Urodynamic Stress Urinary Incontinence Research Articles

Minimally invasive surgery in urogynecology

Minimally invasive surgery has been a term used to describe laparoscopic surgery and more recently the trocar-guided synthetic mid-urethral slings for stress incontinence and the trocar-guided synthetic mesh kits to treat prolapse. This term implies a lesser operation, more pain free and safer, which in many cases is not true. This description seems more to do with marketing the product and the surgeon than actually describing the benefits and risks of the procedure. When complications occur as they always will, they may be more unexpected by the patient and poorly tolerated. Therefore informed consent, giving the patient a clear understating of the procedure, possible risks and benefits, and likely outcome, is essential. Synthetic polypropylene slings (SPS) are not new and were used to treat women with stress incontinence by Morgan in Northern America and Moir in the UK in the 1960s. These slings were placed under the bladder neck through open abdominal and vaginal incisions. However, it was not until the mid-1990s with the introduction of the tension-free vaginal tape (TVT) that SPS gained widespread usage when placed through small incisions using trocar needles at the mid-urethral position. These retropubic slings have been found to have benefits of shorter hospitalization, less postoperative pain and a lower morbidity than the Burch colposuspension and fascial slings but equal effectiveness. Over the last 6 years, numerous variations of the TVT have been introduced, including the transobturator approach and the no-incision mini-slings (TVT Secur, Gynecare Ethicon Inc., Somerville, NJ) and Miniarc (American Medical Systems Inc., Minnetonka, MN). A major advantage of the transobturator and minislings is the avoidance of the retropubic space, decreasing complications such as bladder and bowel perforation, and major vascular injury. Bladder perforation in retropubic slings is a common complication with reported rates of 0.7% to 34.2% compared to 0% to 3.1% in the transobturator approach [1]; if recognized, sling replacement is performed without clinical sequel. Bowel and vascular injuries are more serious and have resulted in patient deaths. These complications have resulted in many surgeons changing from retropubic slings or preferring to learn the other approaches. Current sales of these stress incontinence devices according to industry sources are “obturator slings make up just over half of the total synthetic sling procedures performed in the US. Newer single incision slings represent between 15%–20%. The remaining 30% are retropubic slings. This is across all major/medium size brands.” However, is this change away from retropubic slings for perceived safety reasons premature and in the patient’s best long-term interests? Prospective randomized studies [1] comparing the retropubic and transobturator slings in woman with non-intrinsic sphincter deficiency (non-ISD) stress urinary incontinence (SUI) have shown no significant difference in effectiveness, although follow-up in these studies is of short duration (less than a year) and based on symptoms only. However, short-term subjective outcomes may not be indicative of more long-term results. In a study comparing pubovaginal sling to transurethral Macroplastique injection in ISD patients [2] the subjective symptomatic improvement was not significantly different at 6 months, but urodynamic SUI cure at 6 months, (81% vs. 9%) and 5 year symptomatic cure was significantly in favor of the pubovaginal fascial sling (69% vs. 21%). In women with ISD, SUI the retropubic TVT sling has been shown to be more Int Urogynecol J (2009) 20:485–486 DOI 10.1007/s00192-009-0854-5

Could the National Institute for Health and Clinical Excellence guidelines on urodynamics in urinary incontinence put some women at risk of a bad outcome from stress incontinence surgery?

To evaluate the potential impact of the UK National Institute for Health and Clinical Excellence (NICE) recommendation that preoperative urodynamics are not necessary for women with 'pure symptoms of stress urinary incontinence' (SUI), by using data from a population of women referred with lower urinary tract symptoms. In a retrospective study of 6276 women with UI, from an electronic database at a tertiary referral centre, information was collected and entered into a urodynamics computer database at the time of history taking and before conducting the tests. The database was used to identify women aged 18-80 years who had multichannel cystometry for UI over a 17-year period (1 January 1990 to 31 December 2006). To apply the NICE criterion of a 'clearly defined clinical diagnosis of pure SUI', strict selection criteria were used to identify patients with pure SUI. The reliability of the patients' history in predicting 'pure' urodynamic SUI in patients with 'pure' SUI was investigated. The correspondence of the symptomatic diagnosis of pure SUI with the urodynamic findings was assessed, and sensitivity, specificity, positive and negative predictive values were calculated using contingency tables. Only 324 (5.2%) women had pure SUI; moreover, a quarter of those with pure SUI symptoms ultimately had urodynamic diagnoses other than urodynamic SUI, that could affect the outcome of continence surgery. These findings indicate that only a small group of women fulfil the NICE criteria of pure SUI. These strict criteria do not ensure that all women with potentially important urodynamic findings are evaluated accordingly. Therefore, we suggest that this NICE recommendation was unwise and, furthermore, was not based on properly acquired expert opinion.

Bulking Agents: Anesthesia Techniques

Bulking therapy for the minimally invasive treatment of stress urinary incontinence (SUI) may be offered to women with urodynamic SUI, wishing to avoid the complications associated with more invasive surgery, on the basis of low operative morbidity and low long-term success rates. These bulking agents may be injected by a retrograde or antegrade technique in the periurethral tissue around the bladder neck and proximal urethra. This therapy is strongly dependent on the anesthetic technique of choice; moreover its application as an outpatient procedure implies the potential for a cost-effective treatment for selected patients with SUI. In the present paper all factors affecting the choice of different types of anesthetic techniques are discussed.

Managing the Urethra at Transvaginal Pelvic Organ Prolapse Repair: A Urodynamic Approach

We evaluated the protocol that we use to determine whether a mid urethral synthetic sling will be placed at transvaginal pelvic organ prolapse repair. A total of 140 patients underwent transvaginal repair for stage 2 to 4 pelvic organ prolapse, of whom 105 were treated according to the protocol and had a minimum 3 months of followup or required earlier intervention. Urodynamics were performed without prolapse reduction. When stress urinary incontinence was not identified, a pessary was placed and the study was repeated. Patients were designated as having urodynamic, occult or no stress urinary incontinence. Patients with urodynamic or occult stress urinary incontinence underwent a simultaneous mid urethral synthetic sling procedure, while those without urodynamic or occult stress urinary incontinence did not. Charts were reviewed to determine whether further intervention was required for stress urinary incontinence or obstruction. The risk of intervention due to obstruction after receiving a mid urethral synthetic sling was 8.5%. The risk of intervention for stress urinary incontinence in patients with no clinical, urodynamic or occult stress urinary incontinence and no mid urethral synthetic sling was 8.3%. The risk of intervention for stress urinary incontinence in patients with clinical stress urinary incontinence but no urodynamic or occult stress urinary incontinence and no mid urethral sling was 30%. Using our urodynamic protocol to manage the urethra at transvaginal pelvic organ prolapse repair the risk of intervention due to obstruction is essentially equal to the risk of intervention due to stress urinary incontinence when no clinical, urodynamic or occult stress urinary incontinence was present and no mid urethral synthetic sling was placed. In patients who report clinical stress urinary incontinence preoperatively despite no urodynamic or occult stress urinary incontinence there is a much higher rate of further intervention for stress urinary incontinence.

Effects of laparoscopic Burch colposuspension and tension-free vaginal tape in treatment of female stress urinary incontinence: a comparative study

To evaluate the efficacy and complications of laparoscopic Burch colposuspension and tension-free vaginal tape (TVT) in treatment of female stress urinary incontinence (SUI). Thirty patients underwent laparoscopic Burch colposuspension and 67 age, BMI, parity, and grading-matched patients underwent TVT because of moderate to severe hypermotility urodynamic SUI from 2002 to 2006. Follow-up was conducted for (9 +/- 10) months. The clinical characteristics, mean operation time, hospital stay, peri-operative complications, and late complications were compared. The mean operative time and the hospital stay of the TVT group was (29.57 +/- 8.23) min and (3.0 +/- 2.1) d, both significantly shorter than those of the Burch operation group [(87 +/- 23) min and (4.8 +/- 1.9) d respectively, P < 0.001 and P < 0.01]. The blood loss of the TVT group was (27 +/- 12) ml, significantly less than that of the Burch operation group [(59 +/- 30) ml, P < 0.001]. The subjective cure rate of the Burch operation group was 86.5%, not significantly different from that of the TVT group (95.5%, P > 0.05). Short-term complications included 1 case of bladder injury and 1 case of circumflex iliac vein injuring, both occurring in the Burch colposuspension group. The postoperative urine retention rate of the Burch colposuspension group was 23.5%, not significantly different from that of the TVT group (14.9%, P > 0.05), and the postoperative fever rate of the Burch colposuspension group was 16.2%, significantly higher than that of the TVT group (4.5%, P < 0.05). Three cases of erosion of sling were found in the TVT group as late complications. Both Burch colposuspension and TVT are effective in the treatment of female SUI. The mean operative time of Burch operation and the hospital stay thereafter are longer; however, the cost of TVT is much higher than that of the Burch operation.

Risk factors associated with failure 1 year after retropubic or transobturator midurethral slings

The objective of the study was to identify predictors of recurrent urinary incontinence (UI) 1 year after treatment with tension-free vaginal tape (TVT) and transobturator tape (TOT). One hundred sixty-two women with urodynamic stress urinary incontinence (SUI) were included in a clinical trial comparing TVT with TOT with at least 1 year of follow-up were included in this analysis. Potential clinical and urodynamic predictors for development of "any recurrent UI" or "recurrent SUI" 1 year after surgery were evaluated using logistic regression models. Subjects who received concurrent prolapse surgery and those taking anticholinergic medications preoperatively were more likely to develop any recurrent UI. Increasing age was independently associated with recurrent SUI. Risk factors were similar for TVT and TOT for both definitions of treatment failure. Concurrent prolapse surgery and preoperative anticholinergic medication use are associated with increased risk of developing recurrent UI 1 year after TVT or TOT. Increasing age is specifically associated with the recurrence of SUI symptoms.

TVT-secur: a minimally invasive procedure for the treatment of primary stress urinary incontinence. One year data from a multi-centre prospective trial

The objective of this study is to evaluate the efficacy and morbidity of the new minimally invasive TVT-secur procedure. This was a prospective multi-centre trial. All patients with primary urodynamic stress urinary incontinence were prospectively selected to receive the TVT-secur procedure. The International Consultation on Incontinence-Short Form (ICIQ-SF), Women Irritative Prostate Symptoms Score (W-IPSS), Patient Global Impression of Severity (PGI-S) and Patient Global Impression of Improvement (PGI-I) questionnaires were used to evaluate the impact of incontinence and voiding dysfunction on quality of life (QoL) and to measure patient's perception of incontinence severity and improvement. The SPSS software was used for data analysis. From November 2006 to September 2007, 95 consecutive patients were enrolled in the study. At 1 year, 91 patients were available for the analysis. The subjective and objective cure rates were 78% and 81%, respectively. The ICIQ-SF and W-IPSS symptoms score showed a statistically significant decrease. Post-operative complications included voiding difficulty, recurrent UTI, de novo urgency incontinence and dyspareunia. Our data show that TVT-secur is associated with an 80% success rate at 1 year.

Urinary nerve growth factor level could be a biomarker in the differential diagnosis of mixed urinary incontinence in women

To measure urinary nerve growth factor (NGF) levels in women with stress urinary incontinence (SUI) and overactive bladder symptoms (OAB) and to assess whether urinary NGF levels can be a biomarker of detrusor overactivity (DO) in women with mixed urinary incontinence. Urinary NGF levels were measured in 38 women with urodynamic SUI (USI) with OAB, in 26 with urodynamic DO but no SUI, in 21 with persistent USI after anti-incontinence surgery, in 15 with de novo DO, and in 31 normal control subjects. All participants had a video-urodynamic study for the differential diagnosis of the underlying causes of UI. Urinary NGF levels were measured using an enzyme-linked immunosorbent assay and were compared among all subgroups, and corrected using urinary creatinine (Cr) levels. The mean (sem) urinary NGF/Cr levels were low both in controls, at 0.06 (0.004) and in women with pure USI, at 0.056 (0.037) (P = 0.108). The NGF/Cr levels were significantly higher in women with mixed USI and DO, at 1.00 (0.244), than in controls (P < 0.001) and those with pure USI (P = 0.006), but were similar to the levels in women with pure DO, at 0.58 (0.17) (P = 0.058). The NGF/Cr levels were undetectable in women with persistent USI but were significantly higher in those with de novo DO, at 2.39 (0.90), after anti-incontinence surgery than in controls and those with USI. A urinary NGF/Cr level of >0.05 was found in 9% of women with USI, 77% with DO, 81% with mixed USI and DO, and 80% with de novo DO. The urinary NGF level could be a potential biomarker of DO in women with mixed UI.

Effects of Macroplastique® Implantation System for stress urinary incontinence and urethral hypermobility in women

A study was carried out to evaluate efficacy of Macroplastique(R) (MPQ) Implantation System (MIS) in women with urodynamic stress urinary incontinence (SUI) and urethral hypermobility after an unsuccessful conservative treatment. This is a prospective randomized controlled trial in women without previous incontinence surgery. Twenty-four women received MPQ. Twenty-one controls underwent a pelvic floor muscle exercises home program. Follow-up was at 3 months and the MPQ group also at 12 months. At 3 months, pad usage decreased significantly more in the MPQ group than in the control group (p = 0.015). According to physician and patient self-assessment, respectively, 71% and 63% women in the MPQ group were considered cured or markedly improved. This was significantly higher compared to controls. There was a significant higher increase of Incontinence Quality-of-Life questionnaire score in the MPQ group compared to controls (p = 0.017). Improvements in MPQ group at 3 months are sustained to 12 months. Adverse events were mild and transient. MIS is an acceptable option for women with SUI and urethral hypermobility.

Single-Blind, Randomized, Controlled Trial of Pelvic Floor Muscle Training, Electrical Stimulation, Vaginal Cones, and No Active Treatment in the Management of Stress Urinary Incontinence

PURPOSETo compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence.PATIENTS AND METHODSOne hundred eighteen subjects were randomly selected to recieve pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response.RESULTSIn the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. In the control group, only 21% patients were satisfied with the treatment.CONCLUSIONBased on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence.

Leak point pressure does not correlate with incontinence severity or bother in women undergoing surgery for urodynamic stress incontinence

The aim of this study was to correlate the lowest Valsalva or cough leak point pressure (LPP) with clinical measures of incontinence severity and quality of life in women with pure urodynamic stress incontinence (SUI). This is an analysis of the baseline data from a prospective, multicenter, randomized trial comparing the Monarc transobturator sling to the tension-free vaginal tape. One hundred fifty-five women with SUI underwent urodynamic evaluations including abdominal or vesical LPP determinations, and each completed the Sandvik Incontinence Severity Index, a 3-day voiding diary, and quality-of-life questionnaires. In patients with a LPP, there were no significant correlations between LPP and the above clinical measures of incontinence severity or condition-specific quality-of-life questionnaire scores. In this patient population with pure urodynamic SUI, LPP is not a useful urodynamic predictor of baseline SUI severity and its effects on quality of life.

Randomized Trial of Laparoscopic Burch Colposuspension Versus Tension-Free Vaginal Tape: Long-Term Follow Up

A recent Cochrane review found that women with stress urinary incontinence (SUI) were less likely to leak on objective testing following the mid-urethral tension-free vaginal tape (TVT) procedure than after the laparoscopic Burch colposuspension operation. Subjective cure rates were similar, however, and postoperative follow-up was limited to 18 months. The present prospective randomized trial, carried out at an academic tertiary referral center, followed 72 women with urodynamic SUI who were randomly assigned to have the Burch operation or TVT procedure for a median of 65 months. Nearly three-fourths of the women were followed for 4 to 8 years. Patients completed the Incontinence Severity Index, Urogenital Distress Inventory, Incontinence Impact Questionnaire, and Patient Global Impression of Improvement scales. Somewhat more women having laparoscopic surgery (57% vs. 48%) reported any degree of urinary incontinence 4 to 8 years after surgery, for a relative risk of 1.19 (95% confidence interval, 0.71–2.0); the difference was not significant. Only 11% of women in the Burch group and 8% of those in the TVT group reported having bothersome incontinence after surgery. The group difference in rates of moderate to severe incontinence 4 to 8 years after surgery was not statistically significant. More than 65% of women in both groups reported being better or very much better than before surgery. Only 7% and 4%, respectively, felt that they were much worse or very much worse. In all, 4% of women were reoperated on for SUI. Comparable numbers of patients in the 2 groups were using pads or taking anticholinergic medication. Quality of life had improved significantly in both groups within 1 to 2 years after surgery, and this continued throughout follow-up. The investigators believe that the TVT procedure is about as effective as the laparoscopic Burch colposuspension operation in women with SUI. Although a substantial number of women has some degree of incontinence 4 to 8 years postoperatively, this is not bothersome to a majority of those affected.

Tape functionality: Sonographic tape characteristics and outcome after TVT incontinence surgery

To investigate tension-free vaginal tape (TVT) position and shape using ultrasound (US) and correlate the findings to outcome. The results of TVT surgery were investigated in 72 women with urodynamic stress urinary incontinence. The main outcome parameters were US tape position in relation to the urethra and dynamic changes in TVT shape at rest and during straining. Sixty-two patients (86%) were continent, 6 (8%) significantly improved, and the operation failed in four cases (6%). The median tape position was at 66% of the urethral length measured by US. The median tape-urethra-lumen distance was 3.8 mm at rest. Tape placement in the upper or lower quarter of the urethra was associated with a higher failure rate. Tapes positioned less than 3 mm from the urethra significantly increased postoperative complications (P < 0.0001). The tape was flat at rest and curved during straining in 44 (61%) patients; 98% (43/44) of these women were continent after surgery. An unchanged tape shape was associated with a poorer outcome (P = 0.00038). Patients with a flat tape at rest and during straining failed in 25% and patients with a permanent curved shape in 10%. TVT position relative to the patient's urethra seems to play a role in treatment outcome. Outcome was best in patients with dynamic change in tape shape during straining and location of the tape at the junction between the lower and middle urethra and at least 3 mm from the urethral lumen.

Treatment of Postprostatectomy Stress Urinary Incontinence Using a Minimally Invasive Adjustable Continence Balloon Device, ProACT: Results of a Preliminary, Multicenter, Pilot Study

To evaluate the safety and efficacy of a new minimally invasive device, Adjustable Continence Therapy (ProACT) for patients with postprostatectomy stress urinary incontinence (SUI). Sixty-two patients with urodynamic SUI after prostate surgery were evaluated according to daily pad count and a specific validated evaluation for persons with urinary incontinence. All patients were successfully implanted in a single procedure using general or spinal anaesthesia. Procedural time was 37 minutes (range, 18 to 80 minutes). Daily pad usage decreased from 4.6 pads per day to 1.06 pads per day at 12 months. Mean quality-of-life index score increased from 48 to 67 at 12 months.Fifty-nine percent of patients without adjuvant radiation were improved (greater than 50% reduction in pad use), and 30% were cured (no pads), whereas 83% of postirradiated patients failed intervention. Fifty-five patients (88%) required percutaneous balloon adjustments. The mean optimal volume after adjustments for all 45 improved patients was 3.8 mL per balloon. Complications necessitating removal occurred in 19 patients and included erosion, infection, migration, and failure to respond. Of these, 4 were successfully reimplanted. All complications occurred in the first postoperative month. Implantation of postoperatively adjustable balloons in postprostatecomy men is technically feasible, with an improvement in continence particularly in patients with nonirradiated periurethral tissues. Optimal urethral resistance is achieved, with easy postoperative adjustment. Implantation of ProACT balloons may represent a promising development in the treatment of postprostatectomy SUI.

Preliminary Report on a Modified Surgical Technique Using Canal Transobturator Tape for the Treatment of Female Stress Urinary Incontinence

Purpose: Canal transobturator tape (TOT) was developed to reduce the complications of TOT by modifying the sling procedure of TOT with using a distal urethral polypropylene sling (DUPS). The aim of this present study was to describe a modified surgical technique for the treatment of female urodynamic stress urinary incontinence and to assess the objective and subjective efficacy of Canal TOT. Materials and Methods: Between October 2006 and November 2007, 87 female patients with stress urinary incontinence were enrolled in this retrospective study. All the patients underwent the Canal TOT procedure. The Incontinence Impact Questionnaire-7 (IIQ-7) and the Urogenital Distress Inventory-6 (UDI-6) were used to evaluate the surgical outcomes. Results: The mean operative time for Canal TOT was 22.4 minutes (range: 15-39). During the surgery, there were 10% intraoperative and postopreative complications, including De novo urgency (n=3), weak stream (n=4) and difficult emptying (n=2). Yet all these complications occurred in the short-term and they were transient. Concomitant procedures were performed, including cystocele repair (n=7), rectocele repair (n=5), rectocele and cystocele repair (n=14), laparoscopically-assisted vaginal hysterectomy (n=5) and total vaginal hysterectomy (n=1). The average follow-up was 4.5 months (range: 3-12). Both the mean IIQ-7 and UDI-6 scores significantly decreased after Canal TOT and all the patients showed significant improvement of their subjective symptoms of stress incontinence. Conclusions: Our results demonstrate that Canal TOT may be a safe and effective surgical method for treating urodynamic stress incontinence in Korean women and this procedure provides a high cure rate. (Korean J Urol 2008;49:1119-1124) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Randomised trial of laparoscopic Burch colposuspension versus tension‐free vaginal tape: long‐term follow up

To compare the long-term efficacy of laparoscopic Burch colposuspension with tension-free vaginal tape (TVT) for the treatment of urodynamic stress urinary incontinence (SUI). Long-term follow up from a prospective randomised trial. Academic tertiary referral centre. Seventy-two women with urodynamic SUI from two institutions. Subjects were randomised to either laparoscopic Burch or TVT from August 1999 to August 2002. Follow-up evaluations occurred 6 months, 1 year, 2 years, and 4-8 years after surgery. Subjects completed the Incontinence Severity Index, Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Patient Global Impression of Improvement (PGI-I) scales. Median follow-up duration was 65 months (range 12-88 months) with 92% completing at least one follow-up visit. Seventy-four percent of subjects had long-term (4-8 years) follow up. Fifty-eight percent of subjects receiving laparoscopic Burch compared with 48% of TVT subjects reported any urinary incontinence 4-8 years after surgery (Relative Risk (RR):1.19; 95% CI: 0.71-2.0) with no significant difference between groups. Bothersome SUI symptoms were seen in 11 and 8%, respectively, 4-8 years after surgery (P = 0.26). There was significant improvement in the postoperative UDI-6 and IIQ-7 scores in both groups at 1-2 years that were maintained throughout follow up with no significant differences between the groups. TVT has similar long-term efficacy to laparoscopic Burch for the treatment of SUI. A substantial proportion of subjects have some degree of urinary incontinence 4-8 years after surgery; however, the majority of incontinence is not bothersome.

Does the tension-free vaginal tape procedure (TVT) affect the voiding function over time? Pressure-flow studies 1 year and 3(1/2) years after TVT

Aim The aim was to evaluate the voiding function over time after the TVT procedure for stress incontinence. Materials and Methods Thirty-eight women with urodynamic stress urinary incontinence were included in the study. For voiding function assessment the patients were asked if voiding had changed postoperatively, and objectively uroflowmetry, residual urine measurement and pressure-flow were performed preoperatively, 1 year and 3½ years postoperatively. Results At 1/3½ years follow-up 87%/69% were subjectively cured and 13%/26% improved, respectively. The objective cure rate was 89%/74%. Subjectively 77%/63% of the patients felt an altered voiding function towards more difficult voiding one and 3½ years after surgery, respectively. Objectively all the uroflowmetry variables deteriorated and residual urine volume increased over time although the changes were not statistically significant between the 1 and 3½ years follow-up. Pressure-flow variables were essentially unchanged. Conclusion The changes in voiding function after a TVT do not reverse over time. This may imply a potential risk of development of clinically important impaired emptying function. Neurourol. Urodynam. 26:995–997, 2007. © 2007 Wiley-Liss, Inc.

Long-term follow-up of a transvaginal Burch urethropexy for stress urinary incontinence

The objective of the study was to describe long-term objective and subjective success rates and complications following transvaginal Burch urethropexy for stress urinary incontinence. A case series of 66 women who underwent vaginal Burch urethropexy for urodynamic stress urinary incontinence with urethral hypermobility using a suture carrier device is presented. Concurrent prolapse repairs were performed as indicated. Sixty-six women (mean age 49.4 +/- 12.1 years) underwent vaginal Burch urethropexy. Mean follow-up time was 20.9 +/- 18.9 months. Objective failure was observed in 16 patients (24.2%). Subjective failure was reported by 21.2% of patients, with 50% and 28.8% reporting success and improvement, respectively. Six patients (9%) experienced febrile illness, 4 (6%) experienced intraoperative hemorrhage, 1 (1.5%) received transfusion, and 1 (1.5%) experienced pelvic abscess. Twelve patients (18.2%) experienced suture erosion; half required surgical revision or excision. Vaginal Burch urethropexy is generally well tolerated but is associated with poor long-term success and high suture erosion rates.

POD-11.06: Use of the adjustable continence therapy for post prostatatectomy urodynamic stress urinary incontinence

The ProACT™ (Adjustable Continence Therapy) is a minimally invasive, post operatively adjustable device for the treatment of post prostatectomy stress urinary incontinence We evaluated the efficacy of this device and the merit of it’s adjustability over time.

MP-10.13: Use of the adjustable continence therapy for the treatment of recurrent female urodynamic stress urinary incontinence

MP-10.13: Use of the adjustable continence therapy for the treatment of recurrent female urodynamic stress urinary incontinence