Surgery For Female Urinary Incontinence Research Articles

Making a decision about surgery for female urinary incontinence: a qualitative study of women\u2019s views

Introduction and hypothesisThis qualitative interview study explores aspects women with urinary incontinence(UI) reflect upon when considering whether or not to have surgery. Conducted prior to the recent mesh pause in the UK, the article provides insights for current and future approaches to shared decision-making.MethodsQualitative in-depth interviews of 28 patients referred to secondary care for stress and mixed UI who were considering UI surgery. Participants were recruited from four urogynaecology clinics in the Midlands and South England, UK. Interviews were conducted in clinics, in patient homes, and by telephone. Data analysis was based on the constant comparative method.ResultsParticipants’ accounts comprised three key concerns: their experience of symptoms, the extent to which these impacted a variety of social roles and demands, and overcoming embarrassment. Accounts drew on individual circumstances, values, and concerns rather than objective or measurable criteria. In combination, these dimensions constituted a personal assessment of the severity of their UI and hence framed the extent to which women prioritized addressing their condition.ConclusionsAcknowledging women’s personal accounts of UI shifts the concept of ‘severity’ beyond a medical definition to include what is important to patients themselves. Decision-making around elective surgery must endeavour to link medical information with women’s own experiences and personal criteria, which often change in priority over time. We propose that this research provides insight into how the controversy around the use of mesh in the UK emerged. This study also suggests ways in which facilitating shared decision-making should be conducted in future.

Mini-invasive tension-free surgery for female urinary incontinence

The Authors describe the techniques they perform of prepubic, retropubic and transobturator mini-invasive anti-incontinence surgical procedures and point-out some technical details. The state of art and the results of these three main surgical procedure are compared and discussed. Data from the Literature have been reviewed in order to evaluate the efficacy of the techniques. A Medline search has been performed, and 65 relevant articles from 1996 to 2012 were selected. Literature showed similar cure rates among retropubic (71,4-91%), trans-oburator (77,3-95%) and prepubic (81-87,2%) anti-incontinence procedures. Cystoscopy was considered necessary in the retropubic, optional in transobturator and in the prepubic techniques. Intra-operative cough stress test was believed useful only in the retropubic and prepubic procedures. Obstruction symptoms prevailed in the retropubic, were rare in the transobturator and missing in the prepubic technique. Erosion rate was very low and similar for all the three techniques. Intra-operative vascular and perforating risks prevailed in the retropubic technique, due to the danger present in the retropubic space, whereas late infective complications overcame in the transobturator procedure. Severe complications in the prepubic procedure were not reported, but the procedure is performed only in few centers.

Transvestibular urethrolysis

ObjectiveBladder outlet obstruction with obstructive and irritative urinary symptoms may be a complication of surgery for female urinary incontinence. In the presence of persistent symptoms, the therapy is surgical and usually consists in an accurate urethrolysis. The way of approach is generally transvaginal. In this paper we propose and describe our experience with a transvestibular approach. Material and methods18 women who had undergone anti-incontinence surgery (TVT 12 pts, TOT 3 pts, Burch retropubic colposuspension 3 pts) with obstruction and/or irritative symptoms underwent a transvestibular urethrolysis. Five patients had urinary retention and the rest of the patients had post voiding residual urine>100ml. Using a scalpel blade a circum-meatal incision was performed and the urethra was progressively freed, dissecting just below the os pubis upwards and on the vaginal wall downwards, untethering it under direct vision in order to obtain a complete circular freeing of the urethra. In the end, the urethral meatus is repositioned with circular stitches. ResultsThe operation lasts between 20 and 40min. An urethral catheter was left in place for 24–48h and no complications were observed. The post-voiding residual urine decreased in all of the cases and the irritative symptoms were reduced. ConclusionsThe transvestibular approach for urethrolysis is safe and effective regardless of the previous anti-incontinence surgery carried out. This procedure has the advantage of working in a relatively unscarred tissue, allows for a complete untethering of the urethra even in the retropubic space and leaves the vaginal wall intact.

Uretrolisis transvestibular

ObjectiveBladder outlet obstruction with obstructive and irritative urinary symptoms may be a complication of surgery for female urinary incontinence. In presence of persistent symptoms, the therapy is surgical and usually consists in an accurate urethrolysis. The way of approach is generally transvaginal. In this paper we propose and describe our experience with a transvestibular approach. Material and methods18 women who had undergone anti-incontinence surgery (TVT 12 pts, TOT 3 pts, Burch retropubic colposuspension 3 pts) with obstruction and/or irritative symptoms underwent to a transvestibular urethrolysys. Five patients had urinary retention and the rest of patients had post voiding residual urine>100ml. Using a scalpel blade a circum-meatal incision was performed and the urethra was progressively freed, dissecting just below the os pubis upwards and on the vaginal wall downwards, untethering it under direct vision in order to abtain a complete circular freeing of the urethra. In the end, the urethral meatus is repositioned with circular stiches. ResultsThe operation lasts between 20 and 40minutes. An urethral catheter was left in place for 24-48hours and no complications were observed. The post-voiding residual urine decreased in all of the cases and the irritative symptoms were reduced. ConclusionsThe transvestibular approach for urethrolysis is safe and effective regardless of the previous anti-incontinence surgery carried out. This procedure has the advantage of working in a relatively unscarred tissue, allows for a complete untethering of the urethra even in the retropubic space and leaves the vaginal wall intact.

Minimally Invasive Surgery for Female Urinary Incontinence: Experience with Periurethral Microballoon Implantation

To assess the effectiveness of periurethral microballoon implantation for management of female urinary incontinence. A total of 45 women with urinary incontinence (age range 47-88 years) were treated between May 2000 and June 2001. Microballoons were placed in the proximal periurethral tissue using endoscopic instrumentation under local anesthesia. Follow-up assessment including urodynamic study and quality- of-life assessment was performed at 1, 3, and 6 months. Implantation was successful in all cases with no significant adverse effects. Cure was achieved in 60% and improvement in 5%. The failure rate was 35%. Microballoon implantation significantly increased the mean urethral closure pressure, from 35.2 cm H(2)O (SD 14.9; range 15-72 cm H(2)O) to 46.5 cm H(2)O (SD 19.7; range 16-87 cm H(2)O) (P = 0.001). The best predictors of successful outcome in univariate analysis were initial urethral closure pressure (P = 0.047) and degree of incontinence (P < 0.001). Periurethral microballoon implantation is a useful technique for the management of female urinary incontinence, especially in elderly and inoperable patients. The microballoons do not present the adverse effects associated with other bulking agents.

Declining trend in major gynaecological surgery in The Netherlands during 1991-1998. Is there an impact on surgical skills and innovative ability?

To assess the number of major surgical procedures in gynaecology over a period of eight years in The Netherlands and to detect possible trends. Relevance of the trends and the possible impact on surgical skills and on innovative ability are discussed. Observational study. Hospital care in The Netherlands. Data from a national hospital discharge database, from all 119 hospitals in The Netherlands. When a patient is discharged from the hospital. data on the diagnosis and treatment are registered by local medical officers and administrators. Registration of surgical procedures is based on the International Classification of Procedures in Medicine (ICPM, WHO 1978), the so-called WCC-standard. All hospitals but one (a cancer centre) in The Netherlands participate in this registration, resulting in 99.3% of all admissions. Data on gynaccological manpower were obtained from the Dutch College of Obstetricians and Gynaecologists. In order to standardise the frequency numbers per 1,000 women, yearly data of the female population according to age were obtained from the Central Office for Population Statistics. The female population aged 20 years of age and older increased 3% between 1991 and 1998, from 5.8 million to 6.0 million. In the same period the number of gynaecologists grew from 604 to 625, also an increase of 3%. The total number of hysterectomies dropped from 21,433 in 1991 to 16,320 (-24 %) in 1998 (chi2 for trend 1,245.1. P < 0.001) Surgery of the uterine cavity, either performed hysteroscopically or blind, increased from 311 to 1,958 (+ 625%) cases per year (chi2 for trend 2,459.2, P < 0.001). No trend has been detected in the numbers of adnexal operations, including surgical treatment of tubal pregnancy (tubotomy or tubectomy). In 1998, 12% of all ovarian surgery and 28% of all surgery for ectopic pregnancies was performed laparoscopically. Surgery for female urinary incontinence experienced a strong decline of 46% in the studied period. The frequency of vaginal repair decreased with 1354 (-16%) cases. The abdominal prolapse surgery (abdominal sacral colpopexy, obliteration of the Douglas pouch) is steadily increasing, although the absolute numbers are small. In 1998 seven hundred and forty-three women underwent an abdominal approach of their prolapse repair, compared with 7239 that had the vaginal repair. The declining trend of major gynaecological surgery in combination with the increasing number of gynaecologists will result in more difficulty for gynaecologists to acquire and maintain surgical skills and may therefore affect their ability to innovate within the surgical profession.

Declining trend in major gynaecological surgery in The Netherlands during 1991-1998. Is there an impact on surgical skills and innovative ability?

Objectives To assess the number of major surgical procedures in gynaecology over a period of eight years in The Netherlands and to detect possible trends. Relevance of the trends and the possible impact on surgical skills and on innovative ability are discussed. Design Observational study. Setting Hospital care in The Netherlands. Sample Data from a national hospital discharge database, from all 119 hospitals in The Netherlands. Methods When a patient is discharged from the hospital, data on the diagnosis and treatment are registered by local medical officers and administrators. Registration of surgical procedures is based on the International Classification of Procedures in Medicine (ICPM, WHO 1978), the so-called WCC-standard. All hospitals but one (a cancer centre) in The Netherlands participate in this registration, resulting in 99.3 % of all admissions. Data on gynaecological manpower were obtained from the Dutch College of Obstetricians and Gynaecologists. In order to standardise the frequency numbers per 1000 women, yearly data of the female population according to age were obtained from the Central Office for Population Statistics. Results The female population aged 20 years of age and older increased 3% between 1991 and 1998, from 5.8 million to 6.0 million. In the same period the number of gynaecologists grew from 604 to 625, also an increase of 3%. The total number of hysterectomies dropped from 21,433 in 1991 to 16,320 (-24 %) in 1998 (χ 2 for trend 1245.1, P< 0.001) Surgery of the uterine cavity, either performed hysteroscopically or blind, increased from 311 to 1,958 (+ 625 %) cases per year (χ 2 for trend 2459.2, P<0.001). No trend has been detected in the numbers of adnexal operations, including surgical treatment of tubal pregnancy (tubotomy or tubectomy). In 1998, 12% of all ovarian surgery and 28% of all surgery for ectopic pregnancies was performed laparoscopically. Surgery for female urinary incontinence experienced a strong decline of 46% in the studied period. The frequency of vaginal repair decreased with 1354 (-16 %) cases. The abdominal prolapse surgery (abdominal sacral colpopexy, obliteration of the Douglas pouch) is steadily increasing, although the absolute numbers are small. In 1998 seven hundred and forty-three women underwent an abdominal approach of their prolapse repair, compared with 7239 that had the vaginal repair. Conclusions The declining trend of major gynaecological surgery in combination with the increasing number of gynaecologists will result in more difficulty for gynaecologists to acquire and maintain surgical skills and may therefore affect their ability to innovate within the surgical profession.

Surgery for female urinary incontinence

There has been very little advance in the surgery of female urinary incontinence over the past 20 years. In our opinion this is due to 1) uncritical acceptance of the intraabdominal pressure transmission theory, 2) uncritical acceptance of the concept of "detrusor instability," and 3) limited and uncritical evaluation of results of surgery. A new theory for female urinary incontinence is presented. This theory explains existing phenomena in terms of anatomic defects in the vagina and its supporting ligaments. Based on this theory, a new classification of female urinary incontinence and several new minimally invasive surgical procedures are briefly introduced.

Predictive value of detrusor instability index in surgery for female urinary incontinence

AbstractPre‐ and postoperative data were reviewed in 33 female patients with urinary incontinence associated with demonstrated detrusor instability who underwent conventional anti‐incontinence surgery (anterior colporrhaphy or colposuspension).Generally, the surgical result was poor. Only 27% (95% confidence limits 13–46%) were subjectively and objectively cured. In patients with a detrusor instability index ≤0.4 cure rate was significantly better compared to patients with an index &gt; 0.4.In conclusion, simple cystometric data, in particular the detrusor instability index, seem to provide valuable predictive information regarding the outcome of conventional surgery in females with urinary incontinence associated with detrusor instability.

313 - Outcome of Surgery for Female Urinary Incontinence

No AccessJournal of Urology1 Jun 1987Outcome of Surgery for Female Urinary Incontinence Ananias C. Diokno, M.D. Morton B. Brown, Ph.D. Bruce M. Brock, andPh.D. A. Regula HerzogPh.D. Ananias C. DioknoAnanias C. Diokno More articles by this author , Morton B. BrownMorton B. Brown More articles by this author , Bruce M. BrockBruce M. Brock More articles by this author , and A. Regula HerzogA. Regula Herzog More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)75463-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Outcome of Surgery for Female Urinary Incontinence." The Journal of Urology, 137(6), p. 182A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 6June 1987Page: 182A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Ananias C. Diokno More articles by this author Morton B. Brown More articles by this author Bruce M. Brock More articles by this author A. Regula Herzog More articles by this author Expand All Advertisement PDF DownloadLoading ...