Stress Urinary Incontinence Patients Research Articles

MR defecography in assessing stress urinary incontinence with or without symptomatic pelvic organ prolapse.

Utilize magnetic resonance defecography (MRD) to analyze the primary pelvic floor dysfunctions in patients with stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP), and in SUI patients with asymptomatic POP. We performed MRD in both SUI and POP subjects. As a primary analysis, the functional MR parameters were compared between the isolated POP and POP combined SUI groups. As a secondary analysis, the functional MR data were compared between the POP combined SUI and the SUI with asymptomatic POP (isolated SUI) groups. MRD noted the main characteristics of SUI combined moderate or severe POP, including the shorter closed urethra length (1.87cm vs. 2.50cm, p < 0.001), more prevalent urethral hypermobility (112.31° vs. 85.67°, p = 0.003), bladder neck funneling (48.28% vs. 20.51%, p = 0.020), lower position of vesicourethral junction (2.11cm vs. 1.67cm, p = 0.030), and more severe prolapse of the posterior bladder wall (6.26cm vs. 4.35cm, p = 0.008). The isolated SUI patients showed the shortest length of the closed urethra (1.56cm vs. 1.87cm, p = 0.029), a larger vesicourethral angle (153.80° vs. 107.58°, p < 0.001), the more positive bladder funneling (84.85% vs. 48.28%, p = 0.002) and a special urethral opening sign (45.45% vs. 3.45%, p < 0.001). Patients with SUI accompanying POP primarily exhibit excessive urethral mobility and a shortened urethral closure. SUI patients with asymptomatic POP mainly show dysfunction of the urethra and bladder neck, characterized by the opening of the urethra and bladder neck and a shortened urethral closure.

Urethral-sparing laparoscopic simple prostatectomy for the treatment of benign prostatic hyperplasia with asymptomatic urethral stricture after urethral stricture surgery

ObjectiveTo evaluate the efficacy of urethral-sparing laparoscopic simple prostatectomy (US-LSP) for the treatment of large-volume (>80 ml) benign prostatic hyperplasia (BPH) with asymptomatic urethral stricture (urethral lumen > 16 Fr) after urethral stricture surgery.MethodsWe retrospectively analyzed clinical data of 39 large-volume BPH patients with asymptomatic urethral stricture after urethral stricture surgery who underwent US-LSP from January 2016 to October 2021. Postoperative follow-ups were scheduled at 1, 3, and 6 months.ResultsAll patients affected by significant BPH-related lower urinary tract symptoms (LUTS) including 22 cases with asymptomatic anterior urethral stricture and 17 cases with asymptomatic posterior urethral stricture. Median operative time was 118 min (interquartile range [IQR]100–145). Median estimated blood loss was 224 ml (IQR: 190–255). 33 patients(84.6%) avoided continuous bladder irrigation. Postoperative complications occurred in 5 patients (12.8%), including 4 cases with Clavien-Dindo grade 1 and grade 2 and 1 case with grade 3a. During follow-up, US-LSP presented statistically significant improvements in LUTS compared to baseline (P < 0.05). A total of 25 patients had normal ejaculation preoperatively and 3 patients (12%) complained retrograde ejaculation postoperatively. Two patients (5.1%) reported stress urinary incontinence (SUI) and no patient reported aggravated urethral stricture during follow-up.ConclusionsUS-LSP was safe and effective in treating large-volume BPH with asymptomatic urethral stricture after urethral stricture surgery. Meanwhile, US-LSP could reduce the risk of SUI in patients with asymptomatic posterior urethral stricture and maintain ejaculatory function in a high percentage of patients.

Effect of stress urinary incontinence on vaginal microbial communities

BackgroundPostpartum women often experience stress urinary incontinence (SUI) and vaginal microbial dysbiosis, which seriously affect women’s physical and mental health. Understanding the relationship between SUI and vaginal microbiota composition may help to prevent vaginal diseases, but research on the potential association between these conditions is limited.ResultsThis study employed 16S rRNA gene sequencing to explore the association between SUI and vaginal dysbiosis. In terms of the vaginal microbiota, both species richness and evenness were significantly higher in the SUI group. Additionally, the results of NMDS and species composition indicated that there were differences in the composition of the vaginal microbiota between the two groups. Specifically, compared to postpartum women without SUI (Non-SUI), the relative abundance of bacteria associated with bacterial dysbiosis, such as Streptococcus, Prevotella, Dialister, and Veillonella, showed an increase, while the relative abundance of Lactobacillus decreased in SUI patients. Furthermore, the vaginal microbial co-occurrence network of SUI patients displayed higher connectivity, complexity, and clustering.ConclusionThe study highlights the role of Lactobacillus in maintaining vaginal microbial homeostasis. It found a correlation between SUI and vaginal microbiota, indicating an increased risk of vaginal dysbiosis. The findings could enhance our understanding of the relationship between SUI and vaginal dysbiosis in postpartum women, providing valuable insights for preventing bacterial vaginal diseases and improving women’s health.

Safety and Efficacy of Erbium: Yttrium-Aluminum-Garnet Laser Treatment in Chinese Women with Mild-to-Moderate Stress Urinary Incontinence.

Background: This study aims to evaluate the safety and efficacy of erbium:yttrium-aluminum-garnet (Er:YAG) laser treatment in female patients with mild-to-moderate stress urinary incontinence (SUI). Methods: From July 2018 to June 2020, 72 female patients with mild-to-moderate SUI were enrolled in this study. A baseline assessment was conducted, which included a 1-hour pad test, the validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), postvoid residual (PVR) testing, pelvic organ prolapse quantification (POP-Q) testing, and a cough stress test. All patients underwent four sessions of Er:YAG laser treatment using a smooth mode. A reassessment was performed 6 months after treatment to evaluate the safety and efficacy of the Er:YAG laser. Results: All patients completed four clinic visits, with a 1-month interval, and were followed up for a minimum of 6 months. No severe adverse reactions were observed during the treatment process. The 1-hour pad test revealed a significant reduction in urinary leakage from baseline (6.30 ± 1.06 g) to the 6-month follow-up (2.70 ± 0.96 g, p < 0.001), with 34 of 72 (47.22%) patients achieving negative results. The ICIQ-UI-SF score significantly decreased from baseline to 6 months (10.82 ± 1.38 to 2.96 ± 0.52, p < 0.001). PVR experimental results showed a significant decrease in residual urine volume after treatment (103.72 ± 8.61 mL to 43.86 ± 4.92 mL, p < 0.001). At the 6-month follow-up, hematoxylin and eosin staining results demonstrated that Er:YAG laser treatment significantly facilitated an increase in the thickness of squamous epithelial cells. The efficacy of Er:YAG laser treatment for SUI was 77.78% (56/72). Conclusions: Several objective and subjective assessments confirmed the safety and efficacy of vaginal smooth mode Er:YAG laser treatment for mild-to-moderate SUI during the 6-month follow-up period. Nonablative Er:YAG laser in the smooth mode is a viable treatment option for SUI patients.

Effectiveness of Kelly Plication Method on Clinical Improvement in Stress Urinary Incontinence Patients

BACKGROUND: Patients with pelvic organ prolapse (POP) usually present with POP, but stress urinary incontinence (SUI) is also found during history taking and physical examination. As a result, the complaint of SUI is persistent despite POP surgery. Therefore, SUI found along with POP and undergoing surgery can be performed Kelly plication method. OBJECTIVES: To examine the effectiveness of Kelly's plication method on clinical changes and quality of life of patients suffering from SUI. METHODS: A single cohort prospective one-group pretest-posttest design conducted at RSUP Dr. Kariadi Teaching Hospital Semarang involving 31 research subjects. All subjects were measured preoperative IIQ-7 questionnaire and pad test. Then, all subjects will undergo Kelly method surgery. Postoperative evaluation will be conducted 3 months later, including measurement of the IIQ-7 questionnaire and pad test. All data will be analyzed with univariate and bivariate analysis using paired t-test and Wilcoxon test. RESULTS: The effectiveness rate of Kelly's plication method was 58.06% in this study. Most of the subjects were aged 50-59 (38.7%) years and had experienced menopause (87.1%). Correlation analysis of baseline data on the degree of preoperative SUI showed that the degree of POP correlated SUI. The Pad test and IIQ-7 questionnaire test showed a significant decrease in postoperative measurements in the treatment group (p: &lt;0.001 &amp; p: &lt;0.001). CONCLUSIONS: Kelly's plication method is effective in treating SUI.

Incidence and risk factors of stress urinary incontinence after laparoscopic hysterectomy

ObjectiveTo observe the long-term effects of total hysterectomy on urinary function, evaluate the effects of preoperative nutritional status, urinary occult infection, and surgical factors on the induction of postoperative stress urinary incontinence (SUI), and explore the incidence and risk factors of SUI.Study designFrom January 2017 to December 2017, 164 patients with benign non-prolapsing diseases who underwent a laparoscopic total hysterectomy in the First People's Hospital of Taicang were selected as the analysis objects. The International Incontinence Standard Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Pelvic Floor Impact Questionnaire-short version 20 (PFDI-20) were used for telephone follow-up to subjectively assess the urinary function of patients, collect their medical records, and statistically analyze the number of postoperative SUI cases. Logistic multivariate analysis was used to analyze the influencing factors of postoperative female SUI, presented as adjusted odds ratios with 95% confidence intervals.ResultsOnly 97 out of 164 patients completed the ICIQ-FLUTS and PFDI-20 questionnaires. Among these participants, 28 patients (28.86%) were diagnosed with SUI (study group), while 69 patients (71.13%) were classified as women without SUI (control group). The age, menopause, parity ≥ 2 times, Body mass index (BMI) ≥ 28 kg/m2, neonatal weight ≥ 4000 g, history of chronic cough, preoperative hemoglobin ≤ 100 g/L, preoperative urine bacteria ≥ 100u/L, preoperative uterine volume ≥ 90 cm3, intraoperative blood loss, and operation time of the study group were compared with those of the control group. The differences were statistically significant (P < 0.05). Further Logistic multivariate analysis showed that menopause, preoperative hemoglobin ≤ 100 g/L, preoperative urine bacteria ≥ 100u/L, uterine volume ≥ 90 cm3, history of chronic cough, BMI ≥ 28 kg/m2 were risk factors for postoperative SUI in patients undergoing hysterectomy (P < 0.05).ConclusionsHysterectomy for benign non-prolapse diseases has a long-term potential impact on the urinary system of patients, and the risk of postoperative SUI increases. The main risk factors of SUI are parity, menopausal status, obesity, preoperative nutritional status, and occult infection of the urinary system.

(362) Stress Urinary Incontinence Rates in Men Undergoing Optilume Balloon Dilation for Radiation-Induced Posterior Urethral Stenosis: A Single Center Experience

Abstract Introduction While radiation can be a viable treatment option for prostate cancer, development of radiation-induced urethral stenosis occurs in approximately 2% of patients. Optilume, a paclitaxel-coated urethral dilation balloon was FDA approved in 2021 and has shown improved urethral patency and reduced rates of reintervention for anterior urethral strictures relative to standard endoscopic procedures. As the utility of Optilume expands into posterior urethral stenosis, it is important to identify the associated potential complications. Incidence of stress urinary incontinence (SUI) has been reported to be as high as 33% following urethroplasty for patients with radiation-induced urethral stenoses. Rates of SUI following Optilume balloon dilation have yet to be evaluated in this high-risk population. Objective To evaluate rates of SUI in patients undergoing Optilume balloon dilation for radiation-induced posterior urethral stenosis. Methods From March 2022 to February 2023, select men with radiation-induced posterior urethral stenoses underwent Optilume balloon dilation. Initial evaluation included retrograde urethrogram and/or diagnostic cystoscopy. Dilation was performed with a 30-French Optilume and left inflated for five minutes per standard protocol. A 16-French catheter was inserted and left in place for three to five days. Patients were scheduled for a three-month post-dilation cystoscopy. Pre- and post-dilation continence rates were compared. Results A total of 16 men with confirmed radiation-induced posterior urethral stenoses underwent Optilume balloon dilation. Of the 16 patients, 12 patients had documentation regarding their pre- and post-treatment continence status. No patients developed de novo SUI. Baseline pre-treatment SUI was noted in one patient (8.3%) requiring an average of 4 Depends per day. This patient noted no change in his degree of SUI following Optilume dilation and the dilation site was found to be widely patent on his follow up cystoscopy. He is scheduled for artificial urinary sphincter in the near future. Mean follow up was 77 days (range 30-180 days). Repeat intervention was required in three patients (18.8%) for repeat stenosis. Conclusions Optilume balloon dilation for radiation-induced posterior urethral stenosis does not appear to lead to de novo SUI in short to intermediate term follow up. Further prospective studies with a larger group of patients and longer follow up duration are warranted in this complex population. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Laborie.

Acupuncture combined with pelvic floor rehabilitation training for postpartum stress urinary incontinence: protocol for a systematic review and meta-analysis.

The purpose of this study is to systematically evaluate the efficacy and safety of acupuncture combined with pelvic floor rehabilitation training in the treatment of postpartum stress urinary incontinence, and to promote the further promotion and application of acupuncture in the field of rehabilitation. Randomized controlled trials (RCTs) of acupuncture combined with pelvic floor rehabilitation in the treatment of postpartum stress urinary incontinence will be searched in PubMed, Web of Science (WOS), Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang (WF), and VIP databases. The clinical trial Registry (ClinicalTrials.gov and Chinese clinical trial Registry) will also be searched. The search period is limited to July 1, 2023, and the language limit of this systematic review is Chinese and English. The primary outcome is clinical effective rate. International Consultation on Incontinence Questionnaire-Short Form (ICI-Q-SF), 1-h pad test, pelvic floor muscle potential value, incidence of adverse events are secondary outcomes. A meta-analysis will be performed using RevMan 5.4 statistical software. If feasible, subgroup analysis and sensitivity analysis will be performed to address potential causes of inconsistency and heterogeneity. The risk of bias will be assessed using the approach recommended by Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence will be assessed using GRADE. This Protocol has been developed in accordance with the guideline of Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015. Acupuncture combined with pelvic floor rehabilitation training can effectively promote the rehabilitation of postpartum stress urinary incontinence patients, and provide a reference for the clinical application of integrated Chinese and Western medicine treatment in the field of rehabilitation. PROSPERO CRD42023455801.

Mobile Application Based Pelvic Floor Muscle Training for Treatment of Stress Urinary Incontinence: An Assessor-Blind, Randomized, Controlled Trial.

A first-line treatment for stress urinary incontinence (SUI) is pelvic floor muscle training (PFMT) for at least three months. The key problem is that patients do not understand the importance of these exercises and their effectiveness. Mobile health apps offer new possibilities to increase treatment adherence. This study compared a reduction in SUI, exercise adherence, and quality of life in PFMT with animation vs. standard instruction. A prospective, single-blind, randomized control trial was collected. SUI patients were randomized into the application or control groups confirmed using a one-hour pad test. In the intervention group, the PFMT application was applied via mobile phone (PFMT with animations, recording system, and reminder system). The standard exercise protocol was similar in both groups. Additional follow-up was conducted at 4, 8, and 12 weeks. A total of 51 participants were randomized to the application (n = 26) and control groups (n = 25), respectively. At the 12-week follow-up, there was no significant difference between the two groups in terms of SUI cure rate, SUI severity by pad test, and daily SUI episodes from the bladder diary (p-value of 0.695, 0.472, and 0.338, respectively). The mean PFME adherence in the application group was higher than the control group at 8 weeks (66.3 ± 13.6 vs. 52.7 ± 16.6, p = 0.002) and 12 weeks (59.1 ± 13.9 vs. 37.8 ± 11.0, p = 0.001). The application group reported no difference from the conventional PFMT group in terms of improvements in SUI cure rate, symptom severity, and quality of life effects at 12-week follow-up. However, the improvement evaluated by the mean difference in SUI episodes and quality of life effects (ICIQ-UI SF) reported a better outcome in the mobile app group. The PFMT application has been proven to be an effective tool that improves PFMT adherence.

Urethral Slings for Irradiated Patients With Male Stress Urinary Incontinence: A Meta-analysis

To systematically compare success, cure and complication rates of urethral sling surgeries in stress urinary incontinence patients with and without a history of pelvic radiotherapy (RT). We searched PUBMED, EMBASE, and Web of Science to identify relevant articles. The primary outcomes were the success and cure rates. The secondary outcomes included the rates of infection, urethral erosion, total complications, explantation, and satisfaction. Outcomes were analyzed using a random-effects model to calculate the unadjusted odds ratio (OR) in patients with a history of RT compared with those without prior RT. On pooled analysis, we found significantly lower odds of success (OR 0.68; 95% confidence interval [CI] 0.53-0.87, P<.001) and cure (OR 0.67; 95% CI 0.55-0.82, P<.001) in radiated patients than in nonirradiated patients. Subgroup analysis by type of sling showed significantly lower odds of success in Advance subgroup (OR 0.66; 95% CI 0.45-0.95, P<.001) and significantly lower odds of cure in Advance (OR 0.59; 95% CI 0.36-0.95, P<.001) and Atoms subgroups (OR 0.70; 95% CI 0.54-0.93, P<.001). We also found significantly greater odds of sling explantation (OR 2.93; 95% CI 1.62-5.29, P<.001) and infection (OR 3.06, 95% CI 1.03-9.07, P<.001) in radiated patients than in nonradiated patients. Patients with a history of pelvic RT have lower odds of success and cure and higher odds of infection and sling explantation than those without a history of pelvic RT.

Sunt meşele necesare în tratamentul incontinenţei urinare de efort la femei?

Introduction. Stress urinary incontinence (SUI) impacts over 20% of women, and its prevalence is increasing with the aging of population. This review assesses mesh surgery for SUI treatment by analyzing midurethral slings, retropubic urethropexy, bulking agents and artificial sphincters. Methodology. We searched the PubMed database from 1995 to 2023 inclusive, and 31 studies met our inclusion criteria, focusing on women aged 20-70 years old with SUI, excluding nervous system diseases affecting the function of the bladder. Results. Minimally invasive midurethral slings – particularly transvaginal tension-free tape (TVT) and transobturator tension-free vaginal tape (TOT) – have become the standard of care, endorsed by the Food and Drug Administration (FDA) in 2011. TVT offers reduced hospital stays and shorter operating times, with risks including bladder perforation and infections. TOT, while minimizing bladder perforation risks, may increase groin pain. Mini-slings and autologous fascial slings show varying success; the latter has higher success but more complications than Burch colposuspension. Retropubic urethropexy is effective on the long term, but with longer recovery and more complications. Conclusions. Mesh-based midurethral slings (MUS) are pivotal in SUI treatment, providing high short-term success and enhanced quality of life. Effective SUI management requires individualized treatment, with a fine balance between benefits and risks. With emerging regenerative medicine, the future of SUI treatment is promising. Until then, MUS remains a key modality, necessitating careful patient selection and ongoing research to refine the surgical outcomes and improve the quality of life for SUI patients.

Identifying Womens' Needs in Making a Treatment Decision for Stress Urinary Incontinence: A Qualitative Study.

Choosing a treatment option for female stress urinary incontinence (SUI) is a preference-sensitive decision. Nowadays, shared decision making (SDM) is the preferred way of decision making. SDM considers the needs patients have regarding the decision-making process. The aim of this study was to identify decisional needs of women who are making a treatment decision for SUI. Semistructured interviews were planned with women who had been seeking treatment for SUI. Patients were recruited in two teaching hospitals in the Netherlands. Interviewers used a topic list based on the Ottawa decision support framework. The interviews were transcribed and coded. Themes and subthemes of factors relating to the treatment decision-making process were identified and described. We interviewed a total of 16 women. Four major themes of SUI patients' needs were identified: information on disorder and treatment, SDM, personalized health care, and consideration for social context. Within these themes, specific needs varied between individuals. In addition to the provision of objective information, other important identified needs were subjective, such as acknowledgment of symptoms and feeling understood by a physician. It was important for patients that they had a sufficient amount of time to make their decision. To ensure a good quality treatment decision in female SUI, several topics need to be addressed in an SDM process. The themes of decisional needs identified in this study can help improve the decision-making process.

MP48-16 TRENDS IN STRESS URINARY INCONTINENCE PROCEDURES FROM 2012 TO 2020 FROM THE UDA PROJECT

You have accessJournal of UrologyCME1 Apr 2023MP48-16 TRENDS IN STRESS URINARY INCONTINENCE PROCEDURES FROM 2012 TO 2020 FROM THE UDA PROJECT John Lavelle, Chad Ellimoottil, Ziya Kirkali, Julia S. Barthold, Lei Sandy Ye, Po-Lun Chou, Zhihang Lin, Myrna Cozen, Kyle Buika, and John Hornberger John LavelleJohn Lavelle More articles by this author , Chad EllimoottilChad Ellimoottil More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , Julia S. BartholdJulia S. Barthold More articles by this author , Lei Sandy YeLei Sandy Ye More articles by this author , Po-Lun ChouPo-Lun Chou More articles by this author , Zhihang LinZhihang Lin More articles by this author , Myrna CozenMyrna Cozen More articles by this author , Kyle BuikaKyle Buika More articles by this author , and John HornbergerJohn Hornberger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stress urinary incontinence (SUI) is a major quality of life problem for many people. In women, SUI is associated with pelvic organ prolapse (POP) and in men after a radical prostatectomy. A safety review started in 2011 by the FDA of POP mesh resulted in the 2019 recall. This study reviews the prevalance and procedure trends for SUI between 2012 to 2020. METHODS: Using the 100% Optum® Clinformatics® Data Mart data and 100% national Medicare Fee-for-Service data, we identified subjects claims for urinary incontinence (UI) and any procedures performed for UI. Results reported as mean ± standard deviation. RESULTS: From 2012 - 2020, the mean prevalence of any UI in the 18-64 age group was 37,529 ± 3292 or 0.62% of the population. In the Medicare population (aged 65+), it was 1,439,221 ± 90507, or 5.7% of the group. The Female to Male ratio in the <65 yr group was 2.52:1 and in the 65+ was 5.31:1. The Medicare mean SUI prevalence was 212223 ± 14292 (0.84% population), and the Optum group was 13,179 ± 1,535 (0.22%).38,677 Medicare patients received procedures for UI in 2012. This increased to 54,122 by 2019, falling to 45,667 during COVID. In 2012, 12,286 patients received SUI procedures, which plateaued at 8,670/yr for 2015 to 2019. In 2020, 6508 patients had a SUI procedure. (Breakdown in Figure 1A). 4020 patients with UI aged 18-64 got a procedure in 2012, which decreased by 45% to 2635 in 2019 with a dip for COVID to 2020. The numbers plateaued from 2014 to 2019 at 2500 patients/yr approximately. The SUI patient numbers for this group decreased from 2501 in 2012 to 967 in 2020, plateaued between 2014 and 2019 at 1250 patients/yr approximately. (Breakdown in Figure 1B) There was a 50% decrease in patients getting sling procedures. Patients obtaining artificial urinary sphincter, and injectables remained constant. Men receiving artificial urinary sphincter, slings, and injectables has remained even in the 65+ age group. However, in the 18-64 age group, men obtaining slings decreased. CONCLUSIONS: The claims prevalence for UI has increased in older age and decreased in younger patients. Sling use has decreased in all female patients and younger men. The overall decrease in procedures for SUI, appears partly due to decreased reporting of incontinence claims in the younger population, together decreased Sling procedures in female patients. Source of Funding: NIDDK Contract Number GS-10F-0133S © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e661 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Lavelle More articles by this author Chad Ellimoottil More articles by this author Ziya Kirkali More articles by this author Julia S. Barthold More articles by this author Lei Sandy Ye More articles by this author Po-Lun Chou More articles by this author Zhihang Lin More articles by this author Myrna Cozen More articles by this author Kyle Buika More articles by this author John Hornberger More articles by this author Expand All Advertisement PDF downloadLoading ...

PD14-11 PERCUTANEOUS URETHRAL SPHINCTER STIMULATION: SWINE MODEL FOR FEASIBILITY OF USE IN STRESS URINARY INCONTINENCE

You have accessJournal of UrologyCME1 Apr 2023PD14-11 PERCUTANEOUS URETHRAL SPHINCTER STIMULATION: SWINE MODEL FOR FEASIBILITY OF USE IN STRESS URINARY INCONTINENCE Kyle Waisanen, Tyler Maiers, Peter Natalzia, and Teresa Danforth Kyle WaisanenKyle Waisanen More articles by this author , Tyler MaiersTyler Maiers More articles by this author , Peter NatalziaPeter Natalzia More articles by this author , and Teresa DanforthTeresa Danforth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current treatment modalities for stress urinary incontinence (SUI) include pelvic floor physical therapy, urethral bulking agents, and urethral sling support. We aim to assess direct electrical external urethral sphincter stimulation as a means for treating SUI patients with intrinsic sphincter deficiency. The objective of this study was to assess the feasibility of percutaneous external urethral sphincter access and urethral pressure profiles associated with direct electric sphincteric stimulation. METHODS: An IACUC-approved swine model study was performed under general anesthesia. The urinary bladder was accessed by open cystotomy for placement of antegrade 7F urethral pressure catheter. Stimulation leads were deployed into the external urethral sphincter under transvaginal ultrasound guidance and antegrade urethroscopy was performed to confirm urethral integrity. Leads were then stimulated with serial increases in amplitude from an external pulse generator from 0.1 mA to 3.6 mA with pressure monitoring of the external urethral sphincter. RESULTS: Three swine subjects were utilized in the study. All subjects underwent successful percutaneous insertion of stimulation leads into the EUS without urethral violation. External urethral sphincter pressures recorded with electric stimulation amplitudes of 0 mA, 1.8 mA, and 3.6 mA were found to exhibit increased urethral pressures of 6-10 cm H2O, 16-20 cm H2O, and 31-36 cm H2O, respectfully. EMG capture was achieved in each subject with a corresponding increase in EMG activity with pulse generator amplitude increase represented in the urodynamic strip from subject #2 (Figure 1). CONCLUSIONS: Direct external urethral sphincter stimulation with increased urethral closure pressures is achievable by an ultrasound-guided percutaneous approach. Further studies are required to assess long-term effects and success of the stimulation in SUI modeled subjects with promising results seen in this preliminary proof-of-concept study. Source of Funding: Lent Foundation, University at Buffalo © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e416 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyle Waisanen More articles by this author Tyler Maiers More articles by this author Peter Natalzia More articles by this author Teresa Danforth More articles by this author Expand All Advertisement PDF downloadLoading ...

Multifunctional Evaluation Technology for Diagnosing Malfunctions of Regional Pelvic Floor Muscles Based on Stretchable Electrode Array Probe.

The pelvic floor dysfunction (PFD) has become a serious public health problem. Accurate diagnosis of regional pelvic floor muscle (PFM) malfunctions is vitally important for the prevention and treatment of PFD. However, there is a lack of reliable diagnostic devices to evaluate and diagnose regional PFM abnormality. In this work, we developed a multifunctional evaluation technology (MET) based on a novel airbag-type stretchable electrode array probe (ASEA) for the diagnosis of malfunctions of regional PFM. The inflatable ASEA has specifically distributed 32 electrodes along the muscles, and is able to adapt to different human bodies for tight contact with the muscles. These allow synchronous collection of high-quality multi-channel surface electromyography (MC-sEMG) signals, and then are used to diagnose regional PFM malfunctions and evaluate inter-regional correlation. Clinical trial was conducted on 15 postpartum stress urinary incontinence (PSUI) patients and 15 matched asymptomatic women. Results showed that SUI patients responded slowly to the command and have symptoms of muscle strength degeneration. The results were consistent with the relevant clinical manifestations, and proved the reliability of MET for multifunctional PFM evaluation. Furthermore, the MET can diagnose malfunctions of regional PFM, which is inaccessible with existing technology. The results also showed that the dysfunction of PSUI patients is mainly located in iliococcygeus, pubococcygeus, and urethral sphincter regions, and there is a weak correlation between these specific regions and nearby regions. In conclusion, MET provides a point-of-care diagnostic method for abnormal function of regional PFM, which has a potential for the targeted point-to-point electrical stimulation treatment and PFD pathology research.

Optimal Duration for Supervised Pelvic Floor Muscle Training in Stress Urinary Incontinence Women: A Prospective Study

Objectives: We evaluated the optimal duration of pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) patients. Methods: This cross-sectional study was conducted at Cipto Mangunkusumo Hospital from November 2018 to June 2019. We recruited 55 subjects diagnosed with SUI based on the questionnaire for urinary incontinence diagnosis (QUID) score &gt;4 and more than 2 grams of 1-hour pad test. Considering the inclusion and exclusion criteria, we taught and supervised them for PFMT and evaluated them every four weeks to observe the urogenital distress inventory-6 (UDI-6), incontinence impact questionnaire-7 (IIQ-7), 1-hour pad test, and perineometer score. We used the Wilcoxon test to evaluate the improvement at a significance level of P&lt;0.05. Results: Our subjects were mostly obese (65%), 30-55 years old (60%), and had &gt;2 children (90%). There were improvements in UDI-6 and IIQ-7 for every four weeks up to 12 weeks of PFMT (P&lt;0.05, 95% CI). Pelvic floor muscle strength only improved significantly (P=0.001 and P=0.006, respectively) after eight weeks of PFMT. Also, the 1-hour pad test score decreased significantly after four weeks of training (P&lt;0.001). Discussion: SUI distress and symptoms decrease after four weeks of Kegel exercises and continue to improve until 12 weeks of therapy. However, the 1-hour pad test reaches clinical and statistical significance during the first month of exercise with no further improvement clinically. Pelvic floor muscle strength increased significantly after eight weeks of training.

Lateral abdominal muscle thickness during breathing maneuvers in women with and without stress urinary incontinence.

Stress urinary incontinence (SUI) patients predominantly experience involuntary leakage during respiratory functions that induce a rapid increase in intra-abdominal pressure (IAP) such as coughing and sneezing. The abdominal muscles have an important role in the forced expiration and modulation of IAP. We hypothesized that SUI patients have different thickness changes in the abdominal muscles compared to healthy individuals during breathing maneuvers. This case-control study was conducted on 17 adult women with SUI and 20 continent women. Muscle thickness changes were measured by ultrasonography at the end of deep inspiration and expiration, and the expiratory phase of voluntary coughing for external oblique (EO), internal oblique (IO), and transverse abdominis (TrA) muscles. The percent thickness changes of muscles were used and analyzed with a two-way mixed ANOVA test and post-hoc pairwise comparison at a confidence level of 95% (p < 0.05). The percent thickness changes of TrA muscle were significantly lower in SUI patients at deep expiration (p<0.001, Cohen's d=2.055) and coughing (p<0.001, Cohen's d=1.691). While, percent thickness changes for EO (p=0.004, Cohen's d=0.996) and IO thickness (p<0.001, Cohen's d=1.784) were greater at deep expiration and deep inspiration, respectively. The percent thickness changes of abdominal muscles differed between women with and without SUI during breathing maneuvers. The present study provided information regarding the altered function of abdominal muscles during breathing maneuvers; therefore, it is important to consider the respiratory role of abdominal muscles for the rehabilitation of SUI patients.

Perinatal mesenchymal stromal cells of the human decidua restore continence in rats with stress urinary incontinence induced by simulated birth trauma and regulate senescence of fibroblasts from women with stress urinary incontinence.

Stress urinary incontinence (SUI) is a condition that causes the involuntary loss of urine when making small efforts, which seriously affects daily life of people who suffer from it. Women are more affected by this form of incontinence than men, since parity is the main risk factor. Weakening of the pelvic floor tissues is the cause of SUI, although a complete understanding of the cellular and molecular mechanisms of the pathology is still lacking. Reconstructive surgery to strengthen tissue in SUI patients is often associated with complications and/or is ineffective. Mesenchymal stromal cells from the maternal side of the placenta, i.e. the decidua, are proposed here as a therapeutic alternative based on the regenerative potential of mesenchymal cells. The animal model of SUI due to vaginal distention simulating labor has been used, and decidual mesenchymal stromal cell (DMSC) transplantation was effective in preventing a drop in pressure at the leak point in treated animals. Histological analysis of the urethras from DMSC-treated animals after VD showed recovery of the muscle fiber integrity, low or no extracellular matrix (ECM) infiltration and larger elastic fibers near the external urethral sphincter, compared to control animals. Cells isolated from the suburethral connective tissue of SUI patients were characterized as myofibroblasts, based on the expression of several specific genes and proteins, and were shown to achieve premature replicative senescence. Co-culture of SUI myofibroblasts with DMSC via transwell revealed a paracrine interaction between the cells through signals that mediated DMSC migration, SUI myofibroblast proliferation, and modulation of the proinflammatory and ECM-degrading milieu that is characteristic of senescence. In conclusion, DMSC could be an alternative therapeutic option for SUI by counteracting the effects of senescence in damaged pelvic tissue.

Diagnostic value of transperineal ultrasound in patients with stress urinary incontinence (SUI): a systematic review and meta-analysis.

We aimed to analyze the diagnostic value of transperineal ultrasound in patients with stress urinary incontinence (SUI) using evidence-based methods. A comprehensive search of the studies on the diagnosis of SUI by transperineal ultrasound in PubMed, EMBASE, MEDLINE, Cochrane library, Medicine, Web of Science, and clinicaltrials.gov databases on August 1, 2022. Studies were included if they met the inclusion criteria and were evaluated by different quality evaluation methods according to study types. Various ultrasound parameters were collected and counted to analyze and judge the diagnostic value of transperineal ultrasound in SUI patients. A total of 13 studies with 1563 participants were finally included. The combined statistics showed no significant difference in age and parity among the included patients, and the BMI of the SUI group was slightly higher than that of the normal population (MD 1.20, 95%CI 0.68-1.72). The results indicated that compared with the normal population, the α angle (MD 15.56, 95%CI 9.93-21.90), β angle (at rest: MD 10.02mm, 95%CI 1.95-18.09; at Valsalva: MD 22.40mm, 95%CI 13.79-31.01), bladder neck descent (MD 6.82mm, 95%CI 4.49-9.14), area of hiatus (MD 2.83 cm2, 95%CI 0.71-4.94) and bladder neck funneling (RR 4.71, 95%CI 1.08-20.62) of SUI patients were significantly different, which illustrated the potential value of transperineal ultrasound in diagnosing SUI. Evidence-based medicine was applied to statistically analyze published articles on the diagnostic value of transperineal ultrasound in SUI. The results suggested that transperineal ultrasound had application value in the diagnosis of SUI and had the potential to become a routine examination method to assist clinical decision-making.

Transobturator tape surgery experience: Urodynamic evaluation of 220 patients in a single tertiary center in Turkey

Background/Aim. Stress urinary incontinence (SUI) is the involuntary leakage of urine after increased intraabdominal pressure, and it causes a significant public health problem by reducing the quality of life, causing sexual dysfunction, and increasing the cost of care due to in-creased morbidity. The aim of the study was to investigate the intra? and postoperative results and complication rates of the transobturator tape (TOT) procedures used for SUI treatments in a tertiary center located in central Turkey. Methods. This prospective study analyzed a total of 220 patients undergoing TOT procedures for SUI. The demo-graphic and clinical characteristics, preoperative and post-operative cystometry values, and operative outcome parameters of the study participants were analyzed. Results. While no significant difference was noted between the preoperative and postoperative periods with respect to residual volume (27.09 ? 8.51 mL vs. 26.01 ? 3.51 mL, p = 0.125), there were significant differences in terms of the first urinary urge (142.61 ? 20.25 mL vs. 145.64 ? 20.91 mL, p &lt; 0.001), maximum bladder capacity (423.70 ? 38.43 mL vs. 402.32 ? 39.46 mL, p &lt; 0.001), the Q-tip angle (45.54 ? 5.330 vs. 43.81 ? 6.150, p = 0.001), the maxi-mum flow rate (37.65 ? 11.54 mL/s vs. 24.38 ? 9.26 mL/s, p &lt; 0.001), average flow rate (19.92 ? 9.64 mL/s vs. 14.77 ? 8.71 mL/s, p &lt; 0.001), the number of urinations in the daytime (7.29 ? 1.35 vs. 6.58 ? 1.29, p &lt; 0.001), and the number of urinations at nighttime (1.48 ? 1.01 vs. 0.92 ? 0.83, p &lt; 0.001). Conclusion. The TOT procedure im-proves the quality of life of SUI patients and can reduce morbidity. Nevertheless, additional studies are needed to corroborate our findings and determine the long-term effects.