Subsequent 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.

The Risk of Stress Urinary Incontinence After Hysterectomy for Uterine Fibroids.

We evaluated the relationship between previous hysterectomy for uterine fibroids and subsequent stress urinary incontinence (SUI). This study analyzed national health insurance data. The hysterectomy group (aged 40 to 59) comprised patients who underwent hysterectomy for uterine fibroids between January 1, 2011 and December 31, 2014, and the control group (aged 40 to 59) comprised patients who visited a medical facility for a checkup during the same time span. One-to-one propensity score matching was performed to balance confounders. SUI was defined as the need for SUI surgery accompanied by a diagnosis code for SUI. After matching, 81,373 cases (hysterectomy group) and 81,373 controls (nonhysterectomy group) were enrolled. The mean follow-up period was 7.9 years for the cases and 7.8 years for the controls. The incidence of anti-incontinence surgery was slightly but significantly higher in the cases than in the controls (2.0% vs. 1.7%, P<0.001). Compared to the control group, abdominal hysterectomy significantly increased the likelihood of anti-incontinence surgery both before (hazard ratio [HR], 1.235; 95% confidence interval [CI], 1.116-1.365) and after adjusting for confounders (HR, 1.215; 95% CI, 1.097-1.347). In contrast, laparoscopic hysterectomy, laparoscopic hysterectomy with adnexal surgery, and abdominal hysterectomy with adnexal surgery were not associated with an increased rate of anti-incontinence surgery. The significant association between abdominal hysterectomy and an elevated rate of anti-incontinence surgery persisted even after stratifying patients by age group. Prior abdominal hysterectomy without adnexal surgery was associated with an increased incidence of subsequent anti-urinary incontinence surgery.

MP37-01 HYSTERECTOMY FOR UTERINE FIBROIDS AND STRESS URINARY INCONTINENCE SURGERY: A NATIONWIDE COHORT STUDY

You have accessJournal of UrologyCME1 Apr 2023MP37-01 HYSTERECTOMY FOR UTERINE FIBROIDS AND STRESS URINARY INCONTINENCE SURGERY: A NATIONWIDE COHORT STUDY Jun Ho Lee Jun Ho LeeJun Ho Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Uterine fibroids (myomas or leiomyomas) are the most common benign uterine neoplasm. Hysterectomy is the most effective treatment for symptomatic uterine fibroids and uterine fibroids are currently the most common indication for hysterectomy worldwide. Previous studies investigated the relationship between the previous hysterectomy for benign conditions and subsequent stress urinary incontinence (SUI). However, the results are inconsistent across the studies. Additionally, long-term follow-up data from large data sets are lacking. Moreover, the impact of the previous hysterectomy for benign indication on subsequent surgery for SUI is scarcely investigated. METHODS: A retrospective cohort study was conducted on women aged 40 to 59 from the Korean Health Insurance Data 2010 to 2018. The hysterectomy group consisted of women who underwent hysterectomy for uterine leiomyoma and the control group consisted of women who visited a medical facility for a checkup between January, 2011 and December, 2014. Main outcome measures included the occurrence of stress incontinence surgery (R3564, R3565, R3562, R3563) with a urinary incontinence diagnosis code (N39.3, N39.4). For the selected hysterectomy group and control group, 1:1 propensity score matching was done on age at 5-year intervals, year at inclusion, socioeconomic status, parity, region, Charlson Comorbidity Index, adnexal surgery before inclusion, menopause before inclusion, menopausal hormone therapy, and pelvic organ prolapse before inclusion. RESULTS: After 1:1 propensity score matching, 81,373 cases and 81,373 controls were enrolled. The mean follow-up period was 7.9 years for cases and 7.8 years for control subjects. The rate of anti-incontinence surgery was significantly higher in the hysterectomy group compared to the non-hysterectomy group (1.7 vs. 2.0%; p<.001). As compared to the non-hysterectomy group, abdominal hysterectomy significantly increased anti-incontinence surgery before and after adjusting confounders (HR: 1.215; 95% CI: 1.097-1.347; p<.001). However, laparoscopic hysterectomy, laparoscopic hysterectomy with adnexal surgery, and abdominal hysterectomy with adnexal surgery did not increase anti-incontinence surgery as compared to the non-hysterectomy group before and after adjusting confounders. This significant relationship between abdominal hysterectomy and anti-incontinence surgery was maintained after stratifying patients according to age group. CONCLUSIONS: In conclusion, hysterectomy, especially transabdominal hysterectomy significantly increases the risk of subsequent anti-incontinence surgery. Our data suggest that patients who plan to undergo transabdominal hysterectomy for the treatment of uterine fibroids should know and be counseled about the risk of SUI and especially the risk of anti-incontinence surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e513 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jun Ho Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Management of post-operative urinary incontinence after midurethral sling explantation for pelvic or perineal pain.

The objective was to report the management of post-operative urinary incontinence after midurethral sling (MUS) revision for chronic pelvic pain (CPP), and to report functional outcomes. From November 2004 to February 2018, a total of 89 women who underwent removal or section of MUS for CPP, were enrolled. Patients were divided into the transobturator tape (TOT) group (50 patients) and the tension-free vaginal tape (TVT) group (37 patients); 2 patients had had both slings implanted. We report the rate of stress urinary incontinence (SUI) recurrence, the rate of de novo urge urinary incontinence (UUI), the need for subsequent SUI or UUI surgery, and functional outcomes (pain and continence). Median follow-up was 41.4months [0.9-138.8]. SUI recurrence or de novo UUI occurred in 52 cases (58.4%): 19 (51.3%) patients in the TVT group, 31 (62%) in the TOT group, and both patients (100%) who underwent total removal of both slings. Among patients with SUI recurrence or de novo UUI, 39 (75%) had pain relief after sling removal. Seventeen patients (32.6%) refused any treatment, 14 (26.9%) were cured with conservative therapy, and 21 (40.3%) underwent SUI or UUI surgery. One patient had de novo pelvic pain after reoperation. The overall continence rate for all patients who underwent sling revision was 82% (73 out of 89) at the last follow-up. After MUS revision for CPP, post-operative UI may occur in 58.4% of patients, of which, one-fourth may be managed with conservative measures only. Forty percent of them had redo surgery with a low risk of pain recurrence and a high rate of urinary continence.

Efficacy and Incontinence Rates After Urethroplasty for Radiation-induced Urethral Stenosis: A Systematic Review and Meta-analysis

To estimate the efficacy of urethroplasty and rates of de novo stress urinary incontinence (SUI) in the specific setting of radiation-induced urethral stenosis. A systematic search of databases (PubMed and EMBASE) was performed between 1980-2019 (CRD42020144845). Inclusion criteria were: (1) prior pelvic radiotherapy; (2) surgical urethroplasty; (3) rates of successful treatment and/or SUI development and (4) total case number provided. The pooled summary of stenosis resolution rate and SUI were calculated using the random-effects model weighted by the inverse variance. Accessory analyses were performed by reconstructive technique and type of RT. Ninety-six studies were identified, of which 8 retrospective studies met inclusion criteria, comprising 256 patients. The proportion of cases treated with external beam RT (EBRT), brachytherapy (BT), or combination (EBRT+BT) were 52%, 33%, and 15%, respectively, of studies that specified modality. Most strictures involved the bulbomembranous region (n = 212; 83%). Sixty-one percent of cases (n = 157) entailed primary anastomosis, while the remainder underwent augmentation reconstruction (graft or flap). The mean follow-up time after urethroplasty varied from 10 to 50.5 months. The pooled stenosis resolution rate was 80% (95% CI: 74%-86%). There were no significant associations between stenosis resolution rate and reconstructive technique (rho=0.20, P = .74) or RT modality (rho=-0.31, P = .53). Fifty-three cases developed subsequent SUI, with a pooled complication rate of 19% (95% CI: 10%-31%). Urethroplasty after radiation-induced urethral stenosis is effective for 80% of cases, independent of prior RT modality or urethroplasty technique; however, 1 out of every 5 patients develops SUI post-procedure.

Bladder neck and urethral erosions after Macroplastique injections

To evaluate the presentation, risk factors, diagnostic workup, management, and outcomes of Macroplastique (MPQ) erosions. We performed a retrospective chart review of women experiencing MPQ erosion at two tertiary care centers (United States and United Kingdom). Data collected included age, presenting symptoms, parity, comorbidities, hormone replacement therapy, sexual activity, and smoking status. Previous surgical history, time from MPQ injection, urine culture results, and cystoscopic and imaging findings were also reviewed. Development of stress urinary incontinence (SUI) after MPQ removal and subsequent SUI treatments were recorded. From 2012 to 2018, 18 patients were identified with a median follow-up time of 24 months (interquartile range [IQR] 8-33). All patients presented with recurrent urinary tract infections (rUTI) and had cystoscopic evidence of MPQ erosion. The most common location of erosion was the bladder neck area (72%). Median time to presentation since MPQ injection was 14 months (IQR 11-35). The majority of patients (72%) had a previous history of anti-incontinence surgery. The overall success rate of endoscopic management defined as resolution of presenting symptoms including rUTI was 80%. The majority of patients (80%) developed recurrent SUI following MPQ resection with 33% requiring a subsequent autologous fascial sling placement. MPQ erosions present predominantly with UTI, sometimes years after the original injection, and may necessitate endoscopic management with satisfactory results in most patients. Following excision of MPQ, these patients are highly likely to experience SUI recurrence and need to be appropriately counseled. Some may require additional subsequent autologous fascial sling placement for treatment of their SUI symptoms.

Rates and Risk Factors for Future Stress Urinary Incontinence Surgery after Pelvic Organ Prolapse Repair in a Large Population-based Cohort in California

ObjectivesTo determine the rate and risk factors for future stress urinary incontinence (SUI) surgery in a large population-based cohort of previously continent women following pelvic organ prolapse (POP) repair without concomitant SUI treatment. MethodsData from the Office of Statewide Health Planning and Development were used to identify all women who underwent anterior, apical, or combined anteroapical POP repair without concomitant SUI procedures in the state of California between 2005 and 2011 with at least 1-year follow-up. Patient and surgical characteristics were explored for associations with subsequent SUI procedures. ResultsOf 41,689 women undergoing anterior or apical POP surgery, 1,504 (3.6%) underwent subsequent SUI surgery with a mean follow-up time of 4.1 years. Age (odds ratio [OR] 1.01), obesity (OR 1.98), use of mesh at the time of POP repair (OR 2.04), diabetes mellitus (OR 1.19), white race, and combined anteroapical repair (OR 1.30) were associated with increased odds of future SUI surgery. ConclusionThe rate of subsequent surgery for de novo SUI following POP repair on a population level is low. Patient and surgical characteristics may alter a woman's individual risk and should be considered in surgical planning.

32: Reoperation rates for stress urinary incontinence and pelvic organ prolapse in women undergoing a mid-urethral sling in academic centers within the United States

The aim of this study was to look at reoperation rates for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women who underwent a primary mid-urethral sling with or without concurrent POP repair. We hypothesized that women undergoing an SUI procedure with concurrent prolapse repairs would have decreased rates of reoperation for both prolapse and stress urinary incontinence. We also theorized that concurrent hysterectomy would be associated with lower rates of reoperation for POP and SUI, while prolapse repair with mesh would be associated with higher complication rates but lower rates of reoperation. The Faculty Practice Solutions Center (FPSC) is an academic hospital consortium database with information from over 60,000 physicians. This database was used to identify a cohort of patients who were treated surgically for SUI with a mid-urethral sling, with or without concurrent prolapse repair between 2009 and 2011. These patients were followed until 2014 for any subsequent SUI or POP surgeries and for any mesh complications that occurred during this time period. Patient variables (age, region, insurance) as well as surgeon volume were analyzed. Concurrent prolapse repair was analyzed based on anatomic involvement (anterior, apical, posterior, or “complete”). Sub-analyses were performed to evaluate the differences in secondary procedures. Of the 20,484 patients who underwent an SUI repair with or without concurrent POP repair, 7.2% required reoperation within the follow up period. There was a significantly higher rate of reoperation in those women who underwent concurrent prolapse repair (8.6 vs 6.3%). Women who had a concurrent prolapse repair had a 2-to-5-fold higher hazard of undergoing a repeat prolapse repair. Concurrent hysterectomy was performed in 15% of patients. While its addition did not lower the hazard of requiring any secondary surgery, it lowered the rate of repeat prolapse surgery in patients who received a concurrent ‘complete’ repair (HR = 0.48). Prolapse mesh was placed in 5% of patients. Its use resulted in a higher hazard of requiring any additional surgery (HR = 1.4), and specifically, increased the hazard of requiring repeat prolapse repair (HR = 1.5). Post-operative fistula, although rare (0.4%), had a significant association with older patients (HR = 2.1) and prolapse mesh (HR = 2.7) placement. Medicaid insurance was associated with higher risk of requiring secondary surgery (HR = 1.3). With over 20,000 patients and up to a 5 year follow-up, this is one of the largest cohort studies performed on the surgical outcomes of mid-urethral slings with or without prolapse repair surgery. While the overall reoperation rate was low, the addition of prolapse repair surgery with the initial sling procedure was associated with higher reoperation rates. In contrast, the addition of a hysterectomy lowered the risk of secondary surgery in some patients. This data allows for a clearer understanding of reoperative rates for patients undergoing mid-urethral sling placement with or without prolapse repair.

Urinary and Fecal Control and Incontinence: Pathogenesis and Management

Introduction: Urinary and Fecal Control depends on two factors, the first is an inherent, and the second is an acquired. The inherent factor is the presence of an intact sound IUS and IAS. The acquired factor is, through toilet training, having and maintaining high sympathetic tone at the IUS and the IAS. This keeps the sphincters contracted and the urethra and the anal canal empty and closed all the time. Laceration of the collagen chassis of the IUS leads to its weakness and subsequent stress urinary incontinence (SUI) and/or over active bladder (OAB). Similarly, lacerations of the collagen chassis of the IAS lead to its weakness and subsequent fecal incontinence (FI). The lacerations in one/or both sphincters are mainly caused by childbirth trauma (CBT). The pelvic collagen is hormone dependent and drop in the estrogen level causes further weakness of the sphincters. In men senile prostatic enlargement compress the upper part of the urethra leading to irregular dilatation of the bladder neck allowing some urine to enter the urethra on increases of abdominal pressure causing frequent desire to void. The start of voiding may take some time (hesitancy) because of the effort to open the urethra which is compressed by the enlarged prostate. Reconstructive surgery: In women the commonest cause of incontinence is traumatic lacerations of the collagen chassis of the IUS and/or the IAS from CBT. Reconstructive surgery is to restore the normal anatomy and it will restore the function. A new operation “urethra-ano-vaginoplasty” is introduced where mending the torn collagen chassis of the IUS and overlapping the anterior vaginal wall flaps over the mended IUS; and mending the torn chassis of the IAS, overlapping the posterior vaginal wall flaps over the mended sphincter, approximate the two levator ani muscles and repair of the perineum is done.

Waves of Change: National Trends in Surgical Management of Male Stress Incontinence

To determine the trend in surgical management of male stress urinary incontinence (SUI) in the context of the rate of radical prostatectomy (RP) as reported by a national database. Traditionally, the artificial urinary sphincter (AUS) has been the gold standard, but the male sling represents a newer and popular alternative. Refinements in prostate surgery may reduce the incidence and degree of subsequent SUI. A retrospective cross-sectional analysis was performed using the National Inpatient Survey database, which captures discharge data from inpatient and overnight admissions. Cases were identified by their International Classification of Diseases, Ninth Revision procedure codes. We queried the codes 58.93 (implantation of AUS), 59.4 (suprapubic sling operation), 59.5 (retropubic urethral suspension), and 59.6 (paraurethral suspension). We also queried 60.5 (RP) for comparison. Data were collected from January 2000 to December 2012 and weighted to a national average using National Inpatient Survey guidelines. A total of 32,416 anti-incontinence operations (20,790 AUS and 11,625 sling procedures) were performed over the study period. There was a significant downward trend in the total number of incontinence procedures (F(1,11) = 6.15, P = .03). However, when stratifying the data by procedure type, only AUS placement demonstrated a significant decline (F(1,11) = 21.70, P <.01), whereas sling procedures significantly increased (F(1,11) = 12.95, P <.01). There was no significant change in the annual incidence of RP. Inpatient surgery for male SUI is decreasing overall. Placement of the AUS declined significantly, whereas sling placement became more common. Future study will determine the etiology of these trends.

Cumulative Incidence of a Subsequent Surgery After Stress Urinary Incontinence and Pelvic Organ Prolapse Procedure.

To assess the 5-year risk and timing of repeat stress urinary incontinence (SUI) and pelvic organ prolapse (POP) procedures. We conducted a retrospective cohort study using a nationwide database, the 2007-2014 MarketScan Commercial Claims and Encounters and Medicare Supplemental Databases (Truven Health Analytics), which contain deidentified health care claims data from approximately 150 employer-based insurance plans across the United States. We included women aged 18-84 years and used Current Procedural Terminology codes to identify surgeries for SUI and POP. We identified index procedures for SUI or POP after at least 3 years of continuous enrollment without a prior procedure. We defined three groups of women based on the index procedure: 1) SUI surgery only; 2) POP surgery only; and 3) Both SUI+POP surgery. We assessed the occurrence of a subsequent SUI or POP procedure over time for women younger than 65 years and 65 years or older with a median follow-up time of 2 years (interquartile range 1-4). We identified a total of 138,003 index procedures: SUI only n=48,196, POP only n=49,120, and both SUI+POP n=40,687. The overall cumulative incidence of a subsequent SUI or POP surgery within 5 years after any index procedure was 7.8% (95% confidence interval [CI] 7.6-8.1) for women younger than 65 years and 9.9% (95% CI 9.4-10.4) for women 65 years or older. The cumulative incidence was lower if the initial surgery was SUI only and higher if an initial POP procedure was performed, whether POP only or SUI+POP. The 5-year risk of undergoing a repeat SUI or POP surgery was less than 10% with higher risks for women 65 years or older and for those who underwent an initial POP surgery.

PD49-11 IS THE GOLD STANDARD SHIFTING? NATIONAL TRENDS IN ANTI-INCONTINENCE SURGERY FOR MEN BASED ON THE NATIONAL INPATIENT SAMPLE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy II1 Apr 2016PD49-11 IS THE GOLD STANDARD SHIFTING? NATIONAL TRENDS IN ANTI-INCONTINENCE SURGERY FOR MEN BASED ON THE NATIONAL INPATIENT SAMPLE Susan MacDonald, Marc Colaco, and Ryan Terlecki Susan MacDonaldSusan MacDonald More articles by this author , Marc ColacoMarc Colaco More articles by this author , and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2747AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stress urinary incontinence (SUI) threatens the quality of life for men after prostate surgery, most commonly radical prostatectomy. The gold standard of surgical management has traditionally been the artificial urinary sphincter (AUS). Alternatively the male sling is typically reserved for men with lesser degrees of incontinence. Refinements in instrumentation and technique related to prostate surgery may reduce the incidence and degree of subsequent SUI. We sought to determine the national trend in surgical management of male SUI in context of the rate of radical prostatectomy. METHODS A retrospective cross sectional analysis was performed using data collected in the National Inpatient Survey (NIS) database. Cases were identified by their ICD-9 procedure codes. For the purpose of identifying incontinence procedures we queried the codes 589.3 (implantation of artificial urinary sphincter [AUS]), 59.4 (suprapubic sling operation), 59.5 (retropubic urethral suspension), and 59.6 (paraurethral suspension) for incontinence procedures. We also queried the database for cases of radical prostatectomy (ICD-9 code 60.5) for comparison. All data was collected for the time period from January 2000 through December 2012. Data was weighted to a national average using NIS guidelines. RESULTS 32,416 men underwent anti-incontinence surgery from 2000-2012, with 20,790 AUS and 11,625 sling procedures. Over the study period there was a significant downward trend in the number of total incontinence procedures performed (F(1,11)=6.15, p= 0.03). However, when stratifying the data by type of procedure, only AUS placement showed a significant decline (F(1,11)=21.70, p<0.01) while sling procedures demonstrated a significant increase (F(1,11)=12.95, p<0.01). There was no significant change in the number of radical prostatectomies. CONCLUSIONS The rate of anti-incontinence surgery for men is decreasing nationally. As it relates to the type of procedure, AUS placement is becoming significantly less common while sling placement is becoming significantly more common. Future work will determine if the trends are related to improved outcomes following prostate surgery, changes in reimbursement for prosthetic urology, or changes in patient and/or surgeon preference. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1184-e1185 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Susan MacDonald More articles by this author Marc Colaco More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP75-19 STRESS URINARY INCONTINENCE OUTCOMES FOLLOWING TRANSVAGINAL SLING INCISION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology II1 Apr 2014MP75-19 STRESS URINARY INCONTINENCE OUTCOMES FOLLOWING TRANSVAGINAL SLING INCISION Lara MacLachlan, Justin Ellett, Kelly Johnson, Gini Ikwuezunma, Michelle Koski, Ross Rames, Ahmed El-Zawahry, and Eric Rovner Lara MacLachlanLara MacLachlan More articles by this author , Justin EllettJustin Ellett More articles by this author , Kelly JohnsonKelly Johnson More articles by this author , Gini IkwuezunmaGini Ikwuezunma More articles by this author , Michelle KoskiMichelle Koski More articles by this author , Ross RamesRoss Rames More articles by this author , Ahmed El-ZawahryAhmed El-Zawahry More articles by this author , and Eric RovnerEric Rovner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2392AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Mid-urethral slings (MUS) have been commonly used in the operative management of stress urinary incontinence (SUI). Unfortunately, many women suffer from complications following MUS surgery that may necessitate a subsequent surgery such as a transvaginal sling incision (TVSI). The objective of this study is to assess the SUI outcomes following TVSI. METHODS A retrospective review of patients who underwent TVSI from 2007 to 2013 was conducted. Indications for the surgery included bladder outlet obstruction (BOO), pelvic pain, dyspareunia, transvaginal exposure of mesh and erosion of mesh into the urinary tract. SUI at baseline and at 3 months follow-up was assessed. SUI was defined as any patient-reported symptoms of SUI, or demonstration of SUI on physical exam, or urodynamic examination. RESULTS A total of 167 patients underwent TVSI with the most common indication being BOO (67.7%). Of the entire cohort, 88/167 (52.7%) had no SUI at baseline and following TVSI 26.1% of these patients had SUI at 3 months follow-up. Of the 113 patients with BOO at presentation, 67 (59.3%) patients had no SUI at baseline and 16/67 (23.9%) patients had SUI at 3 months follow-up. 17/39 (43.6%) patients with transvaginal mesh exposure had no SUI at baseline and 23.5% of these patients had SUI following TVSI. Of the 23 patients with mesh erosion into the urinary tract, 11 (47.8%) patients had no SUI at baseline and 6/11 (54.5%) patients had SUI at 3 months. Of the 66 patients with pelvic pain, 10/30 (33.3%) patients had SUI following TVSI who did not have SUI at baseline. Of the 78 patients with dyspareunia, 10/34 (29.4%) who did not have SUI at baseline had SUI following TVSI. There were 46 patients with SUI and BOO at baseline and following TVSI, 21 patients (45.7%) continued to have SUI at 3 months. Of the 33 patients with SUI and no BOO at baseline, concomitant slings were done on 5 patients at the time of TVSI (2 MUS and 3 autologous pubovaginal slings (aPVS). One patient with concomitant MUS had SUI at 3 months and no patient with a concomitant aPVS had SUI at 3 months. 19 patients have undergone subsequent SUI surgery or bulking injection (11 aPVS, 3 MUS, 2 bladder neck closures, and 3 bulking agents). CONCLUSIONS For patients who do not have SUI at baseline, recurrent SUI following TVSI is not commonly seen. However, for those patients with mesh erosion into the urinary tract or SUI at presentation, recurrent/persistent SUI is seen in over 50% of patients. This knowledge can be used in counseling patients who undergo TVSI. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e881 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Lara MacLachlan More articles by this author Justin Ellett More articles by this author Kelly Johnson More articles by this author Gini Ikwuezunma More articles by this author Michelle Koski More articles by this author Ross Rames More articles by this author Ahmed El-Zawahry More articles by this author Eric Rovner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Risk of Surgically Managed Pelvic Floor Dysfunction in Relation to Age at First Delivery

Objective The purpose of this study was to compare the risk of surgically treated stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in relation to mode of delivery and age at first childbirth. Study Design This was a cohort study. Data from the Swedish Medical Birth Register on women with only cesarean delivery (n = 30,880 women) or only vaginal delivery (n = 59,585 women) were compared with the Swedish Patient Register to calculate incidence rates and hazard ratios (95% confidence interval [CI]) for SUI and POP surgery. Results In analyses that were stratified by age, vaginal delivery consistently increased the risks of SUI and POP surgery. Among vaginally delivered women who were ≥30 years old, incidence rates of POP surgery were 13.8 (95% CI, 12.7–15.1), and for younger women were 6.4 (95% CI, 6.0–6.8) per 10,000 person-years. Exclusion of instrumental vaginal delivery did not alter the conclusions. Conclusion Increasing age at first delivery increased the risk of subsequent SUI and POP surgery after both vaginal and cesarean delivery.

Risk of surgically managed pelvic floor dysfunction in relation to age at first delivery

The purpose of this study was to compare the risk of surgically treated stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in relation to mode of delivery and age at first childbirth. This was a cohort study. Data from the Swedish Medical Birth Register on women with only cesarean delivery (n = 30,880 women) or only vaginal delivery (n = 59,585 women) were compared with the Swedish Patient Register to calculate incidence rates and hazard ratios (95% confidence interval [CI]) for SUI and POP surgery. In analyses that were stratified by age, vaginal delivery consistently increased the risks of SUI and POP surgery. Among vaginally delivered women who were ≥ 30 years old, incidence rates of POP surgery were 13.8 (95% CI, 12.7-15.1), and for younger women were 6.4 (95% CI, 6.0-6.8) per 10,000 person-years. Exclusion of instrumental vaginal delivery did not alter the conclusions. Increasing age at first delivery increased the risk of subsequent SUI and POP surgery after both vaginal and cesarean delivery.

Adherence to the 1997 American Urological Association Guidelines for the Surgical Treatment of Stress Urinary Incontinence

To review the published literature in the Journal of Urology (JU) and Urology (UR) particular to the surgical treatment of stress urinary incontinence (SUI), to assess whether the recommendations as set forth by the original American Urological Association (AUA) Female Stress Urinary Incontinence Clinical Guidelines Panel were substantially adhered to in the subsequent SUI surgical literature. An online search of JU and UR was conducted to collect all articles published between January 1998 and September 2006 reporting on the surgical treatment of female SUI using any technique. Articles were reviewed and abstracted for the various data points specified by the original Guidelines Panel that were recommended as a minimum baseline data set as well as standards of efficacy for future trials. A total of 90 articles (JU = 57, UR = 33) meeting the above criteria were identified and included in this analysis. There were no articles meeting all criteria, but most complied with at least half of the recommendations. Since the publication of the 1997 AUA SUI guidelines, adherence to the recommendations of efficacy for future trials in the articles published in the major U.S. urological journals has been suboptimal. The implications of this for the next AUA SUI Guidelines Panel, whose recommendations are based on the intervening literature since the last Guidelines Panel report, are unclear.