Symptomatic urinary tract infections following voiding cystourethrography

The objective of this study was to assess the frequency of symptomatic urinary tract infections (UTIs) following voiding cystourethrography (VCUG) while using prophylactic antibiotics. Medical records of 421 patients who underwent a VCUG during a period of 4 years were reviewed. Three hundred forty-nine had a VCUG following a febrile UTI, and 72 had the test for evaluation of hydronephrosis. All received prophylactic antibiotics and were evaluated within 7–10 days following the VCUG. One hundred seventy-two children (41%) had an abnormal VCUG. Seven of 421 children (1.7%) had symptoms suggestive of UTI. Two had culture negative pyuria; one had Escherichia Coli UTI, and four had Pseudomonas aeruginosa UTI. On multivariate logistic regression analysis, the risk factors contributing to the development of UTI following VCUG were the presence of vesicoureteral reflux (VUR) and its severity (odds ratio [OR] 2.52; 95% confidence interval [CI] 2.24, 2.83, p =0.001; and OR 2.32; 95% CI 2.05,2.62, p =0.04, respectively). The incidence of VCUG-induced UTI in children receiving prophylactic antibiotic therapy is low. There is a relatively high rate of Pseudomonas UTI, especially in children with moderate to severe reflux. We recommend that children with symptoms suggesting a UTI following a VCUG should be treated for Pseudomonas aeruginosa pending culture results.     

De novo stress urinary incontinence after pelvic organ prolapse surgery in women without occult incontinence

Introduction and hypothesis

There is a paucity of data evaluating the risk of de novo stress urinary incontinence (SUI) after surgery for pelvic organ prolapse (POP) in women with no preoperative occult SUI. We hypothesized that apical suspension procedures would have higher rates of de novo SUI.

Methods

This was a retrospective database review of women who had surgery for POP from 2003 to 2013 and developed de novo SUI at ≥6 months postoperatively. Preoperatively, all patients had a negative stress test and no evidence of occult SUI on prolapse reduction urodynamics. The primary objective was to establish the incidence of de novo SUI in women with no objective evidence of preoperative occult SUI after POP surgeries at ≥6 months.

Results

A total number of 274 patients underwent POP surgery. The overall incidence of de novo SUI was 9.9 % [95 % confidence interval (CI) 0.07–0.14]. However, the incidence of de novo SUI in those with no baseline complaint of SUI was 4.4 % (95 % CI 0.03–0.1). There was no difference in de novo SUI rates between apical [9.7 % (n?=?57)] and nonapical [10.5 %, (n?=?217] procedures (p?=?0.8482). Multivariate logistic regression identified sacrocolpopexy [adjusted odds ratio (OR) 4.54, 95 % CI 1.2–14.7] and those with a baseline complaint of SUI (adjusted OR 5.1; 95 % CI 2.2–12) as risk factors for de novo SUI.

Conclusions

The incidence of de novo SUI after surgery for POP without occult SUI was 9.9 %. We recommend counseling patients about the risk of de novo SUI and offering a staged procedure.

     

Discrepancies between patient-reported outcome measures when assessing urinary incontinence or pelvic- prolapse surgery

Introduction and hypothesis

In order to assess the outcome following surgery for urinary incontinence (UI) and pelvic organ prolapse (POP) the importance of patient-reported outcome measures, in addition to the clinical objective measures, has been recognised. The International Consultation on Incontinence has initiated the development and evaluation of disease-specific questionnaires (ICIQ) to compare the patient’s degree of improvement. Alternatively, the Patient’s Global Impression of Improvement (PGI-I score) with an inherent before–after assessment has been widely accepted in recent studies. The aim of this study was to compare the PGI-I versus the ICIQ score for women undergoing UI or POP surgery.

Methods

This study is based on self-administered pre- and postoperative questionnaires, completed by women undergoing surgery for UI or POP in Denmark in 2013. Weighted Kappa statistics and 95 % limits of agreement method were used when comparing the PGI-I and ICIQ scores.

Results

Among the 3,310 women included the PGI-I score showed a higher improvement than the IQIC score, for UI 0.83 (CI 95 %: 0.80–0.85) vs 0.62 (0.60–0.64) and for POP 0.77 (0.75–0.78) vs 0.66 (0.65–0.67).

Conclusions

The PGI-I score renders higher satisfaction than the ICIQ score and the PGI-I score overestimates the improvement following UI and POP surgery.

     

Risk factors for urinary tract infection following incontinence surgery

Introduction and hypothesis

The purpose of this study is to describe risk factors for post-operative urinary tract infection (UTI) the first year after stress urinary incontinence surgery.

Methods

Multivariable logistic regression analyses were performed on data from 1,252 women randomized in two surgical trials, Stress Incontinence Surgical Treatment Efficacy trial (SISTEr) and Trial Of Mid-Urethral Slings (TOMUS).

Results

Baseline recurrent UTI (rUTI; ??3 in 12?months) increased the risk of UTI in the first 6?weeks in both study populations, as did sling procedure and self-catheterization in SISTEr, and bladder perforation in TOMUS. Baseline rUTI, UTI in the first 6?weeks, and PVR?>?100?cc at 12?months were independent risk factors for UTI between 6?weeks and 12?months in the SISTEr population. Few (2.3?C2.4%) had post-operative rUTI, precluding multivariable analysis. In women with pre-operative rUTI, successful surgery (negative cough stress test) at 1?year did not appear to decrease the risk of persistent rUTI.

Conclusions

Pre-operative rUTI is the strongest risk factor for post-operative UTI.     

Symptomatic urinary tract infections in patients on maintenance hemodialysis

15 episodes of symptomatic urinary tract infection are described in 11 patients on maintenance hemodialysis. The diagnosis was confirmed by clean-catch or simple voided urine samples where possible, urethral catheterization and bladder washout being used only in anuric patients. Treatment with oral antibiotics proved successful in 13 episodes but 2 patients with polycystic kidneys were admitted to hospital for intravenous therapy. Urinary tract infections are common in dialysis patients including those who are anuric, and patients with polycystic kidneys have an increased risk of serious complications.     

Occult incontinence as predictor for postoperative stress urinary incontinence following pelvic organ prolapse surgery

Introduction and hypothesis

Recommending prophylactic anti-incontinence procedures to continent women undergoing surgery for pelvic organ prolapse (POP) is controversial. We hypothesized that testing for occult incontinence before surgery using four different tests and three defined test combinations would identify individual women at risk for postoperative stress urinary incontinence (POSUI). The diagnostic accuracy of these tests and test combinations were evaluated.

Methods

We tested 137 women before and after surgery. Fisher’s exact test was used when evaluating associations between test results and outcomes. The validity of each test and test combinations was calculated.

Results

We found a statistically significant association between occult incontinence and POSUI in two tests and all test combinations. However, all tests and test combinations displayed poor performance when predicting at individual levels.

Conclusions

This study confirms a positive association between occult incontinence and POSUI. Occult incontinence does not, however, adequately identify individual women in need of prophylactic anti-incontinence surgery when undergoing POP repair.     

Rectal prolapse and surgery for incontinence

Pelvic floor disorders, which include rectal prolapse (RP) and faecal incontinence (FI), are benign conditions, which are not life threatening but affect the quality of life. This is usually a disease of elderly, mostly frail patients. Management is multidisciplinary based on the symptoms, co-morbidities and patient's expectations.     

Pelvic organ prolapse and the lower urinary tract: The Relationship of vaginal prolapse to stress urinary incontinence

Vaginal prolapse and urinary incontinence frequently coexist. Rather than having a cause-and-effect relationship, these two common problems share etiologic factors. Specific tissue and functional deficiencies resulting in prolapse also are significant contributors to lower urinary tract symptoms, particularly stress urinary incontinence. This article reviews this relationship, the etiologic factors, and aspects of the clinical evaluation of the patient with prolapse and stress urinary incontinence.     

同期手术治疗女性压力性尿失禁与盆腔脏器脱垂的临床研究

目的 探讨同期手术治疗女性压力性尿失禁(SUI)与盆腔脏器脱垂(POP)的适应证及治疗效果.方法 回顾性总结16例同期手术治疗SUI与POP患者的病例资料,其中有SUI症状并伴有中度以上阴道前壁膨出的患者12例,主诉阴道脱出物,检查发现子宫中度以上脱垂伴排尿困难4例,术前经查体、尿动力及膀胱造影检查确诊均存在Ⅱ型SUI.盆底修补手术包括Gynemesh网片、Prolift前片及全片植入,抗尿失禁手术采用TVT或TVT-O术,术中先行盆底修补术.结果 随访6～30个月,全部患者获满意效果,达到完全控尿,同时无排尿困难发生,未发现盆底膨出复发.结论 对合并有症状或中度以上POP的SUI患者,应积极同期处理相应的POP,以免加重POP的程度或排尿困难的发生;对单独发生的POP患者,应警惕隐性SUI的可能,同期行相应的控尿手术可避免术后SUI的发生.     

Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence

The objective of our study was to estimate the age-specific incidence and lifetime risk of surgically managed pelvic organ prolapse (POP) and urinary incontinence (UI). Women aged 20 and older who underwent primary surgical management of POP or UI in 1993 were identified from the database of a health maintenance organization using ICD-9 codes and confirmed through chart abstraction. From a population of 147,719 women, 135 were identified who underwent prolapse surgery only, 82 incontinence only, and 34 surgery for both conditions. From the age-specific incidence, we estimated the lifetime risk of undergoing an operation by age 80 to be 11.8%. Our findings agree with a previous estimate that ∼11% of women will undergo surgery for POP or UI by age 80. POP and UI appear to be common problems, undoubtedly affecting an even larger proportion of the women than suggested by this high cumulative incidence of surgery.     

Rectal prolapse and surgery for faecal incontinence

Rectal prolapse and faecal incontinence are relatively common conditions that present to the colorectal and pelvic floor clinics. Both can be complex to treat given they are often multifactorial in origin and tend to present in elderly comorbid patients. Treatment often involves significant patient or family participation, particularly for faecal incontinence, and therefore patients and their families need to understand the risks and benefits of all treatment options available to them. This article outlines the currently available surgical interventions for rectal prolapse and faecal incontinence to allow the surgical trainee to begin these conversations in the clinic.     

Rectal prolapse and surgery for faecal incontinence

Both rectal prolapse and faecal incontinence are common, multifactorial conditions that present both electively to colorectal and pelvic floor clinics, and to the emergency take. The conditions can be complex to treat as can the medical conditions of the elderly patients they can affect. Treatments are evolving but will often involve significant buy in from patients and their carers. This article highlights some of these surgical interventions to enable trainees to have discussions in outpatient settings.     

Bacteriological analysis of meshes removed for complications after surgical management of urinary incontinence or pelvic organ prolapse

The aim of this study is to examine the role of bacterial infection in complications following surgical management of urinary incontinence and genital prolapse using meshes. There were sixteen prostheses removed. Eight were monofilament polypropylene-knitted meshes, one was a silicone-coated polypropylene mesh, another was a collagen-coated polypropylene mesh, four were silicone-coated polyester meshes and two were polyester meshes. The most frequent cause for removal was symptomatic vaginal erosion (62%). Cultures were performed under aerobic, anaerobic and enrichment conditions. Infection was multimicrobial for 31% of meshes. When only one bacteria was found, it was Proteus mirabilis in 25% of cases. Forty-three per cent of bacterial quantifications were under 10³ colony-forming units per millilitre. Bacterial contamination was found in all meshes, quantification was often low, and therefore, its exact role is not yet clear.     

Feasibility and patient satisfaction with pelvic organ prolapse and urinary incontinence day surgery

We performed a prospective cohort study to characterize the feasibility of urinary stress incontinence and pelvic organ prolapse surgery in day care. Two hundred and one women were prepared for day surgery by a standardised protocol; 132 women underwent a single Tension-free Vaginal Tape/Tension-free Vaginal Tape–Obturator procedure, and 69 women had additional or only pelvic organ prolapse surgery. The main outcome measures were complications, satisfaction score and recommendation to others, recorded after 3 days and 6–10 weeks. We found that it is feasible and safe to perform pelvic organ prolapse and urinary incontinence surgery in day care. Patients’ satisfaction is high in all aspects of care and the majority would recommend it to others. In multivariate logistic regression analysis, only dissatisfaction with the care provided by the staff of the surgical ward was significantly associated with a negative recommendation to others (odds ratio 7.3, 95% confidence interval 1.6–33.5).     

Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery

Introduction and hypothesis  

This study aims to determine the risk of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) surgery related to mode of hysterectomy focusing on vaginal hysterectomy.     

Reconstructive surgery for urinary incontinence

The clinical urologist often is faced with the referral of a patient with urinary incontinence refractory to conservative measures. Given the broad spectrum of causes of urinary incontinence, the clinician must base evaluation and therapeutic management on current principles of urinary tract pathophysiology. This article organizes the pertinent diagnostic considerations that must be addressed in guiding the clinician to the appropriate surgical treatment option.