Urethral Mobility Research Articles

Urethral configuration and mobility during urine leaking described using real-time transperineal ultrasonography.

PurposeThe aim of this study was to explore differences in the bladder neck configuration and segmental urethral mobility during the cough stress test (CST) in the supine and standing positions between women with and without stress urinary incontinence (SUI).MethodsThis prospective study included 100 control women and 100 incontinent women who had a CST with transperineal ultrasonography. The bladder neck configuration and urethral mobility were described in terms of urethral funneling, bladder neck descent (BND), retrovesical angle (RVA), urethral rotation angle, and urethral mobility at six points along the urethra (vectors 1 to 6). The two groups’ ultrasound findings in the two positions were compared.ResultsValid data were collected from 78 control women and 90 women with SUI. Significant differences were found in age and body mass index between the two groups (P<0.01). Urethral funneling was found in 33 women (36.7%) with SUI and five continent women (6.4%) and altered little in the standing position. In the standing position, the mean RVA significantly increased (160° to 179°, P<0.001) in the SUI group; The mean vector of points 1 to 6 significantly increased in the control group (all P<0.001). The RVA, BND, and vectors 1 to 4 were significantly greater (all P≤0.01) in women with SUI than without, in both positions.ConclusionUrethral funneling was an intrinsic anatomical characteristic relative to SUI. Weak upper- and mid-urethral support and an unstable connection between the trigone and proximal urethra were the anatomical signs of SUI.

Impact of intrinsic sphincter deficiency on mid-urethral sling outcomes.

Our primary objective was to study outcomes of patients with intrinsic sphincter deficiency (ISD) following mid-urethral slings (MUS) at 1-year. Our secondary objective was to delineate factors affecting success in these patients. Six hundred eighty-eight patients who had MUS between January 2004 and April 2017 were reviewed retrospectively; 48 women were preoperatively diagnosed with ISD. All completed urodynamic studies and validated quality-of-life (QOL) questionnaires at baseline and 1 year. Primary outcomes were objective and subjective cure of stress incontinence, defined as no involuntary urine leakage during filling cystometry and 1-h pad test < 2g and negative response to Urogenital Distress Inventory-6 Question 3. Ultrasound was performed to determine tape position, urethral mobility and kinking at 1 year. Women with ISD had significantly lower objective and subjective cure rates of 52.1% and 47.9%, respectively, compared to an overall of 88.2% and 85.9%. QOL scores significantly improved in those with successful surgeries. The sling type did not make a difference. Multivariate logistic regression identified reduced urethral mobility [OR 2.11 (1.24-3.75)], lower maximum urethral closure pressure (MUCP) [OR 1.61 (1.05-3.41)] and tape position [OR 3.12 (1.41-8.71)] to be associated with higher odds of failed slings for women with ISD. Although there are good overall success in women undergoing MUS, those with ISD have significantly lower cure rates at 1 year. Factors related to failure include reduced urethral mobility, low MUCP and relative tape position further away from the bladder neck. Optimal management of patients with ISD and reduced urethral mobility remains challenging.

The Association of Hiatal Dimensions and Urethral Mobility With Stress Urinary Incontinence.

To investigate the association of hiatal area (HA), bladder neck mobility, and urethral mobility during the cough stress test (CST) with stress urinary incontinence (SUI). This was a prospective study of 110 continent and 190 incontinent women using transperineal ultrasound. HA, bladder neck mobility, and the mobility of six points along the urethra (Vectors 1-6) were measured. The cohort was randomly divided at a ratio of 2:1 into a training cohort and a validation cohort. The correlations of HA with bladder neck mobility, urethral mobility, and SUI were tested. The predictive model was yielded by fisher linear discriminant analysis and receiver operating characteristics to assess the parameters' ability to predict SUI. Valid data were collected from 177 incontinent women and 105 continent women. Significant differences were identified in HA, body mass index (BMI), funneling, bladder neck mobility, and Vectors 1-6 between them. HA was positively correlated to bladder neck mobility. In the training cohort, bladder neck position on Valsalva, Vectors 3, and BMI had the area under curves of 0.74, 0.69, and 0.66 (all P< 0.001); Funneling and Vector 3 had odds ratios of 18.96 and 3.65 (all P< 0.001), for predicting SUI. The predictive model incorporating funneling, Vectors 3, and BMI provided the best performance in predicting SUI in both cohorts. The larger the HA was, the higher the bladder neck mobility. However, it was mid-urethral mobility rather than bladder neck mobility that performed best at predicting SUI.

Is location of urethral kinking a confounder of association between urethral closure pressure and stress urinary incontinence?

Intact urethral support and normal sphincter function are deemed important for urinary continence. We aimed to test whether the location of urethral kinking (as the probable anatomical correlate of maximal pressure transmission) is associated with stress urinary incontinence and/or urodynamic stress incontinence. This was a retrospective study of women seen at a tertiary urogynecological center in 2017. Patients had undergone an interview, multichannel urodynamic testing and four-dimensional translabial ultrasound examination. Those with a history of anti-incontinence surgery, absence of urethral kinking on ultrasound and/or missing or inadequate ultrasound volume data were excluded. Volume data were used to assess urethral mobility using a semi-automated Excel® urethral motion profile program. Mobility vectors were calculated using the formula √((x valsalva - x rest )2 + (y valsalva - y rest )2 ), where x and y are the coordinates of six equidistant points along the length of the urethra from the bladder neck to the external urethral meatus. The location of urethral kinking was identified as a concave contour of the urethra on the vaginal side in the midsagittal plane on maximum Valsalva maneuver. The distance between the center of the kink and the bladder neck was measured and expressed as a centile in relation to the total length of the urethra, using the formula: (distance from bladder neck/total length of urethra) × 100. Univariate and multivariate analyses were performed to test the associations of stress urinary incontinence and urodynamic stress incontinence with age, maximum urethral pressure, urethral mobility vectors and location of urethral kinking. Of 450 women seen during the study period, 61 were excluded owing to previous incontinence surgery and 82 owing to absence of urethral kinking, inadequate volume data or missing data, leaving 307 women included, of whom 227 (74%) complained of stress urinary incontinence and 211 (69%) complained of urgency urinary incontinence. 190 (62%) of the women were diagnosed with urodynamic stress incontinence. On multivariate analysis, maximum urethral pressure (36 vs 50 cmH2 O; P < 0.001), mid-urethral mobility (2.27 vs 2.03 cm; P = 0.003) and location of urethral kinking (63.1st vs 59.7th centile; P = 0.002) were associated significantly with urodynamic stress incontinence. The location of urethral kinking was associated with stress urinary incontinence on univariate analysis (P = 0.026) but not on multivariate analysis (P = 0.21). The location of urethral kinking is associated with urodynamic stress incontinence. The further urethral kinking is from the mid urethra, the more likely is urodynamic stress incontinence. This provides circumstantial evidence for the pressure-transmission theory of stress urinary continence. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Analysis of outcome and risk factors for failure after single-incision sling procedure

Aim: To assess the effectiveness and safety of a single-incision sling (SIS) and to detect the risk factors for failure after surgery in woman with stress urinary incontinence (SUI).Materials and Methods: The medical records of the one hundred thirty-two patients were analyzed. Preoperatively, medical history was taken and urogynecological examination was made. Patients were asked to answer Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). Objective cure of SUI was defined as the absence of leakage of urine on the cough test. Subjective cure was based on negative response to UDI-6, question 3. Patients were divided into two groups according to objective cure rate: cured patients (Group A) and failed patients (Group B). Results: The overall objective and subjective cure was 87.8% and 90.1%, respectively. According to the objective cure rate, there were 116 patients (87.8%) in Group A and 16 patients (12.2%) in Group B. In terms of subjective cure, Quality of Life (QoL) scores (IIQ-7 and stress subdomain of UDI-6) of Group B were statistically improved after surgery (p=0.001 and p=0.005 respectively). When two groups were compared, Group B had higher prevalence of severe SUI (IIQ scores ≥15 points) and reduced urethral mobility (Q-tip ≤ 30°) (0.8% vs 87.5%, p=0.0001 and 3.4% vs 68.7%, p=0.0001, respectively). The overall recommendation rate for surgery was 90%.Conclusion: Our study showed that SIS procedure has high subjective and objective cure rates. The main risk factors for failure were detected as reduced urethral mobility and SUI severity expressed with IIQ scores.

Present value of the Urethral mobility test as a tool to assess Stress urinary incontinence due to Intrinsic sphincteric deficiency

Q-tip test offers a simple approach for identifying urethral hypermobility. Considering surgical treatment, stress urinary incontinence (SUI) must be classified and the contribution of intrinsic sphincter deficiency (ISD) and/or urethral hypermobility must be determine. We believe there's a correlation between abdominal leak point pressure (ALPP) and urethral mobility degree, and the aim of this study is to explore it using Q-tip. We conducted a prospective study, between years 2014 and 2016. Females over 18 years presenting with signs and symptoms of SUI according to the 2002 ICS Standardization of Terminology were included. Assessment was made with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), the Q-tip test and invasive urodynamics. Urethral mobility (UM) and ALPP were analyzed. We built two composite variables based on reported risk factors for ISD, defined as composite variable A (equal to a Q-tip test < 30° AND ICIQ-SF ≥ 10 points) and composite variable B (equal to low urethral mobility AND/OR hypoestrogenism AND/OR history of radiotherapy AND/OR previous pelvic surgery). Correlation analyzes were made according to the type of variable. A total of 221 patients were included. Incontinence was rated as moderate and severe by 65.3% and 6.8%, respectively. The analysis showed a 61.75%, 51.61% and 70.6% agreement between ALPP and UM, ALPP and composite variable A and ALPP and composite variable B respectively. Correlation and concordances were low (r = 0.155, r_s = − 0.053 and r_s = − 0.008), (rho_c = 0.036, k = 0.116 and k = 0.016). Neither the degree of UM, nor the composite variables, correlate or agree with urethral function tests in UDS, suggesting that the ALPP cannot be predicted using the Q-tip test or the ICIQ-SF for classifying patients with SUI.

Intra- and inter-rater reliability of urethral mobility measurement by ultrasound in women: a cross-section study.

To verify the intra- and inter-rater reliability of urethral mobility measurement evaluated by ultrasound (US). This is a reliability study realized according to Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. Twenty-one nulliparous women (25.5 ± 3.3 SD years) were volunteers. Two examiners (E1 and E2) performed the measurement of urethral mobility at rest and Valsalva on the same day. Three measurements were recorded for each moment and the mean of them were used for analysis. To perform the analysis, bladder mobility was calculated using the following equation: [Formula: see text], where "x" is the vertical distance, "y" is the horizontal distance from the dorsocaudal margin of the pubic symphysis, "V" is the Valsalva maneuver, and "R" means rest. The intraclass correlation coefficient (ICC) was calculated considering: ICC ≥ 0.75, excellent; 0.40 ≤ ICC <0.75, satisfactory; ICC < 0.40, poor, with a significance level of 5% and 95% confidence interval. The intra-rater reliabilities of E1 and E2 were considered excellent between the two evaluations, with ICC 0.98 (p < 0.0001) for the E1 and 0.84 (p < 0.0001) for E2. The inter-rater reliability was considered excellent (ICC = 0.83). Both intra- and inter-rater reliabilities of urethral mobility measurement were considered to have excellent agreement.

MP05-03 USEFULNESS OF VESICAL NECK MOVEMENT MEASUREMENT BY CINEMRI IN PREDICTING STRESS URINARY INCONTINENCE AFTER PELVIC ORGAN PROLAPSE REPAIR SURGERY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse (MP05)1 Apr 2020MP05-03 USEFULNESS OF VESICAL NECK MOVEMENT MEASUREMENT BY CINEMRI IN PREDICTING STRESS URINARY INCONTINENCE AFTER PELVIC ORGAN PROLAPSE REPAIR SURGERY Masao Kataoka*, Hitomi Imai, Yuki Yoshida, Toru Meguro, Ruriko Honda, Kanako Matsuoka, Seiji Hoshi, Junya Hata, Yuichi Sato, Hidenori Akaihata, Souichiro Ogawa, Nobuhiro Haga, and Yoshiyuki Kojima Masao Kataoka*Masao Kataoka* More articles by this author , Hitomi ImaiHitomi Imai More articles by this author , Yuki YoshidaYuki Yoshida More articles by this author , Toru MeguroToru Meguro More articles by this author , Ruriko HondaRuriko Honda More articles by this author , Kanako MatsuokaKanako Matsuoka More articles by this author , Seiji HoshiSeiji Hoshi More articles by this author , Junya HataJunya Hata More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , Souichiro OgawaSouichiro Ogawa More articles by this author , Nobuhiro HagaNobuhiro Haga More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000819.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It has been reported that urinary symptoms, especially stress urinary incontinence may worsen after pelvic organ prolapse repair surgery. In this study, we try to evaluate the possibility that the parameters obtained by cine MRI could be a predictor of stress urinary incontinence after POP repair. METHODS: 116 patients who underwent POP repair with a diagnosis of pelvic organ prolapse were included in the analysis. All patients were performed reinforcement of the anterior vaginal wall using a mesh. In patients with uterine prolapse and large rectocele, mesh was also placed on the posterior vaginal wall. In all cases, cine MRI was performed before surgery. Urethral length, urethral mobility (UM), vesical neck movement (VNM) were evaluated, and correlation analysis with postoperative urinary symptoms were performed. RESULTS: Among 90 preoperative SUI negative cases, postoperative SUI was observed in 38 cases (42%).Among the preoperative SUI negative cases, the VNM of the group with postoperative SUI and the group without postoperative SUI were 10.9 ± 6.7 mm and 4.4 ± 3.7 mm, respectively, with a significant difference (p <0.01). There was a correlation between preoperative VNM and de novo SUI (r: 0.51, 95% CI: 0.28-0.68, p <0.01, ROC curve: AUC 0.78, cut off value 6.5 mm). On the other hand, among 26 preoperative SUI positive cases, SUI was persisted in 6 cases (23%). Among them, there was a significant difference in VNM of 14.0 ± 7.1mm and 5.3 ± 3.9mm in the postoperative SUI persisted group and postoperative SUI disappearance group (p <0.01). Correlation was observed between preoperative VNM and postoperative SUI (r: 0.51, 95% CI: 0.28-0.68, p <0.01, ROC curve: AUC 0.70, cut off value 7.6 mm). CONCLUSIONS: VNM evaluation by cine MRI was considered to be a useful tool with excellent objectivity that can predict SUI after POP repair without depending on the operator's skill like Barrier test. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e41-e42 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masao Kataoka* More articles by this author Hitomi Imai More articles by this author Yuki Yoshida More articles by this author Toru Meguro More articles by this author Ruriko Honda More articles by this author Kanako Matsuoka More articles by this author Seiji Hoshi More articles by this author Junya Hata More articles by this author Yuichi Sato More articles by this author Hidenori Akaihata More articles by this author Souichiro Ogawa More articles by this author Nobuhiro Haga More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement PDF downloadLoading ...

PD27-07 ROBOT-ASSISTED ARTIFICIAL URINARY SPHINCTER IMPLANTATION IN FEMALE PATIENTS: AN INTERNATIONAL MULTICENTER STUDY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (PD27)1 Apr 2020PD27-07 ROBOT-ASSISTED ARTIFICIAL URINARY SPHINCTER IMPLANTATION IN FEMALE PATIENTS: AN INTERNATIONAL MULTICENTER STUDY Benoit Peyronnet*, Frank Van der Aa, Vincent Cardot, Grégoire Capon, Xavier Biardeau, Olivier Belas, Frederic Dubois, Juliette Hascoet, Vincent Cardot, Frederic Dubois, Vidart Adrien, Aurelien Descazeaud, Andrea Manunta, Luis Castro-Sader, Marta Allue, Frederic Thibault, Rainer Hein, Pierre Lecoanet, and Georges Fournier Benoit Peyronnet*Benoit Peyronnet* More articles by this author , Frank Van der AaFrank Van der Aa More articles by this author , Vincent CardotVincent Cardot More articles by this author , Grégoire CaponGrégoire Capon More articles by this author , Xavier BiardeauXavier Biardeau More articles by this author , Olivier BelasOlivier Belas More articles by this author , Frederic DuboisFrederic Dubois More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Vincent CardotVincent Cardot More articles by this author , Frederic DuboisFrederic Dubois More articles by this author , Vidart AdrienVidart Adrien More articles by this author , Aurelien DescazeaudAurelien Descazeaud More articles by this author , Andrea ManuntaAndrea Manunta More articles by this author , Luis Castro-SaderLuis Castro-Sader More articles by this author , Marta AllueMarta Allue More articles by this author , Frederic ThibaultFrederic Thibault More articles by this author , Rainer HeinRainer Hein More articles by this author , Pierre LecoanetPierre Lecoanet More articles by this author , and Georges FournierGeorges Fournier More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000884.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The morbidity related to artificial urinary sphincter (AUS) implantation in women is usually considered as the drawback which has limited its widespread. In order to decrease this morbidity, several teams have recently reported the use of a robotic approach to implant the AUS in female patients. The aim of this study was to report the perioperative and functional outcomes of robotic AUS implantation in women. METHODS: All female patients who underwent robotic AUS implantation using a standardized technique (anterior approach) between 2013 and 2019 at fourteen european institutions were included in a retrospective study. The indication for AUS implantation was type III stress urinary incontinence and intrinsic sphincter deficiency defined as a combination of a low urethral closure pressure/Valsalva leak point pressure and loss of urethral mobility. The primary endpoint was the functional outcome categorized as dry (0 pads), improved or unchanged. RESULTS: One hundred and twenty-three patients underwent robotic AUS implantation. Patients’ characteristics are summarized in table 1. There were 20 intraoperative complications (16.3%): 12 bladder neck injuries and 8 vaginal injuries. Surgeons carried on with AUS implantation in all cases. Twenty-two patients experienced postoperative complications (18%) but only four were Clavien ≥3 (3.3%): three early AUS explantations (2 due to vaginal erosion, 1 due to infection) and one reoperation for bladder fistula. After a mean follow-up of 13 months, there were 5 AUS explantations performed in total (4.1%): the 3 early explantations reported above, one for chronic urinary retention and one for urethral erosion. At the latest follow-up visit, 99 patients were dry (80.5%), 12 were improved (6.9%) and 12 were unchanged (9.8%). CONCLUSIONS: This study is the first international multicenter series assessing the outcomes of robotic AUS implantation in women using a standardized technique. This series confirm the promising perioperative and functional outcomes reported in previous studies. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e551-e552 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benoit Peyronnet* More articles by this author Frank Van der Aa More articles by this author Vincent Cardot More articles by this author Grégoire Capon More articles by this author Xavier Biardeau More articles by this author Olivier Belas More articles by this author Frederic Dubois More articles by this author Juliette Hascoet More articles by this author Vincent Cardot More articles by this author Frederic Dubois More articles by this author Vidart Adrien More articles by this author Aurelien Descazeaud More articles by this author Andrea Manunta More articles by this author Luis Castro-Sader More articles by this author Marta Allue More articles by this author Frederic Thibault More articles by this author Rainer Hein More articles by this author Pierre Lecoanet More articles by this author Georges Fournier More articles by this author Expand All Advertisement PDF downloadLoading ...

Protective Role of Moolabandha While Practicing Bhastrika and Kapalabhati by Women Vulnerable to Bladder Dysfunction: A Preliminary Ultrasound Study.

Aim:Obstetrical trauma and chronic exposure to increased intraabdominal pressure (IIAP) are known to increase vulnerability toward stress urinary incontinence. Bhastrika and Kapalabhati being fast yogic breathing maneuvers (FYBM), their association with IIAP is likely. Therefore, a preliminary descriptive study was conducted using transabominal ultrasound mode, to find whether impact of FYBM reinforced by prevailing risk factors had any adverse effect on the bladder neck status and urethral mobility of female yogic practioners and whether simultaneous application of Moolabandha inhibited such impact.Material:Mindray DC N3 model of diagnostic ultrasound unit with M probe was used for assessment.Methods:This study included 15 heterogenous female yoga teachers having average age, years of practice, and body mass index as 42.7 years, 7.33 years, and 24.86 kg/m2, respectively. Retrovesical angle (RVA) and posterior displacement (PD) and inferior displacement (ID) of urthetrhra were assessed while performing Bhastrika and Kapalabhati maneuvers with and without applying Moolabandha. Data obtained were then used for descriptive analysis.Results:Analysis showed a mixed picture, i.e., negative impact as well as preservation of protective strain-levator reflex in certain variables while practicing FYBM. Complicated labor and practice of power yoga appeared to reinforce the impact of FYBM. The values of RVA as well as PD and ID dropped and were statistically significant when FYBM was performed with Moolabandha. Aging factor, uneventful vaginal labor, or obesity could not confirm as prevailing risk factors.Conclusion:Moolbandha proved its protective behavior while practicing Bhastrika and Kapalabhati by vulnerable women.

The Effectiveness of Cystography-Measured Bladder Neck Elevation at Predicting the Return of Continence After Robot-Assisted Radical Prostatectomy.

PurposeTo analyze the clinical parameters correlated with early recovery of urinary continence after radical prostatectomy, with a focus on urethral mobility during pelvic contraction at catheter removal.MethodsWe prospectively analyzed 67 patients who underwent prostatectomy for prostate cancer at Jeju National University Hospital from January 2015 to June 2018. At the time of catheter removal, a cystography was performed in 67 men (median age, 65 years; range, 55–76 years) who had undergone robot-assisted laparoscopic prostatectomy. The vertical length of bladder neck movement between relaxing and contracting the pelvic muscles was measured. The correlation between the rate of continence recovery and the length of urethral movement was also assessed. All participants were divided into 2 groups according to the length of bladder neck elevation. Group 1 had ≥0.6 cm of elevation, while group 2 demonstrated <0.6 cm of elevation.ResultsA reverse correlation existed between the length of urethral movement and the recovery rate of urinary continence (r=–0.488, P<0.001). The optimal cutoff value for length of urethral movement was found to be 0.6 cm among patients (area under the curve, 0.703). A statistically significant difference was observed between group 1 (length≥0.6 cm) and group 2 (<0.6 cm) (P<0.05). Multivariate regression analysis showed that urethral movement predicted the postoperative urinary incontinence.ConclusionsThe extent of bladder neck elevation after robot-assisted laparoscopic prostatectomy, which can be easily evaluated using cystography, may be a good predictor of the recovery of urinary continence.

Long-term outcomes and quality of life effects of single incision mini sling procedure in stress urinary incontinence patients

ObjectiveWe aimed to evaluate the long-term outcomes and quality of life of patients who underwent single incision minisling (SIMS) procedure. Study design62 patients who were diagnosed with stress urinary incontinence (SUI) and received treatment with SIMS procedure (Ophira, Promedon, Argentina) were included in the study. Mean age was 50.73 ± 9.28 years and mean follow-up duration after surgery was 30.68 ± 7.52 months. Preoperative urological and gynecological features of the patients were recorded. Gynecological examination, pelvic ultrasonography, stress test, Q-tip test, cystometry were performed and incontinence and quality of life questionnaires (ICIQ-SF, IIQ-7, UDI-6, VAS-QOL, FSFI) were completed by all patients before and after the operation. ResultsStress urinary incontinence was observed in all patients during pre-op evaluations. 62 patients aged between 35–85 (mean age 50.73 ± 9.28) years were included and follow up duration ranged between 12–44 (average 30.68 ± 7.52) months. In regard to patient evaluations, 27 patients (43.5%) felt that the surgery was very effective, 25 (40.3%) felt surgery was effective and 10 (16.1%) did not report any difference after surgery. In the long-term postoperative follow up; 2 (3.2%) patients had dyspareunia and 7 (11.3%) patients had vaginal tape erosions which were diagnosed 2–40 months postoperatively. According to Q-tip test results, proximal urethral mobility was significantly decreased after surgery. All questionnaire scores were also significantly improved at post-operative evaluations. (P < 0.001) ConclusionsOur study confirmed that the Ophira mini sling technique provided high subjective cure rate and improved symptoms and quality of life in patients with SUI. These results suggest that the single incision mini sling procedure is an advisable alternative to other surgical procedures due to its low complication rates and ease of learning and applying the procedure. This procedure also demonstrated excellent tolerability, minimal pain, low morbidity and increased quality of life scores, in ICIQ-SF, IIQ-7, UDI-6, VAS-QOL, FSFI.

Changes in urethral mobility and configuration after prolapse repair.

To evaluate changes in urethral mobility and configuration after prolapse repair. This was a retrospective study of 92 patients who were examined between 2005 and 2016 before and after surgery for pelvic organ prolapse (POP) without concomitant anti-incontinence surgery. All patients were assessed with an interview, POP quantification and translabial four-dimensional ultrasound. Urethral mobility was evaluated using semi-automated urethral motion profile software in which x- and y-coordinates of six equidistant points along the length of the urethra were determined both at rest and on Valsalva, relative to the posteroinferior margin of the pubic symphysis. Urethral kinking was measured by placing tangents distal and proximal to any visually identified change in the urethral axis. Imaging data obtained before and after prolapse surgery were compared. Mean age was 58 years and mean follow-up was 5.8 months. Prolapse symptoms had resolved in 85% of patients. Highly significant reductions in urethral mobility and urethral kinking were seen after surgery (all P ≤ 0.001). Similar changes were observed after anterior vaginal repair with or without apical repair, without concomitant posterior repair (n = 23; all P < 0.05). POP surgery was associated significantly with 'straightening' of the urethra and reduction in urethral mobility. The effect seems to be due largely to cystocele repair. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Urethral mobility and Point Aa of the Pelvic Organ Prolapse Quantification (POP-Q) system before and after midurethral sling operation.

The aim of the present study was to verify the usefulness of Point Aa as a substitute marker of the Q-tip angle and urethral mobility before and after midurethral sling operation for the treatment of stress urinary incontinence (SUI) in women. In this study, 118 women presenting with SUI who underwent the tension-free vaginal tape obturator (TVTO) procedure were prospectively examined and followed-up for ≥6 months after operation. Spearman's correlation coefficient was used to assess the degree of correlation between Point Aa of the Pelvic Organ Prolapse Quantification system and Q-tip angles before and after midurethral sling surgery. There were significant postoperative changes in Point Aa (from -0.4 ± 1.9 to -2.7 ± 0.6; P = .001) and Q-tip angle (from 58.7 ± 19.4 to 15.4 ± 17.5 degrees; P =.001) compared with preoperative values. A fair correlation between Point Aa position and straining Q-tip angle was found before (r = 0.45, P = .05) and after (r = 0.49, P = .04) the procedure, with no significant difference in values before and after the procedure (P = .62). The results of the present study show fair correlation between the Point Aa position and straining Q-tip angle before and after midurethral sling surgery. Point Aa could be used as an indicator of urethral mobility after the TVTO procedure in women with SUI.

Risk factors for stress urinary incontinence recurrence after single-incision sling.

The aim of the study was to identify in a pure stress urinary incontinence (SUI) population risk factors for recurrence after single-incision slings (SIS). This retrospective study analyzed women with complaints of SUI symptoms and urodynamically proven SUI. Exclusion criteria were recurrent SUI, overactive bladder syndrome/detrusor overactivity, preoperative postvoid residual >100 mL, reduced urethral mobility (<10° at the Q-tip test), concomitant anterior prolapse >I stage and previous history of radical pelvic surgery. Objective cure rate was assessed with stress test. A total of 192 patients were analyzed. Objective cure rate was obtained in 86.5% of patients. According to univariate analysis, recurrences had higher prevalence of severe ICIQ-SF score (≥18 points), higher prevalence of reduced urethral mobility (Qtip ≤30°), higher prevalence of low detrusor pressures during voiding phase (opening pressure <15 cmH2 O, pressure at maximum flow <20 cmH2 O, closing pressure <15 cmH2 O), and higher prevalence of postoperative complications According to multivariate analysis ICIQ-SF score ≥18 points (P = 0.02; OR = 2.7) and detrusor pressure at maximum flow <20 cmH2 O (P < 0.01; OR = 3.6) resulted as independent risk factors for SUI recurrence (Table 3). A trend was found for urethral mobility ≤30° (P = 0.07; OR = 2.2). Our study identifies SUI severity expressed with ICIQ-SF scores and low detrusor pressure at maximum flow as independent risk factors for SUI recurrence after SIS implantation while only a trend was found for reduced urethral mobility. Therefore, preoperative assessment of symptoms and urodynamics evaluation may play a key role in improving preoperative counseling and tailoring surgical treatment.

Surgical Management of Stress Urinary Incontinence

Stress urinary incontinence (SUI) is a prevalent and distressing condition that affects up to 50% of women over their lifetime. If nonsurgical treatments are not effective, surgery is highly successful. Preoperative evaluation includes at minimum a thorough history and physical examination, urinalysis, demonstration of SUI, assessment of urethral mobility, and measurement of postvoid residual urine volume. The midurethral sling is the most studied surgical procedure for urinary incontinence and is safe and highly effective. With the recent concern about permanent mesh in urogynecologic surgery, many patients might choose a laparoscopy- or robot-assisted Burch colposuspension or fascial sling. This review contains 5 figures, 5 tables and 38 references Key words: intrinsic sphincter deficiency, mesh, midurethral sling, minimally invasive surgery, preoperative evaluation, retropubic colposuspension, stress urinary incontinence, urethral bulking, urodynamic testing

Association between Magnetic Resonance Imaging Findings of the Pelvic Floor and de novo Stress Urinary Incontinence after Vaginal Delivery.

ObjectiveThe study aimed to evaluate the contributions of levator ani muscle (LAM) injury, vesical neck movement, urethral length and mobility, and urethral sphincter dysfunction observed on magnetic resonance imaging (MRI) towards stress urinary incontinence (SUI) after vaginal delivery.Materials and MethodsFifty primiparous women after 6 months of delivery (15 with SUI and 35 without) and 35 nulliparous as continent controls underwent MRI at rest and Valsalva maneuver. A published levator ani scoring system was used to characterize morphological changes of LAM. The severity of the injury was divided into three categories as none, minor, and major. A series of common parameters including levator plate angle, iliococcygeal angle, and levator hiatus were used to describe the functional conditions of LAM. Urethral mobility was defined based on the rotation of the urethra between Valsalva and rest status. Vesical neck movement was evaluated by its distance to the pubococcygeal line. Urethral sphincter dysfunction was defined as the widening of the proximal urethra and/or funneling at the urethrovesical junction during Valsalva.ResultsPrimiparous incontinent (PI) women had additional major levator ani defects (33.3% vs. 17.1%) while less minor defects (0.7% vs. 31.4%) than primiparous continent (PC) women. Vesical neck downward movement in PI women was more obvious than PC women (28.5 mm vs. 24.2 mm, p = 0.006). Urethral mobility was more active in primiparous women than in nulliparous continent controls (57.4 vs. 52.4), whereas no difference was observed on urethral mobility in the primiparous group (p = 0.25). Urethral sphincter dysfunction and funneling were present in 80% of PI women versus 22.9% in PC women (p < 0.001).ConclusionThe MRI findings revealed that de novo SUI was associated with major LAM injury, vesical neck downward movement as well as urethral sphincter dysfunction. Vesical neck funneling on sagittal images can be treated as a valuable predictor for SUI. The intervention for the PI should focus on the elevation of vesical neck, rehabilitation of LAM as well as recovery of the urethral sphincter muscle.

Correlations between Sonographic and Urodynamic Findings after Mid Urethral Sling Surgery

We studied correlations between sonographic and urodynamic findings after suburethral sling surgery. This retrospective study was done in 141 women who underwent multichannel urodynamic testing and translabial 4-dimensional ultrasound after suburethral sling surgery between 2006 and 2016. We determined the sling-pubis gap, ie the distance between the sling and the inferior posterior margin of the pubic symphysis, during the Valsalva maneuver and the urethral motion profile. The latter was assessed by calculating the mobility vectors of 6 equidistant points along the length of the urethra from the bladder neck to the external urethral meatus against the dorsocaudal margin of the pubic symphysis during the Valsalva maneuver. Correlations were determined between the sling-pubis gap and the mobility vectors, and between these measures and urodynamic data. Median followup in the 126 women with complete data was 36 months. Significant correlations were found between the sling-pubis gap and the midurethral mobility vectors (all p <0.02). The sling-pubis gap and the mid urethral mobility vectors negatively correlated with detrusor pressure at maximum flow (p = 0.037 and 0.004, respectively). Urodynamic stress incontinence was more likely in women with a greater sling-pubis gap (p = 0.003). The tighter the sling on ultrasound, the less likely is urodynamic stress incontinence and the higher the detrusor pressure during voiding.

Effects of pushing techniques during the second stage of labor: A randomized controlled trial

ObjectiveSpontaneous pushing is a method that is used in the management of the second stage of labor and suggested to be more physiological for the mother and infant. The present study aims to evaluate the effects of pushing techniques on the mother and newborn. Materials and methodsThis randomized prospective study was performed between June 2013–March 2014 in a tertiary maternity clinic in Istanbul. 80 low risk, nulliparous cases were randomized to pushing groups. Valsalva pushing group was told to hold their breath while pushing. No visual-verbal instructions were given to spontaneous pushing group and they were encouraged to push without preventing respiration. Demographic data, second stage period, perineal laceration rates, fetal heart rate patterns, presence of meconium stained amniotic liquid, newborn APGAR scores, POP-Q examination and Q-tip test results were evaluated in these cases. ResultsThe second stage of labor was significantly longer with spontaneous pushing. Decrease in Hb levels in valsalva pushing group was determined to be higher than spontaneous pushing group. An increased urethral mobility was observed in valsalva pushing group. ConclusionsAlthough the duration of the second stage of labor was longer compared to valsalva pushing technique, women were able to give birth without requiring any verbal or visual instruction, without exceeding the limit value of two hours and without affecting fetal wellness and neonatal results.

OC20.05: Changes in urethral mobility and kinking after prolapse repair

OC20.05: Changes in urethral mobility and kinking after prolapse repair