Urodynamic Stress Research Articles

The predictive value of ePAQ in the urodynamic diagnoses-A prospective cohort study.

To assess whether the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF) had accuracy in predicting the urodynamic diagnoses of Detrusor Overactivity (DO) and/or Urodynamic Stress Incontinence (USI). Tertiary urogynaecology unit linked to an academic university teaching hospital. Consecutive women who presented with lower urinary tract symptoms (LUTS) and were booked to have urodynamic studies. Women completed an ePAQ-PF prior to having urodynamics (UDS) by clinicians who were blinded to the ePAQ-PF results while conducting this procedure. Receiver Operating Characteristics (ROC) curves were constructed for predictive accuracy of overactive bladder (OAB) score in DO and of stress urinary incontinence (SUI) score in USI. Prospective cohort study designed to meet the requirements of the standards for reporting of diagnostic accuracy (STARD). 390 women with a mean age of 54.2 (range 21-92) years were recruited. The majority (n = 294; 75%) were White Caucasian and had two children (n = 157; 40.3%). Of them, 67.2% (n = 262) had DO and USI was confirmed in 21.5% (n = 84). The area under the ROC curve for DO was 0.704 (95% confidence interval 0.650-0.759) and for USI it was 0.731 (95% confidence interval 0.652-0.778). The OAB and SUI scores on the ePAQ-PF demonstrated that they are fair predictors in diagnosing DO and USI. As the OAB and SUI score on ePAQ-PF increased so did the likelihood of DO (up to a score of 75) and USI on UDS.

857 - Management of urodynamic stress urinary incontinence in urethral diverticulum

857 - Management of urodynamic stress urinary incontinence in urethral diverticulum

Diagnostic agreement of the 3 Incontinence Questionnaire to video-urodynamics findings in women with urinary incontinence: Department of Urology, Frimley Health NHS Foundation Trust Wexham Park Hospital Slough, Berkshire, United Kingdom.

IntroductionThere are limited studies evaluating the 3 Incontinence Questionnaire (3IQ) against urodynamics based diagnosis as a reference standard. The 3IQ has been proposed to be useful to evaluate women at the level of primary care. The aim of this study was to determine correlation between 3IQ and video-urodynamics (VUDS) in diagnosing types of urinary incontinence.Material and methodsProspective data was collected on 200 consecutive female patients referred by primary care physicians for urinary incontinence. The mean age was 55 years (range 15–83 years). The patients were evaluated using the 3IQ and video-urodynamics. The 3IQ-based diagnosis of type of female urinary incontinence was compared to VUDS-based results. Sensitivity, specificity, positive likelihood ratios and positive predictive values were calculated.ResultsOn 3IQ based self-evaluation, 28% of patients were classified as having stress urinary incontinence, 20% with urge incontinence and 40% with mixed incontinence. On video-urodynamics, urodynamic stress urinary incontinence (UDSUI) was detected in 56% of patients, detrusor overactivity (DO) in 15% and mixed urinary incontinence (MUI) in 19%. The 3IQ had a sensitivity and specificity respectively of 43% and 92% for UDSUI, 57% and 86% for DO and 58% and 64% for MUI. The corresponding positive likelihood ratios (CI, 95%) were 5.4 (CI 2.6 to 11.3) for stress urinary incontinence, 4.0 (CI 2.5 to 6.5) for DO and 1.62 (1.2 to 2.3) for MUI. The respective positive predictive values were 87% (CI 75% to 95%), 42% (CI 26% to 58%) and 28% (18% to 39%).ConclusionsIn our study population, stress urinary incontinence was reasonably well predicted by the 3IQ, but the questionnaire under-performed in the diagnoses of detrusor overactivity and mixed urinaryincontinence.

Preliminary report on the effect of urethral diverticulum magnetic resonance imaging configuration on the incidence of new onset urodynamic stress urinary incontinence following excision.

Context:Excision of urethral diverticulum in females has been reported to be associated with new onset urodynamic stress urinary incontinence (USUI) in up to 49%.Aims:We have assessed the incidence of new onset USUI in all patients having urethral diverticulum excision with Martius fat pad interposition under the care of a single surgeon between May 1, 2007, and December 1, 2011. The incidence of new onset USUI has been correlated with the preoperative magnetic resonance imaging (MRI) appearance of the urethral diverticulum.Patients and Methods:All 33 patients (mean age 42) having urethral diverticulum with Martius fat pad interposition had prospective data tabulated on demographics, preoperative MRI appearance, and pre- and post-operative videocystometrogram.Statistical Analysis Used:Statistical analysis was performed by Chi-squared and Fisher's exact.Results:Of the 33 patients, 10 (30%) had preoperative USUI and have been excluded from this study. Other preoperative urodynamic findings included idiopathic detrusor overactivity in ten (30%) and bladder outflow obstruction in five (16%). Two (10%) of the patients had a simple diverticulum, 16 (73%) had a horseshoe diverticulum, and 5 (17%) had a circumferential diverticulum. The rate of new onset USUI was 0% for simple, 6% for saddle, and 20% for circumferential.Conclusions:New onset USUI occurs in 9% of patients having excision of urethral diverticulum with Martius fat pad interposition. The incidence appears to increase with increasing complexity of urethral diverticulum on preoperative MRI – rising from 0% following simple urethral diverticulum excision to 20% following circumferential diverticulum excision.

A sequential comparison of postoperative voiding function between two different transobturator sling procedures.

We evaluated sequential postoperative voiding function of two types of sling procedures (Monarc® and ALIGN®) in patients with stress urinary incontinence. Ninety-one women diagnosed with urodynamic stress incontinence were randomly assigned to the study. All enrolled patients underwent Monarc or ALIGN procedure. They were postoperatively evaluated at one day, one week, one month, three months, 12 months, and 24 months. The voiding function was evaluated with uroflowmetry and post-void residual urine. Patients were asked if voiding had changed after surgery and had to complete the incontinence quality of life scale (I-QoL) questionnaire at 12 months. The Monarc (n=47) and ALIGN (n=44) groups had similar demographic characteristics. The maximal flow rate (Qmax) was significantly decreased on the first day after surgery and gradually increased during the following weeks. Comparing the two groups at one week, the ALIGN group had a significantly decreased Qmax than the Monarc group (17.6 ± 5.2 vs. 20.7 ± 5.0; p=0.004). However, at one, three, 12, and 24 months, there were no significant differences between the two groups. This study demonstrated that an absorbable tensioning suture in the Monarc mesh could increase Qmax compared to ALIGN at one week after surgery. An absorbable tensioning suture may reduce the risk of an early postoperative voiding dysfunction compared to other meshes that do not have this.

Coital incontinence: a factor for deteriorated health-related quality of life and sexual function in women with urodynamic stress urinary incontinence

Introduction and hypothesisTo assess the impact of coital incontinence (CI) on health-related quality of life (HRQoL) and quality of sexual function (QSF) in women with urodynamic stress urinary incontinence (SUI).MethodsWomen were recruited for this cross-sectional study from among 289 patients with lower urinary tract symptoms, underwent clinical and urodynamic evaluation. Of these 289 women, 127 sexually active women with SUI completed the King’s Health Questionnaire (KHQ) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ), of whom 97 were enrolled for the study. The study group comprised 53 women with CI occurring ‘sometimes’, ‘usually’ or ‘always’, and the control group comprised 44 women without CI. Total and individual domain scores were evaluated.ResultsCI was reported by 65.35 % of the women. The frequency of CI was correlated with lower educational level and higher body mass index (r = 0.22 and r = 0.23, respectively; p = 0.01). The KHQ results showed significantly lower HRQoL in women with CI in all domains (p < 0.05) apart from Sleep/energy’ (p = 0.054). PISQ revealed no significant differences in QSF in the Behavioral/emotive and Partner–related domains (34.3 ± 10.0 vs. 33.0 ± 12.2 and 18.0 ± 2.9 vs. 18.2 ± 3.6, respectively). Women with CI reported a significantly lower QSF in the Physical domain (29.1 ± 6.6 vs. 35.0 ± 4.6, p = 0.001), and the total PISQ score was lower but the difference was not significant (81.4 ± 14.3 vs. 86.2 ± 16.5). Total PISQ score was correlated with age (r = −0.28, p = 0.001). Women with CI were significantly more likely to admit that fear of incontinence or fear of embarrassment restricted their sexual activity (p < 0.001).ConclusionsA large percentage (65.35 %) of women with SUI reported CI, which had a negative impact on HRQoL and QSF in the Physical domain, but no significant impact on overall QSF.

Single incision sacrospinous hysteropexy combined with cystopexy (SISHC): a suitable mini-invasive approach for pelvic organ prolapse in post menopausal women

The aim of our study was to demonstrate, even in elderly postmenopausal patients, the minimal surgical impact of sacrospinous hysteropexy and cystopexy for uterovaginal prolapse using a single anterior vaginal incision (SISHC). Materials: Patients with genital apical prolapse stages ≥3 (POPQ System; BadenWalkerHWS) were eligible for the study. Other inclusion criteria: associated symptomatic stage ≥2 anterior prolapse, wish of uterus preservation, negative smear test, TVUSS and urodynamic test in previous 6 months. Exclusion criteria: abnormal uterus/ovaries, endometrial thickness >4 mm, abnormal smear test, clinical and/or urodynamic stress incontinence and/or symptomatic posterior prolapse. Subjective data on bladder, bowel, POPQ were collected before surgery, 6 months after surgery and at follow up. Sacrospinous hysteropexy was performed unilaterally to right ligament, under spinal anaesthesia. After a midline incision on anterior vaginal wall, endopelvic fascia was opened and dissection was extended through paravesical fossa. Two non-absorbable Prolene®00 filaments were placed through the right sacrospinous ligament, 2–3 cm medial to ischial spine. Filaments were fixed in the anterior part of cervix. Fascial cystopexy was performed. Patients were discharged 24 h after surgery, if post voiding residual was <100 cc. Patients were stratified in two groups: GROUP 1 (<15 years after menopause) and GROUP 2 (≥15 years after menopause). Shapiro–Wilk, Wilcoxon and Student's t-test. Significance level p-value <0.05. Results: 42 women had SISHC (16 GROUP 1, 26 GROUP 2). Main results are shown in Table. The preoperative POP scores were similar between the two groups. For both groups, anatomical findings for anterior and apical segments and symptoms of vaginal bulge were improved after surgery (p < 0.05). No women presented de novo incontinence symptoms. Neither significant effects on constipation, nor accidental bladder or rectal injuries were noted. A patient in GROUP 1 required removal of suture due to persistent pain for more than 6 months. Average hospital stay was 1.9 (±1.1) days. There was one recurrence after 1 month due to thread detachment. Discussion: Our data demonstrate, in both groups, that SISHC is a safe procedure (low incidence of complications and recurrence); it is effective for correction of anterior and apical segment. Anterior approach provides benefits compared to traditional posterior approach: a wider anatomical space for vaginal vault placement, a better exposure of the upper portion of sacrospinous ligament [[1]Dubuisson J. Gynecol Obstet Fertil. 2012; Google Scholar], longer average total vaginal length [[2]Goldberg R. Obstet Gynecol. 2001; Google Scholar], lower anterior and apical recurrence [[3]Tseng L.H. Taiwan J Obstet Gynecol. 2013; PubMed Google Scholar]. The risk of anterior approach is related to neurological damage (S3) [[4]Cayrac M. Int Urogynecol J. 2012; PubMed Google Scholar]. The conservative treatment could reduce surgical morbidity, ensure the anatomical integrity and reduce the risk of bladder injuries.

Outcome of coexistent overactive bladder symptoms in women with urodynamic urinary incontinence following anti-incontinence surgery.

The objective was to investigate the outcome of stress urinary incontinence (SUI) and overactive bladder (OAB) symptoms in women with urodynamic stress incontinence (USI) after transobturator sling procedures (TOTs). We evaluated 109 consecutive patients with USI, who had undergone TOT in a tertiary hospital between 2012 and 2014. All patients received evaluations, including structured urogynecological questionnaires and pelvic organ prolapse quantification examination before, and 3 and 12months after surgery. One-hour pad test and urodynamic testing were performed before and 3-6 months postoperatively. Patient demographics, lower urinary tract symptoms, and urodynamic results were analyzed between pure USI and USI with OAB symptoms. Persistent SUI occurred in 8 patients at 3months (7.3%) and 7 patients at 12months (6.4%) postoperatively. The most common OAB symptom was frequency (54.1%), followed by urgency urinary incontinence (52.3%), urinary urgency (42.2%), and nocturia (33%). Most of these OAB symptoms were resolved at the 3-month and 12-month follow-ups both in patients treated with TOT only and in those treated with TOT combined with other pelvic surgeries. There was no significant difference in the preoperative urodynamic changes between patients with pure USI and USI without OAB groups. However, postoperative urodynamic results showed a significant decrease in the maximal urethral closure pressure in the group of patients with USI and OAB symptoms, but no significant urodynamic changes in the group with pure USI. Coexistent OAB symptoms are common in women who were diagnosed with USI and most of these symptoms may resolve 3 and 12months after TOT.

Effects of laser procedure for female urodynamic stress incontinence on pad weight, urodynamics, and sexual function.

The impact of the IncontiLaseTM procedure on lower urinary tract symptoms (LUTS) remains unclear. Our aim was to evaluate the effects of the IncontiLaseTM procedure for urodynamic stress incontinence (USI). All consecutive women with USI prospectively underwent the IncontiLaseTM procedure. Urodynamic studies, pad testing, LUTS, and sexual function questionnaires were assessed before and after treatment. Thirty-five women underwent the IncontiLaseTM procedure. Among the 28 women with baseline pad weights >1g, 11 (39.3%) were objectively cured and 11 (39.3%) improved. Among the 18 women with mild USI (i.e., baseline pad weight 1-10g), nine (50%) were cured and five (27.8%) improved. Among ten women with baseline pad weight >10g, two (20%) were cured and six (60%) improved. Among the 32 women with complete questionnaire data at 6months, seven (21.9%) were subjectively cured, and four (12.5%) improved. Regarding LUTS, the majority of domains on the King's Health Questionnaire and female sexual desire and function exhibited significant improvements. Forty percent (12/30) of the partners of these patients felt their sexual function had improved at 6months. Nonetheless, urodynamic values did not differ across the timeline. The effect of the IncontiLaseTM procedure for mild USI was moderate at 6-month follow-up but was not effective for pad weight >10g. Moreover, it improved LUTS, quality of life, QoL, and sexual function of both partners. Further studies should be performed to assess long-term sustained efficacy.

Tension-free Vaginal Tape–Obturator for Treatment of Pure Urodynamic Stress Urinary Incontinence: Efficacy and Adverse Effects at 10-year Follow-up

BackgroundInside-out transobturator tape (tension-free vaginal tape–obturator [TVT-O]) is currently one of the most effective and popular procedures for the surgical treatment of female stress urinary incontinence (SUI). However, data reporting long-term outcomes are lacking. ObjectiveTo assess the efficacy and safety of TVT-O 10 yr after implantation for the treatment of female pure SUI. Design, setting, and participantsA multicenter, prospective study was conducted in five tertiary referral centers in three countries. All consecutive women with urodynamically proven pure SUI treated by TVT-O were included. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded. InterventionTVT-O implantation. Outcome measurements and statistical analysisData regarding subjective outcomes (International Consultation on Incontinence Questionnaire–Short Form, Patient Global Impression of Improvement, and patient satisfaction scores), objective cure (stress test) rates, and adverse events were collected during follow-up. Univariable analysis was performed to investigate outcomes. Results and limitationsOne hundred sixty-eight women had TVT-O implantation. At 10-yr follow-up, 160 patients (95%) were available for the evaluation. We did not find any significant change of the surgical outcomes during this time. At 10 yr after surgery, 155 of 160 patients (97%) declared themselves cured (p=0.7). Similarly, at 10-yr evaluation, 148 of 160 patients (92%) were objectively cured. No significant deterioration of objective cure rates was observed over time (p=0.4). The history of failure of previous anti-incontinence procedures (hazard ratio: 5.34; 95% CI, 2.61–11.9; p=0.009) was the only predictor of recurrence of SUI. The onset of de novo overactive bladder was reported by 23 of 160 patients (14%) at 10-yr follow-up. No other late complications were reported. ConclusionsThe 10-yr results of this study showed that TVT-O is a highly effective and safe option for the treatment of SUI. Patient summaryAt long-term follow up, tension-free vaginal tape-obturator is highly effective and safe for the treatment of stress urinary incontinence.

OP04.01: Ultrasonographic evaluation of the urethral rhabdosphincter's morphology in female patients with urodynamic stress incontinence

OP04.01: Ultrasonographic evaluation of the urethral rhabdosphincter's morphology in female patients with urodynamic stress incontinence

Can we predict detrusor overactivity in women with lower urinary tract symptoms? The King's Detrusor Overactivity Score (KiDOS)

ObjectiveTraditionally, urodynamic studies (UDS) have been used to assess lower urinary tract symptoms (LUTS), but their routine use is now discouraged. While urodynamic stress incontinence is strongly associated with the symptom of stress urinary incontinence (SUI) and a positive cough test, there is a weak relationship between symptoms of overactive bladder and detrusor overactivity (DO). The aim of our study was to develop a model to predict DO in women with LUTS. Study designThis prospective study included consecutive women with LUTS attending a urodynamic clinic. All women underwent a comprehensive clinical and urodynamic assessment. The effect of each variable on the odds of DO was estimated both by univariate analysis and adjusted analysis using logistic regression. Results1006 women with LUTS were included in the study with 374 patients (37%) diagnosed with DO. The factors considered to be the best predictors of DO were urgency urinary incontinence, urge rating/void and parity (p-value<0.01). The absence of SUI, vaginal bulging and previous continence surgery were also good predictors of DO (p-value<0.01). We have created a prediction model for DO based on our best predictors. In our scoring system, presence of UUI scores 5; mean urge rating/void≥3 scores 3; parity≥2 scores 2; previous continence surgery scores −1; presence of SUI scores −1; and the complaint of vaginal bulging scores −1. If a criterion is absent, then the score is 0 and the total score can vary from a value of −3 to +10. The Receiver Operating Characteristic (ROC) analysis for the overall cut-off points revealed an area under the curve of 0.748 (95%CI 0.741, 0.755). ConclusionThis model is able to predict DO more accurately than a symptomatic diagnosis alone, in women with LUTS. The introduction of this scoring system as a screening tool into clinical practice may reduce the need for expensive and invasive tests to diagnose DO, but cannot replace UDS completely.

Correlation of bladder wall thickness and treatment success in types of urinary incontinence

The aim of the study was to investigate the correlation between mean bladder wall thickness (BWT) and treatment success in patients diagnosed with urinary incontinence, based on urodynamic test results. In this prospective study, patient urinary incontinence type was identified using urodynamic tests. Patients (N = 125) were categorized into three groups: urodynamic stress incontinence (SUI), detrusor over-activity (DO) and mixed urinary incontinence. Measurements from the bladder dome, anterior wall and trigone were averaged to calculate BWT. Student's t test and Mann-Whitney U test were used to compare pre-treatment BWT. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values for BWT to predict treatment success. Mean pre-treatment BWT significantly differed between success and non-success groups for each urinary incontinence type (p value for the SUI, DO and MUI groups was 0.043, 0.001 and 0.002 respectively). Using ROC curves to anticipate the treatment success, a threshold was calculated for mean pre-treatment BWT; 5.05mm for SUI (sensitivity 74%, specificity 66%, positive predictive value [PPV] 85%, negative predictive value [NPV] 50%), 4.98mm for DO (sensitivity 73%, specificity 92%, PPV 95%, NPV 63%) and 5.31mm for mixed type (sensitivity 88%, specificity 73%, PPV 79%, NPV 85%). The study results suggest a significant relationship between the pre-treatment BWT and the success of urinary incontinence treatment. The mean BWT may be used as a benchmark in assessing the responsiveness to treatment of urinary incontinence types.

Trans-Obturator Tape Operation Using MONARC Technique (Outside-In Technique) --- Revisited Objective And Subjective Assessment

Objective: This study was undertaken to describe and evaluate the outcome of trans-obturator tape (TOT) operation using Outside-In technique without cystoscopy. This procedure was carried out either solely or as a part of pelvic reconstructive surgery. Design: Retrospective cohort study with follow up objective and subjective assessment. Population: 84 women were presented with urodynamic stress incontinence at North Cumbria NHS Trust. They were treated with transoturator tape operation using outside-in technique between the years 2007 and 2008. Method: Eighty-four women underwent trans-obturator tape operation (outside-in technique) without cystoscopy. Diagnosis of stress urinary incontinence (SUI) was made by uro-dynamic studies. They were all operated only by a single surgeon. The mean length of follow-up was 6 months. Operative complications were recorded. The anatomic integrity of urethra, the anterior vaginal wall was objectively assessed at follow up visit. Subjective assessment was made during patient consultation. Objective failure was defined as persistence of urodynamic stress urinary incontinence. Subjectively, failure was defined mainly as persistence of stress incontinence symptoms. Other related symptoms are noted like voiding difficulties and sexual dysfunction. Results: In the study data eighty four women underwent a TOT operation. The mean age was 50 years (38-63). Pre-operatively, of those 84 patients, SUI was diagnosed in 62 patients while mixed urinary symptoms were present in 22 patients. Transobturator tape operation was carried out using MONARC subfacial hammock system in all women. Additional pelvic surgical procedures were performed according to the presence of other pelvic defects. No intraoperative complications were recorded. The estimated blood loss was 125 mL (range, 50-200 mL). None of the patient had suspected bladder or urethral injury intraoperatively. Transient urinary retention was observed in 8% (n= 7) of women in immediate postoperative period. Three women developed urinary tract infection in immediate postoperative period and in one woman urethral pus was noted which resolved with the help of oral antibiotics. Postoperative objective assessment was made with speculum examination and stress provocation tests like cough and valsalva manoeuvres. There was no stress incontinence on stress provocation tests. Two women developed de novo urge incontinence that was treated with anticholinergics. Two complained of worsening urge incontinence symptoms and none of the women having concurrent urge incontinence symptoms showed any improvement in their urge incontinence symptoms. The overall subjective success rate was 92% (n= 77). Six women judged themselves to be improved in terms of stress incontinence but were still wearing protection, although less, to avoid any urinary leakage. One woman gave history of prickling sensation in the vagina after the procedure at her follow-up visits, from 6 weeks to 9 months although she was reassured and that prickling sensation resolved at 9 month follow-up. Conclusion: Transobturator tape operation (outside-in technique) without cystoscopy seems an effective and safe treatment of urodynamic stress incontinence. It has a good subjective and objective outcome. A large study may be required to confirm the results.

Tension-releasing suture appendage on single-incision sling device: A novel approach to postoperative voiding dysfunctions

ObjectiveVoiding dysfunction following a midurethral sling procedure is still a relevant consequence that can affect patients' quality of life. Various invasive methods have been described to manage this problem. We hypothesize that we if we could diagnose the condition early using noninvasive tools, we would be able to offer appropriate effective management. We sought to study the effectiveness of attaching a tension-releasing suture on a single-incision sling (SIS) tape as a prophylactic measure for the treatment of immediate postoperative voiding dysfunctions, and secondarily, to evaluate the objective and subjective cure rates of the treatment for stress urinary incontinence. Materials and MethodsIt is a prospective observational study. A tension-releasing suture was prepared by appending a polyglactin suture to one end of the MiniArc sling tip fiber, which could be used to manipulate the sling tip when postoperative voiding dysfunction was identified. Primary outcome measure was the number of patients requiring tension-releasing suture manipulation to treat postoperative voiding dysfunctions successfully. ResultsTwelve of the 131 (9.2%) patients who underwent SIS procedure for urodynamic stress incontinence surgery required tension-releasing suture manipulation due to voiding dysfunction during the immediate postoperative period with a good outcome. Postoperative overall objective and subjective cure rates were 90.5% and 88.9% (126 available patients at 1-year follow up, mean 19.2 ± 8.0 months), respectively. The subanalysis of the objective and subjective cure rates of the group with tension-releasing suture manipulation were 91.7% (11/12) and 91.7% (11/12), and those of the group without tension-releasing suture manipulation were 90.4% (103/114) and 88.6% (101/114), respectively, at 1-year follow up. ConclusionTension-releasing suture is effective in the management of immediate postoperative voiding dysfunction in an SIS procedure. SIS operation has good short-term objective and subjective cure rates for female urodynamic stress incontinence.

Long Term Quality of Life after Tension-Free Vaginal Tape-Obturator Procedure in Women with Stress Urinary Incontinence

Introduction: Stress urinary incontinence represents a common but strongly underestimated health problem that affects women of all ages and severely downgrades their health related quality of life. The transobturator vaginal tape (TVT-O) approach offers long term success rates, while minimizing complications. In this study, we examined quality of life of patients suffering by stress urinary incontinence and investigated whether TVT-O procedure offers considerable benefits in patient’s quality of life after 5 years of placement. Methods and results: Women with confirmed urodynamic stress urinary incontinence that underwent TVT-O procedure were included in this prospective study. Patient’s quality of life was evaluated by using the Greek version of SF-36 preoperatively and 60 months postoperatively. The outcomes demonstrated that incontinence had significant adverse effect in patient’s quality of life. However, TVT-O procedure offers a safe and efficient treatment, substantially improving both physical and mental dimension of women’s health related quality of life (P&gt;0.05). Discussion: Stress urinary incontinence strongly impairs women’s health related quality of life, limiting their physical activities, social function and causing emotionally imbalance. Insertion of tension free vaginal tape reverses symptoms and significantly improves all health indicators associated with patient’s health related quality of life. In our study, we demonstrate that minimal invasive surgery, by using TVT-O procedure is highly effective, in long term, in improving quality of life of women with stress urinary incontinence.

Does the diagnosis of detrusor overactivity affect the long-term prognosis of patients treated with a retropubic midurethral sling?

There are few long-term studies on the midurethral sling (MUS) procedure in patients with preoperative detrusor overactivity (DO) and there is debate regarding the usefulness of preoperative cystometry. This study was designed to provide long-term efficacy and safety data for the Advantage MUS and to compare the outcomes in patients with pure urodynamic stress incontinence (USI) with the outcomes in patients with mixed USI and DO. This was a retrospective consecutive case series study of 100 patients with USI (USI-only group) matched to a consecutive group of a further 100 patients with preoperative USI and DO (mixed group) treated with a retropubic MUS. Outcomes were assessed using the King's Health Questionnaire and Patient Global Impression of Improvement questionnaire. After a mean follow up of 6years more patients in the USI-only group described themselves as "very much better" or "much better" (86% USI-only group vs. 57% mixed group; p = 0.007). Quality of life was improved at 6years from baseline in both groups. Patients in the mixed group were more likely to complain of urgency (69% vs. 42%; p = 0.0007) which was more likely to be severe (34% vs. 10%; p = 0.004). A repeat MUS procedure was needed in 1% of patients and 0.6% needed surgical removal of the MUS for persistent troublesome pain. This study suggests that the preoperative diagnosis of DO affects the long-term patient-perceived outcome of the MUS procedure. However, most patients have significant long-term improvement in quality of life.

Detrusor contractility in women: Influence of ageing and clinical conditions

We assume that the voiding process in women is governed by the detrusor contractility and a "urethral resistance". The value of these 2 parameters, respectively named k and U in the VBN (Valentini-Besson-Nelson) mathematical model of micturition is deduced from the VBN analysis of pressure-flow recordings (PFs). Our objectives were to search for a correlation between these 2 parameters and clinically relevant variables such as chief complaint, urodynamic diagnosis (UD), and age by decades. PFs from 125 non-neurogenic women (mean age 58.0±17.2years [range 20-90years]) were retrospectively analyzed using the VBN model. VBN criteria for inclusion were maximum flow rate>2mL/s, voided volume>100mL, and non-interrupted flow. Evaluated parameters were k (without unit) and U (unit: cm H2O). Standard values were k=1.0 and U=0. VBN parameter ranges were k [0.14-1.55] and U [0.0-73.0cm H2O]. There was a significant correlation between k and U for the whole population (P<0.0001) with k=(.259+0.015*U) (R(2)=0.723) and each chief complaint. For UD, significant difference comparing k and U in phasic detrusor overactivity with intrinsic sphincter deficiency and urodynamic stress incontinence was noted. In sub-groups defined according to decades of age, the values of k and U remained similar in sub-groups for those who are less than 50years old and decreased regularly with ageing. The detrusor contractility can be easily evaluated in women; lower than in men, its range is less spread out but also adjusted to compensate a "urethral resistance". Phasic detrusor overactivity and post-menopausal age significantly affect detrusor force value. 3.

Five-year follow-up study of Monarc transobturator tape for surgical treatment of primary stress urinary incontinence

We hypothesized that transobturator tape (TOT) is safe and efficacious for the treatment of urodynamic stress incontinence in the long term. We conducted a prospective study of patients with confirmed urodynamic stress incontinence (USI) who underwent a MonarcTM TOT procedure in a tertiary center between February 2006 and March 2009 without other concurrent surgical procedures. Urodynamics were conducted at 1 and 3years postoperatively. Subjective evaluation included Incontinence Impact Questionnaire (IIQ-7), Urinary Distress Inventory Questionnaire (UDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Objective cure was defined as no urinary leakage demonstrable on provocative filling cystometry and/ or 1-h pad test of <2g. Subjective cure was based on a negative response to question 3 in UDI-6. Paired-samples t test, chi-square, and Fisher exact tests were applied; p < 0.05 was considered significant. The log-rank tests were used to compare event-free survival. Sixty patients were enrolled, and 56 were evaluated at 5years postoperatively. The majority were middle aged, postmenopausal, and overweight. Mean operating time was 31.1 ± 8.9min, intraoperative complications were minor, and median period of follow-up was 80.3 ± 9.6months. At 5years of follow-up, objective and subjective cure rates were 89.3% and 87.5%, respectively. No mesh-related complications were seen. One patient needed a repeat midurethral sling procedure, and one patient each had bladder and bowel cancer. Monarc TOT was safe and retained its high cure rate in the short- and long-term treatment of stress urinary incontinence.

Comparison of the efficacy of tension-free vaginal tape obturator (TVT-O) and single-incision tension-free vaginal tape (Ajust™) in the treatment of female stress urinary incontinence: a 1-year follow-up randomized trial.

The aim of this study was to compare the efficacy of the tension-free vaginal tape obturator (TVT-O) and single-incision tension-free vaginal tape (Ajust™) in the treatment of stress urinary incontinence in a randomized two-arm study with a 1-year follow-up. This single-centre randomized trial compared the objective and subjective cure rates of TVT-O and Ajust using objective criteria (cough test) and subjective criteria (International Consultation on Incontinence Questionnaire short form, ICIQ-UI SF). The objective cure rate was defined as the number of patients with a negative cough stress test. Subjective cure was defined as no stress leakage of urine after surgery based on the ICIQ-UI SF. The primary outcome was to establish differences in objective and subjective cure rates between the TVT-O and Ajust groups. We also compared postoperative pain profiles using a visual analogue scale (VAS), improvement in quality of life using the ICIQ- UI SF and the Incontinence Quality of Life questionnaire, and overall satisfaction with the surgical procedure using a VAS and a five-item Likert scale. Inclusion criteria were age over 18years, signed informed consent, and urodynamic stress urinary incontinence. Following a power calculation, 50 patients were enrolled into each group (Ajust and TVT-O). The mean follow-up after surgery was 445days (SD 157.6days) in the TVT-O group and 451.8days (SD 127.6days) in the Ajust group (p = 76.6%). At 1year, 47 patients were evaluated in the TVT-O group and 49 in the Ajust group. No differences in subjective cure rates or objective cure rates were observed. In the Ajust and TVT-O groups, the rates for no subjective stress leakage were 89.8% and 91.5%, respectively (p = 1.0, OR 1.22, 95% CI 0.24-6.58), and the rates for a negative stress test were 89.8% and 87.2%, respectively (p = 0.76, OR 0.77, 95% CI 0.17-3.32). In the Ajust group two patients reported de novo pain during sexual intercourse. After a 1-year-follow-up, no significant differences were found with regard to subjective and objective outcomes between the single-incision tape Ajust and TVT-O.