Surgical Treatment Of Urinary Incontinence Research Articles

Results of surgical treatment of urinary incontinence in women with pelvic organ prolapse

Objective: long-term evaluation of the results of surgical treatment of mixed urinary incontinence in women with pelvic organ prolapse by the Kelly method in its own modification.Materials and methods: diagnosis and surgical treatment of pelvic organ prolapse and urinary incontinence were performed in 95 women aged 52–60 years. The patients underwent vaginal hysterectomy, anterior and posterior colporraphy, levatoroplasty, and perineoplasty. In order to optimize the surgical treatment of mixed urinary incontinence, urethral plastic surgery was performed using Kelly's method in its own modification. 3 years after the operation, the effectiveness of the operation was evaluated.Results: the performed surgical treatment improved the quality of life of the patients during the next 3 years of life, since there were no violations of the anatomy of the vagina and bladder. There were good forces of contraction of the pelvic floor muscles, women fully retained urine. The patients are completely satisfied with the results of the operation, are able-bodied and take an active life position.Conclusions: the proposed technique is a pathogenetically justified method of restoring adequate urination, reduces the number of relapses of the disease, and returns the main functions to the urethra: to retain urine in the bladder and ensure its release to the outside, which increases the effectiveness of surgical treatment and the duration of the positive effect.

Urinary incontinence in obese women

In recent decades, obesity has assumed the features of a pandemic. Leading to the development of many complications, obesity also contributes to the development of urinary incontinence. The review presents current data on the etiology, pathophysiology and approaches to the treatment of stress urinary incontinence in obese patients. There are a large number of publications by foreign authors on the problem of urinary incontinence in patients with obesity. The results of the studies allow us to say with confidence about the direct relationship between an increase in body mass index and the risk of developing urinary incontinence. Long-term results of surgical treatment of urinary incontinence in obese patients require reflection and further observation. It is noteworthy that this problem is practically not reflected in the works of domestic authors. It is relevant to conduct domestic clinical studies on the problems of urinary incontinence in patients with obesity.

Оценка возможности применения местной анестезии в оперативном лечении стрессового недержания мочи у пациенток геронтологического профиля

Оценка возможности применения местной анестезии в оперативном лечении стрессового недержания мочи у пациенток геронтологического профиля

50 years in urinary incontinence: a bibliometric analysis of the top 100 cited articles of the last 50years.

A large body of literature has been published on urinary incontinence, ranging from medical treatment, epidemiology and surgical techniques. A bibliometric analysis is used to identify high-quality research papers using criteria such as citation rate and journal impact factor. To describe key themes and topics in urinary incontinence literature in the last 50years. Thomson Reuters Web of Science citation indexing database was used to identify the top 100 cited articles in urinary incontinence in the last 50years. Data sets were subdivided into manuscript type, theme, author, institution, country of origin, journal and citation rate. Mean number of citations in the top 100 group for manuscripts was 676, ranging between 2444 and 306. Most cited paper was by Irwin et al. The manuscript with the highest citation rate was by Dumoulin et al., citation rate of 470.7/year. The largest number of manuscripts was published between 2000 and 2009 (n = 47). The New England Journal of Medicine (NEJM) had the highest impact factor (74.67) and five manuscripts were published in this journal. Fifty-seven per cent of articles were published in journals with impact factor < 5. The vast majority of the articles focussed on epidemiology, followed by surgical treatment of urinary incontinence, 69% being original research studies. This is the first bibliometric analysis of the top 100 most influential papers in urinary incontinence. The key themes identified were epidemiology and surgical management, with most papers being original research studies.

Коррекция недержания мочи после радикальной простатэктомии. Хирургическая техника шаг за шагом

Introduction. The main cause of stress urinary incontinence in men is prostate surgery - radical prostatectomy, transurethral resection of the prostate (TURP), enucleation, etc. The gold standard for the surgical treatment of urinary incontinence after prostate surgery is the implantation of an artificial urinary sphincter. For the treatment of mild/moderate urinary incontinence, implantation of synthetic urethral male slings is recommended. For the treatment of severe urinary incontinence, implantation of artificial urinary sphincter recommended. According to the Decree of the Moscow Government dated 12.24.2019 N 1822-PP, surgical interventions on the organs of the genitourinary system with the implantation of synthetic complex and mesh prostheses are included in the standards for the provision of high-tech medical care. Materials and methods. The paper presents a surgical technique for implantation of an artificial urinary sphincter model AMS 800 (Boston Scientific, Boston, MA, USA) and a male urethral sling AdVance XP (Boston Scientific, Boston, MA, USA). The indications for surgical treatment of stress urinary incontinence in men are listed, the criteria for selecting patients for the implantation of an artificial bladder sphincter and the installation of a urethral sling are described, and described in detail. Conclusion. The materials presented in the lecture will help urologists in mastering the technique of implantation of an artificial bladder sphincter and urethral sling in men.

Relationship between the shape of the obturator foramen and the shape of the pelvic cavity in adult women

Objectives: There is variable information on the efficiency of surgical treatment of urinary incontinence (SUI). To date, there is no common understanding of the role of variations in the pelvic anatomy for the success of surgical treatment of SUI. The aim of the present study was to investigate the relationship between the morphometric characteristics of the pelvis, and particularly the shape of the obturator foramen with the shape of pelvic cavity, in adult women. Methods:Sixty-one articulated specimens of female pelvis from the bone collection of the Museum of the St. Petersburg Military Medical Academy named after S.M. Kirov were studied. A pelviometric form was developed, according to the linear and angular parameters of the pelvis and the obturator foramen, and indices of the pelvic cavity and the obturator foramen were evaluated. The discriminant analysis was used to determine the parameters that have the greatest effect on the shape of the obturator foramen. Results: Based on the calculated indices of the pelvic cavity, the form of the pelvic cavity was determined as: narrowing downwards, cylindrical, and expanding downwards. For pelviometric parameters, for each form of the pelvic cavity, significant differences were defined, and a wide range of anatomical variations anatomy were also demonstrated. A mathematical model for predicting the shape of the obturator foramen was developed with the help of the discriminant analysis. At the same time, two main forms of the obturator foramen were marked out as triangular and ellipsoid. The triangular form was predominantly found in cylindrical and narrowing downwards pelvis groups, and the ellipsoid form dominated in the expanding downwards group. Conclusion: Longitudinal and transverse indices of the pelvic cavity may allow us to determine its shape as narrowing downwards, cylindrical or expanding downwards. The obturator foramen has a typical shape in each particular configuration of the pelvis.

Surgical treatment for urinary incontinence in children.

Only a small proportion of children with urinary tract malformations are incontinent, but it is important to identify those children for whom surgical treatment can eliminate or reduce urinary leakage.

Conformation and mechanics of the polymeric cuff of artificial urinary sphincter.

The surgical treatment of urinary incontinence is often performed by adopting an Artificial Urinary Sphincter (AUS). AUS cuff represents a fundamental component of the device, providing the mechanical action addressed to urethral occlusion, which can be investigated by computational approach. In this work, AUS cuff is studied with reference to both materials and structure, to develop a finite element model. Materials behavior is investigated using physicochemical and mechanical characterization, leading to the formulation of a constitutive model. Materials analysis shows that AUS cuff is composed by a silicone blister joined with a PET fiber-reinforced layer. A nonlinear mechanical behavior is found, with a higher stiffness in the outer layer due to fiber-reinforcement. The cuff conformation is acquired by Computer Tomography (CT) both in deflated and inflated conditions, for an accurate definition of the geometrical characteristics. Based on these data, the numerical model of AUS cuff is defined. CT images of the inflated cuff are compared with results of numerical analysis of the inflation process, for model validation. A relative error below 2.5% was found. This study is the first step for the comprehension of AUS mechanical behavior and allows the development of computational tools for the analysis of lumen occlusion process. The proposed approach could be adapted to further fluid-filled cuffs of artificial sphincters.

A nationwide cohort study of hospital contacts after surgical treatment for urinary incontinence

The aim was to assess complications of urinary incontinence (UI) for women who had a hospital contact within 30 days and to evaluate the conventional method of classifying complications vs grading complications into the Clavien-Dindo classification (CDC) system. A historical cohort study based on a nationwide population of women who had hospital contact within 30 days of surgical treatment for UI during a 5-year period. There were 874 (16.2%) hospital contacts to the Department of Obstetrics and Gynecology, among 5393 procedures. For retropubic midurethral sling (RPMUS) and transobturator midurethral sling (TOMUS), the most common reasons for hospital contacts were voiding dysfunction, self-reported pain within 14 days and acute cystitis and for urethral injection therapy (UIT) persisting UI, acute cystitis, and voiding dysfunction. Voiding dysfunction requiring surgery, use of catheter or both, occurred more frequently in women who had RPMUS as compared with TOMUS (30.5% vs 21.7%; P = .01). Women, who received RPMUS and TOMUS, had surgical complications classified as up to CD IIIb, whereas women who had UIT were classified as up to CD II. Sixteen percent of the women had a hospital contact within 30 days. A more obstructive character of RPMUS than for TOMUS was indicated, as more women with voiding dysfunction required surgery or catheter following RPMUS. The CDC system in its current form does not improve the overall characterization of complications in terms of type and severity following synthetic midurethral sling and UIT treatment.

Concurrent surgical treatment of urinary incontinence at the time of endometrial cancer surgery is associated with improved quality of life 6 months after cancer surgery: Cancer of the uterus and treatment of incontinence (CUTI) study

Concurrent surgical treatment of urinary incontinence at the time of endometrial cancer surgery is associated with improved quality of life 6 months after cancer surgery: Cancer of the uterus and treatment of incontinence (CUTI) study

PD37-07 ARTIFICIAL URINARY SPHINCTER IMPLANTATION IS A SAFE PROCEDURE WITH LOW COMPLICATION RATES EVEN IN THE ELDERLY AND COMORBID POPULATION

INTRODUCTION AND OBJECTIVES:Many urologists are hesitant to offer surgical treatment for urinary incontinence in the genitourinary cancer survivor with significant comorbidities. We used the Charls...

Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: results of a single centre.

ABSTRACTPurpose:The aim of our study is to evaluate the efficacy and safety of ATOMS® system for the treatment of postoperative male stress urinary incontinence (SUI).Materials and methods:We retrospectively evaluated all patients treated at our institution for postoperative male SUI with ATOMS® implant. We excluded patients with low bladder compliance (< 20 mL / cmH2O), uncontrolled detrusor overactivity, detrusor underactivity (BCI < 100), urethral or bladder neck stricture and low cystometric capacity (< 200 mL).Results:From October 2014 to July 2017 we treated 52 patients, mean age 73.6 years. Most of them (92.3%) had undergone radical prostatectomy, 3.85% simple open prostatectomy, 3.85% TURP; 28.8% of patients had undergone urethral surgery, 11.5% adjuvant radiotherapy; 57.7% had already undergone surgical treatment for urinary incontinence. The average24 hours pad test was 411.6 g (180 – 1100). The mean follow-up was 20.1 months (8.1 – 41.5) 30.8% of patients were dry, 59.6% improved ≥ 50%, 7.7% improved < 50% and 1.9% unchanged. In total 73.1% reached social continence. There was a significant reduction of the 24 hours pad test and ICIQ - UI SF scores (p < 0.01).In the postoperative follow-up we detected complications in 8 patients (19%): 5 cases of displacement of the scrotal port, in 2 cases catheterization difficulties, one case of epididimitis and concomitant superficial wound infection; no prosthesis infection, nor explants.Radiotherapy, previous urethral surgery,previous incontinence surgery were not statistically related to social continence rates (p 0.65;p 0.11;p 0.11).Conclusions:The ATOMS® system is an effective and safe surgical treatment of mild and moderate male postoperative SUI with durable results in the short term.

Surgery for urinary incontinence in women: Report from the 6th international consultation on incontinence.

Urinary incontinence is a prevalent condition worldwide and causes a tremendous impact on a woman's quality of life. While conservative and non-surgical therapies are options for treatment, surgery for stress urinary incontinence (SUI) is common. Options include colposuspension, slings (pubovaginal and midurethral), and periurethral bulking. While evidence supports each of these options in the treatment of SUI, each is associated with various rates of success and unique adverse event profiles. Urgency urinary incontinence (UUI) is initially treated with behavioral modification and pharmacologic means, with surgery reserved for those with refractory symptoms or significant complications from medication use. At present, intravesical onabotulinumtoxinA injections, percutaneous tibial nerve stimulation, and sacral neurostimulation are all viable options for refractory UUI/overactive bladder. As with surgical interventions for SUI, each of these is, likewise, associated with unique outcomes and adverse event profiles. Herein, we summarize the findings and conclusions from the 6th International Consultation on Incontinence (ICI) regarding surgical treatment of urinary incontinence in women.

Surgical treatment of post-prostatectomy stress urinary incontinence in adult men: Report from the 6th International Consultation on Incontinence.

To report the recommendations of the 6th International Consultation on Incontinence (ICI) on post-prostatectomy urinary incontinence. The 6th ICI committee on surgical treatment of urinary incontinence in men assessed and reviewed the outcomes of surgical therapy and updated the prior recommendations published in 2013. Articles from peer-reviewed journals, abstracts from scientific meetings, and literature searches by hand and electronically formed the basis of this review. The resulting guidelines were presented at the 2016 ICI meeting in Tokyo, Japan. Voiding diary and pad tests are valuable for assessing quantity of leakage. Cystoscopy and/or urodynamics may be useful in guiding therapy depending on the type of incontinence and presumed etiology. Artificial Urinary Sphincter (AUS) is the preferred treatment for men with moderate to severe stress urinary incontinence (SUI) after RP. Male slings are an acceptable approach for men with mild to moderate SUI. Much discussion centers on the definition of moderate SUI. Injectable agents have a poor success rate in men with SUI. Options for recurrent SUI due to urethral atrophy after AUS implantation include changing the pressure balloon, downsizing the cuff and increasing the amount of fluid in the system. Infection and/or erosion demand surgical removal or revision of all or part of the prosthesis. Although there are several series reporting the outcomes of different surgical interventions for PPUI, there is still a need for prospective randomized clinical trials. Recommendations for future research include standardized workup and outcome measures, and complete reporting of adverse events at long-term.

Female Sexual Function after Surgical Treatment of Urinary Incontinence

Introduction: Urinary incontinence is a common problem that can affect the quality of life of women of all ages and can negatively influence the exercise of sexuality. Aim: The aim of this study was to compare sexual function of women before and after surgical treatment for urinary incontinence. Method: The sample consisted of 38 women with urinary incontinence and surgical treatment (Burch or Sling procedure). The Female Sexual Function Index (FSFI) was used to evaluate sexual dysfunction before and after surgical treatment. Results: The mean age of the women in the study was 48 ± 8.8 years, and 58% were 50 years old or younger. By analyzing FSFI, it was observed that the majority of subjects had an overall index of sexual dysfunction (score < 26 points) before surgery. The desire and arousal domains improved significantly after surgery for all women included in the study. It was also observed that women with higher levels of education had more positive results related to desire. Conclusions: In our sample, in general, sexual function improved after surgical treatment of urinary incontinence, regardless of technique used, particularly in the discounter and pain domain. There was a substantial improvement of the sexual function among women who had presented with cystocele. Desire and arousal improved significantly after surgery, very likely due to the improvement of self-esteem after surgery.

Петлевые операции в лечении недержания мочи в РФ

Surgical treatment of urinary incontinence using synthetic slings is one of the most frequently used procedures in modern urogynecology. The availability of almost identical surgical sets manufactured by different companies can at times significantly hamper the choice of a synthetic sling for a particular patient. This article presents a brief overview of the literature on the efficacy and safety of sub-urethral synthetic slings registered in the Russian market.

Analysis of Hospital Readmissions After Prosthetic Urologic Surgery in the United States: Nationally Representative Estimates of Causes, Costs, and Predictive Factors

BackgroundThe surgical treatment of urinary incontinence and erectile dysfunction by prosthetic devices has become part of urologic practice, although sparse data exist at a national level on readmissions and hospital costs. AimTo assess causes and costs of early (≤30 days) and late (31–90 days) readmissions after implantation of penile prostheses (PPs), artificial urinary sphincters (AUSs), or PP + AUS. MethodsUsing the 2013 and 2014 US Nationwide Readmission Databases, sociodemographic characteristics, hospital costs, and causes of readmission were compared among PP, AUS and AUS + PP surgeries. Multivariable logistic regression models tested possible predictors of hospital readmission (early, late, and 90 days), increased hospital costs, and prolonged length of stay at initial hospitalization and readmission. OutcomeOutcomes were rates, causes, hospital costs, and predictive factors of early, late, and any 90-day readmissions. ResultsOf 3,620 patients, 2,626 (73%) had PP implantation, 920 (25%) had AUS implantation, and 74 (2%) underwent PP + AUS placement. In patients undergoing PP, AUS, or PP + AUS placement, 30-day (6.3% vs 7.9% vs <15.0%, P = .5) and 90-day (11.6% vs 12.8% vs <15.0%, P = .8) readmission rates were comparable. Early readmissions were more frequently caused by wound complications compared with late readmissions (10.9% vs <4%, P = .03). Multivariable models identified longer length of stay, Charlson Comorbidity Index score higher than 0, complicated diabetes, and discharge not to home as predictors of 90-day readmissions. Notably, hospital volume was not a predictor of early, late, or any 90-day readmissions. However, within the subset of high-volume hospitals, each additional procedure was associated with increased risk of late (odds ratio = 1.06, 95% CI = 1.03–1.09, P < .001) and 90-day (odds ratio = 1.03 95% CI = 1.02–1.05, P < .001) readmissions. AUS and PP + AUS surgeries had higher initial hospitalization costs (P < .001). A high hospital prosthetic volume decreased costs at initial hospitalization. Mechanical complications led to readmission of all patients receiving PP + AUS. Clinical ImplicationsHigh-volume hospitals showed a weaker association with increased initial hospitalization costs. Charlson Comorbidity Index, diabetes, and length of stay were predictors of 90-day readmission, showing that comorbidity status is important for surgical candidacy. Strengths and LimitationsThis is the first study focusing on readmissions and costs after PP, AUS, and PP + AUS surgeries using a national database, which allows ascertainment of readmissions to hospitals that did not perform the initial surgery. Limitations are related to the limited geographic coverage of the database and lack of surgery- and surgeon-specific variables. ConclusionsAnalysis of readmissions can provide better care for urologic prosthetic surgeries through better preoperative optimization, counseling, and resource allocation.Pederzoli F, Chappidi MR, Collica S, et al. Analysis of Hospital Readmissions After Prosthetic Urologic Surgery in the United States: Nationally Representative Estimates of Causes, Costs, and Predictive Factors. J Sex Med 2017;14:1059–1065.

Surgical treatment for urinary incontinence after prostatectomy: A meta-analysis and systematic review.

BackgroundThis meta-analysis was designed to assess the efficacy of the male sling and artificial urinary sphincter on treating post-prostatectomy incontinence by evaluating daily pad use, cure rate, frequency of improvement in incontinence, and quality of life.MethodsMedline, Cochrane, Google Scholar, and ClinicalTrials.gov were searched (until March 31, 2014) for studies that investigated the effectiveness of artificial urinary sphincter or sling surgical treatments for prostate cancer. The primary outcome was daily pad use before and after surgery and secondary outcomes were quality of life before and after surgery, and frequency of cures (no need to use of a pad for at least 1 day) and improvements (decreased pad usage) in incontinence after surgery.ResultsWe found that that both the sling and artificial urinary sphincter significantly decreased the number of pads used per day by about 3 (P-values <0.001) and increased the quality of life compared with before intervention (P-values < 0.001). In addition, the cure rate and was around 60%. Intervention resulted in improvement in incontinence by about 25% (P < 0.001).ConclusionOur findings indicate that both sling and artificial urinary sphincter interventions are effective in reducing incontinence and improving the patient’s quality of life.

Effect of the surface modification of the synthetic meshes used in the surgical treatment of pelvic organ prolapse on the tissue adhesion and clinical functionality

Stress urinary incontinence and pelvic organ prolapse represent important conditions affecting adult women’s health. Lately, the properties and performance of the polymer materials used in the treatment of pelvic organ prolapse have been improved by modulating from their formula. Materials investigated in our study are polypropylene meshes used by clinicians in surgical treatment of urinary incontinence and utero-vaginal prolapse. In order to make a comparative analysis, we confronted the structure and surface morphology of native synthetic polypropylene meshes with explanted fragments from the same mesh type after clinical use. FTIR investigations revealed little change in structure after implantation, somehow insignificant. Scanning electron microscopy (SEM) demonstrates modification in surface morphology even just by passing through the transobturator passage, whereas after implantation the surface deteriorates. SEM on explanted meshes proves the encapsulation process of the mesh to be more similar to a foreign body reaction rather than to the adhesion and integration of the synthetic mesh into the organism. Histological analysis of the surrounding tissues near explanted mesh was made in some relevant clinical cases, because the tissue response is an important factor in order to evaluate the tissue adhesion at the polypropylene mesh surface. Based on our experiments and clinical experience we’ve designed an adhesion score. It applies to meshes used in pelvic organ prolapse surgery measuring the following important factors: tenacity, extent of adhesion, macroscopic and microscopic aspects and ease of dissection from surrounding tissues.

Urinary incontinence in nulliparous women aged 25-64 years: a national survey

A systematic survey of pelvic floor disorders in nulliparous women has not been presented previously. The purpose of this study was to determine the prevalence of urinary incontinence parameters in a large cohort of nonpregnant, nulliparous women, and thereby construct a reference group for comparisons with parous women. This postal and World Wide Web-based questionnaire survey was conducted in 2014. The study population was identified from the Total Population Register in Sweden and comprised women who had not given birth and were aged 25-64 years. Four independent age-stratified, random samples comprising 20,000 women were obtained from the total number of eligible nullipara (n= 625,810). A 40-item questionnaire about pelvic floor symptoms, its severity, and its consequences were used. Age-dependent differences for various aspects of urinary incontinence were analyzed with the youngest group (25-34 years) serving as reference. Crude and body mass index-adjusted prevalence and its 95% confidence limits were calculated for each 10-year category. The response rate was 52% and the number of study participants was 9197. Urinary incontinence increased >5-fold from 9.7% in the youngest women with a body mass index <25 kg/m2 to 48.4% among the oldest women with a body mass index ≥35 kg/m2. The prevalence of bothersome urinary incontinence almost tripled from 2.8-7.9% among all nulliparas. The proportion with bothersome urinary incontinence among incontinent women increased from 24.4% in the youngest age group to 32.3% in the age group 55-64 years. Nocturia ≥2/night increased 4-fold to 17.0% and leakage ≥1/wk increased 3-fold to 12.8% among the oldest women. Mixed urinary incontinence increased from 22.9-40.9% among the oldest 0-para with incontinence, whereas stress urinary incontinence decreased inversely from 43.6-33.0%. In the total cohort surgical treatment for urinary incontinence occurred in 3 per thousand. Almost every aspect of urinary incontinence was present in nulliparous women of all ages and prevalence increased with advancing age between 25-64 years. This must be taken into account when using nullipara as a control group in comparisons with parous women to estimate the effect of pregnancy and childbirth.