Urinary Incontinence Research Articles

Precise treatment of pelvic fracture urethral injury associated with urethrorectal fistula.

To evaluate the effect of a new strategy of transperineal anastomotic urethroplasty (TAU) with proximal transection in treating pelvic fracture urethral injury (PFUI) associated with urethrorectal fistula (URF). A retrospective review of all patients treated by TAU with proximal transection and fistula repair for PFUI associated with URF was performed between August 2013 and July 2022. Information on demographics, peri-operative variables, and postoperative follow-up outcomes was collected. Successful surgery was defined as restoration of a uniform urethral calibre using flexible cystoscopy (third postoperative month) without strictures or leakage, with no further interventions required. Functional outcomes, including erectile function (assessed using the five-item International Index of Erectile Function) and urinary continence, were assessed. Forty patients diagnosed with PFUI associated with URF and treated by TAU with proximal transection and rectal fistula repair were enrolled. Six patients (15.0%) had a history of failed urethral reconstruction. The mean stenosis length and fistula diameter were 2.9 cm and 1.2 cm, respectively. All patients underwent faecal diversion before urethroplasty. After a median (range) follow-up of 45 (3-115) months, the final success rate was 90.0% (36/40). Postoperative complications included haematoma in three patients, epididymo-orchitis in three, wound infection in one, wound bleeding in one, delayed wound healing in three, and wound numbness in three. The overall incidence of postoperative erectile dysfunction reached 75.0%, with a median (range) score of 9 (0-19). Normal continence was achieved in 31 patients (77.5%). Occasional incontinence without the need for urinal pads occurred in eight patients, whereas one patient required urinal pads. Transperineal anastomotic urethroplasty with proximal transection is a precise and effective surgical strategy for treating PFUI associated with URF. This strategy ensures a high success rate and improves surgical efficiency.

99 - Disrupted Cerebellar Functional Connectivity and its Association with Bladder Control in Women with Multiple Sclerosis and Voiding Dysfunction

99 - Disrupted Cerebellar Functional Connectivity and its Association with Bladder Control in Women with Multiple Sclerosis and Voiding Dysfunction

Composite Functional and Quality of Life Outcomes in Adults Operated for Cloacal Malformation

IntroductionComposite long-term outcomes of cloacal malformations remain unclear. We aimed to evaluate bowel and bladder control, sexual function, reproductive health, and quality of life in adulthood. MethodsA Nordic multi-center cross-sectional observational study evaluating the outcome of adult patients with cloacal malformations was performed. Patient characteristics were retrieved from case records. Established questionnaires were sent to the patients to evaluate bowel- bladder- and sexual function and quality of life. ResultsThirty-four of 48 (70%) eligible patients with median age 28 years (18–45) responded. Eight (24%) patients had a common channel >3 cm. Imaging-confirmed spinal and sacral abnormalities were present in 4 and 17 patients respectively. 85% (n = 29/34, four patients with permanent urinary diversions after bladder neck closure excluded) reported no urinary leakage without physical activity or urge to urinate. Three patients had a permanent enterostomy. 42 % (n = 11/26) reported acceptable bowel function according to Bowel Function Score (with eventual ongoing bowel management). The median Profile of Female Sexual Function Score was below normative values. Quality of life was comparable to the reference population, but thirty percent scored within the distress domains. Eight patients (24%) had been pregnant (15 pregnancies), resulting in seven live births, but the need of assisted reproduction techniques (40%, n = 6/15) and miscarriage (40%, n = 6/15) was common. ConclusionsAdequate spontaneous bowel control was rare, while most patients were dry for urine without additional procedures. Cloacal malformation also have a negative impact on sexual function health related quality of life and reproductive health. Long-term follow-up is crucial, not only regarding bowel and bladder function, but also for sexual and reproductive function, which may be important negative factors for health-related quality of life. Level of EvidenceLevel IV.

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

Clean intermittent catheterisation determinants and caregiver adherence in paediatric patients with spinal dysraphism and spinal cord injury in a paediatric spinal differences clinic: a mixed methods study protocol

IntroductionClean intermittent catheterisation (CIC) is the standard of care for treating neurogenic lower urinary tract dysfunction (NLUTD), the most common bladder dysfunction in children diagnosed with spinal dysraphism (SD) and...

Morphometric analysis of the spinal cord in patients undergoing posterior vertebral column subtraction osteotomy for recurrent tethered cord syndrome.

In posterior vertebral column subtraction osteotomy (PVCSO), a section of a thoracic or lumbar vertebra and the adjacent disc are resected to shorten the spinal column, aiming to permanently alleviate tension on the spinal cord in patients with recurrent tethered cord syndrome (TCS). The effects of this procedure on the spinal cord are not well characterized. This study investigated morphometric changes in the cord following PVCSO and assessed associated clinical outcomes in patients with recurrent TCS. A retrospective review of patients with recurrent TCS undergoing PVCSO with robotic assistance at the authors' tertiary care institution between 2019 and 2023 was performed. Clinical data were recorded from electronic medical records, and morphometric measurements, including T12-L2 sagittal height, intradural diameter, and the diameters, area, eccentricity, and positioning of the spinal cord, were collected from MRI. Spinal cord dimensions including anteroposterior and lateral diameters, area, eccentricity, positioning, and intradural diameter were compared before and after surgery. Six patients were included in this study. At 6-week follow-up, all patients had improvement on lower-extremity motor function examinations, 40% had improvement on lower-extremity sensory function examinations, and 83% had improved self-reported pain. Bladder and bowel incontinence were improved in 50% and 60%, respectively. PVCSO reduced the height of the spinal column by a mean of 18.1 ± 5.2 mm. PVCSO increased the mean spinal cord anteroposterior diameter by 0.8 ± 0.5 mm at T12 (p = 0.03) and the mean area by 0.4 ± 0.3 mm2 at T12 (p = 0.03). The mean eccentricity of the spinal cord decreased by 0.15 ± 0.15 at L1 (p = 0.05), indicating that the spinal cord became more circular after surgery. No major complications were reported, although 1 patient experienced atelectasis and pulmonary embolism postoperatively. This study provides novel insights into the morphometric changes induced by PVCSO and their correlation with clinical outcomes in patients with TCS. The procedure effectively increased spinal cord dimensions, alleviating tension and offering potential benefits in symptom relief. The study underscores the need for objective metrics to guide surgical decision-making and enhance the long-term success of PVCSO in the management of TCS.

Real-World Use of Intradetrusor Botulinum Toxin Injections: A Population-Based Study from France.

In recent decades, intradetrusor injections of botulinum toxin A (BoNT-A) have been widely applied to treat incontinence in both idiopathic overactive bladder (iOAB) and neurogenic detrusor overactivity incontinence (NDOI). This analysis, based on the French National Hospital Discharge Database (PMSI), aims to describe real-world trends in intradetrusor BoNT-A use between 2014 and 2022. Among 32,864 patients who received at least one intradetrusor BoNT-A injection, 18,320 (55.7%) had conditions coded under iOAB, 13,376 (40.7%) under NDOI, and 1168 (3.6%) under other indications. The overall mean interval between two intradetrusor BoNT-A injections was 9.7 months, ranging from 8.7 months in patients with multiple sclerosis (MS) to 11.5 months in patients with cerebral pathologies. The median number of injections was two (quartile 1-quartile 3, 1-4) in patients with spina bifida, whereas it was five (2-10) in those with MS. Only 31% of patients with iOAB received more than two intradetrusor BoNT-A injections. Regardless of its indication, BoNT-A was well tolerated. Adverse events occurring during or requiring hospitalization included infections (3.8%), hematuria (0.53%), and bleeding episodes necessitating transfusions (0.11%), all recorded within the initial month following BoNT-A injection. Our analysis of the PMSI database highlights a broad spectrum of intradetrusor BoNT-A injection practices.

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

187 - Extraperitoneal laparoscopic Burch colposuspension after suburethral mesh failure in female stress urinary incontinence

187 - Extraperitoneal laparoscopic Burch colposuspension after suburethral mesh failure in female stress urinary incontinence

77 - Is urinary incontinence affected by modifiable lifestyle habits? Premilinary results from a systematic review

77 - Is urinary incontinence affected by modifiable lifestyle habits? Premilinary results from a systematic review

Sexual Dysfunction in Patients with Overactive Bladder Syndrome Treated with Botulinum Toxin

Introduction: Overactive bladder (OAB) is a syndrome of the lower urinary tract characterized by urinary urgency, frequency, and nocturia, with or without urgency urinary incontinence. OAB significantly impacts all aspects of life—social, psychological, physical, professional, domestic, and sexual—for both women and men. The aim of this study was to investigate sexual dysfunction in both women and men with OAB treated with intravesical onabotulinumtoxinA (Botox) injections using the Sexual Quality of Life questionnaire in two versions: female (SQoL-F) and male (SQoL-M). Methods: Forty sexually active patients (thirty women and ten men) with idiopathic OAB were recruited. Patients completed the SQoL-F or SQoL-M questionnaire before treatment, and again at 3 and 6 months after treatment with intravesical onabotulinumtoxinA injections. Results: All 40 patients completed the study (30 women and 10 men). There were no statistically significant differences in SQoL results before the procedure or at 3- and 6-months post-treatment. Conclusions: OAB treatment with onabotulinumtoxinA did not significantly affect the quality of sexual life in either women or men. Further research is needed using questionnaires specifically designed to assess the sexual life of patients with OAB, especially in men.

12 - Comparing safety of tension-free vaginal tapes (TVT) and trans-obturator tapes (TOT) in treating stress urinary incontinence in women: emulation of a target trial (protocol and preliminary data)

12 - Comparing safety of tension-free vaginal tapes (TVT) and trans-obturator tapes (TOT) in treating stress urinary incontinence in women: emulation of a target trial (protocol and preliminary data)

276 - Effects of External Neuromuscular Electrical Stimulation in Women with Urgency Urinary Incontinence: A Randomized Sham-Controlled Study

276 - Effects of External Neuromuscular Electrical Stimulation in Women with Urgency Urinary Incontinence: A Randomized Sham-Controlled Study

How does the pelvic floor respond to modulations in trunk pressure induced by a variety of voicing tasks? A cross-sectional, observational study.

The pelvic floor responds to changes in trunk pressure, elevating during low-pressure exhale and descending during high-pressure exhale. Voicing occurs during exhalation, spanning low-to-high trunk-pressure, yet it is unknown how voicing affects the pelvic floor. The aim of this study was to quantify pelvic floor response to voicing and identify if there are differences for women with stress urinary incontinence. We hypothesized that shouting would cause pelvic floor descent, with greater magnitude for incontinent women. Sixty women (38 incontinent, 22 continent) performed four voicing tasks (counting to "4" in speaking/shouting/low-pitch/high-pitch voice) while transperineal ultrasound measured changes in pelvic floor morphology. ANOVA compared variance of responses to voicing and t-tests compared groups. Bladder neck height shortened, levator plate length increased and levator plate angle decreased more during shouting compared to speaking; consistent with pelvic floor straining. There were no differences for high versus low pitch-voicing and small group differences based on continence status. Voicing causes pelvic floor muscles to strain, with greater strain during shouting. Changing vocal pitch does not affect pelvic floor morphology and incontinent women had slight differences from continent women. Voicing may be a safe way to lengthen the pelvic floor without provoking incontinence.

291 - The relationship between Urgency Urinary Incontinence and measures of physical function in older women

291 - The relationship between Urgency Urinary Incontinence and measures of physical function in older women

Urinary Continence Restoration Through an Endourethral Device: A 3-Month Pilot Study on 10 Patients.

Background: Stress urinary incontinence (SUI) is a widespread and frustrating condition that affects millions of people worldwide, with severe consequences on patients' quality of life and health care systems' costs. Currently, the most severe cases of SUI are treated using implanted (and rather invasive) extraurethral artificial sphincters. The authors propose an innovative, minimally invasive endourethral device for the treatment of SUI. Methods: Ten patients with SUI were enrolled in three Italian centers and underwent device implantation. After 10, 30, 60, and 90 days, correct device position was confirmed by ultrasonography. Improvements in continence and quality of life were evaluated through a 24-hour pad-test, an International Consultation on Incontinence Questionnarie-Short Form (ICI-Q) and a custom checklist. The device was explanted after 90 days. Results: The proposed device was successfully implanted and explanted in 8 out of 10 patients. The results of the pad-test, ICI-Q, and custom checklist demonstrated remarkable improvements in continence (median improvement: 82% with respect to the initial condition) and quality of life (mean reduction of the impact of urine losses on the quality of life: 61%). No major pain or discomfort was reported. Conclusions: The results demonstrate the efficacy of the proposed endourethral artificial sphincter in addressing SUI. The proposed device was successfully implanted and explanted in a short time (∼10 minutes) without intrinsic side effects and without triggering pain or discomfort.

146 - 9 year analysis of the efficacy, longevity and safety of the Adjustable Transobturator Male System® (ATOMS) in Managing Stress Urinary Incontinence in Men.

146 - 9 year analysis of the efficacy, longevity and safety of the Adjustable Transobturator Male System® (ATOMS) in Managing Stress Urinary Incontinence in Men.

Heterogeneity in extracellular matrix and immune microenvironment of anterior vaginal wall revealed by single-cell sequencing in women with stress urinary incontinence

Stress urinary incontinence (SUI), characterized by involuntary urine leakage during increased abdominal pressure, remains poorly understood regarding its pathophysiology and treatment. In this study, we utilized single-cell sequencing to analyze the transcriptomic profiles of different cell types in anterior vaginal wall of SUI patients, aiming to explore the heterogeneity of the extracellular matrix (ECM) and immune microenvironment in SUI pathogenesis. Our results identified eleven cell types, including connective tissue cells, immune cells, and glial cells. Specifically, fibroblasts, smooth muscle cells, epithelial cells and T cells displayed transcriptional characteristics highly relevant to SUI pathogenesis. We observed that most cell types participate in ECM metabolism and immune-inflammatory responses, indicating a synergistic role of multiple vaginal cell types in SUI. Furthermore, altered intercellular communication, particularly between fibroblasts and T cells, was noted in SUI. This study provides novel single-cell insights into SUI and identifies potential biomarkers and therapeutic targets for future research.

47 - Prospective analysis of urinary incontinence and prolapse symptoms before pregnancy and 12 months postpartum: Prevalence and significant risk factors

47 - Prospective analysis of urinary incontinence and prolapse symptoms before pregnancy and 12 months postpartum: Prevalence and significant risk factors

5 - Prevalence and Experience of Urinary Incontinence Among Elite Gaelic Sportswomen

5 - Prevalence and Experience of Urinary Incontinence Among Elite Gaelic Sportswomen