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Fulltext Patient-reported outcomes of retropubic versus trans-obturator mid-urethral slings for urinary stress incontinence: the malaysian experience

Zalina, N., Kamal, N., Aruku, N., Jamaluddin, A.R.

International Medical Journal Malaysia, 2013;12(2):33-38.
MyJurnal

Studies reported that trans-obturator mid-urethral sling (TOT) is superior in safety and efficacy when compared with retro-pubic trans-vaginal tape (TVT) with regard to bladder, vascular and urethral injury. The purpose of this study is to determine if the TOT is equivalent to the TVT by using patient-reported outcomes for the treatment of urodynamic stress urinary incontinence (USI) at Ipoh Hospital. Methods: It is a cross-sectional study on all consecutive patients who underwent TVT procedure between Jan 2005 and Jan 2006 and TOT procedure from Jan 2006 to Jun 2008. Post operatively; all women were followed up at one month, three months, 12 months and annually, thereafter. Data was retrieved from the patients’ records based on the standard pre-operative assessment sheet and follow up record. Then, interviews were made via a telecommunication to assess the patients’ symptoms and satisfaction using a validated questionnaire. Data analysis were performed using IBM SPSS Statistics for Windows version 19 (SPSS Inc., Chicago, Illinois) considering a significant level of P < 0.05. Results: Total of 51 subjects in TVT group and 52 in TOT group were available for analysis. At 12 months, the stress urinary incontinence (SUI) cure rate is higher in the TVT (90.2%) compared to TOT (80.8%) group; however, it was not statistically significant (p=0.279). The lower urinary tract symptoms (LUT) were improved post-operatively in both groups with urgency and urgency incontinence being significantly better in the TVT group. Four (7.4%) subjects in the TVT group had a bladder perforation (p=0.992) and one case of vaginal erosion reported in the TOT group. Conclusion: TVT had a higher successful rate in the treatment of
SUI; however, it increases the risk of bladder perforation. Over active bladder symptom (OAB) were significantly mproved in the TVT compared to TOT group.

Matched MeSH terms: Urodynamics
Fulltext The prevalence and risk factors of occult stress urinary incontinence in women undergoing genitourinary prolapse surgery

Jibril AH, Norlelawati Ab Latip, Ng, PY, Jegasothy, R

Journal of Surgical Academia, 2016;6(1):10-17.
MyJurnal

De novo stress urinary incontinence (SUI) may occur in up to 80% of clinically continent women following genitourinary prolapse surgery. This had resulted in an increase in the rate of concurrent continence surgery during prolapse repair from 38% in 2001 to 47% in 2009 in the United States. To date, there is no local data available to estimate the prevalence of occult SUI (OSUI) among Malaysian women awaiting surgery. Therefore, this study was conducted to elicit the prevalence of occult SUI and its associated risks factors in patients awaiting prolapse surgery. We retrospectively studied the records of 296 consecutive women with significant pelvic organ prolapse awaiting reconstructive repair. All patients attended the Urogynaecology Unit in Hospital Kuala Lumpur Malaysia between October 2007 and September 2011. They had undergone standardized interviews, clinical examinations and urodynamic studies. During the urodynamic testings, all prolapses were reduced using ring pessaries to elicit OSUI. Primary outcome was the prevalence of OSUI with prolapse reduction to predict possibility of developing de novo SUI following prolapse surgery. Secondary outcome was the assessment of potential risk factors for OSUI. Among the 296 women studied, 121 (40.9%) were found to have OSUI. The risk factors associated with OSUI included age, BMI, numbers of SVD, recurrent UTI, reduction of urinary flow symptoms and grade 2 to 4 central compartment prolapses. We concluded that preoperative urodynamic testing with reduction of prolapse is useful to identify women with OSUI. This is important for preoperative counselling as well as planning for one step approach of prophylactic concomitant anti-incontinence procedures during prolapse surgery in order to avoid postoperative de novo SUI.

Matched MeSH terms: Urodynamics
Effect of acute unilateral renal denervation on renal hemodynamics in spontaneously hypertensive rats

Abdulla MH, Sattar MA, Salman IM, Abdullah NA, Ameer OZ, Khan MA, et al.

Auton Autacoid Pharmacol, 2008 Apr-Jul;28(2-3):87-94.
PMID: 18598290 DOI: 10.1111/j.1474-8673.2008.00421.x

1 This study was undertaken to characterize the renal responses to acute unilateral renal denervation in anaesthetized spontaneously hypertensive rats (SHR) by examining the effect of acute unilateral renal denervation on the renal hemodynamic responses to a set of vasoactive agents and renal nerve stimulation. 2 Twenty-four male SHR rats underwent acute unilateral renal denervation and the denervation was confirmed by significant drop (P < 0.05) in renal vasoconstrictor response to renal nerve stimulation along with marked diuresis and natriuresis following denervation. After 7 days treatment with losartan, the overnight fasted rats were anaesthetized (sodium pentobarbitone, 60 mg kg(-1) i.p.) and renal vasoconstrictor experiments were performed. The changes in the renal vasoconstrictor responses were determined in terms of reductions in renal blood flow caused by renal nerve stimulation or intrarenal administration of noradrenaline, phenylephrine, methoxamine and angiotensin II. 3 The data showed that there was significantly (all P < 0.05) increased renal vascular responsiveness to the vasoactive agents in denervated rats compared to those with intact renal nerves. In losartan-treated denervated SHR rats, there were significant (all P < 0.05) reductions in the renal vasoconstrictor responses to neural stimuli and vasoactive agents as compared with that of untreated denervated SHR rats. 4 The data obtained in denervated rats suggested an enhanced sensitivity of the alpha(1)-adrenoceptors to adrenergic agonists and possible increase of AT(1) receptors functionality in the renal vasculature of these rats. These data also suggested a possible interaction between sympathetic nervous system and renin-angiotensin system in terms of a crosstalk relationship between renal AT(1) and alpha(1)-adrenoceptor subtypes.

Matched MeSH terms: Urodynamics/drug effects
Anterior-apical single-incision mesh surgery (SIMS): surgical and functional outcomes at 1 year

Lo TS, Tan YL, Cortes EF, Pue LB, Wu PY, Al-Kharabsheh A

J Minim Invasive Gynecol, 2015 Jan;22(1):50-6.
PMID: 25017520 DOI: 10.1016/j.jmig.2014.07.002

To study the surgical and functional outcomes of single-incision mesh surgery for treatment of advanced pelvic organ prolapse (POP).

Matched MeSH terms: Urodynamics
Fulltext Magnetic stimulation for stress urinary incontinence: study protocol for a randomized controlled trial

Lim R, Liong ML, Leong WS, Khan NA, Yuen KH

Trials, 2015;16:279.
PMID: 26093910 DOI: 10.1186/s13063-015-0803-1

There is currently a lack of randomized, sham-controlled trials that are adequately powered, using validated outcomes, to allow for firm recommendations on the use of magnetic stimulation for stress urinary incontinence. We report a protocol of a multicenter, randomized, double-blind, sham-controlled parallel-group trial to evaluate the efficacy of magnetic stimulation for stress urinary incontinence.

Matched MeSH terms: Urodynamics
Mid Urethral Slings for the Treatment of Urodynamic Stress Incontinence in Overweight and Obese Women: Surgical Outcomes and Preoperative Predictors of Failure

Lo TS, Al-Kharabsheh AM, Pue LB, Ng KL, Huang TX

J Urol, 2020 10;204(4):787-792.
PMID: 32898974 DOI: 10.1097/JU.0000000000001085

PURPOSE: We evaluated mid urethral sling outcomes in overweight and obese patients compared to normal weight patients and identified risk factors for failure in this population.
MATERIALS AND METHODS: Records of 688 women between January 2004 and July 2017 were retrospectively reviewed. Patients received urodynamic studies, 1-hour pad test, Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7, and were divided into normal weight, overweight and obese. Objective cure at 1 year was defined as no involuntary urine leakage during filling cystometry and pad test less than 2 gm. Subjective cure was established by negative response to question 3 on Urogenital Distress Inventory-6. McNemar's test, chi-square test, Mann-Whitney U and Fisher's exact test were used for paired categorical variables. Independent samples t-tests and paired t-test were used for continuous parametric variables. Multivariate logistic regression was used to identify risk factors for failure.
RESULTS: Objective and subjective cure in normal, overweight and obese patients was 91.4% and 89.1%, 87.5% and 86%, and 76% and 70.1%, respectively. There was no difference in surgical complications. Obese patients had worse quality of life scores preoperatively and postoperatively. Risk factors in obese patients with failed mid urethral sling included 66 years old or older (OR 2.02, 1.56-3.98), menopause (OR 4.21, 1.21-14.22), previous prolapse surgery (OR 4.57, 2.36-8.52), diabetes (OR 2.79, 1.61-5.99) and intrinsic sphincter deficiency (OR 5.06, 3.08-9.64).
CONCLUSIONS: Obese women with mid urethral sling had lower objective and subjective cure at 1 year and worse quality of life scores compared to normal and overweight women. Risk factors for failure include age, diabetes, menopause, previous prolapse surgery and intrinsic sphincter deficiency.

Matched MeSH terms: Urodynamics
Prostatitis-like symptoms: diagnosis and management in a Malaysian primary care population

Lee SW, Liong ML, Yuen KH, Leong WS, Khan N, Cheah PY, et al.

Urol Int, 2009;82(1):32-7.
PMID: 19172094 DOI: 10.1159/000176022

BACKGROUND: Little is known about how primary care physicians (PCPs) in Asia diagnose and manage prostatitis-like symptoms. This study investigated the clinical diagnosis of and care provided for prostatitis-like symptoms by PCPs in a Malaysian population, and compared these findings to reports from other areas.
METHODS: All members of the Penang Private Medical Practitioners' Society were asked to complete a self-administered survey. Nonresponders were contacted after 3 weeks and received a telephone request after 6 weeks.
RESULTS: Of the 786 practitioners contacted, 669 considered themselves to be PCPs, including 279 (42%) who responded to the survey. Adult males with prostatitis-like symptoms typically constitute <1% of the patients seen by PCPs. Most PCPs (72%) believe that prostatitis-like symptoms are caused by bacterial infection. 61% of PCPs base their diagnosis of prostatitis-like symptoms on clinical history, a physical examination and dipstick urinalysis. Standard management was to prescribe 1 or 2 courses of antimicrobials.
CONCLUSIONS: Despite the 8.7% prevalence found in a previous survey in this population, prostatitis remains underdiagnosed in Malaysia. In contrast to many other clinical settings, urologists in Malaysia see a large proportion of newly diagnosed and treatment-naive prostatitis patients, providing an opportunity for clinical diagnostic and treatment studies.

Matched MeSH terms: Urodynamics
Fulltext Single incision anterior apical mesh and sacrospinous ligament fixation in pelvic prolapse surgery at 36 months follow-up

Lo TS, Al-Kharabsheh AM, Tan YL, Pue LB, Hsieh WC, Uy-Patrimonio MC

Taiwan J Obstet Gynecol, 2017 Dec;56(6):793-800.
PMID: 29241922 DOI: 10.1016/j.tjog.2017.10.016

OBJECTIVE: To compare the clinical efficacy, recurrence, complications and quality of life changes 3 years after Elevate-A/single incision mesh surgery anterior apical (SIM A) and sacrospinous ligament fixation (SSF) in the management of pelvic organ prolapse (POP).
MATERIALS AND METHODS: A prospective cohort study, 139 women, underwent transvaginal surgery for anterior and/or apical POP > stage 2, 69 patients had SIM A and 70 patients had SSF. The objective cure was defined as POP ≤ stage 1 anterior, apical according to POP-Q. Subjective cure is patient's negative feedback to question 2 and 3 of pelvic organ prolapse distress inventory 6 (POPDI-6). Patient's satisfaction was reported using validated quality of life questionnaires. Multi-channel urodynamic study was used to report any voiding problems related to the prolapse surgery 6 months after surgery.
RESULTS: 119 patients completed a minimum of 3 years follow-up. 89.8% is the overall prolapse correction success rate for SIM A and 73.3% for SSF group (p = 0.020), and 96.6% versus 73.4% at the anterior vaginal compartment respectively (p ≤ 0.001). Statistically significant difference was noticed in apical compartment with 98.3% with SIM A and 85.0% with SSF (p = 0.009). The subjective success rate, 86.4% in the SIM A and 70.0% in the SSF arm (p = 0.030) was significantly noted. Only, Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) showed significant improvement. Operation time and intra-operative blood loss tend to be more with SIM A.
CONCLUSION: SIM A has better 3 years objective and subjective cure rate than SSF in the anterior and/or apical compartment prolapse.

Matched MeSH terms: Urodynamics