Treatment Option For Stress Urinary Incontinence Research Articles

Применение объемообразующих препаратов для коррекции стрессового недержания мочи у женщин

The problem of stress urinary incontinence (SUI) has become particularly important in recent years. Increasing life expectancy and the desire to improve the quality of life have led to a greater emphasis on these complaints and early referral to specialist care. There are various treatment options for SUI in women that aim to prevent involuntary urination when intra-abdominal pressure increases during physical activity, coughing or sneezing. Among these options, bulking agents occupy a certain niche. Objective. To study the efficacy of bulking agent injections depending on the angle of urethral mobility and to analyze the longterm results of treatment. Patients and methods. This prospective study included 35 women with SUI who experienced failure of behavioral therapy. Patients were divided into two groups depending on urethral mobility: group 1 (n = 15) included patients with a Q-tip angle <30°, group 2 (n = 20) – patients with a Q-tip angle ≥30°. The injection of bulking agent was performed in all patients, and a viscoelastic hyaluronic acid-based filler for contour plasty was used for peri-urethral injections. Treatment results were assessed after 3, 6, 12 and 24 months. Results. The most pronounced positive dynamics was observed in group 1 (with a lower Q-tip angle). Significant improvement at 3 months after injection was noted in 66.7% of patients (n = 10). In group 2 with urethral hypermobility, improvement was noted only in 45% of women (n = 9), which is 21.7% less. After 12 months, the effect in group 1 (with a Q-tip angle <30°) was 26.9% higher than in group 2, and after 24 months it was 20% higher. Conclusion. Peri-urethral injections of bulking agents are most effective at a lower angle of urethral mobility. Further research in this area is needed. Key words: stress urinary incontinence, bulking agents

Treatment of male stress urinary incontinence at time of inflatable penile prosthesis placement a review of contemporary literature.

Male stress urinary incontinence (SUI) and erectile dysfunction (ED) are well established diagnoses within Men's Health, often more specifically within the prostate cancer survivorship cohort. Taken individually, well defined treatment algorithms exist with which many surgeons are comfortable; however, treatment of both in a single setting or staged fashion introduces complexity. Emerging treatment options also exist, and there is immature or minimal data when these are combined with inflatable penile prosthesis (IPP) insertion, radiation history, and/or variable degrees of incontinence. Our objective was to describe and summarize the currently available treatment options for SUI particularly at the time of IPP insertion. A literature review was performed to summarize contemporary treatment of SUI at time of IPP placement. Anecdotal experience was added from high volume, subspecialty trained Men's Health and Reconstructive Urologists. Non-invasive approaches such as pelvic floor muscle training (PFMT), behavioral modification, and external compression devices play some limited role in treatment and/or management of SUI, particularly in the early post operative period, or for those unwilling or unable to undergo more definitive intervention. More invasive options such as artificial urinary sphincter (AUS) implantation, male sling, or other implantable devices are more appropriate for good surgical candidates with higher bother and/or more severe incontinence. These options can be concomitant or staged relative to IPP placement. Climacturia, particularly with mild or no bothersome SUI, can successfully be addressed at the time of penile prosthesis placement with the utilization of the Mini-Jupette suburethral sling. A variety of treatment options exist for concomitant treatment of SUI at time of IPP, and both safety and efficacy have been demonstrated for many in the same operative setting. As with treatment of ED or SUI in isolation, patient selection, careful counseling, and management of expectations can lead to high patient satisfaction.

Medium Term Outcomes of TVT-Abbrevo for the Treatment of Stress Urinary Incontinence: Efficacy and Safety at 5-Year Follow-Up.

Background and objectives: Stress urinary incontinence (SUI) is the most common type of urinary incontinence, affecting approximately 46% of adult women. After failure of conservative treatment, the mid-urethral sling (MUS) is considered the most effective and safe surgical procedure for SUI. In 2012, Waltregny et al. introduced a new trans-obturator tension-free vaginal tape (TVT) procedure, named TVT-abbrevo (TVT-A). The aim of the present study is to evaluate the efficacy and safety of the TVT-A procedure in women with pure SUI at 5-year follow-up. Materials and Methods: All women who complained of pure SUI symptoms with concomitant urodynamic stress incontinence (USI) were prospectively enrolled and treated with the TVT-A procedure. Postoperative subjective outcome measures included: International Consultation on Incontinence Questionnaire–Short Form (ICI-Q SF), Patient Global Impression of Improvement (PGI-I) scale, and patient degree of satisfaction scale. A PGI-I score ≤ 2 and a patient-satisfaction score ≥8 were used to define subjective success. Objective success was defined as the absence of urine leakage during a cough stress test. Adverse events were collected according to the Clavien–Dindo classification during follow-up. Results: Univariable analysis was used to investigate outcomes. Fifty women who met the inclusion criteria underwent TVT-A implantation. At 5 years after TVT-A implantation, 38 out of 45 (84.4%) patients were subjectively cured (p for trend 0.05), and 40 out of 45 (88.9%) patients were objectively cured (p for trend 0.04). A significant trend of de novo OAB symptoms was reported (22.2% [10/45]) at the 5-year follow-up. No serious early or late complications such as urethral/bladder injury, persistent groin-thigh pain, and sexual dysfunction that required mesh removal were detected. The univariate analysis did not reveal any risk factors (i.e., age, body mass index (BMI), menopause, obstetric factors, and preoperative ICIQ- SF questionnaire) statistically associated with failure of the TVT-A procedure. Conclusions: In conclusion, the 5-year follow-up results of this study demonstrated that TVT-A is a safe and effective option for treatment of SUI with a very low rate of post-operative groin–thigh pain

Is it the Time to Revisit Historical Bladder Neck Buttressing for the Treatment of Stress Urinary Incontinence?

Objectives: The aim of our study was to assess improvement in bladder function and quality of life using Australian Pelvic floor questionnaire as Patient Reported Outcome tool following anterior repair and urethral buttressing for treating stress urinary incontinence (SUI) with prolapse using polydioxanone sutures. Material and Methods: This was the prospective review of retrospective data. The data were collected through telephone or postal questionnaire by an independent researcher who was not involved in the patient care directly and analyzed with Stata (14.2). Results: About 78% (61/78) of women responded to the questionnaires. Statistically significant improvement in bladder function scores was noted after surgery (5.12 ± 2.06 vs. 3.69 ± 2.26; P = 0.001) along with an overall improvement in the quality of life scores (17.88 ± 8.03 vs. 11.56 ± 9.01; P = 0.005) at mean follow-up of 31 months. Overall, 54% patients reported improvement in their symptoms. The re-operation rate for second continence procedure for SUI was 1/61 (1.6%). Conclusion: This procedure can be offered to patients as a treatment option for SUI with prolapse.

Making surgery safer through adequate communication with the stakeholders: vaginal slings.

In this review, we explore the evidence behind mid-urethral sling (MUS) surgery, review the rising reports of complications and the subsequent US Food and Drug Administration (FDA) and society statements, and evaluate risk perception and communication with patients, doctors, governing bodies, manufacturers and insurance companies. Our aim was to explore the pitfalls in communication that may be contributing to the decline in MUS use, and develop strategies to make MUS surgery safer. We searched the English language literature using PubMed for articles related to the management of stress urinary incontinence (SUI), MUS, safety and monitoring of transvaginal mesh (TVM), and reviewed all online FDA publications and international position statements regarding MUS for SUI. Polypropylene mesh has been used in MUS since the 1990s, with robust evidence to support its use. There has been a decline in the use of MUS ever since the FDA notifications. In response to the controversy surrounding TVM, position statements have been released portending the safety of, and advocating for the continued use of, MUS for the management of SUI. MUS is a viable, effective and safe treatment for SUI management. Physicians should obtain and document informed consent, be adequately trained, and monitor and report their outcomes using registries. With publication of registry results and ongoing health advocacy, the perception of the safety of MUS can improve and MUS can still be offered as a treatment option for SUI.

The controversy of polypropylene mesh

Synthetic mid-urethral tapes have become the commonest operation for stress urinary incontinence (SUI) since introduction to the UK in 1998. Transvaginal mesh for vaginal prolapse repair became available in 2002. Tapes were implanted in over 90% of SUI procedures in UK at their peak of adoption, compared to less than 10% mesh utilisation in prolapse operations. However, increasing concern about adverse events associated with prolapse devices has led to worldwide scrutiny of all mesh devices, and some manufacturers have withdrawn from the market. Systematic reviews into safety and efficacy have been undertaken in the UK with publications by MHRA (2014), Scottish Independent Enquiry (2017) and NHS England Review (2018). NICE is currently reviewing clinical guidance on incontinence and prolapse; in the interim they continue to recommend tapes be included amongst the treatment options for SUI, but suggest mesh for prolapse only be used in a research setting.

A systematic review on vaginal laser therapy for treating stress urinary incontinence: Do we have enough evidence?

Current treatment strategies for stress urinary incontinence (SUI) raise concerns about safety and efficacy. The purpose of this systematic review was to present available evidence related to vaginal laser therapy as a treatment option for SUI. We searched the MEDLINE (1966-2017), Scopus (2004-2017), Clinicaltrials.gov (2008-2017) and Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2017) databases for relevant studies in this field. We aimed to include all observational studies (prospective and retrospective, randomized and nonrandomized) that reported outcomes on vaginal laser therapy as a treatment option for SUI. Thirteen studies were included that recruited 818 patients who underwent laser therapy for SUI. The methodological quality of most included studies was low, as they were either individual case-control studies, case series or poor-quality cohorts (Oxford Level of Evidence 3b and 4). According to the existing evidence, laser therapy may be a useful, minimally invasive approach for treating SUI. However, the methodological limitations of included studies render them prone to significant bias, limiting their scientific integrity. As the demand for minimally invasive approaches for treating SUI increases, it is expected that more patients will seek alternative treatments over current standards (midurethral slings). Given the limitations of the existing studies, it seems that conducting future trials is necessary to elucidate this field.

Outlet Procedures in Female Cancer Survivors for the Treatment of Stress Incontinence: Differences in Indications, Technique, and Outcome for the Cancer Survivor

This article reviews the literature published over the past 5 years to provide an update regarding outlet procedures in female cancer survivors for the treatment of stress urinary incontinence (SUI), with note made of any specific considerations in terms of indications, surgical technique, and outcomes. Treatment options for SUI depend on the pathophysiology of incontinence and should be performed after cancer treatment is completed. Multidisciplinary considerations are important. Urethral bulking agents may be of benefit in mild incontinence; sling procedures effective in moderate to severe incontinence. For refractory SUI, AUS can be considered but has a high failure rate in irradiated patients; urinary diversion with or without bladder neck closure is also an option. More studies regarding management of SUI in this increasingly prevalent group of female cancer survivors are warranted.

The Non-surgical Options for SUI—Is Any One Optimal?

There are many options for nonsurgical management of stress urinary incontinence (SUI). With the growing aging population, there is increased incontinence and need for less invasive options for SUI treatment. Conservative strategies have long been a fundamental part of treatment and may be the only management required or only management possible in some patients. Lifestyle modification, anti-incontinence devices, and pelvic floor muscle exercises benefit a significant number of patients. This may be performed, with or without the addition of vaginal weighted cones or biofeedback. Pharmacological treatment exists, yet is not considered a standard of care. This is a comprehensive review of the non-surgical treatment options for SUI.

Duloxetine in women awaiting surgery

Stress urinary incontinence (SUI) is a common condition affecting millions of women worldwide. It has a significant impact on the quality of life (psychosocial, social and economic well-being) of sufferers and their families. Until recently, treatment options for SUI were limited to conservative treatments such as pelvic floor muscle training, which usually has a poor compliance over time, or surgical procedures that carry the risk of complications and are mainly an option for more severely affected women. Duloxetine, a potent and relatively balanced serotonin and noradrenaline reuptake inhibitor, has been evaluated in phase II and phase III clinical trials and was found to be efficacious and safe in the treatment of women with moderate to severe SUI symptoms. Even in a subgroup of women with severe SUI awaiting surgery, with or without the presence of intrinsic sphincter deficiency, duloxetine was found to be effective. In addition, a good correlation was found between efficacy outcome measures and ratings of global impression scores. Women begin to perceive themselves as being better with treatment when their incontinence episodes frequency (IEF) decreases by 46% or their Incontinence Quality of Life (I-QOL) score improves by 6.3 points. The improvements in IEF and I-QOL obtained with duloxetine were well above these threshold levels, whereas these with placebo were not. All duloxetine responses were observed within 2 weeks. Overall, duloxetine is an effective treatment for a wide variety of women presenting with SUI symptoms. It has been approved in Europe for the treatment of women with moderate to severe SUI symptoms and is now available in many European countries.