Surgical Management Of Urinary Incontinence Research Articles

Overview of Surgical Management of Urinary Incontinence

Overview of Surgical Management of Urinary Incontinence

SC240 - Contemporary trends in the surgical management of urinary incontinence after radical prostatectomy in the United States

SC240 - Contemporary trends in the surgical management of urinary incontinence after radical prostatectomy in the United States

S2468 Stop, Drop, and Roll: One Woman’s Pelvic Floor Disease Journey

Introduction: Pelvic floor disease includes symptoms of the anterior (urinary, vaginal) and posterior (anorectal) pelvic floor. This case describes a woman who developed dyssynergic defecation after surgical management of urinary incontinence. The diagnostic route taken to reveal the unusual cause of her symptoms is a lesson in how to evaluate ambiguous gastrointestinal(GI)/genitourinary symptoms. Case Description/Methods: A 69-year-old woman presents with bloating and difficulty defecating for 2 years. She senses incomplete evacuation, passing 1-2 thin stools per day despite an extensive bowel regimen (e.g. posturing, straining). Two years ago, she underwent sacrocolpopexy and mesh placement to treat pelvic organ prolapse. Her urinary incontinence improved but constipation worsened. She was thus evaluated by GI- many CTs showed nonspecific sigmoid (SC) thickening. A colonoscopy noted SC narrowing; mucosa pathology was normal. She came to our clinic to investigate further. Digital rectal exam had a normal tone with widening of the vault with strain. Anorectal manometry (ARM) showed dyssynergic defecation and unsuccessful balloon expulsion, consistent with mechanical obstruction. A flexible sigmoidoscopy showed benign-appearing extrinsic compression at the rectosigmoid junction. The SC also had a large stool burden despite 2 pre-procedure enemas. Given a concern for mass effect of the mesh into the colon, an exploratory laparoscopy was performed, showing a redundant SC with scarred, edematous mesentery. A partial sigmoidectomy was performed and adhesions at the anterior rectal wall (near the sacrocolpopexy mesh) were lysed. In just 3 months, the patient’s symptoms resolved. Repeat ARM had a normal defecation pattern and balloon expulsion (Figure). Discussion: Postoperative adhesions are present after 63-97% of open abdominal surgeries. The most common complication of such adhesions is bowel obstruction, occurring in 15% of patients within 1 month of surgery. Our patient had an even more unique complication- constipation and dyssynergic defecation. Literature on post-op adhesions and defecation dysfunction mainly describes surgery of the rectal sphincter. In contrast, the sacrocolpopexy did not involve the rectum or surrounding peritoneum, but caused adhesions with a mass effect on the rectum. Given the morbidity associated with lower abdominal adhesions, suspicion must remain high in populations with a history of complicated abdominal surgery- especially for treatment of anterior pelvic floor disease.Figure 1.: A. Flexible sigmoidoscopy: Very narrowed lumen in the sigmoid colon. B. CT abdomen and pelvis: Coronal view showing sharp angulation in the sigmoid colon (due to the mass effect of the mesh and adhesions) C.Anorectal manometry: The Y-axis notes length (cm) from anal sphincter (0cm) into sigmoid. The X-axis shows time (in seconds). The color of the data points denotes pressure exerted. Here, the top horizontal line in green shows rectal pressure. The same amount of pressure is shows in the bottom “green” areas, indicating that anal tone faily to appropriately relax. This increase in anal pressure with a good push, indicating dyssynergic defecation pattern.

Contemporary trends in the surgical management of urinary incontinence after radical prostatectomy in the United States.

To identify trends, costs, and predictors in the use of different surgical procedures for post-radical prostatectomy incontinence (PPI). We identified 21,589 men who were diagnosed with localized prostate cancer (PCa) and treated with radical prostatectomy (RP) from 2003 to 2017. The primary outcome was the incontinence procedure performances. Optum's de-identified Clinformatics® Data Mart Database was queried to define the cohort of interest. The average costs of the different incontinence procedures were obtained and compared. Also, demographic, and clinical predictors of incontinence surgery were evaluated by multivariable regression analysis. Of the 21,589 men with localized PCa treated with RP, 740 (3.43%) underwent at least one incontinence procedure during a median of 5 years of follow-up. In total, there were 844 unique incontinence procedures. Male slings were the most common procedure (47.5%), had an intermediate cost compared to the other treatment options, and was the first-choice treatment for the majority of patients (50%). The use of an artificial urinary sphincter (AUS) was the second most common (35.3%), but also was the most expensive treatment and was first-choice-treatment for 32.3% of patients. On multivariable analysis, metabolic syndrome related disorders, adjuvant/salvage radiation therapy as well as a history of neurological comorbidities were independently associated with an increased likelihood of incontinence surgery. The receipt of male slings increased and then subsequently decreased, while AUS utilization was stable, and the use of urethral bulking agents was uncommon. From a cost standpoint, AUS was the most expensive option. Finally, patient's comorbidity history and RP related factors were found to influence the choice for primary or subsequent PPI interventions.

MP52-17 RACIAL AND REGIONAL DISPARITIES AND SURGICAL INTERVENTION FOR URINARY INCONTINENCE AFTER PROSTATE CANCER THERAPY: A SEER-MEDICARE STUDY

You have accessJournal of UrologyCME1 May 2022MP52-17 RACIAL AND REGIONAL DISPARITIES AND SURGICAL INTERVENTION FOR URINARY INCONTINENCE AFTER PROSTATE CANCER THERAPY: A SEER-MEDICARE STUDY Nishant Garg, Alexandra Muise, Michael Pan, Michael Witthaus, Brent Rose, and Jill Buckley Nishant GargNishant Garg More articles by this author , Alexandra MuiseAlexandra Muise More articles by this author , Michael PanMichael Pan More articles by this author , Michael WitthausMichael Witthaus More articles by this author , Brent RoseBrent Rose More articles by this author , and Jill BuckleyJill Buckley More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002627.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary incontinence after prostate cancer therapy can significantly affect quality of life, with some men eligible for corrective surgery. Our objective is to evaluate the potential racial disparities for surgical management of urinary incontinence in patients who have undergone prior prostate cancer therapy. METHODS: Medicare claims from 2004-2013 were used to identify men aged 66 years or older who met inclusion criteria and underwent either prostatectomy (RP) or radiation (RT). Medicare Part A and B claims for incontinence were captured using HCPCS and ICD-9-CM codes along with the associated codes for the therapeutic surgeries. Differences in the covariates between treatment groups were evaluated using pairwise Chi-Square tests, and time to event analyses for surgery were calculated using Kruskal-Wallis tests. Outcomes were reported as hazard ratios with 95% confidence intervals, with statistical significance being reported as p < 0.05 on SASTM. RESULTS: A total of 63,158 men were identified in the cohort of which 15,143 men underwent RP and 44,694 underwent RT. There was no statistically significant difference in rates of incontinence surgery such as artificial urinary sphincter (AUS) and male sling (MS) between white and black men after either RT or RP. Black men had delayed treatment for incontinence compared to white men (27 vs 25 months for AUS and 27.5 vs 22 months for male sling). Men in the east were more likely to have incontinence after both RP and RT compared to men in the west but were not more likely to have any corrective surgery for this (Table 1). Men from the south were not more likely to have incontinence after RP compared to men from the west, but were more likely to get a MS (1.356 (1.086-1.692), p <0.0071). CONCLUSIONS: There was no difference in overall rates of surgical treatment for incontinence after either RT or RP between white and black men. There was a difference between men in the east vs west. These results may help improve counseling for men eligible for incontinence surgery, including based on region of the country but not stratified by race. Future research is needed in identifying the systems that may be associated with delayed surgical care. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e893 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nishant Garg More articles by this author Alexandra Muise More articles by this author Michael Pan More articles by this author Michael Witthaus More articles by this author Brent Rose More articles by this author Jill Buckley More articles by this author Expand All Advertisement PDF DownloadLoading ...

Recommandations françaises du Comité de transplantation de l’association française d’urologie (CTAFU) : symptômes du bas appareil urinaire et incontinence urinaire chez le patient transplanté ou en attente de transplantation rénale

To propose surgical recommendations for the management of lower urinary tract symptoms (LUTS) and urinary incontinence in kidney transplant recipients and candidates. Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU focusing on medical and surgical treatment of LUTS and urinary incontinence in kidney transplant recipients and candidates. References were assessed according to a predefined process to propose recommendations with levels of evidence. Functional bladder capacity and bladder compliance are impaired during dialysis. LUTS, related to pre-kidney transplantion alterations, frequently improve spontaneously after kidney transplantation. LUTS secondary to benign prostatic hyperplasia (BPH) may be underestimated before kidney transplantation due to oliguria, low bladder compliance and low bladder capacity. In LUTS associated with BPH, anticholinergics require dosage adjustment with creatinine clearance. If surgery is indicated after kidney transplantation, procedure can be safely performed in the early post-transplant course after removal of ureteral stent. Surgical management of urinary incontinence does not seem to be associated with an icreased risk for infectious complications in kidney transplant recipients. Particular attention should be paid to the management of postvoid residual and bladder pressures in case of neurological bladder disease. Optimal care of neurological bladder should be provided prior to transplantation: with a cautious management, and despite an increased occurrence of febrile urinary tract infections, transplant survival is not compromised. These recommendations must contribute to improve the management of lower urinary tract symptoms and urinary incontinence in kidney transplant patients and kidney transplant candidates.

National Trends in the Surgical Management of Urinary Incontinence among Insured Women, 2004 to 2013: The Urologic Diseases in America Project.

The objective of this study was to examine national trends in the surgical management of urinary incontinence in women in the United States from 2004 to 2013. We analyzed the CDM (Optum® de-identified Clinformatics® Data Mart) for women 18 to 64 years old and the CMS (Centers for Medicare and Medicaid Services) Medicare 5% Sample for women 65 years old or older. We created annual cross-sectional cohorts and assessed trends in the annual prevalence of urinary incontinence related surgical procedures overall and by age, race/ethnicity and geographic region. We observed a decline in the percent of women with urinary incontinence who underwent surgical treatment according to the CMS (from 4.7% in 2004 to 2.7% in 2013) and the CDM (from 12.5% in 2004 to 9.1% in 2013). This trend persisted independently of age, race/ethnicity and geographic region. Slings were the most common procedure but started to decline in 2011, ultimately decreasing by about 50% during the study period. Compared to other groups the prevalence of urinary incontinence related surgical procedures, including slings, was highest among women 35 to 54 years old and White women, and lowest among women residing in the Northeast. These sociodemographic patterns persisted with time. During the study period injection procedures remained stable, sacral neuromodulation increased slightly but remained uncommon and suspension decreased to nearly 0% of all anti-incontinence procedures. Surgical management of female urinary incontinence experienced several shifts from 2004 to 2013, including a decline in sling procedures. Age, racial/ethnic and regional differences in treatment persisted with time. Improved understanding of the drivers of these trends may help direct future development of treatments of pelvic floor disorders.

Recent advances in surgical management of urinary incontinence.

There have been several recent developments in surgical treatments for male and female incontinence. This article reviews the current options for treatments of urge and stress incontinence in men and women. Treatments for urge incontinence discussed include intradetrusor onabotulinum toxin A, sacral neuromodulation and percutaneous tibial nerve stimulation. For stress incontinence, suburethral mesh, bulking agents, autologous slings, colposuspension, male slings and artificial urinary sphincters are assessed.

V03 - Surgical management of urinary incontinence after radical prostatectomy

V03 - Surgical management of urinary incontinence after radical prostatectomy

Commentary to ‘Long-term fate of the bladder after isolated bladder neck procedure’

sphincter in children and young adults. J Urol 2003;169: 650e4. [11] Hidas G, Ortiz-Vanderdys G, Braga LH, Khoury AE. Are bladder and renal function at risk after a procedure to increase bladder outlet resistance? A systematic review and metaanalysis. In: European Society for Pediatric Urology meeting; 2013. Genoa, Italy. [12] Kryger JV, Gonzalez R, Barthold JS. Surgical management of urinary incontinence in children with neurogenic sphincteric incompetence. J Urol 2000;163:256e63.

Simultaneous Augmentation Cystoplasty and Cuff Only Artificial Urinary Sphincter in Children and Young Adults with Neurogenic Urinary Incontinence

We review our experience with artificial urinary sphincter and augmentation cystoplasty in patients with neurogenic bladder. This is the largest known series to specifically evaluate cuff only artificial urinary sphincter at augmentation cystoplasty. A total of 18 males underwent simultaneous artificial urinary sphincter and augmentation cystoplasty at our institution between 1982 and 2012, of whom 13 (72%) underwent cuff only artificial urinary sphincter. Outcomes included urinary continence, emptying modality, artificial urinary sphincter status, complications and additional procedures. Of the patients undergoing augmentation cystoplasty and cuff only artificial urinary sphincter 10 (77%) were initially continent. Average time of continence was 52.9 months. Four patients (31%) required no additional procedures and remained continent. Urinary incontinence developed in 3 patients (23%) immediately postoperatively and in 6 (46%) subsequently. Ultimately 9 patients (69%) required conversion to complete artificial urinary sphincter at a mean of 36.9 months postoperatively. Overall 12 patients (92%) were continent at followup. There were no artificial sphincter specific complications in patients undergoing the cuff only procedure with conversion to complete artificial urinary sphincter. After conversion to complete artificial urinary sphincter 3 patients (23%) experienced artificial sphincter specific complications. Reoperation was performed in 10 patients (77%), for 13 total procedures (1.3 per patient). There were no complications with cuff only artificial urinary sphincter and 6 complications with complete artificial urinary sphincter (p = 0.025). Finally, patients undergoing cuff only artificial urinary sphincter requiring revision were younger than those not requiring revision (15.6 vs 30.8 years, p = 0.026). Simultaneous cuff only artificial urinary sphincter and augmentation cystoplasty appears safe and efficacious in patients with neurogenic bladder, with fewer complications than complete artificial urinary sphincter, and may provide definitive urinary continence in up to a third of patients. This procedure is technically easy, allows for outpatient revision, provides time for the child to mature and may be cost effective in avoiding placement of additional components in this select patient population.

Routine Use of Preoperative Cystourethroscopy on the Surgical Management of Urinary Incontinence and Pelvic Organ Prolapse

To determine the impact of routine preoperative cystourethroscopy on the surgical management of urinary incontinence and pelvic organ prolapse. Retrospective review of consecutive women undergoing surgery for urinary incontinence and/or pelvic organ prolapse at a tertiary referral urogynecology center to determine whether the routine use of preoperative cystourethroscopy changed the surgical management. Patients with other indications for cystourethroscopy were excluded. A total of 283 consecutive charts were reviewed of which 235 met inclusion criteria. Five patients accounted for 6 abnormal findings on preoperative cystourethroscopic examination including 2 bladder calculi, 2 lesions suspicious for neoplasm, and 2 cases of absent unilateral ureteric efflux. In only one case (0.5%) was the surgical plan altered. The routine use of preoperative cystourethroscopy in low-risk patients being prepared for surgery for urinary incontinence and pelvic prolapse is not required when no other indications for cystourethroscopy exist.

Currently performed continence surgery: How useful are hospital episode statistics?

SummaryThe aim of this study was to examine current trends in selecting continence operations for female patients in the UK. An online data search was carried out using the Hospital Episode Statistics website (www.hesonline.nhs.uk). Only operations performed on women were included. A request for more detailed information was submitted but no information was provided. Data were available for 4 years, from 2002–2003 until 2005–2006. It was difficult to establish trends regarding mid-urethral slings, including tension-free vaginal tape and transobturator tape, both inside out and outside in, as well as single incision slings. A respectable number of operations were coded as other specified and unspecified. The poor specificity of codes used and delayed availability of data precluded obtaining clear information about trends in the surgical management of urinary incontinence in women. There is a need to develop new codes that match changes in continence surgery and to provide data at the end of each financial year. This will help monitoring performance, audit as well as research.

Bacteriological analysis of meshes removed for complications after surgical management of urinary incontinence or pelvic organ prolapse

The aim of this study is to examine the role of bacterial infection in complications following surgical management of urinary incontinence and genital prolapse using meshes. There were sixteen prostheses removed. Eight were monofilament polypropylene-knitted meshes, one was a silicone-coated polypropylene mesh, another was a collagen-coated polypropylene mesh, four were silicone-coated polyester meshes and two were polyester meshes. The most frequent cause for removal was symptomatic vaginal erosion (62%). Cultures were performed under aerobic, anaerobic and enrichment conditions. Infection was multimicrobial for 31% of meshes. When only one bacteria was found, it was Proteus mirabilis in 25% of cases. Forty-three per cent of bacterial quantifications were under 10(3) colony-forming units per millilitre. Bacterial contamination was found in all meshes, quantification was often low, and therefore, its exact role is not yet clear.

Surgical Management of Urinary Incontinence in Older Women

The aim of this review is to present an overview of the management of urge urinary incontinence and stress urinary incontinence. The evaluation of incontinence and options for surgical management of both urge and stress urinary incontinence will be presented. In the last decade, new minimally invasive surgical options have reduced the morbidity of anti-incontinence procedures without sacrificing outcomes and, in some cases, have improved outcomes.

A new technique for the surgical management of urinary incontinence after obstetric fistula repair

Obstetric vesicovaginal fistula is a debilitating injury still occurring widely throughout the developing world. Fortunately, now more and more surgeons are becoming aware of this previously hidden problem, and many thousands of women are receiving treatment each year. What is difficult for the fistula surgeon are those women, who after having their vesicovaginal fistula successfully closed, return to their doctor, still just as incontinent as they were with the fistula still open. This study describes a new, simple and cheap surgical procedure that promises to improve the lot of these unfortunate women.

569: Outcome of Cadaveric Fascial Sling Cystourethropexy in the Surgical Management of Urinary Incontinence in Children with Sphincteric Incompetence

You have accessJournal of UrologyDiscussed Poster, Sunday, May 9, 2004, 1:00 - 5:00 pm1 Apr 2004569: Outcome of Cadaveric Fascial Sling Cystourethropexy in the Surgical Management of Urinary Incontinence in Children with Sphincteric Incompetence Julie Franc-Guimond, Ernesto Figueroa, and Ricardo Gonzalez Julie Franc-GuimondJulie Franc-Guimond More articles by this author , Ernesto FigueroaErnesto Figueroa More articles by this author , and Ricardo GonzalezRicardo Gonzalez More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)37831-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "569: Outcome of Cadaveric Fascial Sling Cystourethropexy in the Surgical Management of Urinary Incontinence in Children with Sphincteric Incompetence." The Journal of Urology, 171(4S), p. 151 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 151 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Julie Franc-Guimond More articles by this author Ernesto Figueroa More articles by this author Ricardo Gonzalez More articles by this author Expand All Advertisement PDF DownloadLoading ...

Questionnaire-based survey on obstetricians and gynaecologists’ attitudes towards the surgical management of urinary incontinence in women during their childbearing years

Objective: To determine the appropriate surgical management of incontinence in women who desire to maintain their childbearing capacity. Design: Questionnaire-based survey. Method: A postal questionnaire was sent to 251 (every fourth) consultant obstetricians and gynaecologists in the UK practising in both district general hospitals ( n=156) and teaching hospitals ( n=95). Main outcome measures: Clinical consensus in the management of incontinence in women who are interested in childbearing. Results: One hundred and thirty two (53%) consultants responded of which 22 (17%) were not involved in managing this group of women and were therefore excluded from analysis. Thirty-nine (36%) of the replies were from teaching hospital, 71 (65%) were from district general hospitals. Eighty-six (78%) consultants are prepared to perform a continence procedure on women who had not completed their families. One hundred (91%) would offer caesarean section to those continent pregnant women following their continence surgery. (Fisher’s exact test’ P=0.038). Interestingly, 67 (60.9%) of respondents still perform caesarean section to the pregnant women even if they are incontinent. Conclusions: The majority of UK consultants would perform a continence procedure in women who wish to maintain their childbearing capacity. Colposuspension is the favoured surgical procedure. If women are continent following surgery, most prefer them to be delivered by caesarean section.

Surgical management of urinary incontinence in children with anatomical bladder-outlet anomalies.

Pediatric urinary incontinence secondary to anatomical anomalies of the bladder outlet is relatively rare, and there is no consensus on its surgical treatment. We reviewed the clinical courses and surgical management of children with this pathology. From 1991 to 2001, we performed bladder neck reconstruction on seven children (three boys and four girls). The mean age at the first intervention was 7 years (range 5-12 years). The underlying diagnosis was bladder exstrophy in two children, pseudoureterocele-type ectopic ureter in three, bladder neck incompetence from unknown etiology in one boy with hypospadias, and bilateral single ectopic ureter associated with cloacal malformations in one child. Lower urinary tract was evaluated through various imagings, endoscopy, and urodynamic studies. The methods used to reconstruct the bladder neck was the Young-Dees-Leadbetter procedure (performed on four children); the Kropp procedure (two children); and the Pippi-Salle procedure (one child). Bladder augmentation with intestinal segment was performed on four children; Mitrofanoff continent stoma was created in all patients. Urethral catheterization could not be routinely used in all patients, because of pain, stricture, or complicated urethral anatomy. All patients achieved urinary continence. The treatment of pediatric urinary incontinence from anatomical anomalies is technically challenging. Depending on the underlying disorders and anatomy, one needs to decide which method of reconstruction to perform. It would be safer to employ simultaneous augmentation and to create catheterizable continent stoma.

ACUTE AND LONG-TERM OUTCOMES OF RADIO FREQUENCY BLADDER NECK SUSPENSION

A new treatment modality for women with stress urinary incontinence secondary to urethral hypermobility is radio frequency bladder neck suspension. Radio frequency energy is a form of electromagnetic energy that is reliable and highly controllable. This thermal therapy can produce well-defined areas of tissue heating. The technology has been used extensively in dermatological and orthopedic surgery for tissue shrinkage and ablation. Radio frequency thermal therapy is now being applied to the endopelvic fascia at the bladder neck and urethra for treating hypermobility in patients with stress urinary incontinence. The purported mechanism is shrinkage of the collagenated tissue that supports the bladder neck and proximal urethra. We report our acute and long-term experience with laparoscopic radio frequency bladder neck suspension for stress urinary incontinence. Enrolled in this prospective multicenter trial were 94 women with a mean age of 48.4 +/- 7.6 years who had urethral hypermobility with an average cotton swab angle change of 41 degrees and Valsalva leak point pressures greater than 90 cm. water at 250 ml. bladder capacity. Detrusor instability was excluded by cystometry. In all cases precisely controlled radio frequency energy was applied to the endopelvic fascia to heat and shrink the tissue. The primary end points were physician assessment of continence, patient reported pad use and the number of patient reported episodes of urinary incontinence daily 1, 3, 6 and 12 months after surgery. Average operative time was less than 60 minutes and 98% of the patients were discharged home from the recovery room. Treatment surface area decreased an average of 17% in length and 21% in width. Preoperatively 78% of patients had an average of 1 or more episodes of urinary incontinence daily. At 1, 3, 6 and 12 months there was an average of 1 or fewer episodes of urinary incontinence daily in 84.7%, 85.6%, 85.9% and 77.4% of patients, respectively, and at 12 months 83.5% reported being continent or improved. Preoperatively 41.2% of patients reported using 1 pad or less daily, while at 1, 3, 6 and 12 months 85.6%, 90.4%, 87.2% and 86.9%, respectively, required 1 pad or less daily. Urodynamic evaluation at 12 months showed no leakage during the Valsalva maneuver in 78% of cases. There were no major postoperative complications and the minor complication rate was 5.3%. Early results of thermal treatment of the endopelvic fascia indicate that radio frequency bladder neck suspension is safe and effective for improving stress urinary incontinence in women. The improvement in symptomatology appears to be durable in most patients at the 1-year followup. Longer followup is needed to assess the durability of results and it is currently in progress.