Nonsurgical Transurethral Collagen Denaturation for Stress Urinary Incontinence in Women: 12-Month Results from a Prospective Long-term Study

Study ObjectiveTo assess efficacy of nonsurgical transurethral collagen denaturation (Renessa) in women with stress urinary incontinence (SUI) caused by bladder outlet hypermobility.DesignContinuing, prospective, 36-month, open-label, single-arm clinical trial. Twelve-month results from intent-to-treat (ITT) analysis are reported. Canadian Task Force classification II-2.SettingThirteen physician offices or ambulatory treatment centers.PatientsWomen with SUI secondary to bladder outlet hypermobility for 12 months or longer who failed earlier conservative treatment and had not received earlier surgical or bulking agent therapy.InterventionsWomen were treated as outpatients and received an oral antibiotic and local periurethral anesthesia before undergoing treatment with transurethral radiofrequency collagen denaturation.Measurements and Main ResultsVoiding diaries and in-office stress pad weight tests yield objective assessments. Subjective measures include the Incontinence Quality of Life (I-QOL), Urogenital Distress Inventory (UDI-6), and Patient Global Impression of Improvement (PGI-I) instruments. In total, 136 women received treatment (ITT population). Patients experienced significant reductions versus baseline in median number of leaks caused by activity/day and activity/week (p <.0026 for both), with 50% of patients reporting 50% or more reduction. Pad weight tests revealed that 69% of women had 50% or more reduction in leakage (median reduction 15.2 g; p <.0001); 45% were dry (29% no leaks; 16% < 1-g leakage). Significant improvements occurred in median scores on the I-QOL (+9.5 [range –66.0 to 91.0]; p <.0001) and mean scores on the UDI-6 (–14.1 ± 24.7; p <.0001). Furthermore, 71.2% showed I-QOL score improvement, including 50.3% with 10-point or greater improvement, and 49.6% reported on the PGI-I that they were “a little,” “much,” or “very much” better.ConclusionAt 12 months, treatment of SUI with nonsurgical transurethral collagen denaturation resulted in significant improvements in activity-related leaks and quality of life.     

Coital Incontinence in Women With Urinary Incontinence: An International Study

Introduction

Coital urinary incontinence (CUI) is not much explored during clinical history, and this could lead to an underestimation of the problem.

Efficacy and Safety of Tension-Free Vaginal Tape Compared With Transobturator Tape Among Obese Women With Stress Urinary Incontinence: A Retrospective Cohort Study

ObjectiveTo determine the efficacy and safety of tension-free vaginal tape (TVT) compared with transobturator tape (TOT) in obese women with stress urinary incontinence (SUI).MethodsWe performed a retrospective chart review of patients who underwent insertion of TVT or TOT for stress urinary incontinence between January 2003 and October 2009. Women were excluded if they had had previous surgery for SUI or had a diagnosis of intrinsic sphincter deficiency.ResultsOne hundred eighty obese women (BMI >30 kg/m2) with SUI and with follow-up for at least one year were identified (90 had TVT and 90 had TOT). The rates of success on the objective criteria were 91% for the TVT group and 88% for the TOT group (P = 0.46) and 87% versus 80% (P = 0.23) on subjective assessment.ConclusionOur retrospective cohort study demonstrated similar rates of cure for obese women with SUI who underwent insertion of TVT and TOT.     

女性压力性尿失禁与神经-肌肉疲劳关系的研究

压力性尿失禁（SUI）是女性常见病,神经-肌肉疲劳可能是其主要发病机制之一。应力状态下,尿道和盆底的横纹肌在维持尿道内压中起重要作用,骨骼肌运动易产生神经-肌肉疲劳。能源物质消耗、代谢产物积聚、神经-肌肉接点失衡引起骨骼肌外周性疲劳,中枢神经系统递质5-羟色胺（5-HT）、多巴胺（DA）和去甲肾上腺素（NA）等是导致中枢性疲劳的主要神经生物学因素,并从中枢性疲劳探讨度洛西汀治疗SUI的机制和疗效欠佳的原因,指明NA可能是SUI药物治疗的新研究方向。     

女性压力性尿失禁与神经-肌肉疲劳关系的研究

压力性尿失禁(SUI)是女性常见病,神经-肌肉疲劳可能是其主要发病机制之一.应力状态下,尿道和盆底的横纹肌在维持尿道内压中起重要作用,骨骼肌运动易产生神经-肌肉疲劳.能源物质消耗、代谢产物积聚、神经-肌肉接点失衡引起骨骼肌外周性疲劳,中枢神经系统递质5-羟色胺(5-HT)、多巴胺(DA)和去甲肾上腺素(NA)等是导致中枢性疲劳的主要神经生物学因素,并从中枢性疲劳探讨度洛西汀治疗SUI的机制和疗效欠佳的原因,指明NA可能是SUI药物治疗的新研究方向.     

Sexual Function and Quality of Life for Women with Mild‐to‐Moderate Stress Urinary Incontinence

Introduction: Sexual function is affected by stress urinary incontinence with or without pelvic organ prolapse. The aim of the study was to describe the sexual function of women with mild‐to‐moderate stress urinary incontinence, with or without pelvic organ prolapse (up to stage 2) and examine correlations with symptoms and quality of life. This investigation was part of a large, randomized, clinical trial of women with stress urinary incontinence who participated in an exercise intervention. Methods: Women included in the study suffered from stress urinary incontinence as measured by a pad test and were interested in an exercise intervention. All participants underwent assessment for prolapse staging. Instruments included: the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12), Incontinence Quality of Life Questionnaire (I‐QOL), and a health and urinary leakage questionnaire. Results: One hundred and eighty‐seven ambulatory women, aged 20 to 65 years, had a mean sexual function score of 36.9 (standard deviation [SD] 5.9). No significant correlation was found between the sexual function scores and quantity of urinary leakage. A significant correlation existed between the sexual function and I‐QOL scores (P < .001). An additional finding was that women with urgency symptoms were older (P= .04) and had significantly lower sexual function scores (mean 35.7; SD 6.4) than those who did not report urgency (mean 38.7; SD 4.6; P < .001). Discussion: Women with mild‐to‐moderate stress urinary incontinence, without or with lower stages of pelvic organ prolapse, demonstrated good sexual function, which correlated with physical and psychosocial factors. Health professionals need to perform multifaceted intake assessments on women with urinary leakage to customize their health promotion regimen.     

Short-Term Effect of TVT-SECUR Procedure on Quality of Life and Sexual Function in Women With Stress Urinary Incontinence

Study ObjectiveTo investigate whether patient quality of life and sexual function are improved after the tension-free vaginal tape SECUR (TVT-S) procedure (H-type).DesignProspective study (Canadian Task Force classification II-3).SettingSingle-center hospital.PatientsThirty-three women with stress urinary incontinence (SUI) (high urethral mobility) and no concomitant pelvic floor prolapse underwent TVT-S between October 2009 and October 2011.InterventionTVT-S procedure.Measurements and Main ResultsBefore and after surgery(6 and 12 months), all patients completed the Chinese version of the Incontinence Quality of Life Questionnaire (I-QOL). In addition, 28 sexually active patients who underwent the TVT-S procedure completed the short-form Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) before and after surgery (6 and 12 months). We used a paired t test to compare I-QOL scores before and after surgery. The Wilcoxon signed-rank test was used to compare the preoperative and postoperative PISQ scores. The objective cure rate was 78% (26 of 33 patients) at 12 months after surgery. The objective improvement rate was 12.1% (4 of 33 patients). The subjective satisfaction rate was 90%. Three operations (9.1%) were considered failures. Two patients underwent a TVT procedure after TVT-S because of recurrence. No patients reported severe pain; the mean (SD) visual analog scale pain score was 1.8 (1.2) after surgery. Only 1 patient (3%) was found to have sling erosion at 12 months postoperatively. The I-QOL score was 28.3 (14.2) before surgery and increased to 69.5 (18.9) at 12 months after the TVT-S procedure. The I-QOL score improved significantly after surgery (p <.001). The total PISQ-12 score at 6 months after surgery in all sexually active patients was 33.82 (0.87), compared with 31.57 (1.20) before surgery (p <.05). Physical domain scores on the PISQ-12 demonstrated significant improvement, increasing from 12.61 (0.75) to 14.36 (0.49) (p <.05). No significant difference was found between I-QOL and PISQ-12 scores at 6 and 12 months after surgery. There was no significant difference in total PISQ-12 scores in premenopausal patients before and after surgery (p >.05).ConclusionsAlthough the objective cure rate was not high, the TVT-S procedure is a minimally invasive, safe, and effective surgical procedure for treatment of SUI (high urethral mobility) and can improve the quality of life and sexual function in women with SUI.     

Effects of Pelvic Floor Muscle Training on Sexual Dysfunction,Sexual Satisfaction of Partners,Urinary Symptoms,and Pelvic Floor Muscle Strength in Women With Overactive Bladder: A Randomized Controlled Study

BackgroundIn women with overactive bladder (OAB), sexual dysfunctions and sexual satisfaction of their partners have been problems that are as important as urinary symptoms.AimTo investigate the effects of pelvic floor muscle training (PFMT) on sexual dysfunction, sexual satisfaction of partners, urinary symptoms, and pelvic floor muscle strength (PFMS) in women with OAB.MethodsWomen with OAB were randomized into 2 groups: 6-week PFMT (n = 21) (home exercise program) and a control group (n = 22) (did not receive any treatment for OAB).OutcomesSexual dysfunction, sexual satisfaction of partner, urinary symptoms, and PFMS were assessed at baseline and after 6 weeks with the Female Sexual Function Index (FSFI), a Visual Analogue Scale (VAS), the OAB-Version8 (OAB-V8), and the Modified Oxford Scale (MOS), respectively.ResultsAfter 6 weeks, there was an increase in FSFI domains [desire (95% CI: 0.18 to 0.64; P:.001, d: 0.88); arousal (95% CI: 0.42 to 1.24, P:<.001, d: 1.17); orgasm (95% CI:0.85 to 1.47; P:<.001, d:1.89); satisfaction (95% CI: 0.85 to 1.44; P:<.001, d: 2.29); sexual pain (95% CI:0.80 to 1.52; P:<.001, d:1.47); total score (95% CI: 3.70 to 5.94; P:<.001, d: 2.55)], sexual satisfaction of partners (95% CI: 1.80 to 2.85; P:<.001, d:2.83) and PFMS scores (95% CI: 1.10 to 1.55; P:<.001, d:3.18), and a decrease in the OAB-V8 score (95% CI: -13.01 to -7.10; P:<.001, d:2.19) in the PFMT group compared to the control group. There was a significant decrease in sexual dysfunction in the PFMT group compared to the control group (P:.046).Clinical ImplicationsIn order to improve sexual function, sexual satisfaction of the partners, urinary symptoms, and PFMS in women with OAB, PFMT should be added to the rehabilitation program in clinics.Strengths & LimitationsThe strength of this study was that it is a randomized controlled trial investigating the effect of PFMT in improving sexual function in OAB. The limitations of our study were the lack of a long-term (6 months-1 year) follow-up and the inability to blind.ConclusionPFMT was effective in improving sexual dysfunction, sexual satisfaction of partners, urinary symptoms, and PFMS in women with OAB.Celenay ST, Karaaslan Y, Ozdemir E. Effects of Pelvic Floor Muscle Training on Sexual Dysfunction, Sexual Satisfaction of Partners, Urinary Symptoms, and Pelvic Floor Muscle Strength in Women With Overactive Bladder: A Randomized Controlled Study. J Sex Med 2022;19:1421–1430.     

A Multicenter Prospective Study Evaluating Efficacy and Safety of a Single-incision Sling Procedure for Stress Urinary Incontinence

Study ObjectiveThe aim of the Altis 522 study was to compare the safety and efficacy of the Altis Single-Incision Sling System (SIS) (Coloplast, Minneapolis, MN) with standard midurethral transobturator and/or retropubic slings through 36 months. In this report, we present data through 12 months of follow-up.DesignPostmarket, prospective, multicenter, nonrandomized cohort design.SettingThe study was performed at 23 hospitals in the United States and Canada.PatientsAdult female patients with stress urinary incontinence (SUI) clinically indicated for an incontinence sling were treated (n = 355).InterventionsAltis SIS was compared with any Food and Drug Administration–cleared transobturator or retropubic sling.Measurements and Main ResultsCollected measures included device- and/or procedure-related serious adverse events, relevant nonserious and all adverse events, and revision surgery. Objective efficacy measures included 24-hour pad weight, dryness (defined as pad weight ≤4.0 g), and cough stress test. Subjective outcome measures included patient global impression of improvement, urogenital distress inventory, Incontinence Impact Questionnaire–Short Form, Surgical Satisfaction Questionnaire, and visual analog scale for pain.At 12 months, 24-hour pad weight success (≥50% reduction), negative cough stress test, patient global impression of improvement, urogenital distress inventory, and Incontinence Impact Questionnaire–Short Form appeared similar between groups. Through 12 months, 2 subjects in the Altis group and 3 subjects in the comparator group experienced a serious device- and/or procedure-related adverse event. In the Altis group, 1 subject (0.5%) experienced a device revision, and 1 subject (0.5%) had the device explanted. In the comparator group, 7 subjects (4.1%) experienced a device revision, and 1 device (0.6%) was explanted before the 12-month visit. The occurrence of relevant nonserious procedure and/or device-related adverse events was similar between groups.ConclusionAt 12-months follow-up, safety and efficacy appeared similar between Altis SIS and standard transobturator and retropubic midurethral slings.     

A New Technique of Laparoscopic Implantation of Stimulation Electrode to the Pudendal Nerve for Treatment of Refractory Fecal Incontinence and/or Overactive Bladder With Urinary Incontinence

Study ObjectiveTo show a new technique of laparoscopic implantation of electrodes for stimulation of the pudendal nerve for treatment of fecal incontinence and/or overactive bladder with urinary incontinence.DesignStep-by-step explanation of the technique using videos and pictures (educative video).SettingHyperactivity of the bladder with urinary incontinence, in particular the non-neurogenic form of the condition, but also fecal incontinence may affect millions of women worldwide without any comorbidities and in particular without any neurologic disorders or prolapsed organs. First-line conservative treatments do not always result in sufficient improvement of symptoms and are often associated with disabling adverse effects leading to treatment failure. Electrical stimulation of the pelvic nerves has emerged as an alternative and attractive treatment in refractory cases. A novel technique of implantation of an electrode to the pudendal nerve has been developed for treatment of fecal incontinence and of hyperactivity of the bladder with urinary incontinence. The laparoscopic approach is the only technique that enables placement of an electrode in direct contact with the endopelvic portion of the pudendal nerve within the protection of the pelvis.InterventionLaparoscopic transperitoneal implantation of a stimulation electrode to the endopelvic portion of the pudendal nerve.ConclusionThis technique of transperitoneal placement of an electrode to the endopelvic portion of the pudendal nerve is an effective, safe, and reproducible day procedure for treatment of intractable hyperactive bladder, urinary incontinence, fecal incontinence, and a combination of both forms of incontinence.     

Tension-Free Vaginal Tape for the Treatment of Stress Urinary Incontinence: A 13-Year Prospective Follow-Up

Study Objective

To evaluate the long-term safety and efficacy of tension-free vaginal tape (TVT).

Predictors of Improvement in Sexual Function of Women with Urinary Incontinence After Treatment with Pelvic Floor Exercises: A Secondary Analysis

IntroductionWomen with urinary incontinence (UI) frequently present with complaints of sexual problems.AimTo evaluate the predictors of sexual function improvement after participating in three physical therapy sessions and performing home‐based pelvic floor muscle exercises (PFME) for the treatment of female UI.MethodsThis is a secondary analysis of a randomized trial with a 3‐month follow‐up in which the sexual function of 54 women with UI was evaluated. These women joined three supervised physiotherapy sessions that included PFME and health education during 1 month, with a 15‐day interval between each session, and kept practicing home‐based PFME for a further 2 months.Main Outcome MeasureSexual function was assessed using the Female Sexual Quotient, the pelvic floor muscle strength was measured using the modified Oxford scale, and UI was assessed using the International Consultation on Incontinence Questionnaire.ResultsThe mean of sexual quotient score improved after treatment (P = 0.001). With respect to specific domains of sexual function, improvement was observed only in the questions about sexual desire, arousal/excitement, and orgasm. Before treatment, 18 women (33.3%) were classified as having sexual dysfunction, and after treatment, eight remained with sexual dysfunction and two other joined this category (total of 18.5%). Those women who had sexual dysfunction at baseline experienced a higher level of improvement of the sexual quotient compared with those without sexual dysfunction (P = 0.001, 95% CI = 9.1–31.9). A multivariate linear regression with backward elimination revealed the following predictors of improvement of the sexual quotient: higher parity, higher adherence to PFME, improvement in the strength of PFM, and a decrease in the frequency of urine leakage (R² = 0.497).ConclusionPFME was more beneficial with regard to sexual function in those women who presented with sexual dysfunction at baseline. Sacomori C and Cardoso FL. Predictors of improvement in sexual function of women with urinary incontinence after treatment with pelvic floor exercises: A secondary analysis. J Sex Med 2015;12:746–755.     

女性尿失禁患者盆底组织胶原状态的研究

目的:研究女性尿失禁患者尿道旁粘膜、主韧带、肛提肌组织胶原状态,探讨胶原状态与尿失禁发病的关系。方法:确诊为压力性尿失禁的15例患者行阴式手术者为实验组,以同期10例无压力性尿失禁和盆底器官脱垂因子宫良性病变行阴式手术者为对照组。取主韧带、肛提肌及尿道旁粘膜组织光镜下观察组织形态学结构,再采用免疫组化二步法检测Ⅰ型胶原的含量。结果:实验组盆底组织可见纤维组织密度降低,比较细碎,排列稀疏。免疫组织化学检查显示:实验组胶原阳性细胞的面积均小于对照组,P<0.01。实验组胶原阳性细胞的灰度均大于对照组,P<0.01。实验组胶原阳性单位均小于对照组,P<0.01。结论:尿失禁患者盆底组织存在胶原结构及生化的异常。     

A Triage Approach to the Investigation and Management of Urinary Incontinence in Women

Urinary incontinence is a pervasive condition affecting between 30 and 40 percent of North American women over the age of 30. Most patients see a physician with the hopes of receiving both an explanation for the incontinence and effective therapy. The majority of women undergoing evaluation of incontinence for the first time have neither major lower urinary tract disease nor uncommon neurologic abnormalities. Although a comprehensive evaluation of every patient ensures that nothing will be overlooked, such an unwavering approach is neither cost effective not necessary to maintain a standard of exemplary patient care. This article outlines a triage approach to the investigation and management of urinary incontinence which is designed to achieve the goals of both the patient and the physician, while making efficient use of health care resources.     

A Prospective Study of Urinary Prostaglandins E in Women with Normal and Hypertensive PmGNancies

Studies in vitro suggest that pregnancy induced hypertension, or toxemia, is associated with decreased placental pros-taglandins E (PGE) levels. To validate this observation in vivo PGE were measured weekly in 24h urine collections, in a prospective cross-sectional study in 9 women from 7 to 40 weeks. In addition, urinary PGE levels were also measured in 28 hospitalized pregnant women with either chronic hypertension or toxemia. Prostaglandins E were measured by radioimmunoassay after organic extraction and silicic acid separation. Urinary PGE levels during pregnancy (normotensive and chronic hypertensive women) were significantly elevated than those of the non-pregnant state. Mean urinary PGE levels in toxemic patients were significantly decreased compared to those of normal pregnancy and patients with chronic hypertension but they were similar to the mean levels of the non-pregnant state. One fetal death attributed to aggravation of chronic hypertension and one eclampsia were associated with undetectable levels of maternal urinary PGE. In conclusion, normal pregnancy is associated with a significant increase of urinary PGE; chronic hypertension and occurence of toxemia are associated with significant diminution of urinary PGE excretion.     

Association of Baseline Pelvic Floor Muscle Activities With Sexual and Urinary Functions In Female Stress Urinary Incontinence

BackgroundThe presence of reactive and strong pelvic floor muscle (PFM) activities is supposed to be associated with better urinary and sexual functions in female stress urinary incontinence (SUI).AimThis study was to explore the association of baseline PFM activities, both volitional and reflex, with urinary and sexual functions in women with SUI but who had no experience of PFM training programs before.MethodsSecondary analysis of a prospectively maintained database identified 125 sexually active women with SUI who had met the eligibility criteria. All patients had undergone intravaginal digital examination and pelvic ultrasound to detect volitional and reflex PFM activities, respectively, and responded to questionnaire surveys, including short forms of the urogenital distress inventory, incontinence impact questionnaire-7, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. On pelvic ultrasound, an inward clitoral motion and an anorectal lift preceding or during coughing were regarded as the presence of reflex activities of the PFM.OutcomesThe relationship of volitional and reflex PFM activities with pelvic floor dysfunction relating questionnaires and urethral function on urodynamic studies was analyzed.ResultOf the 125 women studied, 30 (24.0%) had volitional PFM contraction strength less than grade 2, 74 (59.2%) grade 2 to 3, and 21 (16.8%) greater than grade 3 based on the modified Oxford grading scale. During or preceding coughing, an inward clitoral motion was not observed on ultrasound in 9 (7.2%) women and an anorectal lift was not observed in 8 (6.4%) women. The strength of volitional PFM contraction and the presence or absence of anorectal lift reflex was not associated with urethral and sexual function. In contrast, the absence of reflex inward clitoral motion was significantly associated with lower maximum urethral closure pressure (P = .042) and higher scores of urogenital distress inventory-6 (P = .006) and incontinence impact questionnaire-7 (P = .029).Clinical implicationsHigher volitional PFM contraction strength was not associated with better sexual and urinary functions; however, loss of one reflex PFM activity was associated with poorer urinary function.Strengths & LimitationTo our knowledge, this is the first study that evaluates the association of baseline PFM activities with sexual and urinary functions in female SUI. Nevertheless, the cross-sectional design of this study cannot well support the cause-effect relationshipConclusionBesides PFM physiotherapy for enhancing sexual and urinary functions in female SUI, additional treatment strategies such as neuromodulation should take into consideration for those who had absent reflex PFM activities. Yang E, Yang SH, Huang WC, et al. Association of Baseline Pelvic Floor Muscle Activities With Sexual and Urinary Functions In Female Stress Urinary Incontinence. J Sex Med 2021;18:1698–1704.