Treatment Of Incontinence Research Articles

Gatekeeper™ Prostheses Implants in the Anal Canal for Gas Incontinence and Soiling: Long-Term Follow-Up

Introduction: Although several treatments for faecal incontinence are available, gas incontinence (GI) and soiling are difficult to manage. The aim of this study is to evaluate Gatekeeper™ for this subtype of faecal incontinence. Methods: Prospective single-centre case series. Patients with mainly soiling and/or GI were treated with polyacrylonitrile prostheses. An evaluation was performed with a 3-week continence diary. St. Mark’s score and a Visual Analogue Scale (VAS) were used to study the patient’s continence perception and surgical satisfaction, at baseline and 1, 3, 6, 12, and 24 months postoperatively. 3D-Endoanal Ultrasound and Anorectal Manometry were performed at baseline and postoperatively. Results: A total of 13 patients were enrolled (11 women), aged (median (IQR)) 62 (13) years, and all implants were uneventful. A significant reduction in soiling and GI episodes was documented at 1 year, 7 (18) baseline days of soiling/3 weeks vs. 2 (4) (p = 0.002); 13 (13) baseline episodes of GI/3 weeks vs. 4 (10) (p = 0.01). This improvement was correlated with a significant increase in VAS (0–10), 3 (2, 5) baseline vs. 7 (1, 5) (p = 0.03), and maintained throughout the follow-up. There was complete remission or significant improvement defined as >70% reduction in gas and soiling days in 6 patients at 2 years follow-up. Soiling episodes were reduced ≥70% in 8/11 patients (72.7%). Nine (70%) patients would repeat the treatment. Conclusions: Gatekeeper™ is a safe, minimally invasive treatment for soiling and GI. A significant reduction in soiling and GI was observed in our series, with a better response to soiling. Most of the patients would repeat the treatment. Other studies are needed to confirm these findings in this subgroup of FI patients.

Role of Non-Mesh Grafts in Surgical Treatment of Stress Urinary Incontinence

Stress urinary incontinence refers to a multifactorial disease characterized by involuntary urination associated with a sudden increase in intra­abdominal pressure. Millions of females around the world suffer from stress incontinence each year. Conservative methods of treatment and physical rehabilitation are considered to be ineffective, thereby driving the need for surgical treatment. Sling surgeries comprise a widely used surgical technique for the treatment of stress urinary incontinence due to their affordability and minimal time investment. Introduction of synthetic polypropylene mesh prostheses in the treatment of stress incontinence made them the most common material. However, the accumulated experience and complications associated with the use of mesh grafts contribute to the recent decline in the popularity of synthetic slings and give rise to the search for and development of alternative materials for the surgical treatment of stress urinary incontinence. Since the need for treatment of urinary incontinence remains high, fascia autograft surgeries have been proposed, even though they require an additional surgical procedure and expose the patient to complications at the donor site of the graft. In addition, surgeons use allografts and xenografts, and regenerative technology is developing in this field. Considering high social significance of this problem, the present paper is aimed at reviewing the scientific literature concerning grafts for the treatment of stress incontinence.

Platelet-rich plasma for treatment of female stress urinary incontinence.

Stress urinary incontinence (SUI) poses a significant burden on affected individuals, impairing their quality of life and causing embarrassment due to involuntary urine leakage during activities such as sneezing or coughing. While conservative and surgical treatments exist, a subset of patients experiences persistent symptoms despite these interventions. This review provides insights into the potential role of platelet-rich plasma (PRP) as a therapeutic adjunct for patients with SUI that does not respond to conventional non-surgical or surgical treatments. We conducted a literature review of studies in English to evaluate PRP efficacy in managing SUI. The studies conducted on PRP therapy suggest that it is an effective and safe treatment option for SUI in women. PRP injections, when used alone or in combination with other therapies, have shown significant improvements in SUI symptoms. Moreover, these studies indicate that PRP injections offer a less invasive and low-risk alternative to surgical procedures for managing SUI, which could lead to shorter recovery times. The efficacy of PRP therapy is evidenced by significant reductions in SUI symptoms, as well as improvements in bladder function variables, without significant adverse effects reported. However, further research is necessary to establish the long-term effectiveness and safety of PRP therapy for managing SUI in diverse patient populations. Additionally, ongoing evaluations of PRP therapy in combination with other interventions will be essential for optimizing treatment outcomes and broadening the potential applications of PRP in the management of SUI.

Exploring the Efficacy of Artificial Intelligence: A Comprehensive Analysis of CHAT-GPT's Accuracy and Completeness in Addressing Urinary Incontinence Queries.

Artificial intelligence models are increasingly gaining popularity among patients and healthcare professionals. While it is impossible to restrict patient's access to different sources of information on the Internet, healthcare professional needs to be aware of the content-quality available across different platforms. To investigate the accuracy and completeness of Chat Generative Pretrained Transformer (ChatGPT) in addressing frequently asked questions related to the management and treatment of female urinary incontinence (UI), compared to recommendations from guidelines. This is a cross-sectional study. Two researchers developed 14 frequently asked questions related to UI. Then, they were inserted into the ChatGPT platform on September 16, 2023. The accuracy (scores from 1 to 5) and completeness (score from 1 to 3) of ChatGPT's answers were assessed individually by two experienced researchers in the Women's Health field, following the recommendations proposed by the guidelines for UI. Most of the answers were classified as "more correct than incorrect" (n = 6), followed by "incorrect information than correct" (n = 3), "approximately equal correct and incorrect" (n = 2), "near all correct" (n = 2, and "correct" (n = 1). Regarding the appropriateness, most of the answers were classified as adequate, as they provided the minimum information expected to be classified as correct. These results showed an inconsistency when evaluating the accuracy of answers generated by ChatGPT compared by scientific guidelines. Almost all the answers did not bring the complete content expected or reported in previous guidelines, which highlights to healthcare professionals and scientific community a concern about using artificial intelligence in patient counseling.

Long-term results of artificial urinary sphincter in women: A retrospective monocentric study

BackgroundStress urinary incontinence (SUI) is a public health issue, with major impact on quality of life. An efficient treatment for intrinsic sphincter deficiency (ISD) is the artificial urinary sphincter (AUS). ObjectivesAnalyzing patient survival in terms of revision-free survival, removal-free survival and global survival without reintervention long-term results concerning continence status and complications. DesignWomen with severe ISD and negative Bonney test who were treated with AUS first implantation between 1987 and 2022 were included. ResultsIn our study, 478 patients were treated by AUS first implantation with a mean age of 59.7. The median follow-up time was 13.2years. The median revision-free survival was 19.5years with survival rates at 10, 20 and 30years were 86%, 47% and 32% respectively. Removal-free survival rates at 10, 20 and 30years were 84%, 80% and 60% respectively. Median reintervention-free survival was 17.5years. Survival was negatively affected by neurological etiology of the ISD, history of previous incontinence treatment and intraoperative complications with more early removals in the latter group. The absence of previous incontinence surgery was a protecting factor. Continence status was assessed at 10, 20 and 30years follow-up with a fully continence rate of respectively 83%, 68% and 61%. Intraoperative complication rate was 17.7%, explantation rate was 14% and the revision rate was 23%. ConclusionWomen treated with AUS have an excellent revision-free, removal-free and global survival rate. AUS is a very efficient treatment for women with ISD in terms of continence results with an acceptable intraoperative and long-term complication rate of which patients should be well informed before choosing this treatment for their SUI.

Variation in Overactive Bladder Treatment Type by Social Determinants of Health

Importance There is limited understanding of the relationship between social determinants of health (SDOH) and types of overactive bladder/urgency urinary incontinence (OAB/UUI) treatments. Objectives Our objective was to determine if OAB/UUI treatment type differs by SDOH, including insurance and estimated median household income (EMHI). Study Design This was a cross-sectional study of adult patients assigned female at birth with OAB/UUI, identified from 2017 to 2022 within a tertiary academic health system. The primary outcome was any OAB/UUI treatment provision. Secondary outcomes included specific treatments and specialty care. We examined associations between SDOH and OAB/UUI treatments using univariable analysis and multivariable logistic regression. Results Among 33,002 patients with OAB/UUI, 15.4% received treatment. Treatment provision was associated with American Indian/Alaska Native or Black/African American race, Latina ethnicity, Medicaid, low-income Medicare, or Medicare Advantage (vs private insurance) and EMHI ranging from $26,500 to $100,000 (compared with EMHI >$100,000). Patients with Black/African American race, Medicaid or no insurance, and EMHI ≤$80,000 had higher odds of anticholinergic prescription and lower odds of β3-agonist prescription. Advanced therapy was associated with traditional Medicare, Medicare Advantage, and EMHI $26,500–$100,000 and negatively associated with Asian race. Specialty care was associated with Black/African American race, Medicaid, Medicare Advantage, no insurance, and EMHI ≤$80,000. Conclusions Overactive bladder/urgency urinary incontinence treatment provision was associated with American Indian/Alaska Native and Black/African American race, Latina ethnicity, Medicaid, low-income Medicare, or Medicare Advantage insurance. Patients with Black/African American race and with lower EMHI had higher odds of receiving anticholinergic therapy and lower odds of receiving β3-agonist medication, despite higher likelihood of specialty care.

A IMPORTÂNCIA DO TRATAMENTO FISIOTERAPÊUTICO DA INCONTINÊNCIA URINÁRIA (IU) NO PÓS-PARTO VIA VAGINAL

Physiotherapy treatment of urinary incontinence (UI) in the postpartum vaginal period is essential to strengthen the Pelvic Floor (PF), relieve symptoms and prevent future complications, promoting effective recovery and improving quality of life. The objective is to report the impact of urinary incontinence (UI) in the postpartum vaginal period, detailing how it affects the physical-social area of ​​pregnant and postpartum women and, aims to highlight the importance of physiotherapy treatment in the prevention and management of UI, showing how physiotherapy contributes to the improvement of symptoms and the recovery of women after childbirth. For this study, an exploratory bibliographic review was used as the research methodology, and the research sources were extracted from databases such as Scielo, PubMed, ICS, BVS, as well as specialized scientific journals and recognized websites, such as Hospital Albert Einstein and universities, and the time frame covers publications between the years 2015 and 2024. We conclude that Urinary Incontinence (UI) is a condition that can have a significant impact on the lives of women after vaginal delivery, affecting their quality of life and general well-being. This pathology results in the involuntary loss of urine, which can cause physical and emotional discomfort, limit daily activities and generate social embarrassment. Understanding the negative effects of UI is crucial to recognizing the importance of effective prevention and treatment strategies, especially during the postpartum period.

A IMPORTÂNCIA DO TRATAMENTO FISIOTERAPÊUTICO DA INCONTINÊNCIA URINÁRIA (IU) NO PÓS-PARTO VIA VAGINAL

Physiotherapy treatment of urinary incontinence (UI) in the postpartum vaginal period is essential to strengthen the Pelvic Floor (PF), relieve symptoms and prevent future complications, promoting effective recovery and improving quality of life. The objective is to report the impact of urinary incontinence (UI) in the postpartum vaginal period, detailing how it affects the physical-social area of ​​pregnant and postpartum women and, aims to highlight the importance of physiotherapy treatment in the prevention and management of UI, showing how physiotherapy contributes to the improvement of symptoms and the recovery of women after childbirth. For this study, an exploratory bibliographic review was used as the research methodology, and the research sources were extracted from databases such as Scielo, PubMed, ICS, BVS, as well as specialized scientific journals and recognized websites, such as Hospital Albert Einstein and universities, and the time frame covers publications between the years 2015 and 2024. We conclude that Urinary Incontinence (UI) is a condition that can have a significant impact on the lives of women after vaginal delivery, affecting their quality of life and general well-being. This pathology results in the involuntary loss of urine, which can cause physical and emotional discomfort, limit daily activities and generate social embarrassment. Understanding the negative effects of UI is crucial to recognizing the importance of effective prevention and treatment strategies, especially during the postpartum period.

High-intensity focused ultrasound (HIFU) for the treatment of female urinary incontinence: A retrospective analysis.

This study aims to demonstrate the effectiveness of high-intensity focused ultrasound, a noninvasive treatment, for managing urinary incontinence (UI) in women. This is a single-center, retrospective study involving 28 women. Patients, aged between 32 and 65, were included. Patients with insulin-dependent diabetes, neurological disease, active urinary tract infection, undiagnosed vaginal bleeding, who had incontinence surgery, and receiving estrogen therapy were excluded from the study. Incontinence severity was evaluated with the International Incontinence Consultation Questionnaire Short Form (ICIQ-SF). Patients were evaluated before treatment and 6 months after treatment using the ICIQ-SF and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Assessment short form. In the analysis of numerical variables independent or paired t test or linear mixed effects models were used. Least square means were used in post hoc comparisons. Mean age of the patients was 45.50 ± 7.59 years. There were 18 (64%) stress urinary incontinence (SUI) and 10 (36%) mixed urinary incontinence (MUI). Six months after treatment, mean ICIQ-SF and Pelvic Organ Prolapse/Urinary Incontinence Short Form Questionnaire scores showed a significant positive change. After the procedure, UI completely disappeared in 43% of the patients. The rate of severe UI decreased from 39% to 8%, and very severe UI decreased from 8% to 0%. Incontinence severity was significantly different in the MUI and SUI groups before and after the procedure. After the procedure, UI completely disappeared in 67% of the patients in the SUI group, while it remained at a mild level in 33%. The decrease in ICIQ-SF score in the SUI group was significantly higher than that in the MUI group. There were no severe adverse events, in 4 patients there was mild vaginal discharge which resolved in 1 week. This study showed that high-intensity focused ultrasound treatment, can be effective and safe even in a single session. Selection and recall biases are potential biases in retrospective studies. Lacking a control group is another limitation. Although advances in technology are very important for medical treatments, their effectiveness and safety need to be proven. Future research in this area with a larger sample size and a prospective design will offer further evidence supporting effectiveness of this treatment model.

S728 Comparative Effectiveness of Biofeedback and Dextranomer/Hyaluronate Injection for Treatment of Fecal Incontinence: A Multicenter Randomized Controlled Trial

S728 Comparative Effectiveness of Biofeedback and Dextranomer/Hyaluronate Injection for Treatment of Fecal Incontinence: A Multicenter Randomized Controlled Trial

240 - What is the best treatment for urinary incontinence in older women? A Cochrane network meta-analysis

240 - What is the best treatment for urinary incontinence in older women? A Cochrane network meta-analysis

167 - Two-year Follow-up of Revi™ Therapy, Implantable Tibial Neuromodulation (iTNM) for the Treatment of Urinary Urge Incontinence: The OASIS Study

167 - Two-year Follow-up of Revi™ Therapy, Implantable Tibial Neuromodulation (iTNM) for the Treatment of Urinary Urge Incontinence: The OASIS Study

139 - Extended follow-up of the adjustable artificial sphincter VICTO in the treatment of male urinary incontinence after 68Months: Results in a high-volume center

139 - Extended follow-up of the adjustable artificial sphincter VICTO in the treatment of male urinary incontinence after 68Months: Results in a high-volume center

335 - Property of hemorrhoidal tissue mesenchymal stem cells for the treatment of anorectal incontinence

335 - Property of hemorrhoidal tissue mesenchymal stem cells for the treatment of anorectal incontinence

15 - Trends in user profile with a focus on level of education and area of residence among users of a mobile app for treatment of urinary incontinence.

15 - Trends in user profile with a focus on level of education and area of residence among users of a mobile app for treatment of urinary incontinence.

Comparison of Surgical Outcomes of Autologous Mid-Urethral Fascia Slings and Retropubic Mid-Urethral Slings for Women Undergoing a Primary Surgery for Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

Current guidelines on surgical treatment of stress urinary incontinence (SUI) recommend an informed decision making process between the physicians and patients reviewing all available surgical options with and without mesh. However, there is a lack of synthesized clinical evidence on some of the comparisons that can feed into patient counseling processes. The aim of this study was to review the available studies comparing clinical outcomes of an autologous fascial sling (AFS) and a retropubic (RP) synthetic sling for women undergoing a primary surgery for SUI. We conducted a literature search from 1990 to 2024 following international guidelines. We have included studies reporting on comparative outcomes of AFS and RP synthetic sling surgeries as a primary procedure. Three randomized studies were included with follow-up durations ranging from 24 months to 10 years. The mean percentage change in symptom scores ranged from 27.7% to 44.9%, with no significant difference between the two sling types. There was no difference between groups with regard to objective cure rates, subjective cure rates and length of hospital stay between AFS and RP slings. AFS surgeries had longer operative times. There were concerns about bias, particularly related to allocation, blinding, and missing outcome data. Overall, both types of slings had similar cure rates but AFSs were associated with longer operative times. The study highlights the need for more research on the comparative effectiveness of AFS and synthetic slings for SUI surgery to guide decision-making for SUI surgical treatments.

Urethral Bulking Agents for the Treatment of Urinary Incontinence: Efficacy, Safety, and Impact on the Overactive Bladder Symptoms with an Underlying Detrusor Overactivity.

Background: Mixed urinary incontinence (MUI) has always represented a major therapeutic challenge and the management of this type of incontinence is often complicated by uncertain outcomes. Surgical options include interventions targeting both stress urinary incontinence (SUI) and urge urinary incontinence (UUI), although there are no international published guidelines that dictate whether it is better to start with surgical management to address the SUI or UUI component after the failure of conservative treatment. The aim of the present study is to evaluate the effectiveness of the Macroplastique (MPQ) procedure on overactive bladder (OAB) symptoms in women with MUI with a minimum follow-up of 1 year. Methods: A retrospective analysis of prospectively collected data was performed in two tertiary reference centers. We enrolled all women complaining of symptoms of SUI and OAB, dry or wet, with a urodynamically confirmed diagnosis of MUI [urodynamic stress incontinence (USI) with detrusor overactivity (DO)], who took a previous ineffective antimuscarinic treatment and underwent the MPQ procedure. We considered as objectively cured women who did not leak urine during the stress test and with a 1 h pad-test negative, while International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), ICIQ-OAB, Patient Global Impression of Improvement (PGI-I) scale, and a Visual Analogue Scale (VAS) were used to assess subjective outcomes. Results: A total of forty-six patients who met the inclusion criteria and who underwent the MPQ procedure were considered for the analysis. At the 1-year mark of follow-up, 72% of patients were objectively cured at stress test and 65% were objectively cured at pad-test, while 72% of women declared themselves subjectively cured. OAB symptoms significantly improved after MPQ and a complete resolution of OAB was recorded in 35% of patients. Conclusions: This study demonstrated that MPQ is a safe and effective option for the treatment of female MUI. Furthermore, MPQ significantly improves the symptoms of OAB and is able to completely cure this condition in a relevant percentage of women with MUI when pharmacological treatment fails.

Prognostic criteria for surgical treatment of stress urinary incontinence in combination with cystocele in postmenopausal women

Background. The relevance of the problem of stress urinary incontinence (SUI) in combination with cystocele has increased significantly over the past decades, due to the high prevalence of the disease in the population, as well as increased awareness of patients about treatment options. It is known that one-stage surgical treatment significantly reduces the need for re-intervention and, accordingly, the rehabilitation period. The identification of significant criteria that are decisive in the effectiveness of various methods of surgical correction of SUI in combination with cystocele dictates the need for further research in this direction.The purpose of the study. To determine outcome criteria for surgical treatment of stress urinary incontinence in combination with cystocele in postmenopausal women based on a comprehensive preoperative examination.Materials and methods. A prospective randomized study was conducted, which included 80 women with stress urinary incontinence in combination with postmenopausal cystocele, who were routinely hospitalized in the gynecological department of the Federal State Budgetary Institution Research Institute of OMM for surgical treatment. All patients, after signing voluntary informed consent to participate in the study and conducting a comprehensive preoperative examination using a random number generator, were randomized into two groups of equal size. The first group included 40 women who received surgical treatment including anterior colporrhaphy in combination with urethropexy with a synthetic loop; the second group consisted of 40 patients who underwent surgical treatment using the method of paraurethral injection of a volume-forming gel in combination with anterior colporrhaphy.Results and discussion. Criteria for predicting the outcome of surgical treatment of stress urinary incontinence in combination with cystocele in postmenopausal women were determined based on a comprehensive preoperative examination. Conclusion: Analysis of complex urodynamic and ultrasound examination methods in women revealed statistically significant differences between groups of women with positive and negative outcomes of surgical treatment. The identified criteria for predicting the outcome of surgical treatment serve to assist the clinician in choosing the optimal, most effective method of treating SUI in combination with cystocele in postmenopausal women.Conclusions. Analysis of complex urodynamic and ultrasound methods of examination in women revealed statistically significant differences between groups of women with positive and negative outcomes of surgical treatment. The identified criteria for predicting the out-come of surgical treatment serve to assist the clinician in choosing the optimal, most effective method of treating SUI in combination with cystocele in postmenopausal women.

Long-Term Outcomes of Tension-Free Vaginal Tape Obturator: Efficacy and Safety at Long-Term Follow-Up

Background/Objectives: The use of tension-free vaginal tape obturator (TVT-O) for the treatment of stress urinary incontinence (SUI) has been widely debated over the last decade due to the lack of evidence on its long-term outcomes. The aim of this prospective study is to assess, for the first time in the available literature, the efficacy and safety of TVT-O implantation in women with pure SUI over a 17-year follow-up period. Methods: We included all women who complained of pure SUI symptoms (confirmed urodynamically) and underwent the TVT-O procedure. An objective cure was defined as the absence of urine leakage during the stress test, while subjective outcomes were assessed by means of the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF), the Patient Global Impression of Improvement (PGI-I) scale, and a Visual Analogue Scale (VAS). Results: A total of 70 patients who met the inclusion criteria underwent the TVT-O procedure. During the study period, no patients were lost to follow-up, and all women completed the last evaluation at the 17-year mark. At the 17-year mark of follow-up, 62 out of 70 patients (81.4%) were subjectively cured, and 56 out of 70 (80%) patients were objectively cured. These data do not reveal any significant variation in the surgical outcomes over the follow-up period. We recorded seven (10%) tape exposure (three occurred after 10 years and four after 17 years). Among these, one woman was symptomatic for dyspareunia and “hispareunia”. All patients with mesh exposure were treated with partial removal and re-suture of the vagina, but only one developed the recurrence of SUI that required a second treatment with a urethral bulking agent (UBA). In all other cases, women reported a complete resolution of symptoms without any worsening of the urinary continence. No significant bladder or urethral erosion was recorded. Conclusions: The 17-year evaluation of the TVT-O procedure has shown that it is a highly effective and safe option for the treatment of female SUI. Although there was an increased risk of tape exposure 17 years after implantation, no serious complications were reported, and no patient required the total removal of the sling.

A mobile telehealth program for behavioral treatment of urinary incontinence in women Veterans: Qualitative evaluation of MyHealtheBladder

Women Veterans constitute a distinctive cohort whose exposure to military service can contribute to development of bladder conditions, such as urinary incontinence (UI), as they age. Behavioral therapies are recommended as first-line treatment for incontinence, yet many VA Medical Centers do not have staff trained to administer them. The purpose of this research study was to conduct a qualitative program evaluation of MyHealtheBladder, a mobile telehealth version of an evidence-based eight‐week behavioral treatment program designed for women Veterans with incontinence. MyHealtheBladder uses mobile telehealth technology to teach pelvic floor muscle exercises, bladder control strategies, fluid management, risk factor reduction, and self‐monitoring. Eighteen women Veterans who completed a pilot study of MyHealtheBladder participated in semi-structured telephone interviews exploring their experience with the program. A directed content analysis was conducted of the transcribed interview data. Participants described ease of accessing MyHealtheBladder using smart phones and other mobile devices, emphasizing the flexibility of using the program at home, work, or while traveling. Most participants described program content as understandable, relevant, and easy to follow. They discussed how the program increased knowledge of UI, promoted consistency in practicing behavioral therapy, strengthened pelvic floor muscles, reduced urine leakage, and improved psychosocial wellbeing. Suggestions for improvement included more interaction with staff, more individualized tailoring of content to UI type, incorporating in-person clinic visits, and including supplementary material. Participants uniformly endorsed the program and recommended it for other women Veterans, as well as for those in active duty to prevent or treat UI earlier in the life course.