Female sexual function following surgery for stress urinary incontinence: tension-free vaginal versus transobturator tape procedure

The aim of this study was to compare sexual function outcome following tension-free vaginal (TVT) versus transobturator tape (TOT) for stress urinary incontinence (SUI). All women who underwent TVT or TOT procedures for SUI with no concomitant prolapse repair between January 2002 and July 2007 were sent a retrospective pre-post questionnaire. Eighty-one and 64 women were sexually active before and after TVT and TOT procedures, respectively. Sexual function outcome did not differ pre- and postoperatively for the TVT and TOT groups, and postoperatively between the two groups. Responders reported an improvement of intercourse satisfaction in 23 (29.5%) and 21 (32.9%) cases, whereas 14 (17.3%) and eight (12.5%) complained of sexual function deterioration after TVT and TOT procedure, respectively (p = 0.43). This study suggests that anti-incontinence surgery can have a positive and negative outcome on sexual function, with no significant differences between the TVT and TOT procedures.     

Ventral bladder hernia following Marshall-Marchetti-Krantz procedure for stress urinary incontinence

Ventral herniation of the bladder occurred in 2 patients following Marshall-Marchetti-Krantz procedures for stress incontinence. Symptoms included suprapubic pain, urgency, incontinence, and a ventral abdominal hernia. The diagnosis was easily established by cystography in both patients. Possible etiologic factors included postoperative wound infection in 1 patient and possibly suspension of the anterior bladder to the pubis in the other.     

Change of sexual function after midurethral sling procedure for stress urinary incontinence

Objectives:   To compare sexual function in women before and after the midurethral sling procedure for stress urinary incontinence (SUI).
Methods:   A total of 75 women undergoing surgery for SUI between September 2005 and September 2006 were recruited for this study. Those who completed the Female Sexual Function Index (FSFI) preoperatively and 6 months postoperatively were included in the analysis. The FSFI is a validated, 19-item questionnaire, which assesses six domains of sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and pain.
Results:   Data were analyzed for 47 patients. Overall sexual function after the midurethral sling procedure was not significantly different. There were no significant differences in overall sexual function or any of the individual FSFI domain scores between patients with and without concomitant posterior colporrhaphy. There were no significant differences in sexual function between the transobturator and the retropubic surgical routes.
Conclusions:   There is no significant change in overall sexual function in women undergoing the midurethral sling procedure. Posterior colporrhaphy and operative methods do not affect overall sexual function.     

Persistent groin pain following a trans-obturator sling procedure for stress urinary incontinence: a diagnostic and therapeutic challenge

Groin pain after a tension-free vaginal tape–obturator (TVT-O) procedure can occur but mostly disappears within 4 weeks. Persistent groin pain is extremely rare and there is a paucity of literature on how to diagnose and manage this adverse event. We present two cases with severe persistent groin pain after uncomplicated TVT-O, in which magnetic resonance imaging and electromyography did not reveal the cause. We concluded that the tape entrapped or cut through peripheral branches of the obturator nerve. We removed as much of the tape as possible in both cases. Removal partially relieved the pain although sensory loss of the obturator nerve persisted 1 year after surgery. In case of abnormal post-operative groin pain, soon removal of the tape enhances the chance that damage to the obturator nerve is reversible, although it is important to counsel patients with similar pathology that recovery can take long and may be only partial.     

Success and patient satisfaction following the Stamey procedure for stress urinary incontinence.

A long-term followup survey to determine patient satisfaction following Stamey endoscopic vesicourethral suspension was obtained by means of a mail-in questionnaire. A total of 284 charts was reviewed and surveys were mailed, 17 of which were returned for lack of a forwarding address. A total of 192 replies was received for a 72% response rate. Overall improvement was found to be 82%, with approximately half of these patients found to be totally dry. When asked if they would be willing to go through the experience again 65% said they would. Criteria for the success or failure of the procedure were determined, weighing the degree of dryness against the previously mentioned question. With these criteria there was an overall success rate of 73%. Pulmonary disease, body weight greater than 86 kg., prior Marshall-Marchetti-Krantz procedure and concomitant abdominal hysterectomy lowered the success rate. Prior hysterectomy and concomitant vaginal hysterectomy had no influence on the success rate.     

Impact of tension‐free vaginal tape procedure on dysfunctional voiding in women with stress urinary incontinence

Objectives: To determine the prevalence of dysfunctional voiding (DV) in female stress urinary incontinence (SUI) and its modification after tension‐free vaginal tape (TVT) procedure. Methods: Three hundred and sixty women with SUI were enrolled and underwent urodynamics from 2002 to 2008. DV was determined when non‐neurogenic detrusor‐sphincter dyssynergia occurred during voluntary voiding. It was further quantitatively analyzed using the tense/loose value, a parameter derived from external anal sphincter electromyogram. The distribution of other urodynamic variables was also evaluated. One hundred and fifty patients underwent the TVT procedure and forty of them were studied with urodynamics after surgery during follow up. Results: Overall, DV was diagnosed in ninety‐nine patients, with a prevalence of 27.5%. The functional profile length in SUI women with DV was significantly shorter than that in SUI women without DV (3.13 ± 0.76 vs 3.32 ± 0.65, P = 0.017). After the TVT procedure, the recovery of SUI between cases with and without DV showed no significant difference. The rate of DV state change after the surgery, namely from with to without DV or from without to with DV, significantly differed between the female patients with and without DV (66.7% vs 3.6%, P < 0.05) during follow up. The DV improved after the surgery in SUI women with DV. Conclusions: DV might represent a coexistent finding in women with SUI. The main difference of women with SUI and DV, as compared with those without DV, is a shortened functional profile length. In such cases, TVT procedure can improve DV along with the treatment of SUI.     

Intravesical tape erosion following the tension-free vaginal tape procedure for stress urinary incontinence

We report a case of intravesical tape erosion which occurred 6 months after the tension-free vaginal tape (TVT) procedure, which was successfully treated by partial tape removal. A 75-year-old woman, who had complained of recurrent cystitis after TVT procedure, was referred to Kobe City General Hospital in August 2003. The intravesical tape erosion was revealed by cystoscopy and computed tomography, and the tape was removed with a retropubic approach. The recurrent cystitis has been cured and the stress urinary incontinence has not recurred. The intravesical tape erosion was rare, with only seven reported cases including the present case.     

Predictors of successful voiding before hospital discharge after urinary stress incontinence surgery

This study aims to identify variables associated with successful voiding before hospital discharge in women undergoing urinary stress incontinence (USI) surgery. Medical records of women who underwent USI surgery between July 1997 and October 2005 were reviewed. Demographic, urodynamic, and perioperative data were recorded. The primary outcome was successful voiding at hospital discharge. Univariate, bivariate, and logistic regression analyses were performed (SPSS 12.0/SPSS, Chicago, IL, USA). The two groups, successful vs unsuccessful voiders, were similar in age, postmenopausal status, and prior hysterectomy/incontinence/prolapse surgery. Burch colposuspension was performed in 82% and pubovaginal sling in 18% of women. Multivariate logistic regression analysis revealed that age < 45 years (OR 2.6), sustained detrusor contraction (OR 4.4), and Burch colposuspension (OR 2.9) were positively associated with early successful voiding. Early successful voiding was associated with age < 45 years, sustained detrusor contraction, and Burch colposuspension. These data may facilitate preoperative counseling in women undergoing USI surgery.     

Videourodynamic evaluation of urge syndrome following pubovaginal sling procedure for stress urinary incontinence in women

Introduction and hypothesis  

The purpose of this study is to evaluate women with urge syndrome following pubovaginal sling procedure for stress urinary incontinence using a polypropylene mesh.     

Complications following surgical intervention for stress urinary incontinence: a national perspective

AIMS: Stress urinary incontinence (SUI) impacts many women. Treatment is primarily surgical. Post-operative morbidity considerably affects individuals and the health care system. Our objective is to describe complications following surgery for SUI and how they affect resource utilization. METHODS: Utilizing the Nationwide Inpatient Sample (a nationally representative dataset), 147,473 patients who underwent surgery for SUI from 1988 to 2000 were identified by ICD-9 codes. Comorbid conditions/complications were extracted using ICD-9 codes, including complication rates, length of stay (LOS), hospital charges, and discharge status. RESULTS: Overall complication rate was 13.0% (not equal to sum of complication sub-types, as each woman may have had = 1 complication), with 2.8% bleeding, 1.4% surgical injury, 4.3% urinary/renal, 4.4% infectious, 0.1% wound, 1.1% pulmonary insufficiency, 0.5% myocardial infarction, 0.2% thromboembolic. The "gold standard" surgical technique for SUI, the pubovaginal sling, had the lowest morbidity at 12.5%. Mean LOS increased with morbidity: from 2.9 to 4.1 to 6.1 days for those with 0, 1, and =2 complications respectively (P < 0.001). Similarly, inflation-adjusted hospital charges increased with morbidity: from 7,918 dollars to 9,828 dollars to 15,181 dollars for those with 0, 1, and =2 complications respectively (P < 0.001). The percentage of patients requiring post-discharge subacute or home care increased with morbidity: from 4.4% to 8.4% to 14.3% for those with 0, 1, and =2 complications (P < 0.001). CONCLUSIONS: A substantial percentage of women experience complications following surgery for SUI. Post-operative morbidity leads to dramatically increased resource utilization. Prospective studies are needed to identify pre-operative risk factors and intraoperative process measures to optimize the quality of care.     

女性压力性尿失禁经耻骨上膀胱尿道悬吊术后并发症的防治

目的 探讨经耻骨上膀胱尿道悬吊术(SPARC)治疗女性压力性尿失禁术后并发症的防治.方法 2002年7月～2006年1月,采用SPARC治疗女性压力性尿失禁18例,年龄35～68岁,平均49岁.病程2～19年,平均8年.轻度6例,中度8例,重度4例.结果 手术时间25～50min,平均35min.出血量15～40ml,平均30ml.住院3～14d,平均5d.术中膀胱穿孔1例,经留置导尿管2周后治愈.1例术后排尿困难及尿潴留,在门诊行尿道扩张8次后治愈.1例术后3年出现吊带穿破膀胱及膀胱结石形成,经腔镜下膀胱结石碎石后行开放手术将膀胱内吊带切除.余17例随访3～6个月,2例增加腹压时轻度尿失禁,其余15例均排尿通畅,无漏尿及其他并发症.结论 SPARC术中术后注意细心操作和正确及时处理,可以有效降低术后并发症的发生率.     

Predictors of de novo urge urinary incontinence after photoselective vaporization of the prostate

Purpose

To investigate serial changes in the incidences of de novo urge urinary incontinence (UUI) after photoselective vaporization of the prostate (PVP) for BPH using a validated questionnaire, OABSS, and to determine predictors of postoperative de novo UUI (dnUUI).

Methods

A total of 84 men, for whom 12-month follow-up data were available and who did not complain of UUI based on the OABSS [score of OABSS question 4 (OABSS4) ≤1], were included in this study. Outcomes were evaluated at 1 week, and 1, 3, 6, and 12 months postoperatively using IPSS, OABSS, and uroflowmetry. The presence of de novo UUI was defined as OABSS4 ≥2 at the follow-up visit.

Results

Maximum flow rate (Qmax), post-void residual urine volume, voiding symptom score, total IPSS, and QOL index improved from 1 week. Storage symptom score and total OABSS improved from 3 months. Incidences of postoperative dnUUI at 1 week, and 1, 3, and 6 months were 42.9, 27.4, 14.3, and 0.0 %, respectively. The decrease in QOL index in patients with dnUUI at each follow-up visit was lesser than in those without dnUUI. On multivariate regression analysis, older age, shorter time to Qmax on baseline uroflowmetry, higher storage symptom score, higher total OABSS, smaller bladder volume at first desire to void, and smaller maximum cystometric capacity (MCC) on baseline urodynamics were independent predictors of occurrence of dnUUI.

Conclusions

Our data indicate that transient dnUUI occurs in a significant proportion of patients after PVP and it tends to decrease over time. Older-aged patients, patients with shorter time to Qmax, higher baseline storage symptom score, higher baseline total OABSS, smaller bladder volume at first desire to void, and smaller MCC may be prone to develop dnUUI postoperatively.

     

Factors predictive of urinary retention after a tension-free vaginal tape procedure for female stress urinary incontinence

PURPOSE: We performed this study to evaluate factors related to urinary retention after a tension-free vaginal tape (TVT) procedure for female stress urinary incontinence. MATERIALS AND METHODS: We retrospectively analyzed the records of 375 women with a followup of at least 6 months from among patients who underwent the TVT procedure between March 1999 and May 2002 at our institution. We analyzed multiple parameters, including patient characteristics, symptoms and urodynamic studies, using univariate and multivariate regression analyses with respect to postoperative urinary retention, as defined by the need for intermittent catheterization for at least 3 days after the procedure. All patients in the nonretention (343) and retention (32) groups answered a global satisfaction question. RESULTS: In answer to a global satisfaction question 338 of the 375 patients (90.1%) favored the procedure. Univariate analysis demonstrated that patient mean age, parity, peak urinary flow and a history of hysterectomy predicted urinary retention. However, on multivariate analyses the peak urinary flow rate was the only significant independent predictive factor (p = 0.007). While 28 patients (87.5%) in the retention group regained normal voiding without a specific procedure, 4 required tape release or cutting within 3 month of surgery. The global satisfaction question showed a significant difference between the nonretention and retention groups (91.5% vs 75% satisfaction, p = 0.03). CONCLUSIONS: An accurate measurement of the peak urinary flow rate could predict women at risk for postoperative urinary retention that compromises global satisfaction after the highly curative TVT procedure.     

Autologous transobturator midurethral sling placement: a novel outpatient procedure for female stress urinary incontinence

Introduction

We present a novel outpatient transobturator autologous rectus fascia midurethral sling procedure.

Methods

A 55-year old woman presented with stress urinary incontinence (SUI) as documented by history, physical exam, and 24-h pad test. Conservative and surgical treatment options were discussed. The patient was interested only in outpatient surgical options, however, and was adamantly opposed to any mesh procedures due to concerns regarding complications. Therefore, following an in-depth discussion and informed consent, a transobturator, autologous sling procedure was performed. The vaginal dissection was performed in the standard fashion. A rectus fascial strip measuring 7?×?1 cm rectus fascia was harvested. A trocar was passed through each obturator foramen. Fascial stay sutures were retracted through the skin incisions. The sling was then appropriately tensioned and the stay sutures tied together.

Results

The patient had an uncomplicated perioperative course. She voided spontaneously with low postvoid residual. At follow-up, she had no urinary leakage.

Conclusions

The transobturator autologous midurethral sling procedure is technically feasible and, in the short term, effective. Longer follow-up and larger series are needed to validate this procedure, which, however, may become a suitable option for patients and surgeons concerned with potential mesh complications.