Stress Urinary Incontinence Research Articles

Risk prediction models for stress urinary incontinence after pelvic organ prolapse (POP) surgery: a systematic review and meta-analysis

ObjectiveTo systematically evaluate existing developed and validated predictive models for stress urinary incontinence after pelvic floor reconstruction.MethodsRelevant literature in PubMed, Embase, Web of Science, Cochrane Library, OVID, China National Knowledge Infrastructure(CNKI), Wan Fang Database, VIP database and Chinese Biomedical Literature Service System (SinoMed) were search from inception to 1 March 2024. Literature screening and data extraction were performed independently by two researchers. The chosen study’s statistics included study design, data sources, outcome definitions, sample size, predictors, model development, and performance. The Predictive Modelling Risk of Bias Assessment Tool (PROBAST) checklist was used to assess risk of bias and applicability.ResultsA total of 7 studies containing 9 predictive models were included. All studies had a high risk of bias, primarily due to retrospective design, small sample sizes, single-center trials, lack of blinding, and missing data reporting. The meta-analysis revealed moderate heterogeneity (I² = 68.8%). The pooled AUC value of the validated models was 0.72 (95% CI: 0.65, 0.79), indicating moderate predictive ability.ConclusionThe prediction models evaluated demonstrated moderate discrimination, but significant bias and methodological flaws. The meta-analysis revealed moderate heterogeneity (I² = 68.8%) among the included studies, reflecting differences in study populations, predictors, and methods, which limits the generalizability of the findings. Despite these challenges, these models highlight the potential to identify high-risk patients for targeted interventions to improve surgical outcomes and reduce postoperative complications. The findings suggest that by integrating these models into clinical decision-making, clinicians can better tailor surgical plans and preoperative counseling, thereby improving patient satisfaction and reducing the incidence of postoperative stress urinary incontinence. Future research should follow TRIPOD and PROBAST principles, focus on addressing sources of heterogeneity, improve model development through robust designs, large sample sizes, comprehensive predictors, and novel modelling approaches, and validate tools that can be effectively integrated into clinical decision-making to manage stress urinary incontinence after pelvic floor reconstruction.

HoLEP versus ThuFLEP in men with very large prostates (> 175ml).

We aimed to demonstrate and compare the efficacy and safety of HoLEP and ThuFLEP procedures in patients with very large prostates (> 175ml). Patients with prostates larger than 175ml who underwent HoLEP (Group 1, n = 72) and ThuFLEP (Group 2, n = 85) for benign prostatic obstruction (BPO) were retrospectively analysed. Perioperative, postoperative functional outcomes and complications were analysed and compared. Significant improvements were observed in functional parameters related to IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at 1, 6 and 12 months postoperatively. Except for IPSS at the first postoperative month (3.22 ± 1.77 vs. 2.07 ± 1.11; p = 0.001), no difference was observed between the groups in terms of quality of life, IPSS, Qave and PVR at the sixth and twelfth months. There was no significant difference between the laser sources in terms of urge urinary incontinence (UUI) and stress urinary incontinence (SUI) at 1 month postoperatively, and no UI was observed in any patient at 6 and 12 months. No significant difference was observed between laser types in terms of postoperative complications. HoLEP and ThuFLEP are safe and effective minimal invasive surgical methods in very large prostates with improvement in postoperative functional parameters and low perioperative complication rates. Since there are no significant differences in outcomes between these laser sources, they can be employed as alternative surgical techniques for BPO in patients with very large prostates.

The prevalence, types, and risk factors of urinary incontinence among Bangladeshi women aged 15-49: A study based on a nationally representative survey.

To estimate the prevalence of urinary incontinence (UI), its subtypes, and the associated risk factors in women of reproductive age in Bangladesh. Data from the 2016 Bangladesh Maternal Mortality and Health Care Survey was analyzed in a nationally representative sample of 298 284 households that used a multistage sample selection procedure. Data on 183 560 ever-married women aged 15-49 years who had ever given birth were analyzed. Descriptive statistics was used to report the overall prevalence of any UI and its three subtypes: stress, urge, and mixed UI. The wealth index of each household was constructed using principal component analysis. Univariable and multivariable binary logistic regression analyses were conducted to identify the factors associated with each type of UI. The prevalence of any UI was 15.9% (95% confidence interval [CI]:15.7-16.1). Stress incontinence was the most prevalent UI (8.3%, 95% CI: 8.2-8.4), followed by mixed type (5.5%, 95% CI: 5.4-5.6), and urge incontinence (2.1%, 95% CI: 2.1-2.2). In multivariate logistic regression analysis, older age, no or less education, younger age at first birth, higher parity, lower wealth status, self-reported pelvic organ prolapse (POP), and being Muslim had a significant positive association with the presence of UI. About one in six women reported to have suffered from any type of UI in this study. Several common risk factors were found, which call for targeted policy and programmatic interventions.

Impact of Single-Incision Sling Placement on Female Sexual Function in Women with Stress Urinary Incontinence.

Stress urinary incontinence (SUI) is a common condition among women of childbearing age, often requiring surgical intervention. The midurethral sling (MUS), including first-generation tension-free vaginal tapes (TVT) and second-generation transobturator tapes (TOT, TVT-O), has long been the standard treatment. However, both approaches have associated risks, prompting the development of single-incision slings (SIS) as a third option. SIS have proven their efficacy in SUI treatment, but the impact of these slings on female sexual function specifically remains underexplored. A literature search was conducted using PubMed using the keywords "stress urinary incontinence," "midurethral slings," "single-incision slings," "female sexual function," and "dyspareunia." The reviewed studies demonstrated that SIS generally maintain or improve sexual function postoperatively, but with varying impact on specific aspects of sexual function. While coital urinary incontinence often improved or resolved, new or worsened dyspareunia was reported in a significant number of patients. SIS placement for SUI generally preserves or enhances sexual function, though individual aspects, such as dyspareunia, may worsen for some patients. Given that an important goal of SUI treatment is to improve quality of life, it is crucial to identify preoperative factors that will identify patients at risk of developing dyspareunia after surgery or are more likely to experience an improvement in sexual function. Further research is needed to better understand these predictors and optimize surgical outcomes for women undergoing SUI treatment with SIS.

Initial experience of endoscopic thulium fiber laser enucleation of the prostate: perioperative outcomes and learning curve.

Holmium enucleation of the prostate is currently the treatment of choice for the management of complicated or drug-unresponsive lower urinary tract symptoms due to benign prostate hyperplasia(BPH). Thulium Fiber Laser(TFL) is an alternative to holmium laser and seems to be safe and effective. We aimed to report our initial experience with TFL. We included each consecutive patient who underwent TFL enucleation of the prostate (THUFLEP) in a single academic center using the TFL drive laser generator (Coloplast ©) with a 550um fiber. Surgery was performed by 3 surgeons who did not have any experience in prostate enucleation. Perioperative outcomes were collected prospectively, such as functional 3-month follow-up. Pentafecta was used to assess the optimal outcomes of THUFLEP. Preoperative and postoperative IPSS and QoL were also compared. Overall, we included 71 patients with a mean age of 69.4 years (SD 11.6) and a mean prostate volume of 90.2cc (SD 30.5). The mean operative time was 120.9 minutes (SD 49.3), with a mean enucleation time of 85.1 minutes(SD 37.5) and a mean morcellation time of 18.3 minutes (SD 15.6). The mean length of stay was 1.8 days(SD 2.1) and 11 patients (15.5%) had a postoperative complication. Catheter removal failure occurred in 3 patients (4.2%), but at 3 months no patients had a catheter. IPSS and QoL at 3 months were significantly improved compared with before surgery(p<0.001). Three patients reported stress urinary incontinence (4.2%). Pentafecta was achieved for 29 patients (40.8%). This study confirms the safety and efficacy of THUFLEP. The procedure was associated with low postoperative complication rates and satisfactory short-term functional outcomes.

Impact of Minimal Incision Repair of Rectus Abdominis Diastasis on Quality of Life and Stress Incontinence: A Prospective Study

AimThis study evaluates the impact of the minimal incision repair of rectus abdominis diastasis (MIRRAD) procedure on physical activity, muscle strength, quality of life, and overall satisfaction in women with postpartum rectus abdominis diastasis (PP-RAD).MethodsA cohort of 31 female patients, aged 20–50 years, diagnosed with PP-RAD unresponsive to conservative treatment, underwent the MIRRAD procedure. Assessments were conducted preoperatively and 1 year postoperatively, these included the Modified Abdominal Trunk Function Protocol (MATFP), Disability Rating Index (DRI), and Urinary Disability Index (UDI) questionnaires. Physical activity intensity was monitored using accelerometers.ResultsSignificant improvements were observed in vigorous physical activities (Z = −2.352, p = 0.019), vector magnitude counts per minute (Z = −2.163, p = 0.031), and steps per minute (Z = −3.131, p = 0.002). DRI showed significant improvements in physical tasks like dressing, walking, and strenuous work (Z ranging from −2.705 to −4.603, p &amp;lt; 0.001). UDI indicated significant improvements in urinary symptoms, including reduced frequency (Z = −2.984, p = 0.003) and less urinary leakage (Z = −2.357, p = 0.018). MATFP demonstrated gains in back and abdominal muscle strength (Z = −4.321, p &amp;lt; 0.001) and trunk stability (Z = −3.991, p &amp;lt; 0.001).ConclusionThe MIRRAD procedure significantly improves physical strength, trunk stability, and urinary function, enhancing daily activities and overall physical health in women with PP-RAD. Further research is recommended to evaluate long-term outcomes.

Can Baseline Urodynamic Findings Predict the Outcomes and Complications of Intravesical Injections of Onabotulinum Toxin A for Overactive Bladder?

Intravesical Onabotulinum Toxin A (Botox A) injections are an established minimally invasive therapy option for the treatment of refractory overactive bladder (OAB) symptoms in adults. We have assessed whether baseline urodynamic findings can predict self-reported patient outcomes and posttreatment voiding difficulties. We have conducted a retrospective review of 407 patients (median age 61 years, range 22-94 years, 286 women) who have received intravesical Botox A injections for refractory non-neurogenic OAB symptoms between 2006 and 2018. Patient outcomes were assessed using the 5-point PGI-I scale and incidence of posttreatment voiding difficulties was noted. Results were correlated with the baseline urodynamic findings. Good response to Botox A injections was defined as PGI-I scores of 1 and 2, and was seen in 272 patients overall (67%). Women were significantly more likely to have successful outcomes comparing to men (p = 0.034) and the voiding detrusor contraction duration (DCD) was a further classifier for treatment success. Acute posttreatment voiding difficulties requiring catheterization were observed in 96 patients (24%) and were significantly more likely in those with good response. Successful outcomes (based on the self-reported PGI-I score) were more likely in women and correlated positively with the increased duration of voiding detrusor contraction, but no other urodynamic parameters. The risk of developing de novo need to catheterize correlated with patient reported benefit, but not with any baseline urodynamic findings. We did not find pre-existing bladder outflow obstruction, concurrent stress urinary incontinence or complex previous surgical history to adversely affect treatment success.

Association between Life's essential 8 and stress urinary incontinence in women from the National Health and nutrition examination survey 2005-2018: A cross-sectional study.

Stress urinary incontinence (SUI) may be associated with cardiovascular disease. Life's Essential 8 (LE8), a recently updated measure of cardiovascular health (CVH), has been investigated for its association with SUI in women. The study adopted a cross-sectional design with national scope, incorporating 9332 women aged 20 and above, selected from the National Health and Nutrition Examination Survey dataset from 2005 to 2018. The LE8 metric, which varies from 0 to 100, was evaluated based on the criteria set by the American Heart Association. SUI was determined based on self-report. To evaluate these correlations, we employed models with multivariable logistic variables and a restricted cubic spline. In the cross-sectional study, a total of 9332 participants were included (weighted average age, 52.23 years), and 4274 had SUI (weighted percentage, 48.64%). Considering potential confounders, it was found that higher LE8 scores were associated with lower odds of SUI (odds ratio [OR] for each 10-point increase was 0.83; 95% confidence interval [CI], 0.80-0.87). Compared to participants with lower LE8 scores, those with higher LE8 scores had a 57% lower probability of developing SUI. There was a statistically significant association between LE8 score and SUI among participants who were middle-aged, non-Hispanic white, had higher levels of education and income, and were living with a partner. According to this study, there was an association between increase in Life's Essential 8 and reduction in SUI risk. Therefore, promoting optimal CVH may associate with reducing SUI in women.

De novo urethral hypermobility at 6 months after first delivery as a risk factor for stress urinary incontinence 12 years postpartum.

The aim of the study was to analyze the association between de novo urethral hypermobility 6 months postpartum and stress urinary incontinence (SUI) symptoms at 6 months and 12 years after first delivery. Risk factors associated with the development of postnatal urethral hypermobility were also examined. A longitudinal cohort study was conducted on primigravid women, after excluding those with UI before pregnancy and/or urethral hypermobility (rotational angle ≥30°) at term. At 6 months postpartum, SUI was assessed based on symptoms and introital ultrasound performed to measure rotational angle (difference between urethro-pelvic angle at rest and at maximum Valsalva). Twelve years after delivery, women were sent a questionnaire including SUI assessment and questions on parity, current age, and body mass index. Continuous variables were compared using student's t-test and qualitative variables using chi-squared tests. A logistic regression model was constructed including variables that reached statistical significance (P < 0.05) in the univariate analysis. Of the 314 women who completed the 6-month follow-up, 265 (84.4%) were successfully contacted and completed the questionnaire at 12 years and these formed the study group. In 127 women (47.9%), de novo urethral hypermobility had developed by 6 months postpartum. There was no association between urethral hypermobility and SUI symptoms 6 months postpartum (OR: 1.17; 95% CI: 0.59-2.33). Twelve years after delivery, however, SUI was reported by 110 women overall (41.5%) and nearly half of the women who developed postnatal urethral hypermobility (61/127, 48.0%). De novo urethral hypermobility 6 months postpartum constitutes a risk factor for SUI 12 years later.

Role of 3D ultrasound in the treatment of stress urinary incontinence with polyacrylamide hydrogel (Bulkamid®) - A pilot study.

Polyacrylamide hydrogel (PAHG) is a bulking agent used in treatment of stress urinary incontinence (SUI) in women. Some women experience an improvement or cure in stress urinary incontinence (SUI) symptoms lasting only a few weeks after the injection of the bulking agent. The aim of this study was to use three-dimensional ultrasound (3DUS) to describe the changes in volume, number of deposits and echogenicity of the bulking agent 3months after PAHG injection. Prospective cohort study of fourteen women with SUI or mixed primarily SUI, who underwent an injection of PAHG. The subjective outcome was evaluated with Patient Global Impression of Improvement questionnaire. 3DUS was performed in all patients immediately after injection of PAHG and again at 3months follow-up. The study found a mean 36.5% loss in bulking agent volume during the study period. A total of 53 PAHG deposits were found by ultrasound immediately after injection. At 3months follow-up 41 PAHG deposits were left. All deposits were hypoechogenic immediately after injection and only 24% of demonstrated PAHG collections had a hypoechoic echogenicity at 3months follow-up. More than 1/3 of volume of injected PAHG and 23% of deposits could not be found by 3DUS at 3months follow-up. Only 24% of PAHG injections in our patients had hypo-echoic echogenicity at 3months follow-up. Larger 3DUS studies with longer follow-up and focus on exact location of the PAHG injections are important future studies.

Individual Factors in Young Female Athletes' Bladder Health (the Y-FAB Study).

Bladder health in high school and collegiate females is not well understood. The objective of this study was to compare toileting behaviors, lower urinary tract symptoms (LUTSs), and fluid intake in female athletes and nonathletes. English-speaking nulliparous females aged 13-23 years were recruited. Participants completed the Toileting Behaviors: Women's Elimination Behaviors Scale, Bristol Female LUTS Questionnaire, and Beverage Questionnaire. Statistical analysis included univariable analyses and multivariable comparisons of athletes to nonathletes adjusting for age and fluid intake. One hundred athletes and 98 nonathletes participated (mean age 20 ± 2, mean body mass index 23 ± 4). Athletes' sports were predominantly high impact. Dysmenorrhea and anxiety were higher in nonathletes ( P < 0.01) versus more stress fractures in athletes ( P < 0.001). Problematic toileting behaviors were prevalent regardless of athletic status; nonathletes were more likely to hold urine until home and empty away from home without the urge (both P = 0.04). Lower urinary tract symptoms were prevalent regardless of athletic status, including frequency (34.2%), hesitancy (33.3%), urgency (32.8%), stress incontinence (15.3%), and urgency incontinence (11.8%). Athletes had significantly more stress incontinence and urgency and higher incontinence subscores on univariable analysis, although the difference was attenuated after multivariable adjustment. Athletes consumed lower total fluids ( P = 0.03). Problematic toileting behaviors and LUTSs were prevalent in high school and collegiate females, regardless of athletic status. Athletes had higher stress urinary incontinence and urgency and lower fluid intake. These findings support future work toward enhancing early bladder health interventions (screening, education, and LUTS prevention) among high school and collegiate females.

Prevalence and determinants of lower urinary tract symptoms in pregnant women.

The management of lower urinary tract symptoms (LUTS) is crucial for providing quality pregnancy care. This study aims to determine the prevalence and predictors of LUTS in pregnant women. This cross-sectional study was conducted between November 2023 and February 2024 with a total of 1703 pregnant women who attended routine pregnancy care at four state hospital obstetrics outpatient clinics. Data were collected using a pregnant woman information form and the "Bristol Female Lower Urinary Tract Symptoms-Short Form (BFLUTS-SF)". Descriptive statistics, the independent sample t-test, analysis of variance (ANOVA) test, Tukey or Tamhane's T2 post-hoc tests, and multiple linear regression (Stepwise) analysis were carried out. All analyses were conducted with a 95% confidence interval and a significance level of p<0.05. The prevalence of LUTS among pregnant women was found to be 99.2%. High prevalence rates were obtained for storage symptoms, voiding symptoms, and urinary incontinence symptoms (respectively, 99.2%, 48.8%, and 61.2%). Multiple linear regression analysis indicated that previous pregnancy stress urinary incontinence (SUI), history of curettage and urinary tract infection (UTI), absence of episiotomy, presence of SUI in the mother and/or sister, smoking, being employed, and being in the third trimester are significant predictors of LUTS during pregnancy (p<0.05). The findings of this study indicate that LUTS is commonly in pregnant women. For quality pregnancy care, it is recommended to organize community-based, repeated educational programs and counseling services aimed at preventing and reducing LUTS in women.

Disparities in surgical treatments for stress, urge and mixed urinary incontinence: Evidence from the 2019 National Ambulatory Surgery Sample (NASS)

Disparities in surgical treatments for stress, urge and mixed urinary incontinence: Evidence from the 2019 National Ambulatory Surgery Sample (NASS)

Laparoscopic sacrocolpopexy with concurrent hysterectomy or uterine preservation: A metanalysis and systematic review.

Literature is lacking strong evidence about comparisons of efficacy and quality of life-related outcomes between laparoscopic total and/or supracervical hysterectomy (LTH/LSCH) with laparoscopic sacrocolpopexy (LSC) and minimally invasive sacrohysteropexy (LSH). To summarize and compare available data on this topic providing a useful clinical tool in the treatment decision process. We performed a systematic research of PubMed (MEDLINE), Web of Science, and Gooogle Scholar. We included studies that compared at least one efficacy outcome (objective or subjective outcome) between LTH/LSCH with LSC and LSH. Data on surgery-related morbidities were also extracted where available. A random-effect meta-analysis was conducted reporting pooled mean differences and odds ratios (OR) between groups using Review Manager V.7.9.0. We included a total of nine observational studies. LTH/LSCH with LSH was associated with a significantly higher objective success (apical compartment OR 7.95; 95% confidence interval [CI] 2.23-28.33; I2 = 0%; P = 0.001; anterior compartment OR 2.23; 95% CI 1.26-4.30; I2 = 12%; P = 0.007) and subjective success (OR 3.19; 95% CI 1.42-7.17; I2 = 39%; P = 0.005). No differences were found regarding intraoperative and postoperative complications, sexual dysfunction, and stress urinary incontinence rate after surgery. Hysteropexy showed shorter operative time and shorter hospital length with a pool mean difference of 27.37 min (95% CI 18.04-32.71; I2 = 0%; P < 0.001) and 0.7 days (95% CI 0.24-1.17; I2 = 75%; P = 0.003), respectively. Concurrent hysterectomy was not associated with a higher rate of mesh-related complications (P = 0.53). No major differences were found regarding recurrence and reoperation rate (P = 0.10 and P = 0.93, respectively). LTH/LSCH with LSC has better objective and subjective outcomes in pelvic organ prolapse surgery than LSH alone, especially for apical and anterior compartments, and is not associated with higher postoperative sexual dysfunction and mesh-related complications. Adequate preoperative counseling is highly recommended in patients who desire uterine preservation. CRD42024537270.

Efficacy and Tolerance of the Tampsec Vaginal Tampon for Treating Stress Urinary Incontinence. A Randomized Controlled Trial.

Stress urinary incontinence (SUI) is a highly prevalent condition in women. We hypothesized that the Tampsec™ vaginal tampon will be efficacious and well tolerated in its treatment. This was a multicenter open-label parallel-group randomized control trial. All participants were recommended to make lifestyle modifications and perform pelvic floor muscle training for SUI treatment. Additionally, women in the tampon group were instructed to use a Tampsec™ throughout the day. The primary outcome measure was a ≥50% reduction in pad weight by the end of treatment. Secondary outcome measures were women's perception of improvement evaluated using the Patient Global Impression of Improvement (PGI-I) questionnaire, decrease in the mean number of SUI episodes/day, and improvement in the impact of urinary incontinence (UI) on everyday life. Tampon tolerance and usability were also evaluated. Forty-six women with a positive urinary stress test were randomized 1:1 to tampon or control treatments. Regarding the primary outcome, a ≥50% reduction was achieved in 69.9% of patients in the tampon group and 26.1% in controls (RR 2.7; 95%CI 1.3-5.4). On the basis of PGI-I responses, the treatment was successful in 60.9% of women in the tampon group and 17.4% of controls (p = 0.003). The tampon group also reported greater decreases in SUI episodes/day (mean 2.0±2.2 vs 0.5±1.1; p = 0.007) and more improvement in the impact of UI on everyday life. Tolerance and usability were good in most women. The Tampsec™ tampon is efficacious and well tolerated in women with SUI. This treatment decreases the number of SUI episodes/day and improves UI-related quality of life.

The Nerve-Induced Adipose Stem Cells Promote Nerve Repair in Stress Urinary Incontinence by Regulating Schwann Cell Repair Phenotype Conversion Through Activation of the Notch Pathway.

Stress urinary incontinence (SUI) currently lacks effective treatment options, and the restoration of neurological function remains a major challenge, with unmet clinical needs. Research has indicated that adipose-derived stem cells (ADSCs) can be induced to differentiate into neural-induced adipose-derived stem cells (NI-ADSCs) under specific inductive conditions, exhibiting excellent neuroregenerative capabilities. ADSCs were obtained from female SD rats and induced into NI-ADSCs. In vitro, NI-ADSCs were co-cultured with Schwann cells (SCs) to investigate their effects on SC proliferation and repair phenotype transition and further explore its underlying mechanism. In vivo, a rat model of SUI was established using a bilateral pudendal nerve transection method. NI-ADSCs were injected into the urethral sphincter to evaluate their effects on urodynamics, muscle angiogenesis, and neural repair in SUI rats, while also exploring the mechanisms of neural repair. This study used EGF, FGF, and B27 to induce ADSCs into NI-ADSCs expressing neural induction markers (MAP, Nestin, and PAX6). In vitro experiments found no significant difference in the proliferation of L6 and RSC96 between NI-ADSCs and ADSCs (p > 0.05). However, when co-cultured with NI-ADSCs, SCs showed upregulated expression of repair-related phenotypic markers (BDNF, GDNF, and GFAP). In this phenotypic transformation process, the expression of Notch-related pathway proteins (Notch1, NICD, and Hes1) was increased, and the use of DAPT (a Notch pathway inhibitor) could suppress the SC repair phenotype transformation. In vivo, experiments revealed that intraurethral injection of NI-ADSCs significantly promoted the expression of neural marker (S100β) and demyelination markers (GFAP) and urodynamic recovery in SUI rats, while DAPT inhibited its neural repair effect. In summary, our study demonstrates that NI-ADSCs can promote nerve regeneration by promoting and maintaining the repair-related phenotype of SCs. The underlying mechanism may be related to the activation of the Notch signaling pathway.

2835 Evaluation of Paceycuff as a novel treatment for male stress urinary incontinence: the first UK experience

Abstract Background Prostate cancer and bladder outlet obstruction, often treated surgically, are increasing in the ageing population, leading to more cases of stress urinary incontinence (SUI). While implantable continence devices are beneficial for many, a growing number of frail patients are unsuitable for surgery and rely on incontinence pads or penile clamps, which are limited to three-hour use to prevent tissue ischaemia. We present the first UK evaluation of the new PaceyCuff penile clamp, designed for 24-hour wear while maintaining blood flow, to assess its efficacy, safety, and impact on patient quality of life. Method Men with urodynamically-proven SUI were identified. Baseline penile and finger peripheral oxygen saturation (SpO2), three-hour pad weight, 24-hour pad count and patient-reported outcomes (ICIQ-UI, QoL) were measured. Participants were then fitted with the PaceyCuff, and reassessed immediately, at three hours post-application and (via telephone) after two weeks. Results 13 men (average age 74, range 62–82) were recruited. ICIQ-UI scores decreased from 17 to 10, and QoL scores from 13 to 9. Average three-hour pad weight dropped from 94 g to 10 g and daily pad usage decreased from 4 to 0.9 pads. Participants reported good tolerance, with an average pain score of 1.8/10 and only 2 minor adverse effects (skin abrasion, transient pain). Penile SpO2 remained stable before, immediately after, and three hours post-use (76%, 82%, and 81% respectively). Sub-group analysis of patients over the age of 80 (n = 4) confirmed equal effectiveness. (ICIQ-UI decreased 18 to 10, QoL decreased 13 to 9, three-hour pad weight decreased 77 g to 9 g, daily pad usage decreased 4 to 1.5 pads, average pain 1.5/10). Conclusions The PaceyCuff has demonstrated both efficacy and tolerability in managing SUI in a UK cohort for the first time and offers a potential treatment option for elderly patients who are ineligible for surgical intervention.

Radiotherapy improves stress urinary incontinence but impairs pelvic floor function in endometrial cancer patients: a prospective cohort study.

Investigating the impact of radiotherapy on urinary incontinence and pelvic floor dysfunction in endometrial cancer patients. A comparative study was conducted between endometrial cancer patients who underwent radiotherapy and those who did not receive adjuvant therapy. Patients were assessed during their first follow-up visit at third month post-radiotherapy or post-surgery. Demographic data and physical examinations were conducted, along with the administration of validated questionnaires. Turkish validated Incontinence Severity Index (ISI), Incontinence Impact Questionairre-7 (IIQ-7) and 20 ıtem Pelvic Floor Dysfunction Index (PFDI-20) were applied to the all patients. The study comprised 37 patients in the non-radiotherapy group and 41 patients in the radiotherapy group. Comparable demographics were observed between the two groups. Vaginal length was notably longer in the non-radiotherapy group, and the Q-tip test angle was significantly greater in this group. A higher incidence of stress urinary incontinence and higher scores on the Incontinence Severity Index were noted in the non-radiotherapy group. Conversely, the radiotherapy group exhibited significantly higher scores on the Pelvic Floor Dysfunction Index components and total score. Urogenital Distress Inventory scores were similar between the groups. Radiotherapy showed mixed effects on pelvic floor function in endometrial cancer patients. While it potentially improved stress urinary incontinence, it was associated with unfavorable outcomes in overall pelvic floor dysfunction.

Development and Validation of Machine Learning Models for Risk Prediction of Postpartum Stress Urinary Incontinence: A Prospective Observational Study.

This study aims to develop a postpartum stress urinary incontinence (PPSUI) risk prediction model based on an updated definition of PPSUI, using machine learning algorithms. The goal is to identify the best model for early clinical screening to improve screening accuracy and optimize clinical management strategies. This prospective study collected data from 1208 postpartum women, with the dataset randomly divided into training and testing sets (8:2). Five machine learning algorithms-logistic regression, decision trees, random forests, support vector machines (SVM), and eXtreme gradient boosting (XGBoost)-were used to construct the PPSUI risk prediction model. Model performance was evaluated using multiple metrics, and the best-performing model was selected and validated for generalizability with the testing set. The final model retained ten features: birth weight, weight gain during pregnancy, BMI before delivery, pre-pregnancy BMI, age of delivery, gestation, parity, pre-delivery uterine height, age of first delivery, and labor analgesia. Among the five algorithms, the random forest model performed best, with a test AUC of 0.995 (95% CI 0.990-0.999, P < 0.05), accuracy of 0.956, precision of 0.957, recall of 0.944, specificity of 0.966, and F1 score of 0.951. The model's high generalizability was confirmed with the testing set and further validated through bootstrapping and tenfold cross-validation. The random forest model shows strong clinical potential for PPSUI risk prediction and early screening. Future studies should expand the sample size and include multi-center data to further enhance the model's clinical applicability.

Androgen deprivation therapy does not increase rates for reintervention, complication, or infection in primary penile implant or artificial urinary sphincter surgery: a retrospective cohort study from the TriNetX network.

Prostate cancer treatment-related erectile dysfunction and stress urinary incontinence are commonly treated with inflatable penile prosthesis (IPP) or artificial urinary sphincter (AUS). Given the association with androgens and penile/urethral health, we aim to evaluate whether patients on androgen deprivation therapy (ADT) undergoing IPP or AUS surgery are at increased risk for reintervention, complication, or infection. We queried the TriNetX database for adult males receiving IPP or AUS. The ADT cohort included those on ADT 3 months before or any time after surgery. We performed sub-analysis for leuprolide and bicalutamide. Cohorts and outcomes were defined by Current Procedural Terminology and International Classification of Diseases codes. Propensity score matching was performed using age, prostate cancer, history of prostatectomy, and history of radiation. Outcomes were reintervention (revision, removal, or replacement), infection, and complication. Analytics were performed in March 2024. 13,432 patients received an IPP and 5676 received an AUS, 465 and 745 of whom were on ADT, respectively. The only significant AUS analysis was for patients on abiraterone having fewer reinterventions (10.5% vs 20.8%, RR = 0.50 [0.29, 0.88]). Patients receiving an IPP with ADT had fewer reinterventions (7.2% vs 12%, RR = 0.60 [0.39, 0.92]) and complications (12.7% vs 18.5%, RR = 0.68 [0.49, 0.95]). Those on a GnRH agonist had fewer reinterventions (7.4% vs 11.7%, RR = 0.63 [0.41, 0.98]) for IPP. Patients receiving an IPP on bicalutamide had fewer reinterventions ( <5.2%* vs 10.8%, RR = 0.48 [0.23, 0.99]) and on leuprolide had fewer complications (12.2% vs 19.3%, RR = 0.63 [0.43, 0.91]). The remainder of analyses showed no significant differences. Patients with IPP or AUS do not fare worse on ADT. Further evaluation into the duration of ADT may provide clinical context, but based on these results, ADT should not limit implant surgery.