METHODS: Three different types of MUS surgeries [single incision sling(SIS), trans-obturator tape(TOT), retro-public mid-urethral sling-tension-free vagina tape (TVT)]were performed among three age groups of women (young <64 yr, elderly 65-74 yr and old >75 yr) with USI. They were followed up for 1 year.
RESULTS: Complete postoperative data was available for 688 women. After 1 year, overall objective cure rate was 88.2% and subjective cure rate was 85.9%. Among the young, elderly, and old age women objective cure rates were 91.0%, 80.6%, 66.7% and subjective cure rates were 89.2%, 77.6%, 58.3% respectively. Urodynamic parameters demonstrated flow rate, higher post-void bladder residual, smaller cystometric capacity, and lower maximum urethral closure pressure were significantly lower among old and elderly group. Subjectively, urinary distress inventory-6 (UDI-6) and incontinence impact questionnaire-7(IIQ-7) improved significantly in all groups with significant changes from baseline only in older women. Intrinsic sphincter deficiency(ISD) was found to be significantly associated with failure in older women. Other preoperative comorbidities were equally distributed among all the three age groups. The operative time, perioperative complications, and length of hospital stay showed no difference between the study groups.
CONCLUSIONS: MUS surgery is safe for the young and aging patients with USI and demostrated significant improvement in its outcomes, but objective and subjective cure rates decreases with age. ISD was also found to be significantly associated with failure.
METHODS: This is a retrospective study to determine the outcomes of mixed urinary incontinence after mid-urethral sling surgery with two groups, urodynamic stress incontinence (USI) with urgency and urodynamic mixed urinary incontinence (MUI-UD; USI and detrusor overactivity [DO]).
RESULTS: Ninety women (USI + urgency group) with preoperative USI and urgency and no demonstrable DO/DOI attained an objective cure of 82.2%, whereas the remaining 67 (MUI-UD group) women with both USI and DO/DOI were reported to have an objective cure of only 55.2%. Subjective cures were 81.1% and 53.7% respectively. The type of incontinence surgery does not affect postoperative outcomes in either of the groups. Demographic factors identified to have a significant negative effect on cure rates were postmenopausal status (p = 0.005), prior hysterectomy (p = 0.028), pre-operative smaller blafdder capacity (p = 0.001), and a larger volume of pre-operative pad test (p = 0.028). A lower mid-urethral closure pressure (MUCP) was significant with post-operative failure of treatment with MUI-UD group (68.8 ± 36.2 cmH2O vs 51.9 ± 24.7 cmH2O; p = 0.033).
CONCLUSIONS: Although there is evidence for a good cure of the stress component of MUI, urodynamic investigation with its findings prior to management of MUI could have greater implications for selective patient centered counseling. Presence of DO or DOI on urodynamics resulted in poorer objective and subjective outcomes.
METHODS: This study involved 120 female SUI subjects aged ≥21 years old randomized to either active or sham PMS. Treatment involved two PMS sessions per week for 2 months (16 sessions). After 2 months, subjects could opt for 16 additional sessions regardless of initial randomization. The primary response criterion was a 7-point reduction in the total score of the International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol) questionnaire. Follow-ups were conducted at months 1, 2, 5, 8, and 14.
RESULTS: At 2 months, 35 out of 60 (58%) subjects in the active arm and 21 out of 60 (21%) in the sham arm were treatment responders (≥7-point reduction) (p = 0.006). There was a significant difference in changes in the mean ± SE ICIQ-LUTSqol total score between the active and sham arms (Mdiff = -8.74 ± 1.25 vs -4.10 ± 1.08, p = 0.006). At 1-year post-treatment, regardless of number of PMS sessions (16 or 32 sessions), subjects who received active PMS (63 out of 94, 67%) were more likely to be treatment responders compared with subjects who did not receive any active PMS (3 out of 12, 25%; p
METHODS: PRISMA 2009 framework was adopted for study design. Scholarly literature search was done using MEDLINE, EMBASE, the Cochrane Library and Clinical Trials.gov using selected keywords. Five articles fulfilled the inclusion and exclusion criteria. Our main outcome of interest is to review the ideal properties of the suburethral sling, procedure of insertion and post-surgical complication following the sling insertion primarily vaginal erosion. Results were compared using one way-ANOVA test and independent T- test.
RESULTS: Total of 1725 subjects were available for analysis in the five studies. Monofilament polypropylene constituted 92.5% of the total sample size from one study alone. Polyester (n= 16/51) causes higher incidence rate of vaginal erosion compared to monofilament polypropylene (31.4 vs., 4.7; p = 0.01). There was no difference in the vaginal erosion rate between monofilament polypropylene and multifilament polypropylene (4.7 vs, 14.1; p=0.055) as well as between multifilament polypropylene and polyester (14.1 vs, 31.4; p=0.068). Although there was a marginally lower rate of vaginal erosion in TVT-O over TVT, the difference was not significant. (5.6 vs., 6.4, p=0.468). Common presentations of vaginal erosion were vaginal discharge, perineal pain and dyspareunia.
CONCLUSION: Given the limited sample size, polyester sling material appears to cause higher rates of vaginal erosion. No difference in erosion rate was seen between TVT and TVT-O.
MATERIALS AND METHODS: A retrospective follow-up study on patients with clinically confirmed stress urodynamic incontinence and urodynamic stress incontinence who had undergone MiniArc or Monarc surgery. Data regarding preoperative evaluation, intraoperative complications and post-operative follow-ups were collated. Main outcome is to determine the change in position of the sling through measurement of the x- and y-axis at rest and during Valsalva maneuver using the 3D introital ultrasound.
RESULTS: A total of 138 patients were evaluated, 82 belonged to Monarc and 56 to MiniArc. At 3years, objective and subjective cure rates for MiniArc and Monarc were comparable (88%, 91%; p>0.05; 83%, 89%, p>0.05 respectively). Ultrasonographic changes between MiniArc and Monarc from 6 months to 3 years, showed MiniArc to exhibit significant movement in both x- [3.0 ±0.4 mm vs. 2.2 ±0.3 mm (p = 0.02) at rest; 2.6 ±0.3 mm vs. 1.6 ±0.3 mm (p<0.001) during valsalva] and y-axis [3.5 ±0.5 mm vs. 2.0 ±0.3 mm (p<0.001) at rest; 3.3 ±0.5 mm vs. 2.9 ±0.3 mm (p = 0.037) during Valsalva]. The mobility of MiniArc was significantly more than Monarc from rest to Valsalva (1.1 ±0.4 mm vs. 0.3 ±0.3 mm, p = 0.001). Tightness of the sling assessed from the major and minor axis of the urethral core had no significant difference in both groups at rest and during Valsalva. Urethral kinking percentage and the location of the sling did not yield statistical difference.
CONCLUSION: Maintenance of continence rates of mid-urethral slings depends on the compressive effect of the sling on the urethra, urethral kinking, and sling fixation. From 6months to 3 years, MiniArc changed its position in both x- and y-axis over time, which the authors attribute to loosening of the anchoring mechanism since no clinical relevance could be sought.
MATERIALS AND METHODS: A cross-sectional survey was conducted involving sexually active women with or without SUI aged at least 21 years old, and their respective partners. Both partners completed the Golombok Rust Inventory of Sexual Satisfaction (GRISS), a 28-item multidimensional measure with separate forms for male and female designed to assess sexual satisfaction of both partners. Spearman rank correlation coefficient was used to analyze bivariate association, whereas multiple regression analysis was used to identify predictors for overall sexual function as measured using GRISS score.
RESULTS: Sixty-six couples with SUI partners and 95 couples with continent partners were recruited. Overall GRISS scores and thus sexual function of men and women were strongly correlated. The correlation coefficient was higher in couples with SUI partners (r = 0.702, P
MATERIALS AND METHODS: The method used was a cross-sectional study. Self-administered knowledge, attitude, and practice questionnaires were distributed among childbearing women attending Maternal & Child Health Clinics in the East Coast region of Malaysia.
RESULTS: The findings revealed that most respondents (N = 896) had good or moderate knowledge (80.1%) and attitudes (77.3%) regarding PFMT but most of them (87.2%) still lacked practice. However, there was no association between urinary incontinence and PFMT practice. On the contrary, married women showed a higher risk of urinary incontinence.
CONCLUSIONS: The practice of pelvic floor muscle training should be recommended and emphasized to childbearing women by healthcare professionals.
OBJECTIVE: To establish age- and gender-specific normal PVR urine volume in adolescents.
MATERIAL AND METHODS: Healthy adolescents aged 12-18 years were recruited to undergo two uroflowmetry and PVR studies whenever they felt the urge to urinate. Adolescents with neurological disorders, known LUT dysfunction or UTI were excluded.
RESULTS: A total of 1050 adolescents were invited, but only 651 consented. Fourteen participants were excluded due to low bladder volume (BV 100 ml (n = 5) and missing information (n = 6). Ultimately, 894 uroflowmetry and PVR from 605 adolescents (mean age 14.6 ± 1.5 years) were analyzed. PVRs were higher in adolescents aged 15-18 years than in those aged 12-14 years (P 20 ml (7% BV) for males of both the age groups, and PVR >25 ml (9% BV) and PVR >35 ml (>10% BV) for females aged 12-14 and 15-18 years, respectively. Further investigation may be warranted if the repeat PVR is above the 95th percentile, i.e., PVR >30 ml (8% BV) and >30 ml (11% BV) for males aged 12-14 and 15-18 years, respectively, and PVR >35 ml (11% BV) and >45 ml (13% BV) for females aged 12-14 and 15-18 years, respectively.
CONCLUSION: PVR increases with age and varies by gender; thus, age-and gender-specific reference values should be used. Further data from other countries is required to determine whether the study's recommendations can be applied globally.
METHODS: This 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.
RESULTS: Objective 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 %.
CONCLUSION: The 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.