Urodynamic Stress Incontinence Research Articles

Polypropylene anterior-apical single-incision UPHOLD-LITE mesh surgery in women with severe pelvic organ prolapse: Outcome at 53 months follow up

Background and purposeWe present this current study to complement with mesh inlays plausible benefits (UPHOLD-LITE System) on available long-term study amidst FDA's concern on mesh complications. This study aims to assess the medium-term outcomes of UPHOLD-LITE system for treatment of advanced pelvic organ prolapse (POP) and its complications, and lower urinary tract symptoms. MethodsThis is a retrospective case series of 53 months follow-up of 123 consecutive patients who underwent UPHOLD-LITE system. Objective outcome measures the anatomical correction of prolapse with POP-Q ≤ Stage 1. Subjective outcome was patient's feedback to questions 2 and 3 of POPDI-6. Secondary outcome measures the quality of life, presence of lower urinary tract symptoms and complications. Quality of life is assessed by validated questionnaires on Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire 7 (IIQ-7), Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12 (PISQ-12) at 1 and 3 years post-operatively. ResultsObjective outcome at 1 and 3 years was at 96.7 % and 95.4 % respectively. The subjective cure was 95.1 % and 91.6 %. Five-year cumulative cure rate maintained at 87.2 %. Secondary outcomes observed improvement on UDI-6, IIQ-7, POPDI-6 and PISQ-12 postoperatively. Bladder outlet obstruction improved while de novo urodynamic stress incontinence (USI) increased slightly post surgically. Mesh erosion rate was 0.8 %. ConclusionThe UPHOLD-LITE system demonstrated good medium term anatomical correction of apical and anterior prolapse, with good subjective cure and improved quality of life. Whilst complication rate was low, slight increase in de novo USI was observed.

Relationship between Q-Tip Test and Urethral Hypermobility on Perineal Ultrasound.

The aim of this study was to assess the correlation between the overall rest-stress distance measured by transperineal ultrasound (TPUS) and Q-tip test angle in women with urodynamic stress incontinence (USI), and determine a cut-off value of rest-stress distance for predicting urethral hypermobility (UH). Women with USI scheduled for mid-urethral sling surgery were retrospectively recruited. UH was defined as a Q-tip angle more than or equal to 30 degrees. Ultrasonic measurement of the overall rest-stress distance was defined as the linear distance of bladder-neck position change from resting status to maximal strain. Among the 132 enrolled women, the Pearson correlation coefficient between the overall rest-stress distance in TPUS and Q-tip test angle was 0.9104 (95% CI, 0.8758-0.9357, p < 0.001). In receiver-operating-characteristic-curve analysis, a rest-stress distance of more than 13.3 mm was an optimal cut-off value to predict UH (sensitivity = 76.47%, specificity = 93.3%; area = 0.937, 95% confidence interval: 0.881-0.972). The overall rest-stress distance in TPUS correlated well with the Q-tip test angle, indicating that it can be an alternative method for the assessment of USI. A rest-stress distance of more than 13.3 mm was an optimal cut-off value to predict UH in women with USI.

Predictors of Surgical Failure of Open Burch Colposuspension Versus Retropubic Midurethral Sling for Stress Urinary Incontinence

To identify and compare long-term predictors for 'surgical failures' in matched groups of Midurethral sling (MUS) and Burch colposuspension (BC). A secondary analysis of patients with urodynamic stress incontinence who were treated either by open BC or retropubic MUS. The study had a cohort of 1344 women with a ratio of 1:3 (BC: MUS). We defined surgical success or failure by combining Patient Reported Outcome Measures and the need for repeat surgery. Risk factors for failure identified by multivariate analysis. Of the 1344 women included, 336 had BC, and 1008 had MUS. Patients were followed-up for 13.1 and 10.1 years, and the rate of failure was 22% and 20%, for BC and MUS, respectively (P=0.35). Significant predictors for MUS failure were Body mass index (BMI)>30, preoperative anticholinergic medication use, smoking, diabetes, and previous surgery for incontinence (Hazard ratio 3.6, 2.6, 2.5, 1.8, 2.3, respectively). BMI>25, preoperative use of anticholinergic medication, age>60, previous surgery for incontinence, and loss of follow-up>5 years (Hazard ratio: 3.2, 2.8, 2.6, 2.5, 2.1, respectively), were significant predictors of BC failure. This study shows similar predictors for surgical failure for BC and MUS, with high BMI, mixed urinary incontinence, and previous continence procedures being the most important.

Urinary Oxidative Stress Biomarkers in the Diagnosis of Detrusor Overactivity in Female Patients with Stress Urinary Incontinence.

Ninety-three women with urodynamic stress incontinence (USI) and a mean age of 60.8 ± 10.7 (36-83) years were retrospectively enrolled. According to their VUDS, 31 (33%) were grouped into USI and detrusor overactivity (DO), 28 (30.1%) were grouped into USI and hypersensitive bladder (HSB), and 34 (36.6%) were controls (USI and stable bladder). The USI and DO group had significantly increased 8-isoprostane (mean, 33.3 vs. 10.8 pg/mL) and 8-hydroxy-2-deoxyguanosine (8-OHdG; mean, 28.9 vs. 17.4 ng/mL) and decreased interleukin (IL)-2 (mean, 0.433 vs. 0.638 pg/mL), vascular endothelial growth factor (mean, 5.51 vs. 8.99 pg/mL), and nerve growth factor (mean, 0.175 vs. 0.235 pg/mL) levels compared to controls. Oxidative stress biomarkers were moderately diagnostic of DO from controls, especially 8-isoprostane (area under the curve (AUC) > 0.7). Voided volume was highly diagnostic of DO from either controls or non-DO patients (AUC 0.750 and 0.915, respectively). The proposed prediction model with voided volume, 8-OHdG, and 8-isoprostane (cutoff values 384 mL, 35 ng/mL, and 37 pg/mL, respectively) had an accuracy of 81.7% (sensitivity, 67.7%; specificity, 88.7%; positive predictive value, 75.0%; negative predictive value, 84.6%). Combined with voided volume, urinary oxidative stress biomarkers have the potential to be used to identify urodynamic DO in patients with USI.

Comparison of two outside-in transobturator midurethral slings in the treatment of female urodynamic stress incontinence

ObjectiveTo explore the difference between two brands of outside-in transobturator midurethral sling (TOT) for urodynamic stress incontinence (USI). Materials and methodsWomen who underwent an outside-in TOT procedure by either Monarc or Obtryx were retrospectively reviewed. Data of women with available information at baseline and postoperative 12-month follow-up were analyzed. The analyzed data included standardized interview, pelvic examination, as well as sling location and sling tension explored by introital four-dimensional ultrasound. Sling position were explored through the distances between the sling center and the caudal margin of the pubic symphysis (SPd) as well as sling percentile (SP) along the urethral length as a percentage in the midsagittal plane. SPd was also used to explore sling tension. Clinical outcomes were compared between two groups. Sling location and sling tension were compared in success cases between two groups. ResultsThere were 138 women in Monarc group and 140 women in Obtryx group. Rates of stress urinary continence and adverse events were not statistically different after two TOT. SPd was similar between both procedures. Obtryx located more ventrally than Monarc, indicated by a smaller SP during resting (41.6% vs 58.5%, P < 0.001), straining (38.0% vs 54.4%, P < 0.001), and coughing (39.8% vs 48.8%, P < 0.001). ConclusionAt 12-month assessment, both outside-in TOT procedures were not significantly different in terms of clinical results and sling tension, while Obtryx sling located more ventrally than Monarc.

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

Comparison of adjustable and nonadjustable single-incision mini-slings in the treatment of female stress urinary incontinence: An initial experience with 30 cases

ObjectiveSeveral single-incision mini-slings (SIMSs) have been developed to minimize the potential complications associated with retropubic or transobturator mid-urethral slings. However, few studies compared the efficacy of different types of SIMS. This study compared the outcomes of an adjustable SIMS (Ajust) with a nonadjustable SIMS (Solyx) in the treatment of urodynamic stress incontinence (USI) over postoperative follow-up of 12 months. Materials and methodsIn this study, the surgical outcomes of the first 30 patients receiving Ajust and the first 30 patients undergoing Solyx at a university hospital were reviewed retrospectively, all of whom were diagnosed with USI without coexistent pelvic organ prolapse. Preoperative and postoperative examinations included structured urogynecological questionnaires, 1-hour pad tests, and complete urodynamic testing. Patient demographics, urodynamic parameters, and 12-months surgical outcomes were compared between the Ajust and Solyx groups. ResultsThere were no significant differences between the Ajust and Solyx groups in terms of subjective cure rate (93.3% vs 90.0%), objective cure rate (89.3% vs 89.3%), and de novo urgency or urge urinary incontinence (13.3% vs 16.7%) 12 months after surgery. Postoperatively, both Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7 scores were significantly improved in the Ajust and Solyx groups. In comparison with preoperative data, postoperative urodynamic results revealed a significant decrease in maximal urethral closure pressure in the Ajust group (n = 28) and a significant increase in residual urine in the Solyx group (n = 28). However, significant differences were not observed in the postoperative pad test and urodynamic data between the Ajust and Solyx groups, and no major complications occurred in either group. ConclusionsIn this paper describing the preliminary experience of 30 patients, both adjustable and nonadjustable SIMS performed by an experienced surgeon were safe and effective in correcting USI at 12-month postoperative follow-up.

Tension-Free Vaginal Tape and Polyacrylamide Hydrogel Injection for Primary Stress Urinary Incontinence: 3-Year Followup from a Randomized Clinical Trial.

We sought to determine whether polyacrylamide hydrogel (PAHG) is noninferior to tension-free vaginal tape (TVT) in the treatment of women with primary stress urinary incontinence (SUI). In this noninferiority trial, 223 women eligible for operative SUI treatment were randomized for TVT (110) or PAHG (113). Primary outcome was patient satisfaction and the noninferiority margin for the difference was 20%. Secondary outcomes were effectiveness and complications. At 3 years, 188 (84.3%) women attended the followup. The satisfaction score (visual analogue scale 0-100) median was 98.5 (IQR 90-100) in the TVT group and 90.0 (IQR 70-100) in the PAHG group, whereas a score ≥80 was reached in 87 (94.6%) and 65 (67.7%), respectively (difference 26.9%, 95% CI 16.7% to 36.8%). Thus, PAHG did not meet the noninferiority criteria set in our study. The cough stress test was negative in 88 (95.7%) of TVT patients vs 75 (78.1%) of PAHG patients (difference 17.5%, 95% CI 8.6% to 26.9%). Any peri- or postoperative complication before crossover between the groups was detected in 40 (43.5%) women in the TVT group and 23 (24.0%) women in the PAHG group (difference 19.5%, 95% CI 6.8% to 31.4%). In midterm followup, PAHG did not reach in patient satisfaction the noninferiority set in our study. Furthermore, mid urethral TVT slings show better subjective and objective cure rates than PAHG. However, complications were more often associated with TVT. Since the majority of PAHG treated women were also cured or improved, primary SUI women can be offered PAHG as a safe and durable alternative treatment.

Clinical outcome and urodynamic changes of tailored transvaginal mesh surgery for pelvic organ prolapse: A mid-term 40 Months follow-up

To evaluate the changes in clinical outcome and urodynamic parameters after tailored anterior transvaginal mesh (ATVM) surgeries in a mid-term follow-up. Between November 2011 and December 2015, women with ≥stage II pelvic organ prolapse (POP) who underwent ATVM surgeries were retrospectively reviewed. The data-reviewing timeframe was until December 2021. Clinical and urodynamic diagnoses regarding urinary symptoms were evaluated before and after the operation. A total of 160 women were included. Stress urinary incontinence decreased significantly after the operation (99% (159/160) vs. 43% (68/160), p<0.01), as well as the pad weight (20.5±2.7 vs. 9.4±2.0, p<0.001) and diagnosis of urodynamic stress incontinence (83% (132/160) vs. 51% (82/160), p<0.01). Overactive bladder syndrome increased significantly after the operation (18% (29/160) vs. 28% (45/160), p=0.03), even though the objective parameters, such as first and strong desire to void, bladder oversensitivity, and detrusor overactivity, were all improved after the operation. The pad weight was mostly improved significantly within the first postoperative 2 years. Eighteen (11%) women had global recurrent POP, and only one (0.6%) woman had true recurrence of cystocele. Twenty-four (15%) women had mesh extrusion, and two-thirds of them could be managed in an office setting. In women with advanced cystocele, the ATVM surgery provides a favorable anatomic reduction outcome with an acceptable mesh extrusion rate. The ATVM provides an anti-incontinence effect, both in subjective symptoms and objective parameters, but this effect might decline after postoperative 2 years.

Urinary incontinence during pregnancy – of predictive value?

Objective: Primary objective was to find the prevalence of urinary incontinence during pregnancy by its type and see how predicative it was of urinary incontinence in the long term. Associated risk factors were identified as secondary objectives. Method: Antenatal clinics provide opportunistic screening for diseases of the breast, the heart or even the mind. Preventive gynaecological issues could also be addressed likewise. It was felt worth investigating the prevalence of urinary incontinence during pregnancy without undue harassment to the patients by way of a few routinely directed questions about urinary incontinence.This information is rarely volunteered due to embarrassment. 867 women attending antenatal clinics led by the author at teaching hospital Peradeniya, in 2007 and 2008 were interviewed during pregnancy and those incontinent were followed up post-partum at 6 weeks,one and two years till 2010. Patients were inquired regarding the predominant type of incontinence, when the symptoms were mixed(stress and urge both). Results: Of the 867 women analysed, 209 (24%) had some form of urinary incontinence. 110 (52%) of those affected had pure or predominant stress, and 15 (7%) pure or predominantly urge incontinence. The rest 41% had a mixed picture. 154 were still incontinent at 6 weeks post-partum. The proportion of the type of incontinence had changed. 97 (63%) had pure or predominantly stress incontinence, 6 (3.9%) had pure or predominantly urgency and the 33.1% had a mixed picture. 47 of them still complained of some degree of incontinence at the end of one year despite interventions of pelvic floor exercise (PFE),for urodynamic stress incontinence or mixed symptoms. The patterns were even more stress predominant. 33(70%). 2 patients (4.2%) had pure urgency and the rest 12 (25.5%) had a mixed pattern. End of 2 years only 43 patients of those incontinent at 1year were traceable at least over the telephone. Only 23 complained of persistence of the problems. Of the 23 with symptoms at 2 years, 2 were pregnant again. 18 (78%) had pure SI and the rest 5 (22%) had a mixed picture. This indicated that pure stress incontinence tended to persist more than urge incontinence probably indicating some form of permanent damage to the pelvic floor. Older and women of higher parity were found to be more affected again indicating possibility of such injury. Conclusions: The finding that of the initial 209 women who leaked urine during pregnancy 23 remained incontinent at the end of 2 years (11%), is evidence that incontinence during pregnancy is of some predictive value in finding those likely to have long term incontinence.The symptoms of stress incontinence persisted despite PFE. This places doubts on benign physiological and hormonal change theories which is discussed alongside these findings. Incontinence during pregnancy maybe a useful indicator of injury sustained to the pelvic floor providing early warning for trouble ahead with the sphincter mechanism. Questions about urinary incontinence as a routine during antenatal consultations may be a worthwhile exercise. This would take only a very short time and should be encouraged as a higher percentage would have remained incontinent had PFE not been initiated as an ethical intervention.

Sexual and functional outcomes after prolapse surgery: a randomized prospective comparison of trocarless transvaginal mesh and pelvic organ prolapse suspension.

Stress urinary incontinence (SUI) related to pelvic organ prolapse represents a common condition that negatively impacts female sexual activity. Laparoscopic pelvic organ prolapse surgery (POPs) and the anterior repair with a trocar-less trans-vaginal mesh (TTMs) represent two different surgical techniques to treat SUI secondary to POP. This study aimed to report the results of these techniques comparing the sexual and functional outcome improvement. Fifty-nine sexually active female patients, complaining of urodynamic stress incontinence, were enrolled in this prospective study, and simply randomized in two groups: 29 POPs and 30 TTMs. All patients were studied at baseline and 6months after surgery. Preoperative evaluation included medical history, urodynamic test, Female Sexual Function Index (FSFI), and pelvic magnetic resonance defecography. Six months after surgery, all patients completed the FSFI and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and were investigated with a uroflowmetry test with post-void residual volume (PVR). At 6months after surgery, 87% of POPs patients and 79% of TTMs subjects resulted dry. No statistically significant results were obtained in terms of urinary outcomes between the two surgical groups. Regarding sexual function, POPs group exhibited a significant greater improvement of global FSFI (mean: 27.4; SD: 4.31) compared to TTMs group (mean FSFI: 23.56; SD: 2.28; p-value ≤ 0.0001). Our results indicated that POPs and TTMs lead to satisfactory and safe functional outcomes with a good recovery of urinary continence. Furthermore, POPs, when compared to TTMs, led to a greater improvement of sexual function.

The Clinical Features and Predictive Factors of Nocturnal Enuresis in Adult Women.

ObjectiveOur current knowledge on nocturnal enuresis (NE) in adults is scarce due to its uncommon nature. The present study was designed to investigate symptom characteristics and risk factors of NE in adult women to improve the current clinical understanding and management of this rare disease.MethodsOver a 3-year period, we enrolled 70 adult women who complained of bedwetting, with a frequency of at least once per week and a symptom duration of 3 months or longer. Patients were excluded if they had known pregnancy, current urinary tract infection, untreated malignancies, anatomical abnormalities, and irregular sleep cycle. The International Consultation on Incontinence Modular Questionnaire—female lower urinary tract symptoms and bladder diary were employed to appraise lower urinary tract symptoms and voiding behavior. Urodynamics was performed to assess the bladder function. A linear regression analysis was applied to determine potential risk factors for NE frequency.ResultsAmong the recruited subjects, comorbidities and lower urinary tract symptoms were frequently reported. On bladder diary, patients commonly presented with nocturnal polyuria (NP), reduced nocturnal voided volumes (RNVVs), or both. Urodynamics revealed multiple dysfunctions, namely, detrusor overactivity (DO), urodynamic stress incontinence (USI), reduced compliance, bladder outlet obstruction, detrusor underactivity (DU), and simultaneous DO and DU. Patients with more frequent NE (≥4/week) demonstrated markedly increased body mass index, more comorbid conditions, worse incontinence symptoms, NP or NP plus RNVVs, reduced compliance, and poorer voiding possibly owing to DU. Whereas, RNVVs alone and worse overactive bladder-related parameters were associated with milder NE. Multivariate analysis indicated that frequency/urgency quality of life, incontinence symptom, NP + RNVVs, poor flow, increased bladder sensation, USI, and simultaneous detrusor overactivity plus DU were independent risk factors for NE severity.ConclusionNE in adult women may have both urological and non-urological pathophysiology. Imbalanced circadian urine production, jeopardized continence mechanisms, overactive bladder, and DU-induced poor voiding are major factors that contribute to the pathogenesis of NE in adult women. Focused treatments on restoring these functions should be individually considered.

Single-incision mini-sling and trans-obturator sling for stress urinary incontinence: A 5-year comparison

ObjectiveThe aim of our study was to compare objective and subjective outcomes in women with stress urinary incontinence (SUI) submitted to either trans-obturator sling (TVT-ABBREVO®) or single incision mini-sling (SIMS-ALTIS®) at 5-year follow up. Study designA monocentric, retrospective study including women with isolated SUI and with concomitant proved urodynamic stress incontinence (USI), treated with an TVT-ABBREVO® or SIMS-ALTIS®. At 60-month follow up each woman was assessed subjectively, with two validated questionnaires (UDI-6 and ICQI-SF), and objectively with a cough stress test. Adverse events were collected. ResultsForty-two patients were evaluated in the ABBREVO® group and 58 in the ALTIS® group. No significant difference was found in subjective (88.1% vs 89.7%, p = 0.806) and objective (81.0% vs 86.2%, p = 0.479) cure rates between the two groups. Subjectively, improvement in urinary distress after surgery resulted statistically significant in both groups compared to baseline (p < 0.001). Long-term post-operative complications rate (i.e. de novo OAB and sling exposure) was similar in the two groups. They were, in fact, mainly classified as Dindo II grade and conservatively managed (i.e. antimuscarinics or β3 agonists for de novo OAB). ConclusionThis comparative study did not reveal significant difference between single-incision (ALTIS®) and trans-obturator (TVT-ABBREVO®) slings in terms of efficacy and morbidity at 5-year follow up.

Intermediate- to long-term outcomes of transvaginal mesh for treatment of Asian women with pelvic organ prolapse.

Short-term follow-up analyses suggest that transvaginal mesh has limited application for pelvic organ prolapse (POP) treatment. This study evaluated the intermediate- and long-term outcomes of transvaginal mesh surgery. This retrospective study included all women who underwent transvaginal mesh surgery in one urogynaecology centre. Inclusion criteria were women with stage III/IV POP, age ≥65 years, and (preferably) sexual inactivity. Concomitant sacrospinous fixation and mid-urethral slings were offered for stage III/IV apical POP and urodynamic stress incontinence, respectively. Women were followed up for 5 years. Subjective recurrence was defined as reported prolapse symptoms. Objective recurrence was defined as stage II prolapse or above. Mesh complications and patient satisfaction were reviewed. Of 183 women who underwent transvaginal mesh surgery, 156 had ≥1 year of follow-up (mean, 50 ± 22 months). Subjective and objective recurrence rates were 5.1% and 10.9%, respectively. The mesh erosion rate was 9.6%; all affected women received local oestrogen treatment or bedside surgical excision. Three women received transobturator tension-free transvaginal tape for de novo (n=1) or preoperative urodynamic stress incontinence who did not undergo concomitant surgery (n=2); 14% of the women had de novo urgency urinary incontinence. No women reported chronic pain. Overall, 98% were 'satisfied' or 'very satisfied' with the operation. During 50 months of follow-up, transvaginal mesh surgery for stage III/IV POP had low subjective and objective recurrence rates. The total re-operation rate was 9.6%. Most women were satisfied with the operation. Based on the risk-benefit profile, transvaginal mesh surgery may be suitable for women who have advanced POP.

Ultrasonography and clinical outcomes following anti-incontinence procedures (Solyx™ tape): a 3-year post-operative review.

Our primary objective was to study objective and subjective outcomes of patients with urodynamic stress incontinence (USI) following Solyx™ at 3-year follow-up. Our secondary objective was to evaluate ultrasonographic tape and bladder neck position and mobility. Records of 88 women who received Solyx™ surgery between September 2015 and December 2017 were reviewed. Ultrasonographic sling evaluation was performed at 6months and 3 years postoperatively. Primary outcomes were objective and subjective cure of stress incontinence, defined as no involuntary urine leakage during filling cystometry, 1-h pad test < 2g and negative response to Urogenital Distress Inventory-6 Question 3. Subjective and objective cure rates at 3 years were 85.2% and 87.5%, respectively, with no complications reported. QOL improvements were maintained. Bladder neck position and mobility had no significant change between 6-month and 3-year follow-up. Tape position demonstrated significant shifts in the y-axis at both rest and Valsalva and in the x-axis at Valsalva between 6 months and 3 years; overall mobility was unchanged. Percentile of sling location remained unchanged at 60.1%, as did percentage of urethral kinking (67.9%) achieved. Risk factors for failure were bladder neck hypomobility postoperatively and no urethral kinking postoperatively. There was good sustained objective and subjective cure with improved QOL in women who underwent Solyx™ for USI at 3-year follow-up. Ultrasonographic evaluation showed a tape position shift upwards and backwards with unchanged tape and bladder neck mobility. Percentile of sling location and rates of dynamic kinking were maintained.

De novo detrusor overactivity and urgency after mid-urethral slings for urodynamic stress incontinence.

The objective was to identify incidence and risk factors of de novo urgency and detrusor overactivity (DO) following mid-urethral slings (MUS) in patients with urodynamic stress incontinence (USI) without urgency. A total of 688 women between January 2004 and July 2017 were reviewed retrospectively. De novo urgency was established with a positive response to question 2 on the Urogenital Distress Inventory-6 questionnaire (UDI-6). Objective cure of USI is no involuntary urine leakage during filling cystometry and pad test < 2 g. Subjective cure of stress urinary incontinence (SUI) is defined as a negative response to question 3 on UDI-6. Multivariate logistic regression was used to identify risk factors for failure. Forty-four out of 688 women (6.4%) developed de novo urgency, with 16 out of 688 (2.3%) demonstrating de novo DO. Subjective cure for women with de novo urgency was significantly lower at 35 out of 44 (79.5%) compared with 556 out of 644 (86.3%) in those with no urgency (p < 0.001). Objective cure for women with de novo DO was significantly lower at 8 out of 16 (50%) compared with 599 out of 672 (89.1%) in those with detrusor stability (p < 0.001). Quality of life improved for all. Age ≥ 66 (OR, 1.23; 1.07), increased bladder sensation (OR, 4.18; 3.80), lower bladder capacity (OR, 5.28; 4.97), lower maximum urethral closure pressure (OR, 2.32; 5.20), and pad test > 100 g (OR, 1.08; 1.15) were independent risk factors for de novo urgency and DO. Diabetes (OR, 1.32) was an independent predictor of de novo urgency. Cure is significantly reduced in women who report symptoms of de novo urgency or demonstrate DO after MUS at 1 year. Independent risk factors include age ≥ 66, increased bladder sensation, lower bladder capacity, lower maximum urethral closure pressure, greater pad loss, and diabetes.

Urinary symptoms and urodynamic findings before and after vaginal surgery for pelvic organ prolapse

To ascertain the difference in urodynamic findings, specifically bladder sensation, and urinary symptoms after vaginal surgery for Pelvic Organ Prolapse (POP). Retrospective data analysis of 126 women who underwent vaginal surgery for POP without simultaneous anti-incontinence procedure from January 2013 to April 2019 at Siriraj Hospital, Thailand. Baseline characteristics, intraoperative details and pre and post-operative urinary symptoms and urodynamic findings were recorded. There was no significant difference in the pre and post-operative first desire to void, at 158±53 mL and 162±64 mL, respectively (p=0.518). Incidence of increased bladder sensation was also unchanged, from 46.0% to 46.8% (p=1.00). Post-operative urodynamic stress incontinence was significantly increased, from 15.9% to 31.0% (p=0.003), as was the incidence of weak bladder contractility index (&lt;100), from 47.3% to 61.8% (p=0.005). Significant improvements in post-operative urge urinary incontinence, urgency and voiding dysfunction were noted, from 50.8% to 31.7% (p=0.001), 63.5% to 38.9% (p&lt;0.001) and 42.9% to 5.6% (p&lt;0.001), respectively. No significant difference in bladder sensation after vaginal surgery for POP repair was noted. However, urinary symptoms significantly improved after surgery.

Is coital incontinence a manifestation of urodynamic stress incontinence or detrusor overactivity?

Coital incontinence (CI) is an underreported symptom among sexually active women. It has been assumed that incontinence at penetration (CIAP) is due to urodynamic stress incontinence (USI), while coital incontinence at orgasm (CIAO) is thought to be due to detrusor overactivity (DO). To evaluate demographic and urodynamic findings associated with coital incontinence (CI) and to confirm the hypotheses 'CIAP is associated with USI' and 'CIAO is associated with DO we performed a retrospective study of 661 sexually active women attending a tertiary clinic between January 2017 and December 2019 for pelvic floor dysfunction. All patients filled in a standardized questionnaire and had a clinical examination and multichannel urodynamic testing. Women were asked if they experienced urine leakage during intercourse and the timing of such leakage. Of 661 sexually active women, one third (n = 220) reported coital incontinence. While 121 (18%) women experienced CIAP, 172 (26%) had CIAO and 76 (11.5%) suffered both. For women with pure USI, the prevalence of CIAP (61.7%) and CIAO (69.5%) was significantly higher than for women with pure DO, where only 12.3% had CIAP and 8.6% had CIAO. Factors significantly associated with CI were body mass index, mid-urethral closure pressure (MUCP) and abdominal leak point pressure (ALPP). When only women with pure USI or DO were included, USI remained associated with CI while DO was not. CI is clearly associated with SUI and USI and is likely to share etio-pathogenetic mechanisms. CI seems to be a manifestation of USI, even when it occurs during orgasm.

Clinical and urodynamic predictors of Q-tip test urethral hypermobility.

Urodynamics and Q-tip test represent diagnostic tools for the assessment of stress urinary incontinence. The aim of the present study was to investigate the possibility to predict the Q-tip test urethral hypermobility on the basis of clinical and urodynamic parameters. We analyzed all women performed urodynamics between 2008 and 2016 presenting urodynamic stress urinary incontinence. Symptoms were collected by the Incontinence Questionnaire-Short Form Questionnaire. A total of 501 women presented urodynamic stress incontinence, of which 270 had urethral hypermobility, according to the Q-tip test. Patients with urethral hypermobility were younger (P<0.0001) and presented a more advanced anterior compartment descensus according to the POP-Q system (Aa point P=0.0155; Ba point P=0.0374), a higher detrusor pressure at maximum flow (P=0.0075) and maximum flow rate compared to controls. Age, Aa POP-Q point and detrusor pressure at maximum flow were found to be independent predictors of Q-tip test urethral hypermobility. However, the final model cannot be used as an effective predictor of the Q-tip test result.

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.