Change in urinary storage symptoms following treatment for female stress urinary incontinence

Introduction and hypothesis

Sling surgery is common for stress urinary incontinence (SUI). Yet many women have stress-predominant mixed urinary incontinence (MUI). The change in urgency/urge urinary incontinence (U/UUI) following treatment is not well documented. Our aim was to assess changes in U/UUI in women undergoing a sling placement for MUI and correlate this with improvement in quality of life (QOL).

Methods

This was a retrospective review of women treated for SUI with either an autologous rectus fascia pubovaginal sling (AF-PVS) or synthetic retropubic midurethral sling (MUS). Validated questionnaires—Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire–Short Form (IIQ-7), and visual analog scale (VAS) were obtained pre- and postoperatively. The independent association between change in storage symptoms and subjective cure—as defined by improved overall score on UDI-6, VAS score?≥?7, or both —were assessed using multivariate logistic regression.

Results

Nine hundred and twenty-seven women were identified for inclusion; 718 (77.5 %) had preoperative MUI, of whom 487 (67.8 %) received an MUS and 231 (32.2 %) an AF-PVS. Similar objective cure rates were noted following MUS vs. AF-PVS (78.2 % vs. 71.9 %, p?=?0.315). Subjectively, women treated with MUS experienced greater improvement in U/UUI (72.8 % vs. 57.6 %, p?=?<0.001) than AF-PVS. Multivariate analysis showed MUS patients were more than twice as likely to show subjective improvement in UDI-6 and VAS scores than the AF-PVS cohort. Postoperatively, validated questionnaires were significantly associated with storage symptom outcome.

Conclusions

Patients with U/UUI experience significant symptom improvement following treatment for MUI. QoL assessment following surgery is directly correlated with improvement in U/UUI.

     

Hip dysfunction‐related urinary incontinence: A prospective analysis of 189 female patients undergoing total hip arthroplasty

Patients reporting that their symptoms of urinary incontinence have decreased after total hip arthroplasty can be encountered in orthopedic practice. In this questionnaire‐based study, we prospectively evaluated the symptoms of urinary incontinence before and after total hip arthroplasty. The International Consultation on Incontinence Questionnaire‐Short Form was used to prospectively evaluate these symptoms in 189 consecutive female patients undergoing total hip arthroplasty. The patients were asked to fill in a questionnaire before and 3 months after surgery. A decrease in the International Consultation on Incontinence Questionnaire‐Short Form score of ≥1 point was defined as an improvement, whereas an increase of ≥1 point was defined as worsening. A total of 81 (43%) patients reported urinary incontinence before total hip arthroplasty. At 3 months after surgery, symptoms of urinary incontinence were improved in 64% of these patients, remained unchanged in 32% and worsened in 4%. Mean International Consultation on Incontinence Questionnaire‐Short Form score in patients with urinary incontinence before surgery significantly improved from 6.0 to 3.5 (P = 0.0002). These findings suggest a relationship between hip joint function and pelvic floor function, and consequently a hip dysfunction‐related urinary incontinence.     

Instability following total hip arthroplasty

Dislocation is the second most common complication of total hip arthroplasty. Most dislocations occur early in the postoperative period and are caused by patient factors, surgical factors, or a combination of both. Patient factors that predispose to postoperative dislocation include previous surgery and neurologic impairment. Surgical factors include surgical approach, component orientation, and prosthetic and/or bony impingement. Evaluation of patients undergoing total hip arthroplasty requires a thorough history and physical examination, as well as a detailed radiographic assessment. Closed treatment of instability is successful in two thirds of cases; the remainder require surgical management. Surgical techniques used to treat or minimize risk of further dislocation include revision arthroplasty, trochanteric advancement, use of elevated rim liners, and use of constrained liners.     

Rhabdomyolysis following total hip arthroplasty

We report six cases of contralateral limb involvement during total hip arthroplasty including swelling of the gluteal muscle compartments, rhabdomyolysis, myoglobinuria, and sciatic nerve palsy. The risk factors for such complications include obesity, prolonged operative time, and positioning in the lateral decubitus position. The laboratory and clinical findings are consistent with a gluteal muscle crush-injury with consequent compartment syndrome. The patients should be treated conservatively as symptoms can be expected to resolve.     

Dislocation following total hip arthroplasty

Summary The rate of postoperative dislocation after Stanmore total hip arthroplasty in 427 cases was 4.9%; 1.4% were classified as recurrent cases. Retroversion of the acetabular component and postoperative joint laxity were the only factors that were found to predispose to dislocation. The importance of preserving the effective femoral neck length during total hip arthroplasty is emphasized.

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Zusammenfassung Die postoperative Luxationsrate nach Implantation einer Stanmore-Hüftgelenk-Totalprothese betrug in 427 Fällen 4,9%, wovon 1,4% wiederkehrende Luxationen darstellten. Eine Retroversion der Prothesenpfanne and eine postoperative Weichteillaxität im Hüftgelenkbereich waren die einzigen Faktoren, die als pradisponierend für eine Luxation ermittelt wurden. Auf die Bedeutung der Erhaltung der effektiven Schenkelhalslänge bei der Implantation einer Totalprothese wird besonders hingewiesen.

     

Dislocation following total hip arthroplasty

The rate of postoperative dislocation after Stanmore total hip arthroplasty in 427 cases was 4.9%; 1.4% were classified as recurrent cases. Retroversion of the acetabular component and postoperative joint laxity were the only factors that were found to predispose to dislocation. The importance of preserving the effective femoral neck length during total hip arthroplasty is emphasized.     

Prospective study of porous-coated anatomic total hip arthroplasty

Seventy-five uncemented porous-coated total hip prostheses were implanted in 64 patients. The results were reviewed after a mean follow-up period of 47 months (range, 40-64 months). The mean preoperative rating was fair, and the mean postoperative rating was excellent. There were six dislocations. Ten patients had mild thigh pain at one year; by two years, the pain had resolved in six patients. Neither moderate nor severe limp nor significant loosening of beads was observed. Only one patient had progressive radiolucent lines. The high rate of dislocation may be related to a compromise of acetabular position to obtain bony fixation in acetabula early in the series. The clinical results were encouraging.     

Dislocation following revision total hip arthroplasty

Dislocation is a relatively common complication following revision total hip arthroplasty. Risk factors include surgical approach, gender, underlying diagnosis, comorbidities, surgical experience, and previous surgery; for later dislocations, risk factors include wear/deformation of polyethylene, trauma, and decreased muscle strength. Prevention and precaution are the watchwords for dislocations following revision total hip arthroplasty. For dislocations that do occur, treatment rests first on identifying the source of instability. Most dislocations can be managed by closed reduction. Constrained components may increase success rates, but only for appropriate indications. Prevention and treatment of dislocations following revision total hip arthroplasty are discussed in this article.     

Deep infection following total hip arthroplasty

Deep sepsis is a serious postoperative complication of total hip arthroplasty, causing additional suffering, loss of function, need for additional treatment, and possibly early death. In a series of sixteen patients, the only effective treatment was complete extirpation of all implants combined with appropriate long-term administration of antibiotics. In fifteen patients the original operative objectives were not achieved.     

Resection arthroplasty following infected total hip replacement arthroplasty

Thirty-nine patients with 41 hips with resection arthroplasty for infected total hip replacement arthroplasty were evaluated for functional level and factors that contribute to that level. Eighty-three percent were either minimal community ambulators or nonambulators, and only two patients walked without assistive devices. At last follow-up, 93% of the patients had pain in their hips. The best function was obtained in patients with a healed wound and heterotopic ossification. The worst functional result was in patients with chronic drainage. Fifteen of the patients with resection arthroplasties had foot-switch studies to determine gait velocity and single-limb stance time. Ten patients also had oxygen consumption studies performed. The average gait velocity was 35 m/minute (41% of normal). The average oxygen consumption was 0.41 ml/gm (264% normal) with an average heart rate of 121. The energy consumption was greater than that recorded in patients with above-knee amputation.     

Fragility fracture following total hip arthroplasty

BackgroundWhile periprosthetic fractures following total hip arthroplasty (THA) are a well-known phenomenon for orthopedic surgeons, fragility fractures following THA are also a significant, though less studied, concern. Furthermore, patients who have undergone THA have several additional risk factors for fragility fractures, including motor weakness, bone atrophy, and limping. The aims of this study were to evaluate the incidence of fragility fractures following THA and to clarify the characteristics of these fractures.MethodsThis study included 5678 primary THA procedures in 4589 female patients. This study evaluated body morphology data, disease type leading to THA, Japanese Orthopaedic Association hip score, range of motion of the hip joint, and medical history. Distal radius and patella fractures were defined as fragility fractures. Risk factors for fragility fractures after THA were calculated by comparing the fragility fracture group with the non-fracture group.ResultsFifty-three fragility fractures were confirmed in 53 patients (distal radius fracture: 32 fractures in 32 patients, patella fracture: 21 fractures in 21 patients). In the univariate analysis, the following eight risk factors for fragility fractures were significantly different between the groups: height, weight, follow-up period, developmental dysplasia of the hip, primary osteoarthritis, abduction before THA, internal rotation before THA, and external rotation before THA. Medical histories were not significantly different between the groups. There was no difference in any study factor and in the time of occurrence between the radius fractures and patella fractures analyzed as fragility fractures.ConclusionsThis study revealed that there are significant preoperative factors of fragility fractures following THA. These factors will serve as useful data for THA treatment strategies, preoperative explanations, and future studies.     

Systemic complications following total hip arthroplasty

Total hip arthroplasty (THA) has stood the test of time in improving the human quality of life. However, there remain associated complications. Although there is a low incidence of complications, the typical complications following THA have been well described in the literature, including infection, dislocation, wear, thromboembolic disorders, and intraoperative fracture. Knowledge of the systemic complications of THA can dramatically affect patient outcomes.     

Peripheral neuropathies following total hip arthroplasty

The authors reviewed the complication records following total hip arthroplasty at their institution between January 1976 and July 1989. Forty-two patients (12 men and 30 women) with 45 neurologic complications were identified following 7,133 consecutive total hip arthroplasties; an incidence rate of 0.63%. The average age of these patients was 58 years (range, 27–81 years). Thirty-four nerve injuries were noted in the lower extremity (0.48% incidence rate) and 11 in the upper extremity (0.15% incidence rate). The majority of patients (64%) with neurologic injury to the upper extremity had the diagnosis of inflammatory arthritis. The common peroneal was most often involved in the lower extremity. The ulnar nerve was most commonly involved in the upper extremity. The pathogenetic factors leading to neurologic injury in the majority of patients were not clearly established. Leg lengthening did not seem to be a major cause. The prognosis of patients with nerve palsy of the upper extremity is favorable compared with injury to the lower extremity. Similarly, the percentage of patients with a permanent neurologic deficit was lower in the primary surgery group (27%) compared with the revision/reoperation group (43%). The overall percentage of permanent nerve palsy was 33%. Female patients, for unclear reasons, appear to have a higher risk for neurologic injury. Also, the risk of neurologic injury following total hip arthroplasty appears to be higher with revisions/reoperations and with an inexperienced surgeon.     

Evaluation of hip pain following cemented total hip arthroplasty

The occurrence of pain following a technically satisfactory cemented total hip arthroplasty is of concern for both the orthopedic surgeon and the patient. In order that the source of the pain be accurately located, a scientific approach is required. We present an algorithm for the evaluation of pain following an apparently satisfactory hip arthroplasty which, if followed, results in the correct diagnosis.     

Complications following surgery for female urinary incontinence

The two competitive methods available for operative treatment of female stress incontinence are the suspension procedures according to Marshall-Marchetti and according to Burch. With respect to continence, equally favorable results are achieved using both dethods. One way of assessing their value is by measuring the complications involved. A report is presented on osteomyelitis of the pubic symphysis in two cases after the Marshall-Marchetti operation and hydronephrosis in one case after the Burch operation. In all three patients, the complications were accompanied by postoperative fever as an early symptom.     

Evaluation of outcomes following total hip arthroplasty

BACKGROUND: Osteoarthritis of the hip, one of the most frequent civilization diseases, causes not only a large physical and psychological stress for the patients but also generates increasing costs of treatment each year. The aim of our study was to evaluate the patients' functioning in the period of 3-12 years after the Zweymüller total hip arthroplasty. MATERIAL AND METHODS: 323 patients, aged 27-83 years, after the primary Zweymüller cementless total hip arthroplasty, operated in the Orthopedics and Traumatology Department of Poznań University of Medical Sciences. The evaluation was based on the Western Ontario and McMaster Universities (WOMAC) questionnaire supported with additional questions concerning the weight, height, dwelling place, education level, occupational activity, additional diseases and other joints problems. RESULTS: The Zweymüller cementless total hip arthroplasty is characterized by a good stability in 97.8% of patients during the 3-12 years of postoperational period. Additional problems associated with any unoperated lower limb joint almost always result in the increase of the WOMAC score. A positive correlation was also noticed between the level of education and the occupational activity after the treatment in patients with similar WOMAC score. No influence of overweight on the postoperative activity occured. Moreover our study revealed a negative correlation between BMI (Body Mass Index--range up to 40) and the WOMAC form. CONCLUSIONS: The functional evaluation of patients after total hip arthroplasty should consider information about other lower limbs joints problems for better objectivity. It should be mentioned that the occupational activity correlates positively with the level of patients education. The obesity cannot be the criteria disqualifying from the operation as it does not influence the activity after the hip replacement.     

Trochanteric union following revision total hip arthroplasty

Ninety-nine patients (106 hips) with a trochanteric osteotomy during revision total hip arthroplasty were evaluated at a minimum of 5 years after surgery. Trochanteric reattachment was done with monofilament cobalt-chromium wires. The influence of the following variables on trochanteric union was examined: a prior trochanteric osteotomy, an existing trochanteric nonunion, trochanteric advancement to the lateral femur, use of vertical (in addition to horizontal) wires through the trochanter, and use of a trochanteric mesh. Overall, union occurred in 92 of the 106 trochanters (87%). Fifty-three of 61 trochanters (86.9%) healed after an initial osteotomy, whereas 34 of 38 (89.5%) healed after a repeat osteotomy. Five of the 7 trochanters with an existing nonunion healed, and 5 of 5 trochanters reattached to a bulk allograft healed. Twenty-nine of 36 trochanters (80.5%) reattached to cancellous bone healed, compared with 58 of 65 (89.2%) that were reattached to the lateral femoral cortex. Ninety percent (83/92) of the trochanters reattached in conjunction with use of a chrome-cobalt mesh healed, compared with 64.3% (9/14) of those without (P < .05). Of the variables studied, only the use of mesh was statistically significant. Osteotomy through a previously healed trochanter, advancement of the trochanter to cortical bone, existing trochanteric nonunion, trochanteric reattachment to a bulk allograft, and lack of vertical wires for fixation did not adversely affect the likelihood of obtaining trochanteric union.     

Distal cortical hypertrophy following total hip arthroplasty

Through a retrospective evaluation of 1,683 consecutive total hip arthroplasties performed exclusively by the senior author, a progressive occurrence of distal cortical hypertrophy of the bone on the medial and/or lateral portion of the femur was noted in 58 hips. All patients with evidence of hypertrophy had age, sex, weight, prosthetic design and alignment, radiolucency, and calcar resorption noted. A control was established by randomly selecting an equal number of patients without distal cortical hypertrophy for direct statistical comparison. It was concluded that hypertrophy following total hip arthroplasty is a result of abnormal stress distribution in the loaded femur and is not an indication of pain or loosening. Women with the stainless steel T-28 prosthesis were the most prone to hypertrophy.