Treatment Of Female Urinary Incontinence Research Articles

Comparison of retropubic and transobturator tape placement for the treatment of female urinary incontinence

Objective To compare the efficacy and complications of rctropubic and transobturator tape placement for the treatment of female stress urinary incontinence(SUI).Methods 134 cases of SUI treated with midurethral tape procedures were divided into two groups according to the way of tape placement:retropubic group(32 cases)and transobturator group(102 Cases).The operating duration,blood loss and complications of two procedures were analyzed statistically.Results The average operating duration of retropubic group and transobturator group was(24±6)and(22±5)min,and average blood loss (45±27)and(54±23)ml,respectively.The curative rate was 96.88% and 98.04% in retropubic and transobturator groups respectively.There was no significant difference(P＞0.05).The complication rate of the two groups was similar(P＞0.05),including de novo uregency,voiding dysfunction,bladder and vaginal injures.But groin pain was more common in transobturataor group than in retropubic group(P＜0.05).Conclusion Although there are two different ways of tape placement,midurethral tape procedures are efficacious for the treatment of female SUI. Key words: Urinary incontinence; Sling tape procedure; Complications

The Miniarc® sling system in the treatment of female stress urinary incontinence

To assess the technical feasibility of a new mini-invasive sling procedure (MiniArc) and present short-term results in the treatment of female urinary incontinence. A total of 97 women with mixed or stress urinary incontinence (SUI) were treated by placement of the new single-incision sling. Pelvic organ prolapse was graded using the POP-Q system (pelvic organ prolapse quantification system). Preoperative workup included urodynamic evaluation, cough stress test and introital ultrasound. Postoperatively, introital ultrasound was performed to determine residual urine and check tape position. Quality of life was measured using King's Health Questionnaire. A voiding diary and pad count served to verify the patients' subjective complaints. The MiniArc single-incision sling procedure was the initial intervention in 37 (38.2%) patients and the second intervention in 60 (61.7%) patients with recurrent incontinence. The cough stress test was negative in 79 (83.1%) women 6 weeks after the sling procedure and in 74 (77.8%) at 12 months. De novo urge occurred in 32 (36.8%) women. Quality of life was significantly improved at 12-month follow-up in 65 (69.1%) patients (p < 0.001). The number of pads decreased significantly from 2.2 to 0.6 (p < 0.001) after the procedure. One patient developed an hematoma and bladder perforation occurred in another. Our short-term clinical results suggest that the MiniArc is a safe and effective minimally invasive sling procedure for treating female SUI. Randomized comparative controlled trials and long-term results are still required to define the role of the new sling system in comparison to established mid-urethral tape techniques for treating incontinence.

Perceptions and Competence in Evidence-Based Medicine: A Survey of the American Urological Association Membership

We investigated the attitudes and opinions of urologists toward evidence-based medicine to help guide future efforts of the American Urological Association and other organizations vested in the education and training of urologists. From August to November 2006 we performed a mail survey of a random sample of 2,000 members of the American Urological Association. Questions in the survey addressed the role of evidence-based medicine in urology, participants' self-assessed understanding of evidence-based medicine related terminology, their familiarity with and use of web based evidence-based medicine resources, as well as their evidence-based medicine competence based on their understanding of core concepts such as randomization and blinding. A total of 889 respondents completed the survey resulting in a response rate of 45%. There was widespread agreement that practicing evidence-based medicine improves patient care (median score 8; IQR 7, 10) and that every urologist should be familiar with critical appraisal techniques (median score 9; IQR 8, 10). The percentage of respondents who indicated that they "understand and could explain to others" the terms number needed to treat, power and level of evidence was 42%, 29% and 18%, respectively. The American Urological Association Guidelines were used regularly by 35% and on occasion by 51% of respondents. Of the participants 44% were unaware of the PubMed(R) search engine and only 14% used it regularly, while 76% were unaware of the Cochrane Database of Systematic Reviews and only 8% had ever used it. The mean evidence-based medicine competence score for all respondents was 67.2% +/- 17.0%. The findings of this survey confirm that urologists have a favorable attitude toward evidence-based medicine. However, understanding of evidence-based medicine terminology, concepts and use of related resources among American Urological Association members leaves room for improvement. Increased efforts to promote an understanding of evidence-based medicine through workshops, publications and web based resources specifically for a urological audience appear indicated.

457 Meshes under Urethra in the Treatment of Female Urinary Incontinence

457 Meshes under Urethra in the Treatment of Female Urinary Incontinence

Which nonsurgical options are effective for the treatment of female urinary incontinence?

In this study sponsored by the US federal government, Shamliyan et al. extracted data from 96 randomized controlled trials and 3 meta-analyses, and reviewed the evidence of nonsurgical treatment for female urinary incontinence (UI). Pelvic-floor muscle training alone, or in combination with bladder training, was found to be effective in improving UI compared with standard care. Generalizing the clinical relevance of these studies, however, was difficult because of heterogeneity between the trials. Anticholinergic agents were also moderately effective, but adverse effects were frequent. Additionally, slight improvements on subjective variables were noted with duloxetine, but adverse effects were numerous, and some were serious. The aim of conservative treatment for UI is often to improve quality of life rather than cure the disorder; if women are properly counseled, conservative therapies have a valuable place in the management of UI.

Outcomes Following Repeat Mid Urethral Synthetic Sling After Failure of the Initial Sling Procedure: Rediscovery of the Tension-Free Vaginal Tape Procedure

We evaluated outcomes of the repeat mid urethral sling to treat recurrent or persistent stress urinary incontinence after failure of an initial mid urethral sling. We retrospectively analyzed data on patients who underwent the repeat mid urethral sling procedure due to persistent or recurrent stress urinary incontinence. Repeat slings were placed without removal of the previous sling. All patients were followed at least 1 year after the second mid urethral sling. Of the 31 female patients with a repeat mid urethral sling 29 were followed, including 13 with a retropubic and 16 with a transobturator sling. For the first mid urethral sling 17 patients received a retropubic sling (tension-free vaginal tape) and 12 received a transobturator sling (6 inside out and 6 outside in procedures). Cure and improvement rates irrespective of the approach were 75.9% (22 of 29 patients) and 6.9% (2 of 29), respectively. Cure rates for the retropubic and transobturator slings were 92.3% (12 of 13 patients) and 62.5% (10 of 16), respectively, a difference that did not quite attain statistical significance (p = 0.089). The repeat mid urethral sling for persistent or recurrent stress urinary incontinence has a lower cure rate than the initial sling. However, the retropubic approach tends to have a higher cure rate than the transobturator approach in repeat sling cases.

Comparison of health care costs for open burch colposuspension, laparoscopic colposuspension and tension‐free vaginal tape in the treatment of female urinary incontinence

To compare direct health care costs of treatment for stress urinary incontinence in Sweden with four different procedures: (i) open Burch colposuspension (OBC); (ii) laparoscopic colposuspension with sutures (LCS); (iii) laparoscopic colposuspension with mesh and staples (LCM), and (iv) Tension-free Vaginal Tape (TVT). A model was constructed representing a hospital with standardized surgical equipment, staff and average unit costs in 2003 Euros. The time used for anesthesia and surgery was calculated. Clinical data was collected from three different sources, a multicenter, randomized, prospective study comparing OBC with LCM with 1 year follow-up, a three-armed, prospective study where women were randomized to either OBC, LCM, or LCS with 1 year follow-up and a descriptive study reporting results of TVT with 5 year follow-up. Data collected from the studies and hospital cost data were put into the model to create the different cost elements. The total cost per individual, showed a lower cost for TVT compared to the other alternatives. The direct costs for a TVT, euro1,366 were only 56% of the costs for an OBC, euro2,431 (P < 0.001) and 59% of the costs for a LCS, euro2,310 (P < 0.001). When using a model and comparing health care costs for surgical treatment of female stress urinary incontinence in Sweden, the TVT procedure generated a lower direct cost than both open and laparoscopic colposuspension.

1343: Minimal Invasive Treatment of Female Urinary Incontinence with Adjustable Continence Therapy

You have accessJournal of UrologyModerated Poster 41, Tuesday, May 22, 2007, 10:00 am - 12:00 pm1 Apr 20071343: Minimal Invasive Treatment of Female Urinary Incontinence with Adjustable Continence Therapy Johann Wachter, Armin Henning, Anton Ponholzer, Martin Marszalek, Michael Rauchenwald, and Stephan Madersbacher Johann WachterJohann Wachter More articles by this author , Armin HenningArmin Henning More articles by this author , Anton PonholzerAnton Ponholzer More articles by this author , Martin MarszalekMartin Marszalek More articles by this author , Michael RauchenwaldMichael Rauchenwald More articles by this author , and Stephan MadersbacherStephan Madersbacher More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)31557-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1343: Minimal Invasive Treatment of Female Urinary Incontinence with Adjustable Continence Therapy." The Journal of Urology, 177(4S), pp. 442–443 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 442-443 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Johann Wachter More articles by this author Armin Henning More articles by this author Anton Ponholzer More articles by this author Martin Marszalek More articles by this author Michael Rauchenwald More articles by this author Stephan Madersbacher More articles by this author Expand All Advertisement Loading ...

Current drug treatments for female urinary incontinence

Several new drug treatments are now marketed for incontinence with improved efficacy and reduced side-effects. Our Drug review discusses the range of drugs currently available to treat this condition, followed by a review of prescription data, sources of further information and the Datafile. Copyright © 2006 Wiley Interface Ltd

An exploration into patient preference for injectable therapy over surgery in the treatment of female urinary incontinence

To explore patient preference for injectable therapy over open surgery in the treatment of urinary incontinence. Fifty-eight female patients presented for treatment of urinary incontinence. During the initial interview process, they were asked to quantify their preference for injectable therapy over surgery by specifying the lowest success rate they would accept and still try injectable therapy. The results were summarized and assessed in relation to patient age and history of previous urogynecologic surgery. The mean lowest acceptable success rate for all 58 surveyed patients was 34%, with 23 (40%) accepting a success rate of only 10%. Although not statistically significant, the data suggested that older patients may tend to accept lower success rates than younger patients (mean of 39% for patients aged less than 60 years compared to 22% for those aged 80 years or older). There was no difference in response based on history of previous urogynecologic surgery. Patients appear willing to accept a relatively low success rate for injectable therapy compared to open surgery.

Voiding Dysfunction Following Removal of Eroded Synthetic Mid Urethral Slings

Voiding dysfunction following genitourinary erosion of synthetic mid urethral slings is not clearly reported. We investigated the incidence of voiding dysfunction in patients following sling excision due to vaginal, urethral or intravesical mesh erosion. Retrospective review identified 19 patients with genitourinary erosion of polypropylene mesh slings. Comprehensive urological evaluation was performed in all patients, and perioperative and postoperative data were analyzed. Voiding dysfunction was defined as refractory storage symptoms, emptying symptoms and pelvic pain. All subsequent medical and surgical interventions were recorded. In 19 patients a total of 11 vaginal, 7 intravesical and 5 urethral erosions occurred. Mean patient age was 52 years (range 32 to 69) and average followup was 8.4 months (range 3 to 34). Average time from symptom onset to sling removal was 10.1 months (range 1.5 to 38). Of the 19 patients 14 (74%) presented with multiple symptoms. Symptoms varied, including refractory pain, recurrent infections and bladder storage/emptying dysfunction. Urodynamic studies were abnormal preoperatively and postoperatively in 9 of 13 (69%) and 4 of 6 patients (67%), respectively. Following surgery lower urinary tract symptoms resolved completely in only 4 of the 19 patients (21%). Stress incontinence recurred in 8 of the 19 patients (42%). Five patients underwent simultaneous pubovaginal sling, of whom none had recurrent stress urinary incontinence. Only 9 patients (47%) considered themselves dry with no pads following surgery. Four patients required further surgery for refractory voiding symptoms. Voiding dysfunction is not an uncommon finding after sling excision in the setting of genitourinary erosion. It may cause additional patient morbidity.

Evidence-Based Medicine: A Survey of American Urological Association Members

We investigated the attitudes and opinions of urologists toward evidence-based medicine. In April of 2005 we contacted members of the American Urological Association listed with an e-mail address to participate in a web based survey. Participants were asked to characterize their level of agreement with statements referring to the role of evidence-based medicine in urology, to indicate their level of understanding of 15 evidence-based medicine related terms and to report their familiarity with 6 evidence-based medicine related resources. Of 8,100 American Urological Association members 714 (8.8%) responded to this survey. There was widespread agreement (median score 9) with the concept that evidence-based medicine improves patient care and that every urologist should be familiar with critical appraisal techniques. Select terms such as median/mean, selection bias and type I error were well understood ("understand and could explain to others") by 86%, 57% and 17%, respectively. The American Urological Association Best Practice Guidelines were the single best known resource that 91% of respondents reviewed or used regularly. To our knowledge this survey represents the first evidence-based medicine survey of a large international group of urologists. Its results indicate that evidence-based medicine is viewed favorably and that the American Urological Association Best Practice Guidelines present a well accepted instrument for the dissemination of evidence-based medicine in urology. However, given the low response rate and the potential for selection bias, interpretation of these results must be performed with caution. Future efforts should be directed toward providing increased opportunities for urologists to learn the principles of critical appraisal, facilitating the application of evidence-based medicine in the community and promoting high quality research.

Short‐ and long‐term results of the tension‐free vaginal tape procedure in the treatment of female urinary incontinence

The aim was to describe the short- and long-term results of treatment for urinary incontinence (UI) in women using the tension-free vaginal tape (TVT) procedure at a single unit and to identify factors predictive of successful outcome. Consecutive female patients (n = 707) treated for UI with the TVT procedure at Karlstad Hospital from November 1996 to June 2004 were included. After a standardized preoperative evaluation, the women were classified as having either stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). The results of surgery were evaluated after 1, 2, and 5 years, by means of a postal questionnaire. An objective evaluation was performed after 5 years in a subsample of the first patients included (n = 59). Factors influencing the cure rate were analyzed using multiple regression analysis. The subjective cure rate was 83% after 1 year and 73% after 5 years. The objective cure rate was 83% in the subgroup after 5 years. Surgical time was 30+/-9 min (mean+/-SD). The rate of bladder perforations was 1.7%. In patients with MUI the cure rate was lower than in patients with SUI (after 5 years 54.9% versus 81.0%). Type of incontinence was the only independent variable found to influence surgical outcome. The TVT procedure, performed in over 700 women at a single gynecological unit, was found to be a safe and efficient surgical procedure. Type of incontinence was the only independent variable found to predict for outcome of surgery.

TVT and TVT-Obturator: Comparison of two operative procedures

AimTo compare two anti-incontinence operations: the tension-free vaginal tape (TVT) and the TVT-Obturator for the first two 75-patient groups. MethodsOne surgeon operated on two patient groups with urodynamically proven urinary stress incontinence. The first 75-patient group in 1998 included the first TVT procedures performed according to Ulmsten [Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J 1996;7:81–6]. Follow-up lasted for 5–6 years. The second 75-patient group in 2004 included the first TVT-Obturator operations performed according to [De Leval J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur. Urol. 2003;44:724–30]. Follow-up lasted for 6–13 months. ResultsThe two patient groups were similar from the demographic and therapeutic points of view. The TVT-Obturator procedure required neither bladder catheterization nor intra-operative diagnostic cystoscopy. TVT-related bladder penetration (8.0%), post-operative voiding difficulties (5.0%), intra-operative bleeding (4.0%), post-operative field infection (2.7%), and post-operative pelvic floor relaxation (1.3%) were not noted with the TVT-Obturator. The early therapeutic failure rates were 2.7% for the TVT and 1.3% for the TVT-Obturator, and neither bowel nor urethral injuries were recorded. ConclusionsThe surgeons’ learning curves of these two minimally invasive surgical procedures for the treatment of female urinary stress incontinence are comparable. The safety and cost-effectiveness of the TVT are well-established. The TVT-Obturator, a novel mid-urethral sling, was designed to overcome some of the TVT-related operative complications. The TVT-Obturator patients seem to have less intra-operative and post-operative surgical complications than the TVT patients. However, long-term comparative data collection is required prior to drawing solid conclusions concerning the superiority of one of these two operative techniques.

Antimuscarinic Drugs for the Treatment of Female Urinary Incontinence

Overactive bladder syndrome, urge syndrome or urgency-frequency syndrome is defined as 'urgency with or without urge incontinence, usually with frequency and nocturia'. Although this definition indicates that these symptoms are suggestive of detrusor overactivity (the observation of involuntary detrusor contractions during the filling phase of cystometry), a urodynamic demonstration of detrusor overactivity is not necessary in order to make the diagnosis. Nevertheless, patients with overactive bladder syndrome represent a substantial proportion of patients suffering with urinary symptomatology, and approximately a third of individuals with overactive bladder suffer from incontinence. Furthermore, as compared with those patients with stress urinary incontinence, women with urge incontinence have a poorer overall quality of life, perhaps related to both the volume of urine lost as well as the unpredictable nature of the leakage. When combined with behavioral modification, antimuscarinic pharmacotherapy remains the mainstay of treatment for this condition. A number of these agents are available for the treatment of overactive bladder-related incontinence, each with unique pharmacokinetic and pharmacodynamic properties. In order to optimize therapy for patients suffering from this type of incontinence, it is necessary to understand the mechanism of action of these agents, as well as to be familiar with the differences between them with respect to efficacy, safety and tolerability.

89 Twenty years of artificial urinary sphincters in the treatment of female urinary incontinence.

Aim: To review the use of the artificial urinary sphincter (AUS) in female urinary incontinence.Methods: Review of a single surgeon experience with use of the AMS 800 (American Medical Systems) in the period Aug 1983–July 2005. Data was collected prospectively on all patients. Follow‐up information was complete on all cases to Oct 2005.Results: A total of 48 patients had an AUS with an average follow‐up of 12.5 years (0.3–22 years). Indications for placement were urethral incompetence following failed previous anti‐stress surgery (36), pelvic trauma (seven), previous urethral surgery (two), myelomeningocele (one) and other (two). A total of 19 revision procedures were required in 15 patients (31%). With the exception of one case with infection, revisions related to mechanical failure. Fluid loss occurred in 16 cases with either splits or small holes in the tubing being the most commonly identified cause. Non‐leak device malfunction occurred in only two patients (5%).Summary: The AUS is a highly successful intervention for incontinence related to intrinsic sphincter deficiency in female patients. It avoids the potential problem of bladder outflow obstruction associated with slings. Up to a third of patients will require revision surgery with long term follow‐up. However this is largely related to fluid leakage and readily addressed. The AUS may be an underutilised treatment modality for female urinary incontinence and should be considered in selected patients with intrinsic sphincter deficiency in preference to other procedures.

Novel surgical procedure for the treatment of female stress urinary incontinence by using transobturator vaginal tape

Current method in the treatment of female urinary incontinence implies the placement of tension-free suburethral vaginal tape, using a retropubic or transobturator approach. Considering numerous complications related to retropubic approach, we reported the results of transobturator procedure in prospective study. We used a non-absorbable polypropylene tape with the outside-in (Herniamesh) or in-outside (Johnson & Johnson) transobturator approach. During the period from October 2004 to September 2005 the procedure was carried out in 10 patients. In only 2 cases urinary stress incontinence occured as isolated problem managed with transoburator tape, whereas in 8 patients this procedure was associated with other operative gynecologic events. No perioperative complication was encountered. In 80% of the patients a satisfactory result was obtained, while one patient failed to demonstrate any amelioration, and the other developed subsequently urge incontinence. Transobturator tesion-free vaginal tape represents a very simple, safe and, in the large percent of cases, successful procedure in the management of urinary stress incontinence, with rare perioperative complications.

Sub-urethral Tape Treatment of Female Urinary Incontinence—Morbidity Assessment of the Trans-Obturator Route and a New Tape (I-STOP®): A Multi-centre Experiment Involving 604 Cases

Sub-urethral Tape Treatment of Female Urinary Incontinence—Morbidity Assessment of the Trans-Obturator Route and a New Tape (I-STOP®): A Multi-centre Experiment Involving 604 Cases

Objective and Subjective Cure Rates after Trans-Obturator Tape (OBTAPE®) Treatment of Female Urinary Incontinence

Objective(s)To evaluate the safety and efficacy of a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure (OBTAPE®, Mentor-Porges, Le Plessis Robinson, France) for women with stress urinary incontinence. MethodsBetween January 2003 and January 2005, 129 consecutive women (mean age 57.2 years) underwent OBTAPE® in two academic centers. All the patients had stress urinary incontinence preoperatively. Detrusor instability was ruled out by cystometry. The women were evaluated 1, 6 and 12 months postoperatively. The objective cure rate was evaluated by clinical examination and the subjective cure rate was assessed using the KHQ and BFLUTS questionnaire. ResultsMean follow-up was 17.2±4.7 months (range 4 to 28 months). The objective and subjective cure rates were respectively 89.9% and 77.5%. Most of the patients received general anesthesia (85.3%). Urinary retention was observed in two women (1.5%), necessitating tape adjustment. Voiding difficulties were observed in 7 cases (5.4%) necessitating intermittent self-catheterization for 4.2±2.4 days (range 1 to 7 days). Seven patients developed vaginal erosion (one with vaginal extrusion, and two with an obturator abscess). Complete mesh removal was necessary in 6 patients, four of whom had recurrent stress urinary incontinence. ConclusionsOur results suggest that the OBTAPE® is an effective treatment for women with stress urinary incontinence. However, vaginal mesh erosion occurred in 6.2% of women, and this implies the need for careful follow-up.

ROLE OF SLING INTEGRITY IN THE RESTORATION OF LEAK POINT PRESSURE IN THE RAT VAGINAL SLING MODEL

We tested the hypothesis that cutting the sling at its suburethral section does not cancel its anti-incontinence effect. We also examined the long-term effects of the sling on bladder function in a recently validated rat model of vaginal sling. Stress urinary incontinence was created in 60 female Sprague-Dawley rats by the previously established method of bilateral pudendal nerve transection. Under anesthesia 20 animals received a vaginal sling, 20 received a vaginal sling in which the suburethral portion of the sling was cut immediately after placement and 20 received a sham vaginal sling. Six weeks after the procedures leak point pressure was determined and a cystometrogram was done using anesthesia in each animal via a previously implanted suprapubic catheter. Kruskal-Wallis and pairwise separate rank multiple comparison tests were performed with a significance level of 0.05. The cut and intact slings increased leak point pressure similarly and these values were significantly higher than that of the sham sling (24.9 and 27.9 cm H2O, respectively, vs 20.7, p <0.0001). Peak micturition pressure was not significantly different among the 3 groups, indicating absent bladder outlet obstruction in the sling groups. Bladder compliance was significantly decreased 6 weeks after placement of a cut or intact sling compared with the sham sling (p = 0.007 and 0.05, respectively). An intact suburethral portion is not a requirement for sling effectiveness in the rat model of stress urinary incontinence. However, the sling procedure decreases bladder compliance. This may explain the observed voiding dysfunction associated with sling procedures.