The autologous pubovaginal fascial sling: An update in 2019

The contemporary management of stress urinary incontinence (SUI) has seen renewed interest in the use of autologous fascia for the formation of a retropubic suburethral sling. Traditionally, it has been used in only the most severe of incontinence cases, such as those women with intrinsic sphincter deficiency, or in patients requiring concomitant reconstructive procedures. In the current climate surrounding transvaginal mesh, many doctors and patients are shying away from the less morbid synthetic midurethral sling. International literature has demonstrated that the fascial sling is a safe and efficacious procedure for all patients with SUI, adequately treating both urethral hypermobility and intrinsic sphincter deficiency. This paper will discuss the indications, technique, and outcomes of autologous fascial slings. We will explore the use of fascial slings following failed synthetic slings and also the troubleshooting of commonly encountered issues intra‐ and postoperatively.     

Focusing on long-term complications of mid-urethral slings among women with stress urinary incontinence as a patient safety improvement measure: A protocol for systematic review and meta-analysis

Background:There are 3 different types of mid-urethral sling, retropubic, transobturator and single incision performed for women with stress urinary incontinence. Prior studies comparing these three surgeries merely focused on the successful rate or efficacy. But nevertheless, what is more clinically important dwells upon investigating postoperative complications as a safety improvement measure.Methods:A systematic review via PubMed, Ovid, and the Cochrane Database of Systematic Review and studies were applied based on the contents with clearly identified complications. Selected articles were reviewed in scrutiny by 2 individuals to ascertain whether they fulfilled the inclusion criteria: complications measures were clearly defined; data were extracted on study design, perioperative complications, postoperative lower urinary tract symptoms, postoperative pain, dyspareunia, and other specified late complications.Results:A total of 55 studies were included in the systemic review. Perioperative complications encompassed bladder perforation, vaginal injury, hemorrhage, hematoma, urinary tract infection. There were postoperative lower urinary tract symptoms including urine retention and de novo urgency. Furthermore, postoperative pain, tape erosion/ extrusion, further stress urinary incontinence surgery, and rarely, deep vein thrombosis and injury of inferior epigastric vessels were also reported.Conclusions:Complications of mid-urethral sling are higher than previously thought and it is important to follow up on their long-term outcomes; future research should not neglect to address this issue as a means to improve patient safety.     

Different sling procedures for stress urinary incontinence: A lesson from 453 patients

Several midurethral sling (MUS) procedures, such as tension-free vaginal tape (TVT), TVT obturator (TVT-O), tension-free vaginal tape SECUR (TVT-S), and pubovaginal sling (PVS), have been used for the treatment of female stress urinary incontinence (SUI); however, which method is best for a particular patient group is not known. This study aimed to identify the best rationale for choosing the optimal MUS procedure for each patient. In total, 453 consecutive female patients with SUI who were treated with MUSs in West China Hospital of Sichuan University from September 2003 to September 2011 were enrolled in this study. All the patients underwent comprehensive pre-, intra-, and postoperative evaluations, including collection of demographic information, pelvic examination, and urodynamic testing, and operation-related complications were recorded. The Incontinence Quality of Life questionnaire was also completed. Under local or general anesthesia, 105 cases were treated with TVT, 243 with TVT-O, 90 with TVT-S, and 15 with PVS. Patients with different profiles in terms of age, symptom duration, concomitant procedures, urodynamic parameters, and pelvic organ prolapse (POP) quantification score were treated successfully; the body mass index did not differ significantly among the various treatment options. The cure and improvement rates were similar among the treatment groups: 97.14% (102/105) in TVT, 100% (243/243) in TVT-O, 98.89% (89/90) in TVT-S, and 100% (15/15) in PVS. Only minor complications were experienced by the patients. In conclusion, each MUS procedure was observed to be safe and effective in different subpopulations of patients, and the results suggest that appropriate patient selection is crucial for the success of each MUS procedure.     

盆底超声诊断老年女性压力性尿失禁对膀胱功能的影响

目的探讨不同程度老年女性压力性尿失禁(SUI)盆底超声相关参数,为临床判断SUI程度提供参考。方法选取2016年1月至2018年1月西安交通大学第一附属医院超声科收治的老年女性SUI患者378例,根据SUI严重程度将患者分为轻度组167例,中度组114例,重度组87例,同时选取在本院进行体检的无SUI的健康老年妇女100名作为对照组,均经会阴盆底超声观察静息状态、Valsalva状态下相关盆底参数。采用SPSS 19. 0软件进行统计分析。根据数据类型,组间比较采用方差分析、LSD-t检验或卡方检验。结果 4组受试者基线资料比较差异无统计学意义。静息状态下,与对照组比较,轻、中、重度SUI患者膀胱逼尿肌厚度、膀胱尿道后角及尿道内口漏斗形成率显著增大,膀胱颈与耻骨联合的垂直距离(BN-S)显著减小,差异均有统计学意义(P 0. 05);轻、中、高度SUI患者间上述盆底超声参数比较,差异无统计学意义(P 0. 05)。Valsalva动作下,与对照组比较,轻、中、重度SUI患者膀胱尿道后角、尿道旋转角度、膀胱颈移动度及尿道内口漏斗形成率显著增大,BN-S显著减小,差异有统计学意义(P 0. 05);随SUI程度加重,膀胱颈移动度明显增加,轻、中、重度组患者两两比较,差异均有统计学意义[(25. 18±3. 82) vs (29. 80±3. 78) vs (33. 13±3. 60) mm,P 0. 05]。结论经盆底超声可观察出老年女性SUI患者盆底结构与健康人群的不同,且不同程度SUI患者膀胱颈移动度不同,对SUI程度判断有参考意义。     

Efficacy and safety of moxibustion in the treatment of female stress urinary incontinence: A protocol for systematic review and meta-analysis

Background:Stress urinary incontinence (SUI) is one of the common diseases in female urinary system diseases, and the incidence is increasing year by year. Moxibustion therapy, as a kind of acupuncture therapy, has been widely used in the clinical treatment of SUI, but its therapeutic effect and safety have not been scientifically and systematically evaluated. Therefore, the protocol of this systematic review we propose this time is to scientifically evaluate the effectiveness and safety of moxibustion in the treatment of female stress urinary incontinence (FSUI).Methods:The following 8 electronic databases will be searched from establishment to December 2021: PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, VIP Database, Wanfang Database, China Biology Medicine disc. All randomized controlled trials of moxibustion in the treatment of FSUI will be searched in the above electronic databases. Two reviewers will independently complete research selection, data extraction, and research quality evaluation. After screening the studies, the quality of the included studies will be evaluated according to the quality standards specified in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). The primary outcome of included studies is the change from baseline in urine leakage measured by the 1-hour pad test. Secondary outcomes include: the short-form of the International Consultation on Incontinence Questionnaire, the mean 72-hour urinary incontinence episode frequency, self-assessment of the patient''s treatment effect, severity of urinary incontinence, and adverse events. Two reviewers will independently conduct study selection, data extraction, risk of bias assessment, and study quality assessment. And the STATA 14.0 software will be implemented for data synthesis and meta-analysis.Results:The result of this meta-analysis will be submitted to peer-reviewed journals for publication, and a comprehensive review of current evidence will be conducted.Conclusions:The conclusion of this systematic review will provide evidence for judging whether moxibustion is a safer and more effective intervention for female stress urinary incontinence.Trial registration number:The protocol has been registered on INPLASY2021120052.     

Association of impaired respiratory function with urinary incontinence

Background and objective:   This study investigated the relationship between urinary incontinence and respiratory function in middle-aged and older Japanese men.
Methods:   Seven hundred community-dwelling men aged 40 years or above were recruited from community centres and hospital outpatient clinics. The International Consultation on Incontinence Questionnaire-Short Form was administered to ascertain their urinary incontinence status. Standardized spirometric measurements of respiratory function were performed.
Results:   The prevalence of urinary incontinence was 7.6% among the 668 eligible participants (mean age 62.7 years). The 51 men who leaked urine had significantly lower FEV₁ and FVC than those who were continent ( P  < 0.01). The adjusted risks of urinary incontinence were 0.67 (95% CI: 0.43–1.04) and 0.63 (95% CI: 0.40–0.98) for the two continuous respiratory function variables (L), respectively.
Conclusion:   The findings indicate an inverse association between urinary incontinence and respiratory function and an additional health burden in lung diseases.     

无张力阴道吊带术-闭孔系统治疗女性压力性尿失禁

目的探讨无张力阴道吊带术-闭孔系统(TVT-O)治疗女性压力性尿失禁(SUI)的疗效和手术安全性.方法对13例SUI患者行TVT-O手术治疗.采用无张力网状吊带,自阴道前壁切口经耻骨前向两侧股部皱襞穿刺,将吊带无张力置于尿道中段.结果手术时间(15±2) min,术中出血量(11±3) ml.术后平均留置导尿管1.2 d,平均住院1.5 d,患者尿失禁症状均消失.随访1～6个月无复发.结论 TVT-O手术治疗SUI简便、安全、有效.     

The effect of age on short-term outcomes after abdominal surgery for pelvic organ prolapse

OBJECTIVES: To compare perioperative morbidity and 1-year outcomes of older and younger women undergoing surgery for pelvic organ prolapse (POP). DESIGN: Prospective ancillary analysis. SETTING: Academic medical centers in National Institutes of Health, National Institute of Child Health and Human Development Colpopexy and Urinary Reduction Study. PARTICIPANTS: Women with POP and no symptoms of stress incontinence. INTERVENTION: Abdominal sacrocolpopexy with randomization to receive Burch colposuspension for treatment of possible occult incontinence or not. MEASUREMENTS: Perioperative complications and Pelvic Organ Prolapse Quantification and quality-of-life (QOL) questionnaires (Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Medical Outcomes Study Short-Form Health Survey (SF-36) preoperatively, immediately postoperatively, and 6 weeks and 3 and 12 months postoperatively). RESULTS: Three hundred twenty-two women aged 31 to 82 (21% aged > or =70), 93% white. Older women had higher baseline comorbidity (P<.001) and more severe POP (P=.003). Controlling for prolapse stage and whether Burch was performed, there were no age differences in complication rates. Older women had longer hospital stays (3.1+/-1.0 vs 2.7+/-1.5 days, P=.02) and higher prevalence of incontinence at 6 weeks (54.7% vs 37.2%, P=.005). At 3 and 12 months, there were no differences in self-reported incontinence, stress testing for incontinence, or prolapse stage. Improvements from baseline were significant on all QOL measures but with no age differences. CONCLUSION: Outcomes of prolapse surgery were comparable between older and younger women except that older women had slightly longer hospital stays.