary sphincter in women with stress urinary incontinence: mid-term evaluation.

Although artificial urinary sphincter (AUS) has become an established treatment for moderate to severe stress urinary incontinence (SUI), implantation can be challenging. This study aimed to review the outcomes of laparoscopic AUS (LAUS) implantation and revision in women presenting with SUI. We reviewed the files of female patients presenting with moderate to severe SUI treated with LAUS implantation from October 2007 to July 2017. Surgeries were performed by one surgeon experienced in open AUS implantation and starting LAUS implantation. The primary endpoint was postoperative urinary continence, which was divided into three categories: complete continence, improved continence, and unchanged incontinence. The secondary outcomes were complications, explantation-free and revision-free time. A total of 49 women (mean age 64years, range 40-80) had LAUS implantation. Among the 42 patients (85.7%) with an AUS in place at the last follow-up, 25 (59.5%) were fully continent, 16 (38.1%) had improved continence, and 1 (2.4%) had unchanged incontinence. At the lastfollow-up, 29 (59.2%) patients had their initial AUS and 13 (26.5%) had at least one reintervention. There were 9 (18.4%) intraoperative complications and 25 (51%) postoperative complications, of which 9 (18.4%) were Clavien⩾3. After a median follow-up of 4years, 9 (18.4%) explantations and 11 (22.5%) revisions occurred. The average period without explantation or revision was 3.7 and 3.1years, respectively. Our study shows that the laparoscopic approach for AUS implantation is an efficient treatment option for women with moderate to severe SUI.

Autologous Fascial Slings for Surgical Management of Stress Urinary Incontinence: A Come Back.

Stress urinary incontinence (SUI) is a common type of urinary incontinence adversely affecting the quality of life of women. For mild SUI, life style changes, pelvic floor exercises and medical treatment with duloxetine may help. Most patients of moderate to severe SUI usually require surgical treatment. Various surgical treatment options include Kelly's plication, Burch colposuspension, bulking agents and sling surgeries. Although, suburethral fascial slings including the autologous rectus fascia slings were in vogue before 1990, they were overtaken by minimally invasive, faster and easier artificial midurethral slings (tension free vaginal tape and transobturator tape). However, observation of serious long-term and life changing complications of synthetic midurethral slings like mesh erosion, chronic pelvic pain and dyspareunia led to their adverse publicity and medico legal implications for the operating surgeons. This led US FDA (Food and Drug Administration) to issue a warning against their use. Currently, their use has significantly decreased in many countries, and they are no longer available in some countries. This has led to renaissance of use of natural autologous fascial sling, especially rectus fascia for surgical management of SUI. Although performing rectus fascia sling surgery is technically more challenging, takes longer, has more short-term morbidity like voiding dysfunction, their long-term success is high with very little risk of serious complications like mesh erosion, chronic pelvic pain and dyspareunia. However, multicentric trials and longer follow ups are needed before it's routine recommendation This review discusses the role of autologous fascial sling (especially rectus fascia) for the surgical management of SUI in the current time and the need of ongoing training of this procedure to gynecology residents and urogynecology fellows.

Analysis of outcome and risk factors for failure after single-incision sling procedure

Aim: To assess the effectiveness and safety of a single-incision sling (SIS) and to detect the risk factors for failure after surgery in woman with stress urinary incontinence (SUI).Materials and Methods: The medical records of the one hundred thirty-two patients were analyzed. Preoperatively, medical history was taken and urogynecological examination was made. Patients were asked to answer Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). Objective cure of SUI was defined as the absence of leakage of urine on the cough test. Subjective cure was based on negative response to UDI-6, question 3. Patients were divided into two groups according to objective cure rate: cured patients (Group A) and failed patients (Group B). Results: The overall objective and subjective cure was 87.8% and 90.1%, respectively. According to the objective cure rate, there were 116 patients (87.8%) in Group A and 16 patients (12.2%) in Group B. In terms of subjective cure, Quality of Life (QoL) scores (IIQ-7 and stress subdomain of UDI-6) of Group B were statistically improved after surgery (p=0.001 and p=0.005 respectively). When two groups were compared, Group B had higher prevalence of severe SUI (IIQ scores ≥15 points) and reduced urethral mobility (Q-tip ≤ 30°) (0.8% vs 87.5%, p=0.0001 and 3.4% vs 68.7%, p=0.0001, respectively). The overall recommendation rate for surgery was 90%.Conclusion: Our study showed that SIS procedure has high subjective and objective cure rates. The main risk factors for failure were detected as reduced urethral mobility and SUI severity expressed with IIQ scores.

Permanent urethral ligation after AUS cuff erosion: Is it ready for prime time?

Although artificial urinary sphincter (AUS) has long been the gold standard treatment for severe stress urinary incontinence, poor tissue quality in patients with prior cuff erosions may preclude this option. Formal supravesical diversion and/or bladder neck closure comprise alternative salvage options but are associated with significant morbidity and mortality. We review our experience with permanent urethral ligation (PUL) among patients deemed not to be candidates for AUS replacement following cuff erosion. From a single-center database of 396 patients undergoing AUS from 2014 to 2020, 20 men underwent PUL with suprapubic tube (SPT) diversion. Clinical characteristics and outcomes were evaluated. Quality of life (QOL) was assessed using chart review, Michigan Incontinence Symptom Index (M-ISI), and Patient Global Impression of Improvement (PGI-I). PUL resulted in continence in 18 (90%) men; 15 after the initial surgery and three after repeat ligation. Patients were elderly (average age 75) with significant comorbidities. A total of 11 (55.5%) patients experienced complications in the 90-day postoperative period (seven Clavien-Dindo Grade II, four Grade III). Over an average follow-up of 30.3 months (interquartile range: 15.75-48.75), four patients underwent cystectomy and one underwent perineal urethrostomy. In the remaining patients managed by PUL, 13 had satisfactory M-ISI scores and indicated overall improvement on PGI-I. For men with AUS cuff erosion who are poor candidates for replacement, PUL with chronic SPT drainage represents an acceptable alternative option to restore continence and improve QOL. Though complications are not uncommon, the morbidity profile still compares favorably to more invasive formal urinary diversion.

Pixel CO2 Laser for the Treatment of Stress Urinary Incontinence: A Prospective Observational Multicenter Study.

Energy-based treatments have been found to be a promising treatment modality for improving stress urinary incontinence (SUI) symptoms. This prospective two-center study was designed to evaluate the efficacy of fractional-pixel CO2 laser for the treatment of SUI. Eighty-five women with SUI symptoms as per the cough stress test and validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), were treated intravaginally with Pixel-CO2 laser. Two treatment sessions were performed with a 1-month interval. Safety and treatment tolerance were assessed by the visual analog scale (VAS) immediately and at 1 week after each laser treatment. Associations of age and body mass index (BMI) with the ICIQ-UI-SF score were statistically assessed by the Jonckheere-Terpstra test. The ICIQ-UI-SF score was 12.0 at baseline, 7.0, after the first treatment, and 3.5 after the second treatment (P = 0.001). For women with BMI (25.0-29.9), the ICIQ-UI-SF score was 9.0 at the baseline, 6.0 after 1 month, and 5.0 at the 6 months follow-up visit (P = 0.04). For women with BMI ≥ 30.0, the ICIQ-UI-SF score was reduced from 14.0 to 8.0 1 month after the baseline and 5.0 at the 6-month follow-up visit (P = 0.001). SUI severity evaluation at baseline showed that 27.1% of women had mild, 24.7% had moderate, 45.9% had severe, and 2.4% had very severe SUI symptoms. SUI severity scores were significantly reduced, with 45.8% of women with no SUI symptoms, 18.8% with mild, 20.8% with moderate, and 14.6% with severe SUI symptoms at the 6-month follow-up. The patient's evaluation of VAS after the first treatment was 1.0-1.5 (0-10) and 0.0 1 week after the second treatment. Fractional-pixel CO2 laser is safe and effective for treating SUI. No adverse event or significant pain was reported during or after the procedure. Its safety and efficacy are clearly demonstrated. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Twenty years later: is the scrotal one-incision AUS of value?

The artificial urinary sphincter, known as AMS 800, has been the gold standard for treating moderate to severe stress urinary incontinence in males for 40 years. Yet, the number of sphincters done globally is quite small and the majority of urologists doing them are infrequent implanters. Estimates for 2019 showed half of implanters did only one implant that year and worldwide only around 13,000 implantations were performed. The traditional two-incision technique of perineal exposure for cuff placement and abdominal incision for pump and pressure regulating balloon persists as the most common technique to surgically place an artificial urinary sphincter. Present estimates are that upwards of 80% are done via the perineal approach and that approach is the highly favored incision of large volume centers. The scrotal one-incision approach was invented by Wilson 20 years ago and was aimed at making the implantation of a sphincter quicker, easier and safer for the occasional implanter. These physicians perform 1-2 devices per year, comprise 60% of implanters who perform the surgery yearly, and implant 22% of all implanted devices. Our article targets these infrequent inserters discussing the history of the two techniques and what the authors have learned about the advantages and hazards of the one scrotal incision procedure over the last two decades.

Penoscrotal Incision for the Primary Implantation of an Artificial Urinary Sphincter

Background: The artificial urinary sphincter (AUS) has become the gold standard to treat severe stress urinary incontinence in men. The traditional placement of an AUS requires 2 incisions. The cuff is placed through a perineal incision and the reservoir and pump are placed via an inguinal incision. The implantation of an AUS is also possible via a single penoscrotal approach. Objectives: The objective is to demonstrate that the penoscrotal approach is not inferior to the perineal approach. Methods: Retrospective review of a single surgeon database from 2014 to 2019 was performed. A total of 40 patients have undergone implantation of an AUS via a penoscrotal incision. The outcome of patients was followed for an average of 31.3 months for adverse outcomes. Results: A primary American Medical Systems 800 sphincter was placed in 40 patients via a penoscrotal incision. The average age was 72 years. The average operating time was 35 minutes. The average cuff size was 4 cm. There were no infections of the prothesis so far. Three patients required a revision, 2 other patients needed an explant of the AUS, 1 patient underwent a cystectomy because of persistent radiocystitis. After activation of the sphincter, 33 patients (82.5%) were completely dry or using 1 pad per day for accidents. The remainder were all improved. Conclusions: AUS implantation via a single penoscrotal approach is not inferior to the perineal approach and has several advantages. The operating time is shorter and the procedure requires only 1 incision which both reduce the risk of infections, while the continence results are similar for both approaches.

Adjustable bulbourethral male sling: Experience after 30 cases of moderate to severe male stress urinary incontinence.

To report our experience using the Argus perineal sling from July 2015 to April 2018 for male stress urinary incontinence (SUI) after prostatic surgery. To evaluate the safety, efficacy and healthrelated quality of life in patients undergoing this procedure. The positioning of an adjustable bulbourethral male sling provides a perineal incision, exposure of the bulbospongiosus muscle and the application of the sling bearing on it with transobturator passage of the two extremities with out-in technique. To modulate the bearing tension on the urethra, with a rigid cystoscope the Retrogade Leak Point Pressure is measured, increasing it by 10-15 cm of H20 from baseline. We retrospectively evaluated the results of this implant performed by the same operator on 30 patients who presented post-operative SUI from medium to severe (> = 2 pads/day, pad test at one hour > = 11 g). Mean operative time and possible intra and postoperative complications were evaluated. Postoperatively each patient was reassessed according to the following parameters: number of pads consumed/ die, pad tesy at one hour, ICQS-F, any related side effects. After the intervention, 21 of 30 patients (70% of the total) were totally continent (< 1 pad / day, pad test at 1 h < 1-2 g, ICQS-F < 11), out of them 4 required a single adjustment at 3 months in order to achieve this result. 9 of 30 patients (30 %) achieved a clinically significant improvement without obtaining total continence (mean reduction of the n° pads/day: -2.5 ± 1 DS; average reduction of the pad test at 1 h: -20 g ± 4 DS; ICQS-F average reduction: -6 points ± 2 DS), out of them 5 required a 3 month adjustment to obtain these improvements resulting, 4 needed 2 adjustments resulting because the first adjustment was not satisfactory and one who ameliorated from severe to moderate incontinence decided to live in this clinical condition. The results of our study show that the positioning of this sling represents a valid treatment for the moderate and severe post-surgical male SUI. The possibility of adjusting the tension of the sleeve in a "second look" makes the intervention adaptable according to the results obtained. Only multicentric clinical trials on larger series would clarify and eventually confirm the clinical benefits of this sling in post-surgical male SUI.

MP40-11 THE ROLE OF G8 SCREENING TOOL IN THE ASSESSMENT OF SURGICAL OUTCOME OF ELDERLY PATIENTS TREATED WITH ARTIFICIAL URINARY SPHINCTER IMPLANTATION: A PILOT STUDY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I (MP40)1 Apr 2020MP40-11 THE ROLE OF G8 SCREENING TOOL IN THE ASSESSMENT OF SURGICAL OUTCOME OF ELDERLY PATIENTS TREATED WITH ARTIFICIAL URINARY SPHINCTER IMPLANTATION: A PILOT STUDY Kazuhito Matsushita*, Masaki Shimbo, Kazunori Hattori, and Shigeo Horie Kazuhito Matsushita*Kazuhito Matsushita* More articles by this author , Masaki ShimboMasaki Shimbo More articles by this author , Kazunori HattoriKazunori Hattori More articles by this author , and Shigeo HorieShigeo Horie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000889.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Understanding the influence of age on device outcomes is an important consideration given the demographics of male patients presenting with stress urinary incontinence (SUI) after prostate cancer treatment. G8 screening tool is a robust geriatric tool to identify a geriatric risk profile and for prediction of functional decline and prognostic information for overall survival. We evaluated the role of G8 screening tool in the assessment of the outcome of elderly patients (≥ 75 y.o.) who underwent AUS implantation for severe SUI. METHODS: We prospectively enrolled 41 men ≥ 75 years of age with postprostatectomy incontinence treated with AUS surgery. Age, BMI, Charlson Comorbidity Index (CCI) and pre-operative history of pelvic radiation and bladder neck contractures requiring multiple rounds of instrumentation were recorded for each patient. G8 screening tool was administered to each patient before surgery. Clavien-Dindo Complications (CDC) scoring system was used to report postoperative complications. De novo overactive bladder (OAB) was defined as self-reported OAB symptoms such as urgency with or without urgency urinary incontinence. We used logistic regression to identify the role of G8 score in predicting postoperative complications and de novo OAB developed after AUS implantation. RESULTS: Mean age was 77 (IQR 76, 79) years old. Comorbidity factors included: 1 patient (2.4%) with CCI > 3 points, 10 patients (24.3%) with DM, 21 patients (51.2%) with HTN. G8 screening tool < 15 points was found in 16 patients (39%). In all, 36.5% (15/41) had postoperative complications and 39% (16/41) developed de novo OAB. CDC ≥ 3 was present in 1 patient (2.4%). The mean score of G8 screening tool was 13.8 in patients that developed postoperative complications compared to a mean score of 15.6 in patients that did not (p<0.001). G8 score was independently predictive of development of de novo OAB (p=0.005 OR 2.82 (95% CI 1.36-5.85)) and postoperative complications (p=0.001 OR 0.05 (95% CI 0.01-0.31)) on multivariate analysis. CONCLUSIONS: G8 screening tool appears to be an effective and useful instrument for predicting the risk of complications and de novo OAB in elderly patients who undergo AUS implantation. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e590-e590 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kazuhito Matsushita* More articles by this author Masaki Shimbo More articles by this author Kazunori Hattori More articles by this author Shigeo Horie More articles by this author Expand All Advertisement PDF downloadLoading ...

The Effect of Incontinence Severity on Symptom Distress, Quality of Life, and Pelvic Floor Muscle Function in Turkish Women with Urinary Incontinence

Objective: The aim of the present study was to compare the differences in symptom distress, quality of life, and pelvic floor muscle function among Turkish women with mild, moderate, or severe urinary incontinence.Study design: One hundred and twenty women with a diagnosis of urinary incontinence (54.2% stress urinary incontinence and 45.8% mixed-urinary incontinence) participated in the present study. The severity of the urinary incontinence was stratified by the Incontinence Severity Index. The Turkish versions of the Urinary Distress Inventory-6 and the Incontinence Impact Questionnaire-7 were used to assess symptom distress and quality of life, respectively. Pelvic floor muscle strength and endurance were measured using a non-invasive vaginal perineometer.Results: Symptom distress and quality of life significantly differed among the mild, moderate, and severe urinary incontinence groups (p&lt;0.001). Patients with severe stress urinary incontinence displayed a higher decrease in quality of life than those with mild stress urinary incontinence (p&lt;0.001). Furthermore, severe mixed urinary incontinence had a greater impact on symptom distress and quality of life compared to mild and moderate mixed urinary incontinence (p&lt;0.05). The Incontinence Severity Index score was significantly associated with the Urinary Distress Inventory-6 and Incontinence Impact Questionnaire-7 scores (p&lt;0.001).Conclusion: Urinary incontinence affected the symptom distress and quality of life of patients in proportion to the severity of the symptoms. Therefore, the relationship between the severity of urinary incontinence and patients’ quality of life should be evaluated in clinical settings. To prevent the greater influence of incontinence on the quality of life of women with urinary incontinence, early detection of urinary incontinence and early management strategies are essential.

Synchronous surgery for the combined treatment of post-radical prostatectomy erectile dysfunction and stress urinary incontinence: a lucrative evolution or an unnecessary complexity?

Aim of this review is to summarize and evaluate the current literature addressing the synchronous combined surgical treatment approach for co-existent post-radical prostatectomy erectile dysfunction and stress urinary incontinence. Severity of stress urinary incontinence is the basic element that defines which option of combined surgery will be offered to a patient. So, for cases of severe erectile dysfunction and severe stress urinary incontinence (>4 pads/day) the only available option is synchronous inflatable penile prosthesis plus artificial urinary sphincter dual implantation. When severe erectile dysfunction coexist with mild to moderate stress urinary incontinence synchronous inflatable penile prosthesis plus male sling or ProAct (Uromedica, Plymouth, MN, USA) device are the current available treatment options. Finally, when severe erectile dysfunction along with mild stress urinary incontinence and with or without climacturia are present, a new surgical technique of simultaneous inflatable penile prosthesis plus urethral mini-sling, named "Andrianne mini-jupette", implantation has been recently proposed. Synchronous combined surgery for post-radical prostatectomy erectile dysfunction and stress urinary incontinence seems to offer similar efficacy and safety results compared with two-stage implantation but in a more cost- and time effective approach. Thus, synchronous surgery, in the hands of experienced prosthetic surgeons, could be potentially a valuable alternative for the management of co-existent post-radical prostatectomy erectile dysfunction and stress urinary incontinence. Nevertheless, in order to acquire robust scientific data further prospective comparative studies on larger numbers of patients are surely needed.

Retrospective analysis clinical characteristics of female stress urinary incontinence and efficacy of transobturator tension-free vaginal tape procedure

Objective To explore the clinical characteristics of patients with female stress urinary incontinence(SUI) and efficacy of Transobturator Tension-free vaginal tape procedure. Methods We retrospectively analyzed the clinical data of 319 cases who were operated transobturator tension free vaginal tape in Shanghai Changhai Hospital Affiliated of Naval Medical University from Oct.2009 to Jun.2018. Patients age ranged from 39 to 91 years old, with the average age of(59.2±9.7)years old. 145(45.5%) patients aged ≥60 years old. Among them, 155 (48.6%) patients with moderate SUI, 164(51.4%) with severe SUI.96 cases(30.1%) hypertension, 24(7.5%)diabetes, 2(0.6%)had not given birth, 317(99.4%)patients had given birth more than once. 31(9.7%) coexisting pelvic organ prolapse with POP-Q stage 2 and above. Maximum urinary flow rate ranged 5.2-72.6 ml/s. Cystometric capacity ranged 56.7-1 013.6 ml. Average preoperative ICIQ-SF score was 13.9 (range 9-19). Results Operative time of 288 TVT-O procedures ranged 19-60 min, and 31 cases in the surgical management of cystocele with concomitant ranged 50-120 min. A total of 265 patients were evaluable followed up for 12-24 months, Objective cure rate and subjective cure rate were achieved in 95.8%(254 cases) and 93.6%(248 cases) respectively. POP was cured in 96.8% patients.Postoperative complications were 10.6% groin pain, 4.5% urgency, others including urinary tract infection(3.4%), de novo dysuresia(2.6%), dyspareunia(1.1%), and one case of bladder injury, one case sling erosion and one case scar hyperplasia. Conclusions Female stress urinary incontinence were mainly in middle-aged and elderly people who had severely psychological quality of life lasting for several years. TVT-O may achieve a high success or improvement rate and no serious adverse effects. One operation could correct the stress urinary incontinence and simultaneously correct prolapse. Key words: Urinary incontinence, stress; Clinical features; Transobturator tension-free vaginal tape

Long-term device survival and quality of life outcomes following artificial urinary sphincter placement.

Artificial urinary sphincter (AUS) placement is the standard for treatment of severe male stress urinary incontinence (SUI). While there is evidence to suggest satisfactory device survival, there is a paucity of data addressing long-term quality of life outcomes. We identified patients who underwent primary AUS placement from 1983 to 2016. We assessed rates of secondary surgery (overall, device infection/erosion, urethral atrophy, malfunction) and factors associated with these endpoints. Quality of life was evaluated by pad usage and Patient Global Impression of Improvement (PGI-I) at various time points from primary surgery. Follow-up was obtained in clinic or by phoned/mailed correspondence. During the study time frame, 1,154 patients were eligible and included in the analysis. Patients had a median age of 70 years (IQR, 65-75 years) and median follow up of 5.4 years (IQR, 1.6-10.5 years). Overall device survival was 72% at 5 years, 56% at 10 years, 41% at 15 years, and 33% at 20 years. On univariate analysis, variables associated with need for secondary surgery were prior cryotherapy (HR 2.7; 95% CI, 1.6-4.6; P<0.01) or radiation therapy (HR 1.4; 95% CI, 1.1-1.7; P=0.01). On multivariable analysis, only cryotherapy remained significantly associated with this endpoint (HR 2.4; 95% CI, 1.3-4.2; P<0.01). While 36% and 23% of patients 5-10 years out from surgery and >10 years out from surgery, respectively, reported using a security pad or less per day, 78% and 81% of those patients, respectively, reported their PGI-I as at least "much better". AUS placement has excellent long-term outcomes, and is associated with sustained improvement in patient quality of life.

Patients' quality of life after implantation of ZSI 375 artificial urinary sphincter due to stress urinary incontinence.

IntroductionThe study aimed to evaluate the outcomes of artificial urinary sphincter ZSI 375 implantation for stress urinary incontinence, focusing on quality of life assessment (QoL).Material and methodsThe study had a prospective and non-randomized design. It was conducted in two urological centres in Poland. Between July 2013 and June 2019, artificial urinary sphincter ZSI 375 was implanted in 86 consecutive men with stress urinary incontinence. The follow up was completed in December 2019. The assessment of functional results was based on number of pads used and declared to have been used by patients. The quality of life was assessed on the basis of the ICIQ-SF questionnaire (International Consultation on Incontinence Questionnaire-Short Form), SF-36 questionnaire (Short Form 36 Health Survey Questionnaire) and the severity of pain by means of the NRS (numerical rating scale of pain intensity).ResultsThe operations were performed in 86 patients aged 28 to 80 (median 69). With the median (SD; range) follow-up of 21 (20.2; 1–68) months, daily pad usage decreased significantly from ≥4 to 1.1 (±0.97 pads) per day. Seven (8.1%) patients achieved total continence, 60 (69.8%) social continence, 14 (16.3%) improvement and 5 (5.8%) failures (≥4 pads per day). 15 patients (17.5%) experienced complications after surgery. The study showed a significant improvement of QoL evaluated by ICIQ-UI SF and SF-36.ConclusionsTherapy with the use of ZSI 375 device is successfully applied in surgical management of moderate to severe male stress urinary incontinence. The life quality of patients assessed using questionnaires is at a high level.

Erbium:YAG laser treatment of female stress urinary incontinence: midterm data.

Stress urinary incontinence (SUI) is treated using intravaginal laser therapy. We wanted to find out how incontinence severity at baseline and the number of laser interventions affect success rate, and whether the effect of laser therapy was obvious 6months and 2years after the last laser intervention. Fifty-nine women, 32 with SUI I, 16 with SUI II, and 11 with SUI III were treated using an erbium-doped yttrium aluminium garnet (Er:YAG) laser following the IncontiLase® protocol. Therapy included five laser sessions with a 1-month interval between sessions. Objective (1-h pad test) and subjective data (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI SF], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire [PISQ-12]) were assessed at baseline, after two and four laser sessions and 6months and 2years after the fifth laser session. Objective cure/improve rates for mild SUI I were 69%, 78%, 91%, and 78% after two, four, and five laser sessions at the 6-month and 2-year follow-ups. Subjective cure rates (ICIQ-UI SF) were 53%, 69%, 72%, and 66%, and sexual function (PISQ-12) also improved. For SUI II, objective cure/improve rates were 31%, 63%, 69%, and 50%. Subjective cure rate was 13% at the 2-year follow-up. For SUI III, only one patient had an objective improvement after two and four laser sessions. Intravaginal laser therapy led to cure/improvement for SUI I and SUI II, but not for severe SUI III. Outcome was better after four to five laser sessions than after two laser sessions. Follow-up data6months and 2years after laser intervention showed sustainability of the treatment.

Artificial urinary sphincter surgery in the special populations: neurological, revision, concurrent penile prosthesis and female stress urinary incontinence groups.

The artificial urinary sphincter (AUS) remains the standard of care in men with severe stress urinary incontinence (SUI) following prostate surgery and radiation. While the current AUS provides an effective, safe, and durable treatment option, it is not without its limitations and complications, especially with regard to its utility in some “high-risk” populations. This article provides a critical review of relevant publications pertaining to AUS surgery in specific high-risk groups such as men with spinal cord injury, revision cases, concurrent penile prosthesis implant, and female SUI. The discussion of each category includes a brief review of surgical challenge and a practical action-based set of recommendations. Our increased understandings of the pathophysiology of various SUI cases coupled with effective therapeutic strategies to enhance AUS surgery continue to improve clinical outcomes of many patients with SUI.

Efficacy of the use of fractional CO2RE intima laser treatment in stress and mixed urinary incontinence

The objective of this clinical study was to evaluate the efficacy of a vaginal CO2 laser treatment (CO2RE Intima) in patients with moderate, severe and very severe stress urinary incontinence (SUI) or mixed urinary incontinence (MUI), as well as its impact in sexual relations. This was a single-center, prospective, interventional study that included 25 women aged 35-68 years who presented with moderate, severe and very severe symptoms of SUI or MUI, based on Sandvik index and ICIQ-UI scores. A series of three fractional micro-ablative CO2 vaginal laser treatment sessions was performed, each spaced 4-6 weeks apart. Improvements were measured and evaluated using scores from validated questionnaires including the International Consultation on Incontinence Questionnaire (ICIQ-IU), the Sandvik severity index, and the Female Sexual Function Index (FSFI). Adverse events were recorded throughout the study and assessed using the Common Side Effect Questionnaire that evaluates pain, hemorrhage, burn, bruising and edema. CO2RE intima laser treatment resulted in a significant improvement (P < 0.001) in the scores of both the ICIQ-UI questionnaire and the Sandvik index, after the 2nd session; and this significance persisted after the 3rd treatment session. Improvements in UI severity was also achieved; after the 1st laser treatment, a significant improvement in severity was seen (p < 0.01), the significance of which showed to increase after the 2nd and 3rd treatment sessions (p < 0.001). Improvement related to the type of UI measured with the ICIQ questionnaire was significant in both cases with SUI (p = 0.035) and MUI (p < 0.001) after the second treatment. This difference persisted after the 3rd treatment in cases of MUI and the trend, though not the statistical significance, persisted in SUI cases, (p = 0.197). Improvement in severity was significant in both SUI and MUI types, from the first treatment to the end of the study. Sexual function of patients as reflected in the FSFI questionnaire scores also showed to improve; the difference was significant after the second session (p = 0.013) and persisted at the end of the study (p = 0.047). Fractional, micro-ablative CO2RE Intima laser treatment is a minimally invasive procedure that can significantly improve moderate and severe SUI and MUI. It also improves sexual function in women with these types of incontinence. Though our positive results are promising, this preliminary data must be confirmed with other studies.

Treatment of Severe Urinary Incontinence following Radical Prostatectomy: Experience with Bioceram as a Bulking Agent

Background: To evaluate the efficacy of Bioceram injection in men with severe stress urinary incontinence following radical prostatectomy. Methods: A total of 18 patients underwent retrograde injection of Bioceram for severe stress urinary incontinence following radical prostatectomy. Evaluation by pad test, international consultation on the Incontinence Questionnaire - Short Form (ICIQ-SF) and American Urology Association Symptom Score - Quality of Life (AUASS-QOL) was performed before and after injection therapy. Patients were considered cured if they were using no pads or only one safety pad per day. Results: Of 18 patients, 14 had received postoperative external beam radiation therapy. Furthermore, 5 patients required transurethral incision due to simultaneous stricture of the urethrovesical anastomosis. The baseline daily pad count changed from a mean of 6.1± 0.8 to 5.3 ± 1.7 (p = 0.010). None of the patients were cured and only 3 patients showed signs of improvement following injection. Conclusion: In patients with severe urinary incontinence, treatment with bulking agent injection is associated with modest efficacy.