Nonsurgical Transurethral Collagen Denaturation for Stress Urinary Incontinence in Women: 12-Month Results from a Prospective Long-term Study

Study ObjectiveTo assess efficacy of nonsurgical transurethral collagen denaturation (Renessa) in women with stress urinary incontinence (SUI) caused by bladder outlet hypermobility.DesignContinuing, prospective, 36-month, open-label, single-arm clinical trial. Twelve-month results from intent-to-treat (ITT) analysis are reported. Canadian Task Force classification II-2.SettingThirteen physician offices or ambulatory treatment centers.PatientsWomen with SUI secondary to bladder outlet hypermobility for 12 months or longer who failed earlier conservative treatment and had not received earlier surgical or bulking agent therapy.InterventionsWomen were treated as outpatients and received an oral antibiotic and local periurethral anesthesia before undergoing treatment with transurethral radiofrequency collagen denaturation.Measurements and Main ResultsVoiding diaries and in-office stress pad weight tests yield objective assessments. Subjective measures include the Incontinence Quality of Life (I-QOL), Urogenital Distress Inventory (UDI-6), and Patient Global Impression of Improvement (PGI-I) instruments. In total, 136 women received treatment (ITT population). Patients experienced significant reductions versus baseline in median number of leaks caused by activity/day and activity/week (p <.0026 for both), with 50% of patients reporting 50% or more reduction. Pad weight tests revealed that 69% of women had 50% or more reduction in leakage (median reduction 15.2 g; p <.0001); 45% were dry (29% no leaks; 16% < 1-g leakage). Significant improvements occurred in median scores on the I-QOL (+9.5 [range –66.0 to 91.0]; p <.0001) and mean scores on the UDI-6 (–14.1 ± 24.7; p <.0001). Furthermore, 71.2% showed I-QOL score improvement, including 50.3% with 10-point or greater improvement, and 49.6% reported on the PGI-I that they were “a little,” “much,” or “very much” better.ConclusionAt 12 months, treatment of SUI with nonsurgical transurethral collagen denaturation resulted in significant improvements in activity-related leaks and quality of life.     

Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: A Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies

BackgroundStress urinary incontinence (SUI) is a common, distressing health issue which affects many women. Mid-urethral sling (MUS) surgeries are recommended as gold standard interventions, although evidence regarding their impact on female sexual function remains controversial.AimTo provide high-quality evidence of the impact of MUS surgeries on sexual functions in women with SUI.MethodsA systematic search of PubMed, Embase, and the Cochrane Library was conducted to identify studies assessing the effect of MUS treatments on sexual functions in women with SUI. The included studies were prospective randomized or non-randomized trials which assessed patients using 2 validated questionnaires, the Female Sexual Function Index (FSFI) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Pre- and postoperative data regarding sexual function were extracted. Meta-analysis of comparable data was performed using Review Manager (version 5.3) software.Main outcome measuresThe relationship between MUS interventions and sexual functions was analyzed by pooling weighted mean differences (WMD) with 95% CI from studies which used either the FSFI or PISQ-12 questionnaires, before and after receiving surgical interventions.ResultsOf the 22 eligible studies, 13 utilized FSFI and 9 adopted the PISQ-12. Pooled analysis indicates that 6-month postoperative PISQ-12 scores were significantly higher than preoperative scores (WMD −3.31 points; 95% CI −5.32 to −1.30; P = .001). Similar results were found at the 12-month juncture (WMD −3.30 points; 95% CI −6.01 to −0.58; P = .02) and at 24 months (WMD −4.44 points; 95% CI −5.45 to −3.44; P < .00001). Likewise, pooled postoperative FSFI total scores were significantly higher than preoperative scores at 6 months (WMD −2.22 points; 95% CI −3.36 to −1.08; P = .00001) and 12 months (WMD −3.49 points; 95% CI −5.96 to −1.02; P = .006). Postoperative FSFI sub-scores also suggest that desire, arousal, orgasm, lubrication, satisfaction, and pain during sexual intercourse significantly improved postoperatively (all P < .05). Moreover, combined evidence highlighted a significant reduction in coital incontinence postoperatively (risk ratio 5.78; 95% CI 3.16–10.58; P < .00001).Clinical ImplicationsThese assessment tools might be more appropriately used to create opportunities for counseling.Strengths & LimitationsWe encountered substantial heterogeneity and insufficient long term follow-up data. There is also a distinct lack of standards, in terms of data recording and reporting across this evidence base which adds to the problems with the PISQ-12 and FSFI which, even though validated, appear unsophisticated and not necessarily fit-for-purpose.ConclusionThis meta-analysis confirms that sexual functions do improve after MUS surgeries for women with SUI.Lai S, Diao T, Zhang W, et al. Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: A Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies. J Sex Med 2020;17:1956–1970.     

Validation of a Chinese Version of the Short Form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire

IntroductionSexual dysfunction is prevalent in women with pelvic organ prolapse and/or urinary incontinence. An instrument is needed to assess sexual function in urogynecologic patients who speak Chinese.AimTo evaluate the reliability and validity of a Chinese translation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in urogynecologic patients in Taiwan.MethodsAfter a pilot study showing good test–retest reliability and internal consistency of the Chinese PISQ-12, 120 urogynecological patients and 63 normal women were recruited. All participants underwent the Pelvic Organ Prolapse Quantification (POP-Q) system and urodynamic assessment. They each completed the Chinese PISQ-12 and the short form of Incontinence Impact Questionnaire (IIQ-7).Main Outcome MeasuresPISQ-12, POP-Q system and IIQ-7 scores were compared between the urogynecologic patients and normal controls.ResultsThe test–retest reliability and internal consistency of the Chinese PISQ-12 total score (Pearson correlation coefficient r = 0.939, Cronbach's alpha = 0.892, respectively) and of each of its three domains were excellent. The mean total PISQ-12 score and mean scores in each domain indicated significantly worse sexual dysfunction in the urogynecologic group as compared with the control group were correlated with the severity of prolapse and distress caused by incontinence.ConclusionThis Chinese translation of the PISQ-12 is a reliable, consistent and valid instrument to evaluate sexual function in Taiwanese women with pelvic organ prolapse and/or urinary incontinence. Su T-H, and Lau H-H. Validation of a Chinese version of the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire.     

Urinary Function after Surgery for Deep Endometriosis: A Prospective Study

Study ObjectiveTo compare urinary function before and after surgery in patients undergoing laparoscopy for deep endometriosis and to measure the rate of postoperative deterioration in urinary function after surgery.DesignProspective questionnaire-based observational cohort study.SettingTertiary university-affiliated hospital.PatientsIncluded were 149 women who underwent surgery for deep endometriosis.InterventionsParticipants completed the international consultation on incontinence female lower urinary tract symptoms long-form questionnaire before surgery and 6 weeks, 6 months, and 12 months after surgery.Measurements and Main ResultsBladder filling, voiding, and urinary incontinence summary scores were compared before and after surgery with mixed-effects linear regression analysis (correlated observations). Individual domains comprising the summary scores and their bother scores were also compared before and after surgery. Filling score at 6 weeks (3.7 ± 2.6), 6 months (3.2 ± 2.2), and 12 months (3.4 ± 2.2) improved from presurgery scores (4.2 ± 2.6) (p-value for the difference between before and after surgery: p <.001, p = .009, and p = .02 for 6 weeks, 6 months, and 12 months, respectively). No change was observed after surgery in bladder voiding score. Incontinence score improved at 6 weeks after surgery (presurgery and 6-week scores: 2.5 ± 3.3 and 1.6 ± 2.2, respectively, p <.001) but not thereafter. Patients with low preoperative summary scores had higher summary scores (worse function) after surgery, and patients with high preoperative scores had lower summary scores (improved function) after surgery.ConclusionUrinary function improved after laparoscopy for deep endometriosis. Greatest improvement was found in patients with worse preoperative function, whereas postoperative deterioration in urinary function was found for patients with initially normal function. More research is needed to better identify the subpopulations in whom surgical intervention provides symptomatic benefit or deterioration.     

Sexual Function Following Treatment for Stress Urinary Incontinence With Bulk Injection Therapy and Mid-Urethral Sling Surgery

BackgroundPeri-urethral bulking injections (PBI) gain popularity for the treatment of stress urinary incontinence (SUI), but – in contrast to mid-urethral sling (MUS) surgery – little is known about its impact on sexual function.MethodsThis was a secondary analysis of a prospective cohort study that included patients with moderate to severe SUI undergoing either MUS surgery or PBI with polydimethylsiloxane Urolastic (PDMS-U). The validated Dutch and English version of the ‘Pelvic Organ Prolapse and/or Urinary Incontinence Sexual Function Questionnaire – IUGA Revised’ (PISQ-IR) was used to assess sexual function at baseline, at 6 and 12 months of follow-up. For between-group analysis, differences in baseline characteristics were corrected using multivariate analysis of covariance.OutcomesThe primary outcome was the PISQ-IR single summary score of sexually active (SA) women following both procedures, calculated by mean calculation. Secondary outcomes were the PISQ-IR subscale scores of SA and non-sexually active (NSA) women, the proportions of sexual activity and subjective improvement (‘Patient Global Impression of Improvement’ (PGI-I)).ResultsA total of 259 women (MUS: n = 146, PBI: n = 113) were included in this study. The PISQ-IR single summary score of SA women improved following both interventions (in the MUS group from 3.2 to 3.4 and in the PBI group from 3.0 to 3.3 after 12 months). After correcting for differences in baseline characteristics, the PISQ-IR summary score at 6 and 12 months was similar for both treatment groups. For SA women, condition-specific and condition-impact subscale scores significantly improved following both procedures.Clinical implicationsIn treating SUI, PBI is inferior to MUS surgery. However, there is a need for less invasive strategies, especially for women who are unfit for surgery or have contraindications. Sexual function improves after PBI using PDMS-U, which is relevant for the counselling of women with SUI about available treatment options.Strengths & limitationsStrength: until this study, there was a lack of knowledge about the effects of PBI on sexual function. Limitation: there may be indication bias as we did not perform a randomized controlled trial.ConclusionPBI using PMDS-U and MUS surgery for the treatment of SUI improve sexual function equally in SA women, mainly by decreasing the condition's impact on sexual activity and quality.Latul YP, Casteleijn FM, Zwolsman SE, et al. Sexual Function Following Treatment for Stress Urinary Incontinence With Bulk Injection Therapy and Mid-Urethral Sling Surgery. J Sex Med 2022;19:1116–1123.     

Estudio prospectivo sobre la efectividad de una minibanda suburetral en el tratamiento de la incontinencia urinaria de esfuerzo

Objectives

To assess the efficacy of the tension-free vaginal tape mini-sling (TVT-S) to treat stress urinary incontinence (SUI) in women.

Material and method

We performed a prospective study of 170 patients who underwent TVT-S insertion and who were followed-up for at least 24 months. Both the objective and subjective cure rate were evaluated using clinical examination and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF).

Results

The final number of assessed women was 137. The objective cure rate was 84% and the subjective cure rate was 91.2%. There were 7 complications during the surgery and 5 cases of mesh exposure (3.6%) during the follow-up period.

Conclusions

In our experience, the TVT-S cure rate for SUI is acceptable but is lower than the published cure rate for tension-free transvaginal tape (TVT) and tension-free transvaginal tape obturator (TVT-O).     

Correlation of three validated questionnaires for assessment of outcomes following surgical treatment of stress urinary incontinence in women

Objectives

To assess the correlation between women's responses to the “Patient Global Impression of Improvement” questionnaire (PGI-I) and changes in women's quality of life and sexual function following surgical treatment of stress urinary incontinence (SUI).

Study design

Ancillary analysis of data from a prospective randomised surgical trial: 299 women underwent transobturator tape insertion as a sole procedure and completed the King's Health Questionnaire (KHQ) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) at baseline and at 12-month follow-up in addition to PGI-I at 12 months. Spearman's correlation coefficient was used to evaluate the degree of association between PGI-I responses and the changes in total KHQ and PISQ-12 scores. Kruskal-Wallis tests were performed to compare the 7-point scale PGI-I responses in terms of changes in KHQ and PISQ-12 scores.

Results

There was a significant positive correlation between PGI-I responses and changes in the total KHQ scores (r = 0.48, p < 0.001). The changes in the total KHQ score became larger (i.e., more positive) as the PGI-I responses became more positive. There were statistically significant differences across the PGI-I groups with respect to the changes in total KHQ scores (p < 0.001). “Very much improved/Much improved” responses on PGI-I were associated with median (IQR) improvement in KHQ scores of 46 (32, 60) and 35 (18, 49) points respectively. An 18-point improvement in total KHQ score was required to clearly indicate a “better” response on PGI-I. There was a statistically significant, but weak, positive correlation between PGI-I responses and the changes in the total PISQ-12 score (r = 0.17, p = 0.019).

Conclusion

The Patient Global Impression of Improvement Questionnaire strongly correlates with changes in Kings Health Questionnaire scores following surgery for SUI and can reliably predict improvement and deterioration in women's quality of life.

Condensation

The Patient Global Impression of Improvement Questionnaire strongly correlates with, and can predict changes in, Kings Health Questionnaire scores following surgery for stress urinary incontinence.     

Assessment of Collagen-Coated Anterior Mesh Through Morphology and Clinical Outcomes in Pelvic Reconstructive Surgery for Pelvic Organ Prolapse

Study ObjectiveTo assess the morphologic features of anterior armed transobturator collagen-coated polypropylene mesh and its clinical outcomes in pelvic reconstructive surgery to treat pelvic organ prolapse.DesignEvidence obtained from several timed series with intervention (Canadian Task Force classification II-3).SettingChang Gung Memorial Hospital, Taoyuan, Taiwan, China.PatientsBetween April 2010 and October 2012, 70 patients underwent surgery to treat symptomatic pelvic organ prolapse, stage III/IV according to the POP-Q (Pelvic Organ Quantification System).InterventionAnterior armed transobturator collagen-coated mesh.Measurement and Main Results: Morphologic findings and clinical outcome were measured. Morphologic features were assessed via 2-dimensional introital ultrasonography and Doppler studies. Clinical outcome was measured via subjective and objective outcome. Objective outcome was assessed via the 9-point site-specific staging method of the International Continence Society Pelvic Organ Prolapse Quantification before the operation and at 1-year postoperative follow-up. Subjective outcome was based on 4 validated questionnaires: the 6-item UDI-6 (Urogenital Distress Inventory), the 7-item IIQ-7 (Incontinence Impact Questionnaire), the 6-item POPDI-6 (Pelvic Organ Prolapse Distress Inventory 6), and the 12-item PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire), at baseline and at 12 months after the operation. Data were obtained for 65 patients who underwent the combined surgery and were able to comply with follow-up for >1 year. Ultrasound studies reveal that mesh length tends to shorten and decrease in thickness over the 1-year follow-up. Vagina thickness also was reduced. Neovascularization through the mesh was observed in <8.5% of patients in the first month and at 1 year, and was evident in approximately 83%. The mesh exposure rate was 6.4%. The recorded objective cure was 90.8% (59 of 65 patients), and subjective cure was 89.2% (58 of 65 patients) at mean (SD) follow-up of 19.40 (10.98) months. At 2 years, UDI-6, IIQ-7, and POPDI-6 scores were all significantly decreased (p < .001), whereas the PISQ-12 score was significantly increased (p = .01).ConclusionsUltrasound features suggest that the degeneration of collagen barrier may be longer than expected and that integration of collagen-coated mesh could occur up to 1 year. A substantially good clinical outcome was noted.     

Short Term Impact on Female Sexual Function of Pelvic Floor Reconstruction with the Prolift Procedure

IntroductionThe Prolift system is an effective and safe procedure using mesh reinforcement for vaginal reconstruction of pelvic organ prolapse (POP), but its effect on sexual function is unclear.AimTo evaluate the impact of transvaginal pelvic reconstruction with Prolift on female sexual function at 6 months post‐operatively.MethodsThirty‐three sexually active women who underwent Prolift mesh pelvic floor reconstruction for symptomatic POP were evaluated before and 6 months after surgery. Their sexual function was assessed by using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12) before and after surgery. The quality of life was also evaluated with the short forms of the Urogenital Distress Inventory (UDI‐6) and the Incontinence Impact Questionnaire (IIQ‐7) as a control for efficacy of the procedure. The Pelvic Organ Prolapse Quantification system was used to evaluate the degree of prolapse.Main Outcome MeasuresPISQ‐12 scores at 6 months post‐operatively.ResultsThe total PISQ‐12 score decreased from 29.5 ± 9.0 to 19.3 ± 14.7 (P < 0.001), indicating worsening of sexual function 6 months post‐operatively. The behavioral, physical, and partner‐related domains of PISQ‐12 were each significantly reduced (5.2 ± 3.7 vs. 2.9 ± 3.7, P = 0.016; 15.4 ± 4.7 vs. 10.4 ± 8.6, P = 0.001; 8.9 ± 3.8 vs. 6.4 ± 5.5, P = 0.01, respectively). UDI‐6 and IIQ‐7 scores were significantly improved at the 6‐month follow‐up, as was anatomic recovery. Of the 33 subjects, 24 (73%) had worse sexual function 6 months after the procedure.ConclusionThe Prolift procedure provided an effective anatomic cure of POP, but it had an adverse effect on sexual function at 6 months after surgery. Su TH, Lau HH, Huang WC, Chen SS, Lin TY, Hsieh CH, and Yeh CY. Short term impact on female sexual function of pelvic floor reconstruction with the Prolift procedure.     

Comparison of outcomes after vaginal reconstruction surgery between elderly and younger women

ObjectiveThe objective of this study was to estimate the association of vaginal sacrospinous ligament fixation with anterior-transobturator mesh repair surgery for advanced pelvic organ prolapse in patients of two different age groups.Materials and methodsVaginal sacrospinous ligament fixation with anterior mesh repair as primary prolapse surgery was performed on 225 patients with advanced pelvic organ prolapse (POP-Q ≥ stage III). POP-Q < stage II was objective cure and subjective cure was determined according to feedback of POPDI-6 (Questions 2 and 3). Patients provided responses to UDI-6, IIQ-7, POPDI-6, and PISQ-12 pre- and postsurgery. Outcome measures were observed in cohorts of two age groups (<75 years and ≥75 years).ResultsPostoperative data of 217 patients were available. The cumulative objective cure rates were 93.0% and 92.5% for patients aged ≥75 years and <75 years, respectively, with mean follow-up of 33.93 ± 18.52 months and 36.44 ± 19.34 months respectively. The UDI-6, IIQ-7, POPDI-6, and PISQ-12 scores within each of the two age groups improved significantly after surgery. Comparatively, the POPDI-6 score was better whereas the PISQ-12 score was poorer among patients aged ≥75 years. Older women had significantly more preoperative comorbidities. The operative time, perioperative complications, and length of hospital stay showed no difference between the two groups. The intraoperative blood loss was significantly less in the older group and neither group had mortality.ConclusionThis study showed that adequately optimized older patients undergoing pelvic organ prolapse surgery experienced the same anatomical outcomes, comparable improved quality of life, morbidity, and mortality as their counterparts of younger age.     

Validation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in a Turkish population

Objective

To validate the Turkish translated version of short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12).

Study design

After the test–retest reliability and internal consistency were established in a pilot study, 270 patients were enrolled and general and subscale scores of the questionnaire were calculated. All participants underwent the International Continence Society (ICS) prolapse score (POP-Q) and urodynamic assessment. Main scores and scores of Prolapse Quality of Life questionnaire (PQoL) and Incontinence Impact Questionnaire (IIQ-7) were compared between patients with incontinence ± prolapse and asymptomatic women.

Results

62.24% of the participants showed urodynamic abnormality and/or leakage with or without prolapse. 28.91% had prolapse stage 3 or higher diagnosed by the POP-Q system. PISQ-12 showed a high internal consistency (Cronbach's alpha was 0.89). For test–retest reliability Spearman's rho was 0.72–0.79 for all domains. The mean scores of PISQ-12 were significantly better in asymptomatic women compared with the incontinence ± prolapse group. Sexual function was negatively affected by prolapse and/or incontinence as assessed with PQoL and IIQ-7 questionnaires.

Conclusion

The Turkish translated version of the PISQ-12 is a reliable, consistent and valid instrument to evaluate sexual functioning in women with urinary incontinence and/or pelvic organ prolapse. It is easy to understand that it may be easily administered and self-completed by the women.     

Sexual Function of Women With Deep Endometriosis Before and After Surgery: A Prospective Study

BackgroundDeep endometriosis (DE) may significantly affect women's quality of life. Limited data exists on the effect of surgery on the several domains of sexual function.AimTo prospectively compare various domains of sexual function before and after laparoscopic surgery for DE.MethodsA prospective observational cohort study in a tertiary university-affiliated referral center. Patients with suspected DE who were planned to undergo laparoscopic surgery completed the Female Sexual Function Index questionnaire before surgery. The same questionnaire was completed by the participants 6 weeks, 6 months, and 12 months after surgery. Rate of sexual dysfunction over time was compared using multilevel logistic regression. Summary scores were then compared at each time point to the corresponding score before surgery using multilevel linear regression. Multivariable analysis was performed of potential confounders.OutcomesChange in desire, arousal, orgasm, lubrication, satisfaction and pain summary scores as well as in the full-scale score between before and after surgery.ResultsWe followed 149 patients with surgically confirmed DE. Sexual dysfunction rate as per the full-scale score was 75.5% before surgery and remained over 60% to 12 months after. The full-scale sexual function score improved at 6 (change in score = 2.8 ± 9.5, P = .004) and 12 months (change in score = 2.1 ± 9.9, P = .03). None of the summary scores improved at 6 weeks. Desire score (P < .001), arousal score (P = .02), and pain score (P = .01) improved at 6 months. Desire score (P = .03) and pain score (P = .01) also improved at 12 months, as compared to before surgery. On multivariable multilevel analysis, scores before surgery significantly contributed to the scores after surgery (P < .001).Clinical translationWhile sexual function improved after surgery, dysfunction rate remained substantial. Proper preoperative counseling should address sexual function measures and clinical and research attention should be given to seek ways to further reduce sexual dysfunction.Strengths and limitationsThe main strengths of our study are the prospective design, the relatively long follow-up and the use of a detailed validated questionnaire allowing assessment of a large variety of clinically relevant sexual function domains and scores as well as a full-scale score. Among our limitations are the lower response rate at 12 months and the limited generalizability as this is a single center study.ConclusionSexual function is a major and often under reported domain of quality of life. Further research is needed to identify the specific populations who may improve, not change or experience deterioration in their sexual functioning after surgery.Dior UP, Reddington C, Cheng C, et al. Sexual Function of Women With Deep Endometriosis Before and After Surgery: A Prospective Study. J Sex Med 2022;19:280–289.     

Comparison of the quality of life after nonsurgical radiofrequency energy tissue micro-remodeling in premenopausal and postmenopausal women with moderate-to-severe stress urinary incontinence

OBJECTIVE: This study was undertaken to determine the effect of menopause and hormone replacement therapy (HRT) on incontinence quality of life (I-QOL) score improvement in women with moderate-to-severe stress urinary incontinence (SUI) after nonsurgical, transurethral radiofrequency energy (RF) tissue micro-remodeling. STUDY DESIGN: Retrospective review of prospective, randomized, controlled clinical trial. Women with moderate-to-severe SUI were analyzed by menopausal status and HRT use for 10-point or greater I-QOL score improvement (an increase associated with subjective and objective SUI improvement). RESULTS: RF micro-remodeling resulted in 81% of subjects achieving 10-point or greater I-QOL score improvement versus 49% of sham subjects at 12 months ( P = .04). Outcomes did not differ statistically when premenopausal (85%), postmenopausal using HRT (70%), and postmenopausal not using HRT (71%) groups were compared. CONCLUSION: Menopausal status and HRT demonstrated no impact on the quality of life improvement experienced by women with moderate-to-severe SUI who underwent RF tissue micro-remodeling.     

Urinary and psychological outcomes in women with interstitial cystitis/bladder pain syndrome following hyaluronic acid treatment

Objective

To investigate urinary and psychological symptoms in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) after intravesical hyaluronic acid (HA) treatment.

Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence,risk factors and impact on quality of life in Taiwanese women: An observational cohort study

Objective

The study was to investigate the prevalence and risk factors of stress urinary incontinence (SUI) and its impact on the quality of life during pregnancy and 12 months after delivery.

Severe pelvic organ prolapse treated by vaginal native tissue repair: long-term analysis of outcomes in 146 patients

Aims

The aim of this study was to assess the effectiveness and safety of vaginal native tissue repair (VNTR) as a surgical treatment for severe pelvic organ prolapse (POP) and, second, to evaluate the impact on the quality-of-life (QoL) and sexual function.

Methods

Women with symptomatic POP (≥III stage according to POP Quantification System) with or without stress urinary incontinence (SUI) underwent VNTR. The clinical stage, 3-day voiding diary, and urodynamic testing were evaluated in the preoperative and postoperative times, respectively. The International Consultation on Incontinence Questionnaire–Urinary Incontinence Questionnaire Short Form (ICIQ–UI SF), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12), and the prolapse quality-of-life questionnaire (P-QoL) were administered.

Results

One hundred forty-six patients were recruited. The median follow-up was 48 months (36–63). Fifty-two women (36%) had a previous hysterectomy, and 16 (11%) had a previous prolapse/continence surgery. Preoperatively, 135 (92.5%), 109 (74.7%), and 98 (67.1%) patients had anterior, central, and posterior descent ≥III stage, respectively. Thirty-two patients (22%) had concomitant diagnosis of SUI. Median operative time was 85 min (37–154), and median postoperative hospital stay was 2 days (2–4). No intraoperative severe complications occurred. At the long-term follow-up, the subjective cure rate for prolapse was 97.3% and the objective cure rate was 91.1%. A significant improvement of ICIQ-UI SF, the P-QoL, and the PISQ-12 was recorded at the follow-up (p?<?0.001).

Conclusion

VNTR is effective, safe, and durable and improves POP-related symptoms and sexual function.

     

Bladder pain syndrome associated with highest impact on sexual function among women with lower urinary tract symptoms

ObjectiveTo investigate the differential impact of lower urinary tract symptoms (LUTS) on female sexual function (FSF).MethodsIn a cross-sectional study in Agostino Gemelli Hospital, Rome, Italy, 188 sexually active patients with LUTS, as assessed by self-reported questionnaires, underwent comprehensive urologic and urodynamic examination between January 2008 and December 2010. Patients with urinary incontinence, voiding-phase LUTS, overactive bladder (OAB), and bladder pain syndrome (BPS) were included. FSF was assessed by PISQ-12 questionnaire, and scores (0–100; higher scores indicate worse FSF) were compared between the patients and a group of age-matched women without LUTS. PISQ-12 scores of different clinical and urodynamic patient subgroups were also compared by multivariate analysis.ResultsThe global PISQ-12 mean score was significantly higher among patients with LUTS (32.7) than among controls (18.4; P < 0.0001). Women with BPS reported the highest global PISQ-12 score (46.1), followed by those with urodynamic detrusor overactivity (45.0), clinical urgency (41.4), mixed (37.7) and stress urinary incontinence (28.1), dry OAB (22.2) and voiding-phase LUTS (19.6). Age, urinary incontinence, BPS, and detrusor overactivity were independent predictors of FSF.ConclusionBPS was associated with the greatest impairment of FSF among women with LUTS. Clinical and urodynamic urgency-type urinary incontinence affected FSF more markedly than other types.     

Is the Deep Endometriosis or the Surgery the Cause of Postoperative Bladder Dysfunction?

Study ObjectiveTo assess whether deep endometriosis surgery affects the bladder function.DesignProspective multicenter observational study (Canadian Task Force classification II-2).SettingAcademic research centers.PatientsThirty-two patients with diagnosis of deep endometriosis requiring surgery.InterventionsWomen were evaluated with urodynamic studies, International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form, and International Consultation on Incontinence Questionnaire Overactive Bladder Module questionnaires before and 3 months after surgery.Measurements and Main ResultsThe main outcome measure was the impact of deep endometriosis surgery on urodynamic parameters. All cystomanometric parameters showed an improvement postoperatively: in particular, the first desire to void (120 vs 204 mL; p <.001) and the bladder capacity (358 vs 409 mL; p = .011) increased significantly after surgery. Of the uroflow parameters, the maximal voiding flow improved significantly postoperatively (19 vs 25 mL/s; p = .026). The International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (2.5 vs 0; p = .0005) and International Consultation on Incontinence Questionnaire Overactive Bladder Module (4.3 vs 1.2; p <.001) questionnaires showed a significant postoperative improvement too.ConclusionOur data show that in a selected population of patients with deep infiltrating endometriosis (not requiring bowel or ureteral resection), the bladder function improves after surgery, both during filling and on voiding urodynamic phases. Postoperatively, patients with deep infiltrating endometriosis become aware of bladder filling later, have a higher bladder capacity, and have a higher maximal flow. The postoperative urodynamic results are corroborated by the improved scores on the bladder questionnaires.     

The functional and psychosocial impact of fecal incontinence on women with urinary incontinence

OBJECTIVES: The study was undertaken to determine the impact of fecal incontinence (FI) on functional status and quality of life in women with urinary incontinence (UI). STUDY DESIGN: In 24 months 732 women completed a standardized assessment and questionnaire, including the Short Form (SF)-12 and Incontinence Quality of Life (I-QOL) scores. Analysis of variance was used to compare SF-12 scores between groups defined as having UI, FI, or both UI and FI. I-QOL scores in patients with UI or UI and FI were compared by using the Student t test. RESULTS: Of the 732 patients enrolled, 425 patients had either UI (n = 342, 80%), FI (n = 18, 4%), or both (n = 65, 15%). Greater impairment in physical functioning was seen in the group with UI and FI (38.6; P =.027) compared with the group with UI (42.4). Significant decreases in I-QOL scores were seen for the group with UI and FI compared with those with UI (P <.005). CONCLUSION: Fecal incontinence further reduces the functional status and quality of life of women with urinary incontinence.     

Preliminary Outcomes of the Male Urethral “Mini-Sling”: A Modified Approach to the Andrianne Mini-Jupette Procedure With Penile Prosthesis Placement for Climacturia and Mild Stress Urinary Incontinence

IntroductionPrevious worked showed that the Andrianne Mini-Jupette (AMJ) procedure with inflatable penile prosthesis (IPP) significantly improves climacturia or stress urinary incontinence (SUI) that may accompany erectile dysfunction (ED) after radical prostatectomy. However, with the AMJ procedure, the graft is incorporated into the medial aspect of the corporotomy, thereby requiring a more complex closure. Moreover, in the original report, multiple graft materials were used.AimTo describe our technique for “male urethral mini-sling” (MUMS) with a Virtue sling mesh, which is a modified approach to the AMJ, and to assess early postoperative outcomes.MethodsA retrospective chart review was performed for men who underwent IPP and MUMS placement with a modified Virtue mesh by 2 high-volume prosthetic urologic surgeons using the same technique. After proximal urethral exposure, the MUMS is sutured to the latera corpora over the bulbar urethra, proximal to and separate from the planned corporotomy, with care taken to avoid excessive urethral tension. The IPP is then placed in standard fashion. Changes in patient-reported climacturia and pads per day for SUI were assessed before and after surgery.Results36 men underwent both IPP and MUMS placement between January 2016–October 2018. Mean patient age was 68 years. Etiology for ED and urinary symptoms was prostatectomy alone in 30 of 36 (83%) and prostatectomy plus radiation in 6 of 36 (17%). Preoperative urinary symptoms included climacturia in 30 of 36 (83%) and SUI in 27 of 36 (75%). Mean (SD) follow-up was 5.9 (3.7) months. Climacturia resolved in 28 of 30 (93%), and SUI improved in 23 of 27 (85%). The mean (SD) number of pads per day for those patients with SUI decreased significantly from 1.4 (1.1) before surgery to 0.4 (0.6) after surgery (P = .02). 1 patient required MUMS explantation for urethral erosion after prolonged postoperative catheterization.Clinical ImplicationsThe MUMS with modified Virtue mesh at the time of IPP placement can be used to treat ED with climacturia or mild SUI after radical prostatectomy.Strengths & LimitationsStrengths include the use of a consistent operative technique with a single graft material by 2 experienced prosthetic urologic surgeons. Limitations include the retrospective study design, use of subjective postoperative outcomes, lack of comparison group, and relatively moderate follow-up duration.ConclusionsOur early results suggest that the MUMS significantly improves bothersome climacturia and mild SUI in addition to treating ED, with little added morbidity. Although further study, including longer-term follow-up, is needed, this approach may be considered in the appropriately counseled patient.Valenzuela RJ, Ziegelmann MJ, Hillelsohn JH, et al. Preliminary Outcomes of the Male Urethral “Mini-Sling”: A Modified Approach to the Andrianne Mini-Jupette Procedure With Penile Prosthesis Placement for Climacturia and Mild Stress Urinary Incontinence. J Sex Med 2019;16:1310–1317.