Subjective Stress Urinary Incontinence Research Articles

Changes in Stress Urinary Incontinence Symptoms after Pelvic Organ Prolapse Surgery: a Nationwide Cohort Study (FINPOP)

Introduction and hypothesisVarious strategies are employed to manage stress urinary incontinence (SUI) during pelvic organ prolapse (POP) surgery. This study was aimed at facilitating shared decision-making by evaluating SUI symptom changes, staged SUI procedures, and their prognostic factors following POP surgery without concomitant SUI intervention.MethodsWe analyzed 2,677 POP surgeries from a population-based observational cohort, excluding patients with prior SUI surgery. The outcome measures were subjective SUI utilizing the Pelvic Floor Distress Inventory-20 questionnaire and number of subsequent SUI procedures. Multivariable linear models were applied to identify predictors of persistent SUI, procedures for persistent SUI, and de novo SUI. The primary assessment occurred at the 2-year follow-up.ResultsAt baseline, 50% (1,329 out of 2,677) experienced SUI; 35% (354 out of 1,005) resolved, an additional 14% (140 out 1,005) improved, and 5.1% (67 out of 1,308) underwent a procedure for persistent SUI. De novo SUI symptoms developed in 20% (218 out of 1,087), with 3.2% (35 out of 1,087) reporting bothersome symptoms; 0.8% (11 out of 1,347) underwent a procedure for de novo SUI. High baseline symptom severity increased the risk of persistent SUI (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.65–2.53), whereas advanced preoperative apical prolapse decreased the risk (aOR 0.89, 95% CI 0.85–0.93). De novo SUI was more common with advancing age (aOR 1.03, 95% CI 1.01–1.05), baseline urgency urinary incontinence (aOR 1.21, 95% CI 1.06–1.38), and after transvaginal mesh surgery (aOR 1.93, 95% CI 1.24–3.00). It was not dependent on the compartment or preoperative degree of prolapse.ConclusionsIn a pragmatic setting, POP surgery results in a low rate of subsequent SUI procedures.

Does the Polydimethylsiloxane Urethral Injection (Macroplastique®) Improve Sexual Function in Women, in Fertile Age, Affected by Stress Urinary Incontinence?

Background and Objectives: Stress urinary incontinence (SUI) negatively affects women's quality of life, including sexual function. The aim of the current study was to evaluate the effect of polydimethylsiloxane (Macroplastique®) on sexual function in women of fertile age affected by SUI. Materials and Methods: Single-center prospective study. Sexually active women of fertile age with symptoms of pure SUI, which were urodynamically proven, were submitted to intraurethral Macroplastique® injection. At 6-months follow-up, their sexual function was evaluated with Female Sexual Function Index (FSFI), while the SUI cure rate was objectively assessed through a negative stress test and subjectively by a Patient Global Impression of Improvement (PGI-I) score < 3. The difference of coital incontinence prevalence was assessed between the baseline and the 6-month follow-up. Peri- and postoperative complications of Macroplastique® injection were recorded and classified according to the Clavien-Dindo system. Results: Twenty-one women fulfilled inclusion criteria and were submitted to Macroplastique® procedure. The concerning sexual function, desire, satisfaction, and overall FSFI score significantly improved. Since other domains were less impaired at the baseline, we could not assess significant improvement for all of them. We observed a complete regression of coital incontinence (0/21, 0%) in comparison with the baseline (5/21, 23.8%; p = 0.04). The objective SUI cure rate was 76% (16/21), while the subjective SUI cure rate was 80.9% (17/21). One woman developed de novo overactive bladder, and two women developed postoperative voiding dysfunction (self-solved in 24 h). Conclusions: The Macroplastique® urethral injection was demonstrated to be safe and effective in improving sexual function in sexually active women of fertile age affected by pure SUI, urodinamically proven at 6-months follow-up.

CO2 Surgical Laser for Treatment of Stress Urinary Incontinence in Women: A Randomized Controlled Trial

ABSTRACT The common condition of stress urinary incontinence (SUI) has a reported prevalence of 10% to 39% in adult women in most studies. Although treatment of SUI via surgical means is an option, factors such as adverse effects of surgery and mesh-related risks lead many to seek alternative options. In overweight and obese patients, lifestyle changes for improving SUI symptoms entail mainly weight loss. Although pelvic floor muscle training (PFMT) can lead to improvements, further treatment is often necessary. Because of this, interest is high for developing effective nonsurgical treatments for SUI. One such possible treatment is vaginal laser therapy, which has been used as treatment for various vaginal conditions. The authors therefore carried out a randomized controlled trial (RCT) comparing CO2 laser with sham treatment for SUI. This multicenter, participant-blinded, sham-controlled, parallel-group, superiority RCT involved participants from 2 hospitals in Southeast Melbourne in the outpatient setting. Patients aged 18 to 80 years experiencing symptomatic and objective SUI and seeking conservative management participated. Women with prior surgery for SUI were excluded. A positive cough stress test with a comfortably full bladder and uroflow was used to determine objective SUI. Participants lacking positive cough stress test were still eligible for study inclusion with a positive pad weight test in the absence of urgency incontinence symptoms. Intervention took place using FemTouch delivery system in conjunction with the AcuScan 120 Microscanner and the AcuPulse CO2 laser system for fractional treatment. Laser energy was delivered via a standard foot pedal in a fractional manner. The sham treatment used identical methods and settings but used an inactive pedal, which only made mechanical clicks and no electronic beeps. A total of 3 treatments were administered to participants, 4 weeks apart, with incrementally greater density settings. The primary outcome of the study was subjective SUI (defined as positive answers to the inquiries: “Do you leak when you cough or sneeze?” or “Do you leak when physically active/exercising?”). Secondary outcomes were assessed via the Patient Global Impression of Improvement, and International Consultation on Incontinence Questionnaire–urinary incontinence change, International Consultation on Incontinence Questionnaire-overactive bladder, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, the Incontinence Impact Questionnaire–Short Form, and EQ-5D scores. In addition, adverse events (such as pain during the procedure as measured on a visual analog scale) and objective SUI were recorded. A sample size of 101 was chosen to provide 80% power to detect differences between groups for the primary outcome (even assuming a 10% rate of attrition). A total of 97 participants ultimately were treated. Randomization of participants occurred with equal probability to sham treatment or the CO2 laser using a computer-generated random sequence, which allocated participants to blocks of 4, 6, and 8. Unblinding of participants to their allocation occurred following the 3-month review. Participants had a mean age of 53 years and a mean body mass index of 26.1 kg/m2, and 90% were vaginally parous. Most participants had attempted PFMT either independently or under supervision. No detectable difference was found between the sham and active treatment arm in the primary outcome of leak with laughter or cough. Furthermore, there were no significant differences between groups with regard to any of the secondary, patient-reported outcomes of questionnaires. The authors tested the reliability of their masking by assessing whether patients could identify their allocation group. Between the 2 groups, 17 (54%) of the sham group and 15 (63%) of the active treatment group believed they received sham treatment. Adverse events were rare in both groups, with similar visual analog pain scores during treatment and only rare vaginal bleeding and urgency incontinence in both groups. Strengths of this study are several and include its blinded design and randomization methods. The primary outcome was focused on patient-reported outcomes. Responsive and validated questionnaires were utilized for assessment of secondary outcomes. Study limitations include a lack of blinding for investigators, which could have introduced an element of detection bias for SUI. In conclusion, no benefit was shown for 3 treatment sessions of the CO2 vaginal laser when compared with sham therapy. Additional trials with various laser modalities are necessary to determine whether this may produce varying results. Women considering CO2 vaginal laser therapy for SUI should be made aware of the lack of consistent high-quality evidence in support of this treatment.

Suburethral implantation of autologous regenerative cells for female stress urinary incontinence management: Results of a pilot study

ObjectivesTo assess the feasibility and the safety of treating female stress urinary incontinence (SUI) with suburethral implantation of a mixture of the stromal vascular fraction from adipose tissue and leukocyte-and platelet-rich-fibrin. MethodsPatients with SUI were treated with a mixture of stromal vascular fraction and leukocyte-and platelet-rich fibrin. The stromal vascular fraction was obtained from enzymatic digestion of autologous adipose-tissue and added to an leukocyte-and platelet-rich-fibrin membrane. The mixture was transvaginally implanted into the suburethral area. A fraction of the Stromal vascular fraction sample was used for cellular characterization. Patients were followed for 9 months. Every 3 months, the patients were clinically evaluated with a cough- stress test and a validated-questionnaire. An MRI was performed preoperatively and 3 months after the procedure to assess tissue changes. ResultsTen patients received the surgical procedure. The validated-questionnaire revealed a subjective SUI improvement in nine patients 3 months after the operation and in seven patients 9 months after the operation. Eight, six, and four patients achieved a negative cough-stress test 3, 6 and 9 months post-injection, respectively. Flow cytometric analysis of stromal vascular fraction cell phenotypes revealed predominantly mesenchymal and endothelial cell heterogeneity. In total, we injected 0,18 × 106 to 13,6 × 106 cells. No adverse events were observed peri- or postoperatively. ConclusionThese preliminary results suggest that the suburethral implantation of a combination of SVF and l-PRF is a feasible and safe modality for treating female SUI. However, evidence is lacking and further research are needed to clarify the respective roles of SVF and l-PRF in female SUI treatment.

CO2 surgical laser for treatment of stress urinary incontinence in women: a randomized controlled trial

Stress urinary incontinence is a common condition that can be treated conservatively and/or surgically. Given the risks of surgery, developing effective nonsurgical treatment options would be beneficial. Some studies have suggested that laser therapy may improve or cure stress urinary incontinence. However, there is a lack of sham-controlled randomized controlled trials to judge treatment efficacy. This study aimed to compare the effects of CO2 vaginal laser vs sham therapy for treating stress urinary incontinence. This was a multicenter, participant-blinded, sham-controlled, parallel group (1:1) superiority randomized controlled trial performed in outpatient clinics in 2 hospitals. We included women aged 18 to 80 years with objective and subjective stress urinary incontinence. Participants had undertaken or declined supervised pelvic floor muscle training. Intervention was performed using a CO2 fractionated vaginal laser. Participants underwent 3 treatments, 4 weeks apart, with increasing energy and density settings. Sham treatment was performed using an identical technique with a deactivated pedal. The primary outcome was the subjective stress urinary incontinence rate (proportion with leak with cough, sneeze, or laughter) at 3 months after completion of treatment. Secondary outcomes included objective stress urinary incontinence, change in the disease-specific patient-reported outcomes, health-related quality of life, and adverse effects. Categorical outcomes were compared using the chi square test and continuous outcomes using analysis of covariance, adjusting for the baseline score. There were 52 participants who received laser and 49 who received sham treatment. One participant in each group withdrew from the study before the endpoint, and 2 participants in the laser group did not participate in the follow-up visits. Participant mean age was 53 (34-79) years. Mean body mass index was 26.1 (18.1-49.6); 90% were vaginally parous. At 3 months, there was no difference between the sham and active treatment arm in subjective stress urinary incontinence (46 [96%] vs 48 [98%]; relative risk, 0.98 [95% confidence interval, 0.91-1.05]; P=.55) or in objective stress urinary incontinence (37 [80%] vs 33 [80%]; relative risk, 0.99 [95% confidence interval, 0.81-1.23]; P=.995). Patient-reported outcomes and health-related quality of life were also comparable between the groups. Vaginal bleeding occurred in 3 participants after laser and 1 participant after sham treatment. Pain during treatment did not differ between laser and sham treatment. We were unable to show an improvement in stress urinary incontinence after CO2 vaginal laser therapy compared with sham treatment.

Evaluation of pelvic floor muscle function (PFMF) in cervical cancer patients with Querleu-Morrow type C hysterectomy: a multicenter study.

To evaluate the pelvic floor muscle function (PFMF) of cervical cancer patients after type QM-C hysterectomy and to explore the relationship between decreased PFMF and related factors. This was a multi-centered retrospective cohort study. 181 cervical cancer patients who underwent type QM-C hysterectomy were enrolled from 9 tertiary hospitals. Strength of PFMF were measured using neuromuscular apparatus (Phenix U8, French). Risk factors contributing to decreased PFMF were analyzed by univariate and multivariate ordinal polytomous logistic regression. Totally 181 patients were investigated in this study. 0-3 level of type I muscle fibre strength (MFSI) was 52.6% (95/181), 0-3 level of type IIA muscle fibre strength (MFSIIA) was 50% (91/181). Subjective stress urinary incontinence was 46% (84/181), urinary retention was 27.3% (50/181), dyschezia was 41.5% (75/181), fecal incontinence was 9% (18/181). ① MFSI: Multivariate ordinal polytomous logistic regression shows that the follow-up time (p < 0.05), chemotherapy and radiotherapy (p = 0.038) are independent risk factors of MFSI's reduction after type QM-C hysterectomy. ② MFSIIA: multivariate ordinal polytomous logistic regression shows that the follow-up time (p < 0.05) are independent risk factors of MFSIIA's reduction after type QM-C hysterectomy. The pelvic floor muscle strength (PFMS) increased after 9months than in 9months after operation, which showed that the PFMS could be recovered after operation. We advocate for more attention and emphasis on the PFMF of Chinese female patients with cervical cancer postoperation. PFMF after QM-C hysterectomy has not been analyzed by current study. The contribution is that patients with radical hysterectomy should do pelvic floor rehabilitation exercises in 3months after operation. Clinical Trails NCT number of this study is 02492542.

Very long-term follow-up of autologous pubovaginal fascia slings in women with stress urinary incontinence.

The objective was to report on the very long-term outcome of a published series of autologous pubovaginal slings (PVS) in women with stress urinary incontinence (SUI). Following institutional review board approval, a cohort of well characterized, non-neurogenic women who underwent an autologous PVS (primary [PVS1] and secondary [PVS2]) for SUI was re-evaluated for their very long-term outcome status. Data collected included demographics, validated questionnaires (Urogenital Distress Inventory - short form [UDI-6], Incontinence Impact Questionnaire - short form 7, quality of life), SUI retreatment/operations, and subjective patient-reported SUI improvement (%) and symptom recurrence. The primary outcome was success defined as UDI-6 question 3 (SUI) ≤ 1 and no SUI retreatment/operation. Patients not seen in clinic for 2years were contacted via a standardized phone interview. From 83 patients with 7-year intermediate follow-up data, 34 (PVS1 = 18, PVS2 = 16) had very long-term follow-up based on clinic visit (7) or phone interviews (27). Those lost to follow-up (49), including 5 deceased, did not differ in demographics and intermediate outcomes from the followed cohort, but lived further away (>75miles). At a mean age of 74years, and with a median follow-up of 14.5years, 53% met the success criteria (PVS1 = 44%, PVS2 = 63%). Mean postoperative questionnaire scores did not differ significantly between intermediate and very long-term follow-ups, and long-term outcomes between PVS1 and PVS2 remained similar. A majority of women with long-term follow-up after PVS for primary and secondary SUI remained successful more than 14years after their surgery. Both groups, PVS1 and PVS2, fared equally well, confirming the durability of PVS as a treatment alternative for SUI.

Long-term outcomes of transobturator midurethral slings: A critical evaluation of a real-world population.

The American Urological Association/SocietyofUrodynamics,FemalePelvic Medicine and Urogenital Reconstruction stress urinary incontinence (SUI) guidelines strongly recommend the midurethral sling (MUS) for the index female patient with SUI. While numerous studies report long-term outcomes and complications for the retropubic MUS, these are largely absent for the transobturator MUS and are assessed in this study. This is an Institutional Review Board approvedretrospective chart review of all women who underwent a transobturator MUS at a single institution from 2004 to 2010. Pre- and postoperative assessment included a cough-stress test, SEAPI assessment,and validated quality-of-life (QoL) questionnaires. SUI resolution was defined asno subjective or objective SUI, and no additional surgery to achieve stress continence. Of 437 women, 305 (70%) had a minimum follow-up of 48 months (mean 88; median 92). SUI was resolved in 69% of the entire cohort and 58% of the 78 women who had MUS only. The median time to SUI recurrence was 38 months in the entire cohort and 18 months in the MUS only group. Perioperative complications were infrequent and typically associated with concomitant surgery. A statistically significant improvement was observed in SEAPI scores and all QoL indices postoperatively. Long-term resolution of SUI after the transobturator MUS is achieved by 69%, which is commensurate with success rates reported in the literature. Overall, women experience a significant improvement in their QoL after transobturator MUS; however, late recurrences and delayed sequelae may occur. Thus, long-term follow-up is warranted in this population.

Outcomes of a Staged Midurethral Sling Strategy for Stress Incontinence and Pelvic Organ Prolapse.

To evaluate the proportion of women who experienced resolution of stress urinary incontinence (SUI) symptoms after surgery for pelvic organ prolapse (POP) without a concomitant incontinence procedure. We conducted a retrospective observational study of women with preoperative subjective and objective SUI who underwent minimally invasive sacrocolpopexy or uterosacral ligament suspension from 2009 to 2015. We excluded cases with incontinence procedures. The primary outcome was the proportion of women with subjective resolution of SUI postoperatively, defined as the absence of patient reported SUI symptoms during follow-up. Secondary outcomes included the proportion of women who underwent a subsequent staged midurethral sling (MUS) procedure and factors associated with resolution of SUI and staged MUS placement. Of 93 women, most were white (n=90, 98%) with stage III POP (n=55, 59%). Mean age was 59.5±8.9 years and body mass index 28.7±4.7. Seventy-three patients (78%) underwent minimally invasive sacrocolpopexy, and 20 (22%) underwent uterosacral ligament suspension. Median follow-up was 8.3 months (interquartile range 3.4-26.7). Postoperatively, 28 (30%) patients reported resolution of SUI, and 65 (70%) reported persistent SUI. Of the 93 patients, 47 (51%) were treated for persistent SUI and 34 (37%) underwent a staged MUS procedure. Among the staged MUS procedures, 27 (79%) were placed within 12 months. Median time to staged MUS procedure was 5.5 months (interquartile range 4.2-9.9). After controlling for degree of preoperative SUI bother, obese women were less likely to experience resolution of SUI after prolapse repair (odds ratio 0.28, 95% CI 0.08-0.95). We did not identify any factors that were significantly associated with undergoing a staged MUS procedure on univariate analyses (P>.05). Preoperative SUI resolved in nearly a third of women after prolapse surgery without a concomitant incontinence procedure. In a population typically offered a concomitant MUS procedure at the time of prolapse repair, a staged approach may result in nearly two-thirds fewer patients undergoing MUS procedures. This information may be helpful during preoperative shared decision making.

Childbirth after mid-urethral sling surgery: effects on long-term success and complications.

To evaluate long-term outcomes in women with one or more childbirths after mid-urethral sling (MUS) surgery and potential differences in outcomes based on mode of delivery. A population-based cohort study using data from two national registries. Women registered with childbirth after MUS (case group) or without childbirth after MUS (control group), with equal follow-up time, underwent a structured telephone interview using a validated short-form urinary disease-specific questionnaire. Primary outcomes were current stress urinary incontinence (SUI) rate and change in cure rate. Secondary outcomes were effect of delivery mode, rates of repeat operations for SUI, complications, treatment satisfaction and urgency urinary incontinence rate. Childbirth as an independent risk factor for SUI recurrence was also evaluated. Seventy-two women with and 156 women without childbirth after MUS were included. Median follow-up time was 10years for both groups. Subjective SUI cure rates were 82% (cases) and 75% (controls), respectively (p = 0.31). A significantly lower SUI cure rate was seen in the women with more than one childbirth after MUS (50% vs. 88% p = 0.006). No differences in primary or secondary outcomes were found between groups at follow-up, nor did mode of delivery affect outcomes. Childbirth after MUS was not an independent risk factor for subjective SUI recurrence (OR 0.8 CI 0.3-1.7). No differences in outcomes were seen between groups at follow-up independently of delivery mode. However, having more than one delivery after MUS seems to impact the continence status.

Transobturator Tape: Over 10 Years Follow-up

ObjectivesTo assess subjective and objective outcomes in incontinent patients following “out-in” TOT, at >10-year follow-up; to evaluate effect on quality of life and other urinary symptoms, late adverse events and predictive factors for failure. MethodsThis single-centre prospective study evaluated women with “complicated” or “uncomplicated” stress urinary incontinence (SUI) following “out-i”’ TOT between 2003 and 2007.The pre-op work-up comprised: history; pelvic examination; cough stress test; urodynamic study; UDI-6; and King's Health questionnaires.Work-up was the same as pre-op plus the Patient Global Impression of Improvement scale with final follow-up in 2017. ResultsOne hundred thirty six consecutive patients underwent TOT; at final follow-up (mean 145 months) we evaluated 123. Cure rates: objective: 78.9%; subjective: 62.6%; no significant deterioration in SUI cure rates over time.Urgency and urgency urinary incontinence (UUI) significantly reduced. Voiding dysfunction increased without urodynamic obstruction. De novo urgency appeared in 7.3% and de novo UUI in 4.1%.In the 31 uncomplicated SUI patients, the objective cure rate was 87.1% and the subjective cure rate was 72.2%. De novo urgency appeared in 9.7% and de novo UUI in 3.2%.Nine King's Health questionnaires domains saw statistically significant improvements.In univariate analysis, pre-op wet OAB was associated with subjective recurrent SUI (P < .038) and parity >2 was associated with objective recurrent SUI (P = .023).We had 5 cases of partial mesh exposure. ConclusionCure rates are satisfactory, 10 years after TOT surgery, with good quality of life and few major complications. However, some postoperative symptoms may be caused by long-term treatment failure or by advancing age or another pathology.

External validation of de novo stress urinary incontinence prediction model after vaginal prolapse surgery.

Stress urinary incontinence (SUI) may appear after the correction of pelvic organ prolapse (POP). The aim of this study was to externally validate a described predictive model for de novo SUI and to assess its clinical performance when used as a diagnostic test. This was a retrospective descriptive study on a cohort of consecutive women treated in our institution. The main outcome used to validate the model was the presence of objective or subjective SUI 1year after surgery. A receiver operating characteristic curve was generated from our population to evaluate the predictive accuracy and to compare it with the original model. A cutoff point of ≥50% was used to evaluate its clinical performance as a diagnostic test. Of the full cohort, 169 women were suitable for analysis. The rate of de novo SUI was 11.8%. The predictive accuracy of the model in our population was similar to the original [area under the curve (AUC) = 0.69; 95% confidence interval (CI) = 0.58-0.80). However, its performance measures when evaluated as a diagnostic test were low: positive likelihood ratio = 2.71 and negative likelihood ratio = 0.86. Only 15 women presented a positive test result. External validation of the model found a global predictive accuracy similar to that of the original model. Despite the study being underpowered to give firm conclusions, the test did not show a good clinical performance when applied to our population with low de novo SUI prevalence. A larger sample size is needed to validate the model conclusively.

Surgery for women with pelvic organ prolapse with or without stress urinary incontinence.

Surgery for women with pelvic organ prolapse with or without stress urinary incontinence.

Is There a Difference in the Outcome of Mid-Urethral Sling Operations Performed by Urogynecologists Compared with Supervised Residents?

Study ObjectiveTo compare the operative results of midurethral sling (MUS) surgeries for stress urinary incontinence (SUI) performed by residents under the guidance of an attending specialist in urogynecology and those performed by attendings. DesignRetrospective chart review (Canadian Task Force classification II-2). SettingUniversity hospital. PatientsA retrospective analysis of all MUS surgeries performed at a single public tertiary medical center between January 2009 and December 2013 was carried out. A total of 257 patients underwent transobturator tape (TOT) placement during the study period, including 136 (52.9%) placed by an attending specialist in urogynecology (group A) and 121 (47.1%) placed by a resident, under the guidance of an attending (group B). MeasurementsThe efficacy of treatment was evaluated in terms of early postoperative course, reoperation, and symptom improvement, as based on the Pelvic Floor Distress Inventory short form (PFDI-20) questionnaire. The primary outcome was patient-reported symptoms of SUI, as assessed with the PFDI-20 questionnaire, as well as absence of surgical retreatment for SUI. ResultsImmediate postoperative complications were comparable in the 2 groups, as were subjective failure and self-reported SUI. The primary outcome—moderate and severe symptoms of SUI—were reported by 23.7% of the patients in group A and 23.6% of those in group B (p = .91). At a mean follow-up of 40 months in both groups, symptoms, as assessed using the urinary scale and prolapse scale of the PFDI-20, were also similar in the 2 groups. The rate of reoperation with repeated sling for SUI was 5% in both groups. ConclusionThe operative results of TOT surgery for SUI performed by residents under the guidance of an attending specialist in urogynecology did not differ significantly from those performed by the attendings themselves.

Quality of life and objective outcome assessment in women with tape division after surgery for stress urinary incontinence.

BackgroundMidurethral tapes may cause long-term complications such as voiding dysfunction, groin pain, de novo urgency or mesh erosion, which necessitate a reoperation. There is a paucity of data regarding health related quality of life in patients undergoing tape removal. The aim of the study was to evaluate quality of life (QoL) and objective outcome after midurethral tape division or excision.MethodsAll patients who underwent a midurethral tape division for voiding difficulties, pain or therapy resistant de novo overactive bladder between 1999 and 2014 were invited for follow-up. A control group with a suburethral tape without division was established in a 1:2 ratio and matched for age, tape used and year of tape insertion. Patients completed the Kings´ Health Questionnaire (KHQ), Incontinence Outcome Questionnaire, Female Sexual Function Index Questionnaire and the Patient Global Impression of Improvement score.ResultsTape division or excision was performed in 32 women. Overall, 15 (60%) of 25 women who were alive were available for clinical examination and completed the questionnaires. Tape division was performed for voiding dysfunction (n = 7), overactive bladder (n = 2), mesh extrusion (n = 3) and ongoing pain (n = 3). Median time to tape division/excision was 10 months. Three women in the tape division group had undergone reoperation for stress urinary incontinence (SUI). At a median follow-up of 11 years (IQR 9–13) subjective SUI rate was 53% (8/15 women) in the tape division group and 17% (5/30) in the control group (p = 0.016), with no significant differences in objective SUI rates between groups. With regard to quality of life, the study group had significantly worse scores in the SUI related domains role limitation, physical limitation, severity measures and social limitations (KHQ) compared to the control group.ConclusionsWomen needing tape division or excision have lower SUI related QoL scores compared to controls mostly because of higher subjective SUI rates.

Use of Concomitant Stress Incontinence Surgery at Time of Pelvic Organ Prolapse Surgery Since Release of the 2011 Notification on Serious Complications Associated with Transvaginal Mesh

There is controversy regarding the performance of concomitant anti-incontinence procedures at the time of pelvic organ prolapse repair. Data support improvement in stress urinary incontinence with a concomitant sling but increased adverse events. We assessed trends in preoperative stress urinary incontinence evaluation, concomitant anti-incontinence procedure at pelvic organ prolapse surgery and postoperative anti-incontinence procedures at our institution before and after the 2011 FDA (U.S. Food and Drug Administration) Public Health Notification pertaining to vaginal mesh. We retrospectively reviewed the records of patients who underwent pelvic organ prolapse surgery from 2009 to 2015. Preoperative workup included assessment of subjective stress urinary incontinence and/or evaluation for leakage with reduction of pelvic organ prolapse on physical examination, urodynamics or a pessary trial. The percentages of concomitant and postoperative anti-incontinence procedures were compared before and after the 2011 FDA notification. A total of 775 women underwent pelvic organ prolapse repair. The percentage of anti-incontinence procedures at pelvic organ prolapse repair decreased from 54.8% to 38.0% after the FDA notification (p = 0.002) while the incidence of preoperative objective stress urinary incontinence on examination, urodynamics and pessary trials remained constant. The incidence of postoperative anti-incontinence procedures within 1 year of the index surgery remained low. We found a decrease in the incidence of concomitant anti-incontinence procedures at the time of pelvic organ prolapse repair following the 2011 FDA notification despite no significant decline in subjective stress urinary incontinence or demonstrable stress urinary incontinence on preoperative evaluation. Further analysis is warranted to assess the impact of the FDA notification on treatment patterns in women with pelvic organ prolapse and stress urinary incontinence.

Influence of anterior vaginal mesh with concomitant mid-urethral sling surgery on stress urinary incontinence: clinical and sonographic outcome.

To clinically and sonographically evaluate the influence of anterior vaginal mesh (AVM) surgery with concomitant mid-urethral sling surgery (MUS) for stress urinary incontinence (SUI). Women with severe symptomatic pelvic organ prolapse (POP) stage III or IV with concomitant SUI were divided into two groups: Group I had transobturator tape (TOT) and AVM surgery and Group II underwent TOT without AVM surgery. Clinical outcome was assessed pre-operatively and 1year post-operatively, while ultrasound evaluations were performed after one year. Objective cure was defined as no urinary leakage demonstrable on provocative filling cystometry. Subjective SUI cure was a negative response to Urogenital Distress Inventory Six (UDI-6) (question 3). A total of 97 women were recruited, 57 in Group I and 40 in Group II. Three women had symptomatic prolapse in Group I and 5 in Group II. There were no differences in the ultrasound and clinical outcomes between women who had mid-urethral slings with and without AVM. Successful SUI outcome was reported in 85 women. Urethral kinking was demonstrable in 50% of successful cases, but none with failed outcomes. Subanalysis among those with successful SUI outcome (n=85) and failure (n=12) revealed the tape, bladder neck and mesh mobility was significantly higher (P<0.001) among those with SUI success. Among women who had MUS, there were no differences in the ultrasound and clinical outcome between those who had AVM or otherwise.

Lower urinary tract symptoms after subtotal versus total abdominal hysterectomy: exploratory analyses from a randomized clinical trial with a 14-year follow-up.

Lower urinary tract symptoms (LUTS) are common after hysterectomy and increase after menopause. We aimed to compare subtotal with total abdominal hysterectomy regarding LUTS, including urinary incontinence (UI) subtypes, 14years after hysterectomy. Main results from this randomized clinical trial have been published previously; the analyses covered in this paper are exploratory. We performed a long-term questionnaire follow-up of women in a randomized clinical trial (n = 319), from 1996 to 2000 comparing subtotal with total abdominal hysterectomy. Of the randomized women, ten had died and five had left Denmark; 304 women were contacted. For univariate analyses, a χ(2)-test was used, and for multivariate analyses, we used logistic regression. The questionnaire was answered by 197 (64.7%) women (subtotal 97; total 100). More women had subjective stress UI (SUI) in the subtotal group (n = 60; 62.5%) compared with the total group (n = 45; 45%), with a relative risk (RR) of 1.39 [95%confidence interval (CI) 1.06-1.81; P = 0.014]. No difference was seen between subtotal and total abdominal hysterectomy in other LUTS. Factors associated with UI were UI prior to hysterectomy, local estrogen treatment, and body mass index (BMI) > 25kg/m(2). High BMI was primarily associated with mixed UI (MUI) and urgency symptoms. Predictors of bothersome LUTS were UI and incomplete bladder emptying. The difference in the frequency of subjectively assessed UI between subtotal and total abdominal hysterectomy (published previously) is caused by a difference in subjectively assessed SUI; UI prior to hysterectomy and high BMI are related to UI 14years after hysterectomy. The trial is registered on clinicaltrials.gov under Nykoebing Falster County Hospital Record sj-268: Total versus subtotal hysterectomy: http://clinicaltrials.gov/ct2/show/NCT01880710?term=hysterectomy&rank=27.

MP33-17 CONTEMPORARY COMPARISON BETWEEN RETROPUBIC MID URETHRAL SLING (MUS) AND AUTOLOGOUS PUBOVAGINAL SLING (PVS) FOR STRESS URINARY INCONTINENCE (SUI) AFTER THE FDA ADVISORY WARNING

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy I1 Apr 2014MP33-17 CONTEMPORARY COMPARISON BETWEEN RETROPUBIC MID URETHRAL SLING (MUS) AND AUTOLOGOUS PUBOVAGINAL SLING (PVS) FOR STRESS URINARY INCONTINENCE (SUI) AFTER THE FDA ADVISORY WARNING Stephen Mock, Jonathan Angelle, W. Stuart Reynolds, David J. Osborn, Roger R. Dmochowski, and Alexander Gomelsky Stephen MockStephen Mock More articles by this author , Jonathan AngelleJonathan Angelle More articles by this author , W. Stuart ReynoldsW. Stuart Reynolds More articles by this author , David J. OsbornDavid J. Osborn More articles by this author , Roger R. DmochowskiRoger R. Dmochowski More articles by this author , and Alexander GomelskyAlexander Gomelsky More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.968AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES At present, synthetic MUS is widely considered to be the standard of care for female SUI and has largely replaced the PVS, a traditionally more morbid procedure. In light of the 2011 FDA warning on mesh use for pelvic organ prolapse (POP), concerns regarding mesh use, in general, have been raised by both patients and providers. As a result, fewer patients may be opting for mesh. The aim of this study is to compare efficacy and complication rates in a cohort of women who were offered either procedure after the FDA warning and made an informed decision on procedure option. METHODS A total of 201 women underwent either PVS or MUS after the FDA warning was issued in July 2011. Exclusion criteria included prior anti-incontinence surgery, concomitant surgery other than hysterectomy, and POP stage>2. Patients were followed prospectively with validated quality of life (QoL) questionnaires and subjective SEAPI (stress, emptying, anatomy, protection, inhibition) scores. Treatment success was defined as absence of subjective or objective SUI. Peri-operative complications were classified via the Clavien-Dindo scale. RESULTS Minimum follow-up was 12 months (mean 14.6). Ninety one (45%) and 110 (55%) women opted for PVS and MUS, respectively. Preoperative demographics and clinical parameters, including age, body mass index, parity, pad usage, mean abdominal leak point pressure, severity of concomitant POP, SEAPI scores, and mean QoL indices did not differ significantly between the groups. There was no difference in the proportion of women undergoing concomitant hysterectomy (52.7% vs. 50%, p=0.7). Treatment success was similar (75.8% vs. 80.9%, p=0.38) and there was no difference in rates of postoperative voiding dysfunction (1.1% vs. 1.8%, p=0.68) or de novo urgency incontinence (4.4% vs. 4.5%, p=0.96). Length of hospitalization did not significantly differ (1.18 vs. 1.16 days, p=0.9). There was no difference in the occurrence of Clavien-Dindo surgical complications between the two groups (6.6% vs. 10%, p=0.39). CONCLUSIONS Since the 2011 FDA warning, more women are forgoing the use of mesh in the treatment of SUI. In a contemporary cohort of women considered suitable candidates for either sling, both procedures offer comparable efficacy and complication rates. PVS may be safely offered to patients who would otherwise be good candidates for MUS if they are concerned with the implantation of mesh. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e344-e345 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Stephen Mock More articles by this author Jonathan Angelle More articles by this author W. Stuart Reynolds More articles by this author David J. Osborn More articles by this author Roger R. Dmochowski More articles by this author Alexander Gomelsky More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta‐analysis of randomised trials

The combination of prolapse surgery with an incontinence procedure can reduce the incidence of stress urinary incontinence (SUI) after surgery, but may increase adverse events. We compared the effectiveness and safety of prolapse surgery versus combined prolapse and incontinence surgery in women with pelvic organ prolapse. Pubmed, EMBASE, DARE, the Cochrane Library and the register of Current Controlled Trials were searched for randomised trials (restricted to Burch colposuspension and midurethral sling as incontinence procedure) from 1995 to 2013 limited to the English literature. Two reviewers selected eligible articles and extracted the data. Pooling for SUI was based on three patient groups: (1) women with coexisting SUI; (2) women asymptomatic for SUI; and (3) women with occult SUI. For adverse events, pooling was based on incontinence procedure. The primary outcome was SUI. The secondary outcomes were treatment for SUI, bladder storage symptoms, obstructive voiding and adverse events. Seven trials were included. Pooling for women with coexisting SUI was possible for objective SUI with two studies and showed no difference. Statistical (I(2) = 95%) and clinical heterogeneity was, however, high. The largest study showed a lower incidence of persisting SUI (5% versus 23%) and treatment for this (0% versus 57%) in women who underwent prolapse repair with a midurethral sling. The second study did not find a difference in women undergoing a sacrocolpopexy with or without Burch colposuspension. In asymptomatic women, combination surgery resulted in a lower incidence of de novo subjective SUI (two studies; 24% versus 41%; relative risk [RR], 0.6; 95% confidence interval [CI], 0.3-0.9; I(2) = 36%) and the need for subsequent anti-incontinence surgery (three studies; 2% versus 7%; RR, 0.4; 95% CI, 0.2-0.8; I(2) = 13%). For the outcome objective SUI, pooling was possible for five studies, but statistical heterogeneity was high (I(2) = 82%) and the difference was not statistically significant. In the subgroup of women with occult stress incontinence, we found a lower incidence of objective SUI after combination surgery (two studies; 22% versus 52%; RR, 0.4; 95% CI, 0.3-0.8; I(2) = 32%). There were no differences in bladder storage symptoms, urgency incontinence or long-term obstructive voiding symptoms. Adverse events (two studies; 15% versus 10%; RR, 1.6; 95% CI, 1.0-2.5; I(2) = 0%) and prolonged catheterisation (three studies; 6% versus 1%; RR, 4.5; 95% CI, 1.5-13.3; I(2) = 0%) were more frequent after vaginal prolapse repair with a midurethral sling. Combination surgery reduces the risk of postoperative stress incontinence, but short-term voiding difficulties and adverse events were more frequent after combination surgery with a midurethral sling.