Feasibility and results of mid-urethral sling surgery after transurethral injections for stress urinary incontinence in women

ObjectiveTo assess feasibility and results of mid-urethral sling placement for stress urinary incontinence (SUI) in adult women after transurethral injection therapy failure.Patients and methodsEleven patients were operated on for a mid-urethral sling placement after at least one transurethral injection therapy, from January 2005 to February 2008. Injections were performed for moderate non-daily SUI, or according to patient willingness, or for SUI surgical history. Mean age at the time of surgery was 59.9 years (range: 33 to 84).ResultsMean operative time, including control cystoscopy time during TVT placement, was 26 minutes (20–35). There were no peri-operative complications, nor problems for dissection or tape placement. At a mean follow-up of 9.9 months (5–20), 9/11 (81%) patients were dry with no lower urinary tract disorders.Discussion and conclusionSUI treatment by mid-urethral sling after transurethral injections failure is feasible not bothered by the injected material and effective at short-term.     

Value of ultrasonographic measurement of bladder neck mobility in the management of female stress urinary incontinence

Transvaginal ultrasound is the first line imaging investigation in gynaecology. It was thus introduced for the exploration of female stress urinary incontinence at the beginning of the 1980s. Various techniques and parameters of ultrasound examination have been used for the assessment of bladder neck mobility. The aim of this literature review was to suggest the adequate ultrasound technique to study bladder neck mobility. We reviewed articles indexed in MEDLINE dealing with urogenital ultrasound and published between 1998 and 2008. The bladder-symphysis distance measured by transperineal ultrasound is a reliable and reproductive tool to study female stress urinary incontinence. Despite a lack of standardization of Valsalva manoeuvre, normal bladder neck mobility is estimated between 15 and 20 mm. Furthermore, in case of complications from stress urinary incontinence surgery, ultrasound is considered as the first line imaging test. Perineal ultrasound is an interesting investigation for preoperative assessment of stress urinary incontinence or in case of surgery failure or complications. This suggests the need for wider diffusion of this technique in urogynecology teams.     

Beyond the bladder: management of urinary incontinence in older women

Unlike urinary incontinence (UI) in younger women, UI in older women is usually multifactoral in etiology and involves factors beyond the more common types of lower urinary tract (LUT) pathophysiology associated with UI in younger women. The evaluation and management of UI in older women, therefore, must itself be multifactoral and sometimes multidisciplinary, and encompass an understanding of age-related LUT changes, age-specific LUT pathophysiology, and a broadened, multidimensional concept of continence.     

Bladder neck circulation by Doppler ultrasonography in postmenopausal women with urinary stress incontinence.

OBJECTIVE: To investigate the effect of hormone replacement therapy (HRT) on bladder neck circulation in postmenopausal women with genuine urinary stress incontinence (USI). METHODS: A total of 227 women were enrolled in the study, including 114 postmenopausal women with USI (n = 57) or without USI (n = 57) and 113 premenopausal women with USI (n = 55) or without USI (n = 58). The bladder neck circulation was measured in 31 postmenopausal women with USI and in 12 without USI, all of whom received 0.625 mg conjugated equine estrogen plus 5 mg medroxyprogesterone acetate daily for 6 months. Bladder neck blood flow data detected by perineal color Doppler ultrasonography and weekly urinary diary data were collected before HRT and then 3 and 6 months after beginning HRT. Two-way analysis of variance and repeated measures of variance were used for statistical analysis. Power analysis was done by a two-sided test with a significance level at.05. RESULTS: The pulsatility index (PI) was significantly higher in the postmenopausal than in the premenopausal women. The postmenopausal women with USI had the highest PI level. The presence of USI did not change the PI values in the premenopausal women. After 3 months of HRT, the PI levels decreased significantly (P <.001) in the postmenopausal women with USI. The subjective improvement of USI appeared after 3 months of HRT. CONCLUSION: The blood flow around the bladder neck in women can be measured by perineal color Doppler ultrasonography. Hormone replacement therapy increases the blood flow around the bladder neck in postmenopausal women with USI. The clinical improvement of USI can be seen with HRT after 3 months.     

Changes in sexual function and quality of life after single-incision mid-urethral sling for treatment of female stress urinary incontinence

Objectives

To evaluate the effectiveness and assess the changes in sexual function and quality of life after placement of a single-incision sling for the treatment of female stress urinary incontinence.

Study design

A prospective study of women diagnosed with stress urinary incontinence. The single-incision sling was implanted and patients were followed postoperatively for 6 months. The postoperative rate of continence, complications, changes in sexual function, and patient-reported quality of life were evaluated. Female Sexual Function in sexually active patients was evaluated before and after the single-incision sling procedure using the Female Sexual Function Index. From January 2009 to November 2011, 73 patients were enrolled and underwent the procedure to implant the MiniArc^® or Ajust^® single-incision sling.

Results

Overall, 93.2% of the patients who successfully received a single-incision sling demonstrated total restoration of continence (83.6%) or improved continence (9.6%) at the 6-month postoperative visit. Improvements were seen in the quality of life scores related to global bladder feeling (87.7%) and the Female Sexual Function Index (preoperative score 23.86 ± 5.67 vs postoperative score 27.25 ± 4.66 [P < 0.0001]).

Conclusion

Single-incision sling treatment for stress urinary incontinence led to improvements in continence and sexual function at 6 months of postoperative follow-up.     

Pad test with fixed bladder volume in urinary stress incontinence

A pad-weighing test of urinary stress incontinence during a set program of physical exercises is presented. The test was begun at a fixed bladder volume (75% of maximum capacity) and was repeated once. The duration of the exercises was approx. 15 min. Leakage was greater in the second test, but statistical analysis showed highly significant intraindividual correlation between the two amounts. Degree of leakage was not correlated to subjective assessment of incontinence. The test can be done as part of a routine urodynamic investigation.     

Urodynamic studies before and after retropubic colpo-urethrocystopexy in fertile women with stress urinary incontinence

Summary We compared urodynamic parameters in a group of 30 healthy women of fertile age, before and after primary retropubic colpo-urethrocystopexy carried out to correct genuine stress urinary incontinence. The mean interval between surgical treatment and follow-up was 38.0 (SD 10.2) months. In 26 women, subjectively and objectively cured at follow-up, we found an increase of 5.1 mm in functional length of the urethra (t=4.5;P<0.001), an increase of 12.3 cm H₂O in the urethral closure pressure (t=3.9;P<0.001), and a 22.1% increase in the transmission ratio (t=3.2;P<0.01). However, 9 of these 26 women satisfied with the results of the surgical treatment showed a drop in at least 2 of the parameters studied. In the group of 4 women not satisfied with the results of the surgical treatment we found an improvement in all of the urodynamic parameters studied, similar to those found in the group of satisfied women, though less pronounced. This study indicates that successful surgical treatment of genuine stress urinary incontinence is not related to surgically induced changes in the urodynamic parameters.     

Improvement of sexual function after transobturator tape procedure in women with stress urinary incontinence

Sling procedures are a widely proven treatment for stress urinary incontinence. The aim of this prospective study was to evaluate the effect of the transobturator tape on female sexual functioning. Fifty-four women treated for stress urinary incontinence with transobturator tape filled out self-administered questionnaires on quality of life, urinary incontinence, and sexual function prior to surgery and 6 weeks and 12 months postoperatively. Preoperatively, 40 women (78%) were sexually active. There were no significant postoperative changes regarding frequency of sexual activity, sexual desire, and problems with lubrication or orgasm. Preoperatively, 55% reported urinary leakage during sexual activity and after surgery 6.5%. Sexual satisfaction was significantly improved 6 weeks (p = 0.05) and 12 months (p = 0.03) postoperatively. Pain during or after sexual activity was declined, only one patient reported worsening of pain. The transobturator tape procedure has a positive effect on female sexual functioning by reducing urinary leakage and pain during or after sexual activity. It seems to improve the overall sexual satisfaction. Further research is warranted to support these preliminary findings.     

Sexual function in women before and after suburethral sling operation for stress urinary incontinence: a retrospective questionnaire study

BACKGROUND: The aim of this questionnaire study dealing with women with stress urinary incontinence was to find out what influence incontinence and operation for incontinence in the form of tension-free vaginal tape (TVT) or intravaginal slingplasty operation (IVS) had on the patient's sexuality and if there were any adverse effects on sexuality after the operation. METHODS: Eighty-four patients were operated on from April 1998 to September 2002. A questionnaire was sent to all patients with questions concerning their sexuality before and after the operation. RESULTS: Sixty-seven patients (81%) answered the questionnaire. Before the operation 53 patients (79%) were sexually active and 26 patients (49%) experienced incontinence during intercourse. Only one patient (0.01%) stated the incontinence as the reason for not being sexually active. No patients developed de novo incontinence during intercourse after the operation. Half of the patients who were cured of their incontinence during intercourse experienced a better sexual life. Five patients (7%) cited reduced libido after the operation and two patients (3%) felt the operation to be the cause. CONCLUSION: Among sexually active women with stress urinary incontinence referred for suburethral sling operation 49% experienced incontinence during intercourse and half of the cured patients in this group experienced a better sexual life after the operation. Incontinence affects sexual life to a great extend. Two patients (4%) experienced less libido after the operation and found the operation to be the cause of this. The risk of deterioration of sexual life after the operation is very small. Further investigation into this subject is needed.     

Safety and tolerability of duloxetine in women with stress urinary incontinence

Background  The serotonin/noradrenaline uptake inhibitor duloxetine has been shown to be effective in the medical treatment of stress urinary incontinence (SUI) in women.
Aim  To review the safety and tolerability of duloxetine with SUI.
Methods  A systematic Medline search for the key word 'duloxetine' was performed, and abstracts from recent international gynaecological and urological meetings were also considered.
Results  Various unpleasant adverse effects exist, among which nausea is the most frequent, but is mild to moderate and transient in most cases. Dose escalation upon initiation of treatment improves the tolerability of duloxetine. The use of duloxetine appears safe as it lacks the cardiovascular adverse effects of older amine reuptake inhibitors.
Conclusions  Duloxetine has an acceptable safety profile. Dose escalation combined with patient counselling on the intensity and transient nature of adverse effects may help to further improve the benefit/tolerability ratio of duloxetine in the treatment of SUI.     

Effect of non-ablative laser treatment on overactive bladder symptoms,urinary incontinence and sexual function in women with urodynamic stress incontinence

Objective

To investigate the effects of non-ablative laser treatment on overactive bladder (OAB) syndromes, stress urinary incontinence and sexual function in women with urodynamic stress incontinence (USI).

Surgical treatment of stress urinary incontinence in women

Stress urinary incontinence is a common problem with 13.6% of women requiring surgery for it in their lifetime. Surgical treatments either create suburethral support or augment urethral closure. Colposuspensions and autologous rectus fascial slings are effective first-line surgical options. The use of midurethral tapes is currently suspended due to concerns with chronic pelvic and vaginal pain.     

Surgical treatment of stress urinary incontinence in women

Stress urinary incontinence is a common problem with 13.6% of women requiring surgery for it in their lifetime. Surgical treatments either create suburethral support or augment urethral closure. Colposuspensions and autologous rectus fascial slings are effective first-line surgical options. The use of midurethral tapes is currently suspended due to concerns with chronic pelvic and vaginal pain.