Treatment Of Stress Urinary Incontinence Research Articles

Long-Term Outcomes of the Altis® Single-Incision Sling: Up to 10 Years' Follow-up.

Single-incision slings (SIS) have emerged as a less invasive alternative to conventional slings for stress urinary incontinence (SUI) treatment. However, long-term efficacy and safety results remain uncertain owing to a lack of studies. A retrospective review of 155 patients treated with Altis® for SUI between February 2012 and June 2017, held in 2022, as a continuation of a prospective study in which all patients (197) were reviewed for 2 years after surgery (1, 6, 12, and 24months). Preoperative demographic data, comorbidities, and pressure-flow studies were also recorded. Continence status and satisfaction rates were assessed using the International Consultation on Incontinence Questionnaire-short form (ICIQ-SF) and the Patient Global Impression of Improvement (PGI-I) respectively. The assessment in the 2022 retrospective review was performed via a telephone survey. Mean follow-up time after surgery was 85.3months (82.5-88.1). In 2022, complete continence was present in 75.4% of the patients. The presence of urinary urgency conditioned the ICIQ-SF score (10.9 vs 1.7 points, p < 0.01), with the ICIQ-SF = 0 in 84.5% of the patients with no associated urgency. Satisfaction assessed by the PGI-I was high, with 84.6% of the patients showing improvement. De novo urgency was present in 37,9% of the patients by 2022. Urinary tract infections were the most frequent complication (9.7%), with only 5 documented cases of mesh erosion. Altis® SIS is a safe and effective device for SUI treatment, with satisfaction rates comparable with those of the conventional slings. Persistence or development of urinary urgency influences the results.

The relation between usage of an eHealth intervention for stress urinary incontinence and treatment outcomes: an observational study

BackgroundStress urinary incontinence (SUI), though a prevalent condition among women, is undertreated in primary care. EHealth with pelvic floor muscle training is an evidence-based alternative to care-as-usual. It is unknown, however, how eHealth usage is related to treatment outcome, and this knowledge is required for general practitioners to implement eHealth in their practice. This study examines the relation between usage of eHealth for SUI and treatment outcomes by examining log data. Baseline factors were also explored for associations with treatment success.MethodIn this pre-post study, women with SUI participated in “Baasoverjeblaas.nl”, a web-based intervention translated from the Swedish internet intervention "Tät®-treatment of stress urinary incontinence". Usage was based on log data and divided into three user groups (low, intermediate and high). Online questionnaires were sent before, after treatment and at six-months follow-up. The relation between usage and the primary outcome − treatment success (PGI-) − was studied with a binomial logistic regression analysis. Changes in the secondary outcomes − symptom severity (ICIQ-UI SF) and quality of life (ICIQ-LUTSqol) − were studied per user group with linear mixed model analysis.ResultsIncluded were 515 users with a mean age of 50.5 years (12.0 SD). The majority were low users (n = 295, 57.3%). Treatment success (PGI-I) was reached by one in four women and was more likely in high and intermediate users than in low users (OR 13.2, 95% CI 6.1–28.5, p < 0.001 and OR 2.92, 95% CI 1.35–6.34, p = 0.007, respectively). Symptom severity decreased and quality of life improved significantly over time, especially among high users. The women’s expected ability to train their pelvic floor muscles and the frequency of pelvic floor muscle exercises at baseline were associated with treatment success.ConclusionThis study shows that usage of eHealth for SUI is related to all treatment outcomes. High users are more likely to have treatment success. Treatment success is more likely in women with higher expectations and pelvic floor muscle training at baseline. These findings indicate that general practitioners can select patients that would be more likely to benefit from eHealth treatment, and they can enhance treatment effect by stimulating eHealth usage.Trial registrationLandelijk Trial Register NL6570; https://onderzoekmetmensen.nl/nl/trial/25463.

Evaluating Patient Preferences and Clinical Outcomes for Modified Laparoscopic Burch Colposuspension and Transobturator Tape Procedures in Stress Urinary Incontinence Treatment.

This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two prominent surgical techniques for treating Stress Urinary Incontinence (SUI): the modified laparoscopic Burch colposuspension and the transobturator tape (TOT) procedure. A prospective cohort study was conducted on 145 patients who recieved surgical treatment for SUI, of which 71 patients (49%) underwent the modified laparoscopic Burch procedure, while 74 patients (51%) received the TOT procedure. Data on clinical characteristics, treatment success rates, and postoperative outcomes were collected and analyzed to understand patient preferences and real-world clinical effectiveness. This study revealed notable differences in patient demographics and clinical characteristics between the two groups. At the 2-year follow-up, a success rate of 100% was reported in the modified laparoscopic Burch group and 86.48% in the TOT group. A total of 99 patients (68.28%) were considered cured postoperatively, with 47 (66.20%) in the modified laparoscopic Burch group and 52 (70.27%) in the TOT group (p = 0.598). A significant difference was found in the incidence of dyspareunia, with six cases (8.10%) reported in the TOT group, compared to none reported in the modified laparoscopic Burch group (p = 0.028). The median operation time was significantly shorter in the TOT group, namely 15 min, compared to the modified laparoscopic Burch group, which had a median equal to 27 min (p < 0.001). Despite these differences, patient preference for either surgical technique was observed, along with similar success rates and varied postoperative outcomes. The findings provide a comprehensive overview of patient preferences and factual clinical outcomes for the two surgical techniques in SUI treatment. This study contributes to understanding the factors influencing patient choice and offers valuable insights into the real-world application of these techniques, enhancing patient-centered care in SUI management.

Analyze, design, develop, implement, and evaluate approach to develop a pelvic floor muscle training guidebook to treat stress urinary incontinence in women.

Stress urinary incontinence (SUI) is a common problem that affects the quality of life of women worldwide. Pelvic floor muscle training (PFMT) is an effective conservative first-line treatment for SUI. However, low compliance with PFMT is one of the main reasons for therapeutic failure. Indirect supervision using a guidebook may improve PFMT outcomes. To develop a PFMT guidebook using the analyze, design, development, implementation, and evaluation (ADDIE) method. A guidebook was developed from July 2020 to April 2021 using the ADDIE method. This prospective study used mixed methods, namely qualitative analysis, focus group discussions, and in-depth interviews, and involved various experts from urogynecology, urology, medical rehabilitation, and physiotherapy departments. A pilot study was conducted on patients with SUI to evaluate the effectiveness of the guidebook. The ADDIE method was successfully implemented to develop the PFMT guidebook. The formative evaluation of the ADDIE steps mainly focused on the PFMT technique, content clarity, illustration, design, and color choice of the book. After the pilot study, the guidebook significantly improved Incontinence Impact Questionnaire, Short Form, 1-hour pad test, and perineometer scores. However, the pilot study showed no significant improvement in Urogenital Distress Inventory, Short Form scores. The PFMT guidebook developed using the ADDIE method improved outcomes in patients with SUI.

The Influence of Successful Treatment of Stress Urinary Incontinence and Pelvic Organ Prolapse on Depression, Anxiety, and Insomnia-A Prospective Intervention Impact Assessment Study.

Introduction: The association between pelvic floor disorders (PFDs) and psychiatric conditions is an area of emerging interest. The causal direction of this relationship, however, remains ambiguous; it is unclear whether PFDs directly contribute to the deterioration of mental health or if pre-existing psychiatric conditions such as depression exacerbate the symptoms of PFDs. This study aimed to evaluate the effects of successful surgical treatment for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) on symptoms of depression, anxiety, and insomnia. Materials and Methods: This investigation focused on patients who underwent successful surgical interventions for SUI and POP. Both subjective and objective symptoms of PFDs, along with psychiatric status, were assessed before and after the surgical procedures. Results: This study found that successful surgical treatment of SUI and POP led to a significant reduction in anxiety scores. Additionally, in patients with SUI, successful treatment was objectively associated with a decrease in the severity of insomnia. Alleviation of symptoms associated with the lower urinary tract, prolapse, and colorectal-anal region following POP surgery was correlated with improvements in depression and anxiety but not insomnia. Subjectively assessed improvements in SUI subjective symptoms were linked to reductions in the severity of depression, anxiety, and insomnia in patients who underwent anti-incontinence surgery. Conclusions: These findings suggest a potential cause-and-effect relationship between PFDs and certain psychiatric disorders, highlighting the importance of successful treatment of PFDs in mitigating symptoms of depression, anxiety, and insomnia.

Comparative study of two techniques of laparoscopic burch colposuspension using sutures versus mesh in women with genuine stress urinary incontinence

ABSTRACT Background To compare the effectiveness and safety of laparoscopic colposuspension using sutures (LCS) versus mesh and staples (LCM) in the treatment of female stress urinary incontinence. Methods This randomized study was conducted over a total of 80 women with genuine stress urinary incontinence between January 2020 and April 2022. Women were randomly assigned to the LCS group (n = 40) or the LCM group (n = 40). They underwent objective evaluations, including a standardized stress test, a 24-hour pad test, and a frequency-volume chart. Subjective assessments were made using a quality-of-life questionnaire. Results The LCS group exhibited superior outcomes in PAD test improvement (from 147 [31–304] to 3 [0–300] at 1 year, p < 0.001), stress test scores (from 82 [11–153] to 1 [0–124] at 1 year, p < 0.001), and mean micturated volume (increase from 294 ± 65 to 321 ± 57 at 1 year, p = 0.037) compared to the LCM group. Urodynamic findings revealed a higher Maximum Urethral Closure Pressure in the LCS group (33.1 ± 6.9) versus the LCM group (28.3 ± 6.4, p = 0.002). Quality of life improvements were significantly better in the LCS group across various domains. However, the LCM group benefitted from shorter surgery duration, hospital stays, and bladder drainage duration. Conclusion LCS demonstrates significant advantages over LCM in treating female stress urinary incontinence, particularly in cure rates and quality of life improvements. Despite the operational benefits of LCM in terms of reduced surgery and recovery times, LCS offers superior therapeutic outcomes.

Reconstruction of Urethral Sphincter With Polyacrylamide Hydrogel.

Urethral bulking is an alternative to synthetic midurethral sling for the treatment of stress urinary incontinence (SUI) in women. Urethral bulking agents, which are injected in the submucosal tissues of the proximal urethra/bladder neck, have demonstrated less adverse effects with similar satisfaction rates but lower subjective and objective cure rates when compared with midurethral sling. Cystoscopic Reconstruction of External Sphincter Technique (CREST) is a novel technique, which reinforces the natural closure mechanism of the external urinary sphincter (EUS). The aim of the study was to provide safety and efficacy data for injecting polyacrylamide hydrogel (PAHG) in the components of the female EUS. This was a retrospective chart review of patients using CREST with PAHG as initial treatment for SUI by a single surgeon from January 2022 to October 2022. Exclusion criteria are as follows: younger than 18 years, prior SUI surgery, concomitant pelvic organ prolapse or reconstructive procedure, neurological conditions, or history of radiation. Subjective and objective cure rates were measured by patient-reported symptoms and cough stress test. Urinary retention, postoperative urinary infection, and de novo urinary urgency were assessed. One hundred and thirteen consecutive patients met inclusion criteria with median follow-up of 3 months. Eighty-five percent of participants reported subjective improvement, 69% reported subjective cure, and 69% demonstrated objective cure. Nine patients reported transient postoperative retention, 8 reported postoperative urinary tract infections, and 5 reported de novo urgency. There were no serious adverse events. CREST is a novel technique for injection of PAHG, into the EUS to treat SUI. Our data suggest that this technique could improve urethral injection outcomes with minimal complications.

Surgical Procedures for the Treatment of Stress Urinary Incontinence (SUI) in the Light of the Updated FDA-Warning and its Effects on Practice Patterns in Germany between 2010 and 2021.

Changes in surgical practice patterns to cure stress urinary incontinence (SUI) became evident after FDA warnings regarding vaginal mesh were issued. The primary aim was to describe nationwide numbers of suburethral alloplastic slings (SAS) inserted in 2010, 2015, 2018 and 2021 in Germany. Secondary, numbers were related to SUI specific non-alloplastic alternatives and bulking agents. Additionally, age distribution and overall inpatient surgeries in women were subject to analysis. Descriptive study utilizing data gathered from the German Federal Statistical Office ( www.destatis.de ). Included were the following procedures of inpatient surgery: A. SAS; B. non-allplastic slings; C. open/laparoscopic colposuspension; D. Bulking agents; overall changes and changes in age distribution (groups of 5-years intervals) are described. Overall, n=3599466 female inpatient procedures were analyzed. There was a considerable decrease of SAS surgeries of 28.49% between 2010 (n=23464) and 2015 (n=16778), and a decrease of 12.42% between 2015 and 2018 (n=14695) and an additional decrease of 40.66% between 2018 and 2021 (n=8720). Over time a 55.03% continuous decrease in non-alloplastic slings was observed (n=725 in 2010 to n=326 in 2021). Open and laparoscopic colposuspension numbers went down with a rate of 58.23% (n=4415 in 2010, n=1844 in 2021). Between 2010 and 2018, only bulking agent procedures increased with a rate of 5.89% from n=1425 to n=1509. There was a considerable decrease in inpatient surgical procedures using SAS. Alternatives not only failed to compensate, but experienced also a major decline.

Primary implantation of an artificial urinary sphincter using the perineal and penoscrotal approaches: Functional results and assessment of reoperative procedures

IntroductionArtificial urinary sphincter (AUS) is the standard treatment for severe stress urinary incontinence in men. While the perineal access is considered the gold standard, some authors have proposed penoscrotal AUS in order to facilitate the procedure. The main objective of our study was to evaluate the duration of survival without revision surgery (SSRC) according to the surgical approach for primary implantation. Material and methodsData from 1179 patients implanted in France between 1991 and 2020 with an AMS 800 AUS were retrospectively analyzed. A total of 762 men were implanted perineally (VP) and 417 penoscrotally (VPS). ResultsMedian follow-up was 20 vs. 25months respectively. The groups were equivalent overall, apart from the use of anticoagulants (11% VP vs. 6.3% VPS P=0.014). In our population, 54% patients were considered as “dry” in the case of VPS vs. 42% for VP. There was no significant difference in terms of survival time without reoperation, revision, replacement or explantation. In univariate and multivariate analysis, age over 70years was predictive of more reinterventions, whereas the use of a 4.5cm cuff was protective, with hazard ratios of 1.42 (P=0.001) and 0.78 (P=0.04), respectively. ConclusionThe penoscrotal approach does not appear to be associated with more complications, has good functional results and no significant difference in reoperation-free survival. A prospective multicenter non-inferiority study could be of interest to confirm our findings. Level of evidence4.

The effect of injectable platelet rich fibrin as a nonsurgical treatment of the female stress urinary incontinence.

The complications of surgical treatments of stress urinary incontinence have led to the search for less invasive and safer treatment procedures. We aimed to investigate the efficacy of locally administered injectable platelet-rich fibrin (i-PRF), an autologous material that plays an important role in tissue regeneration, in women with stress urinary incontinence. Thirty-four women were included in this prospective, single-center, and interventional study, suffering from stress urinary incontinence refractory to conservative treatment. Three consecutive i-PRF injections were applied to the mid-urethra localization at anterior vaginal wall with an interval of 1month. ICIQ-SF, UDI-6, IIQ-7 and POPDI-6 questionnaires were used to measure pre‑treatment, 1month and 6months post‑treatment symptom severity and the clinical outcomes were recorded. The mean age of the patients was 51.5 ± 9.8years. ICIQ-SF, UDI-6, IIQ-7 and POPDI-6 questionnaires results revealed significant clinical improvement of stress urinary incontinence severity afer the administration of i-PRF (p < 0.001). The results at 1 and 6months after treatment did not change statistically significantly. This study demonstrated that locally administiration of i-PRF is efective in relieving SUI symptoms with high success rates without any adverse effects reported. i-PRF injection may have the potential to be a novel, minimally invasive, and low-risk procedure, that could be an alternative and simple treatment modality to surgery for female patients with stress urinary incontinence. Additionally, it may create new avenues for research on therapeutic implementation of i-PRF.

Current Approaches for the Diagnosis and Conservative Treatment of Stress Urinary Incontinence - A Guideline of Guidelines

Urologists utilize evidence-based guidelines organized by urological organizations in the management of stress urinary incontinence (SUI). The objective of this study is to provide guidance in the clinical management of stress urinary incontinence (SUI) by reviewing key guidelines. We conducted a medical literature analysis in the following databases: PubMed, Medline, Embase, National Guideline Clearinghouse, the National Institute for Health and Care Excellence, and Cochrane Library. We also manually searched the websites of the following international and national societies to identify relevant guidelines for inclusion in this review: the International Consultation on Incontinence, American College of Obstetrics and Gynecology, American Urogynecologic Society, American Urological Association/Society of Urodynamic, Female Pelvic Medicine and Urogenital Reconstruction, National Institute for Health and Care Excellence, European Association of Urology, and Canadian Urological Association. The recommendations in the guidelines are summarized in different areas, including the diagnostic standards of SUI, examination and evaluation methods, and conservative treatment methods. This ‘guideline of guidelines’ presents the similarities and differences between prominent authorities in the management of SUI.

Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy-An Update.

Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are of interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed literature search using the keywords "incontinence" and "bulking" or "laser". Although the two approaches are less effective than sling insertions, there are specific conditions in which one or the other technique is more advantageous. Injecting bulking agents into the urethra only takes some minutes and works without general anesthesia. The method is particularly suited for elderly, frail, or obese patients with multiple comorbidities, but is also applicable for all patients and in combination with other therapies. Generally, the safety profile is good but differs between bulking materials. Two laser types-the Erbium:YAG laser with SMOOTH-mode and the fractional ablative CO2 laser-deliver heat into the tissue to induce tissue tightening and regeneration. Intravaginal laser therapy improves mild to moderate SUI, while studies describe how intraurethral laser therapy is also beneficial for severe SUI. Young women between childbirths, as well as postmenopausal women, may benefit from laser therapy. The method is safe, can be performed on an outpatient basis, and does not require any artificial material.

Evaluation of a new management approach using a mobile application in the treatment of stress urinary incontinence in women

Pelvic floor muscle training (PFMT) is effective in the treatment of stress urinary incontinence (SUI). The aim of this randomized controlled trial was to investigate a new management approach involving the use of a mobile application (app) along with standard pelvic floor physiotherapy. The study included 30 female participants with SUI who were aged between 30 and 60 years. The women in the intervention group performed exercises at home using an app connected to an intravaginal probe. Those in the control group performed the same exercises using paper-based instructions. The period of the intervention was 3 months, and five parameters were analysed: adherence, compliance, SUI symptoms, pelvic floor functionality and quality of life (QOL). All participants received physiotherapy sessions in parallel with PFMT. The intervention group showed improvements in incontinence symptoms (P = 0.002), QOL (P = 0.003) and pelvic floor functionality over the course of treatment. Improvements in symptoms (P = 0.021), QOL (P = 0.008), and the strength and speed of contractions were observed in the control group. Intergroup tests only identified a significant difference for the PERFECT speed parameter (P = 0.011). A decrease in motivation was noted in both groups. This study did not show that an app connected to a probe was superior to paper-based instructions for PFMT. However, it did confirm that a home exercise programme combined with physiotherapy has a positive impact on SUI symptoms and QOL.

Evaluation of Outcomes Between the Top-down Versus the Bottom-up Approach for Retropubic Midurethral Sling

Introduction and hypothesisRetropubic midurethral sling (MUS) placement is the gold standard for the treatment of stress urinary incontinence in the USA. The procedure can be approached from either a top-down or a bottom-up direction, but there is a paucity of contemporary data regarding outcomes between these approaches. The aim of this study was to provide updated clinical outcomes data.MethodsThis was a retrospective cohort study of women undergoing the retropubic MUS procedure alone or at the time of pelvic organ prolapse repair between 2010 and 2020 at a single academic medical center. The electronic medical record was used to extract demographic data, operative approach, and perioperative complications. The primary outcome was a composite incidence of any perioperative complication.ResultsOf the 309 patients analyzed, 140 (45.3%) underwent top-down and 169 (54.7%) underwent bottom-up retropubic MUS placement. Patients undergoing top-down MUS placement were more likely to be older (mean age 58 vs 54, p=0.02), have a history of diabetes mellitus (20% vs 8.9%, p=0.004), and have had a prior hysterectomy (27% vs 16%, p=0.02). They were less likely to have a concurrent anterior (p<0.001) or posterior repair (p<0.001). Patients undergoing the top-down procedure were less likely to experience sling exposure (p=0.02); complications in the two groups were otherwise similar.ConclusionsThe top-down approach to retropubic MUS placement was associated with lower rates of mesh erosion in this population of patients. Neither approach is associated with an increased overall risk of complications or de novo overactive bladder symptoms.

Eighteen years of experience in laparoscopic implantation of artificial urinary sphincter in women with intrinsic sphincter deficiency

Introduction and objectives: Artificial urinary sphincter (AUS) is a treatment option for women with stress urinary incontinence (SUI) after failure of previous surgery or as a primary procedure in severe intrinsic sphincter deficiency (ISD). The aim of the study was to assess the long-term efficacy and risk factors for surgical revision and definitive explantation of AUS laparoscopic implantation in female patients.Methods: A retrospective review of all women submitted to AUS implantation between April 2005 and March 2023 was conducted. The AUS was implanted via transperitoneal laparoscopic approach, by two experienced surgeons. The primary endpoint was postoperative continence. Continence was defined as no leakage and no pad usage or leakage and/or pad usage with no impact on social life and failure as leakage and/or pad usage impacting social life. As secondary outcomes, clinical predictive factors for AUS revision and definitive explantation were evaluated.Results: In the last 18 years, females with a mean age of 68±12 years-old were submitted to laparoscopic implantation of AUS. Early overall complication rate was 16%, but only one case was Clavien-Dindo ≥3. After a median follow-up of 67 months, 22.2% of the patients needed a device revision, the majority due to mechanical device dysfunction. AUS definitive explantation was performed in 16%, mainly due to urethral/vaginal erosion (9.9%) and infection (6.2%). Patients with age ≥70 years and follow-up ≥10 years significantly predisposed for device revision. At the time of the last follow-up, 72% of the patients were keeping the urinary continency.Conclusions: Laparoscopic AUS implantation in females is an effective treatment for SUI due to ISD. Meanwhile, adequate patient selection, multidisciplinary evaluation and careful expectation management are essential to achieving good results, concerning their significant complication rate.

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

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

Autologous Fascial Slings for Stress Urinary Incontinence: a 17-year Follow-up of a Randomised Controlled Study.

Safety concerns with the use of mesh in vaginal surgery have been ongoing. Autologous fascial slings (AFS) avoid foreign body complications. We compared the long-term (17-year) outcomes of two AFS repair methods-the standard sling and short sling (sling-on-string), and assessed durability and patient satisfaction of these for the treatment of stress urinary incontinence (SUI). A total of 107 patients from three urogynaecology units who had participated in a randomised controlled trial assessing standard (n = 52) and short (n = 55) slings were followed up for a median period of 17 years. Primary outcomes were Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores to assess the impact on the quality of life and symptom distress. Logistic quantile regression was employed to compare the two methods. Secondary outcomes included long-term complications and patient satisfaction. Mean scores showed no statistically significant difference between the standard and short slings at the 17-year follow-up relating to IIQ and UDI scores, leakage or urgency (p > 0.05). Improved bladder function was observed at 17 years compared with baseline (standard sling-IIQ scores mean difference [MD] 1.22 [CI: 0.69, 1.74], UDI scores MD 0.83 [CI: 0.70, 0.97]; short sling-IIQ score MD 1.14 [CI: 0.73, 1.54], UDI scores MD 0.54 [CI: 0.40, 0.67]) with age-related deterioration over time. Re-operation rates were low and patient satisfaction rates were high (67.2%) at follow-up. Autologous fascial slings are an effective and durable option for management of SUI and the short sling procedure can be recommended owing to plausible surgical advantages.

More With Less: Single-Incision Sling Insertion Techniques

To demonstrate reproducible procedures for efficient single-incision sling insertion and troubleshooting. Narrated video footage with stepwise demonstration of single-incision sling insertion technique with anchor system. The mesh midurethral sling is a highly effective and safe procedure that is considered the gold standard for surgical treatment of stress urinary incontinence. Retropubic and transobturator approaches for midurethral slings have similar subjective cure rates with differing surgical risk profiles [1,2]. The retropubic route has a higher risk of injury to the bladder, nerves, and vascular structures, whereas the obturator approach carries a risk of groin or thigh pain [3-5]. Use of a single-incision sling decreases these risks and allows flexibility to perform the procedure without sedation or general anesthesia. Recent literature demonstrates similar subjective and objective success and safety of single-incision slings compared with both retropubic and transobturator approaches, although long-term data are forthcoming [5]. We demonstrate a stepwise approach for the insertion of a single-incision sling using a helical trocar. Easily reproducible procedures for setup and sling anchor management allow for efficient placement without assistance. In addition, we outline hand positioning, trocar management, and anchor deployment with troubleshooting techniques for potential placement difficulties. Finally, we review methods for sling tensioning to prevent complications such as voiding dysfunction and mesh or suture exposures. Given that single-incision slings are more likely to be performed under local anesthesia and are less invasive with decreased recovery time, it has the potential to become the preferred approach in the future. This video demonstrates clear and detailed steps to facilitate successful placement of the single-incision mesh midurethral sling.

Analysis of British Columbia practice patterns in the management of female stress urinary incontinence with emphasis on mesh use.

Female stress urinary incontinence (SUI) is common and has a profound impact on quality of life. Suburethral slings are the most common treatment for SUI in this population. These can be placed with synthetic mesh or autologous fascia. Mesh-related complications after midurethral sling procedures are documented in the literature but the risk of complications and reoperation is lower than the use of transvaginal mesh for pelvic organ prolapse repair. In this study, we sought to evaluate local practice patterns of management of female SUI with specific emphasis on mesh use. A survey created by an expert panel was disseminated to respective provincial societies. Sixty-eight percent of respondents offer midurethral slings in their practice but only 60.6% of these respondents would offer surgical removal of the sling if there were complications, such as mesh erosion or pain. A large portion (39.4%) of respondents are performing transobturator slings as compared to retropubic midurethral slings (36.3%) and only 8.5% have removed the leg component associated with the transobturator sling in their practice. Furthermore, compared to most respondents offering midurethral slings (64.8%), only a minority of surgeons offer alternatives: 23.9% of respondents offer periurethral bulking agent injections, 15.5% offer pubovaginal slings, and 12.7% offer retropubic urethropexies. Our study supports that surgeons should continue to review surgical risks and alternative treatment options as part of the surgical consent process. As such, surgeons should be able to offer a variety of surgical approaches to manage female SUI.

Persistent and De Novo Stress Urinary Incontinence After Minimally Invasive Sacrocolpopexy.

Data on stress urinary incontinence (SUI) after minimally invasive sacrocolpopexy (SCP) with or without midurethral sling placement are limited. The aim of the study was to determine the incidence of SUI after minimally invasive sacrocolpopexy. This was a secondary analysis of 2 randomized clinical trials of participants undergoing SCP. Participants completed symptom assessment and urodynamic testing. Participants underwent SCP with or without midurethral sling placement. Preoperatively, participants were defined as having symptomatic SUI, occult SUI, or no SUI. Participants completed the Pelvic Floor Distress Inventory-20 at 6 and 12 months postoperatively and were categorized as having persistent SUI in the setting of symptomatic or occult SUI or de novo SUI. Eighty-one participants were included. Sixty-one participants met inclusion criteria for the persistent SUI analysis: 42 participants with symptomatic SUI and 19 participants with occult SUI. There were 20 participants in the de novo SUI group. The overall incidence of persistent SUI was 26.2% (95% confidence interval [CI], 15.8%-39.1%) with 33.3% (95% CI, 19.6%-49.6%) of symptomatic and 10.5% (95% CI, 1.5%-33.1%) of occult participants. Bothersome symptoms were defined as "moderately" or "quite a bit" bothered postoperatively. Of participants with symptomatic SUI, 14.3% participants were bothered and no participants underwent retreatment. No patient with occult SUI was bothered; however, 1 patient underwent retreatment. The incidence of de novo SUI was 45% (95% CI, 23.1%-68.5%). No patient in the de novo SUI group was bothered or underwent SUI treatment. Approximately 1 in 4 participants reported persistent SUI. Almost 50% reported de novo SUI. However, few participants were bothered or underwent treatment.