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Abstract Overactive bladder (OAB) is a prevalent condition that substantially impairs quality of life. Obesity and overweight status are recognized as significant risk factors for OAB, but their influence on treatment efficacy is not well understood. This cross-sectional study was conducted from January 2023 to October 2024 at a tertiary care hospital. Women diagnosed with refractory OAB were classified into normal weight, overweight, and obese groups according to their body mass index (BMI). Treatment options included combination pharmaceutical therapy and Botulinum toxin injections. Outcomes were assessed using the Overactive Bladder Symptom Score (OABSS) and quality of life questionnaires, administered before and 12 weeks after treatment. A total of 197 women were included in the study. Normal weight women demonstrated significant improvements in OAB symptoms and quality of life following both combination therapy and Botulinum toxin injection. Conversely, overweight and obese women showed limited improvement with pharmaceutical therapy but responded better to Botulinum toxin injections. The findings suggest that Botulinum toxin injection may be a more effective treatment modality for overweight or obese women with refractory OAB compared to pharmaceutical therapy. Normal weight women might benefit from initiating treatment with combination medication therapy.

Abstracts: Mid urethral sling (MUS) surgery is a widely accepted and safe procedure performed for stress urinary incontinence (SUI) with excellent cure rate besides its minimal complications. There are various types of MUS which can be offered. In this review we collated published data on MUS surgery performed among Taiwanese women with SUI in search for the best techniques and its outcome. We reviewed 77 articles, searched using PubMed platform related to MUS in USI among Taiwanese women from 1998 to 2023.24 articles, total 2733 participants with at least 12 months follow up after MUS. Objective cure rate for trans-obturator tape (TOT), retropubic sling (TVT, tension vaginal tape), single incision sling (SIS) (Solyx) and SIS (MiniArc) are 80%–92%, 88%–94%, 87%–90% and 87%–91% respectively, while subjective cure is 60%–90% in TOT, 86% in SIS (Solyx) and almost 90% in SIS (MiniArc), Predictors for surgical failure analyzed in 5 papers of 1006 women. Identifiable risk includes low maximal urethral closure pressure, intrinsic sphincter deficiency, previous anti SUI or prolapse surgery, presence of neurogenic disease, constipation, decreased bladder sensation, age >65 years, high pad test, Diabetes, detrusor overactivity, post-menopausal, reduced postoperative urethral mobility and tape percentile. Subsequently we dwell into complications of each type of MUS. This review showed the evolution of MUS and its comparable therapeutic efficacy. However, with certain complication rates and predictors for failure. This will add value in preoperative counselling while taking into accounts patients’ factors in choosing the appropriate types of MUS. Future research is needed on long term effectiveness and risk of future recurrence.

ObjectiveIn addition to the well-established advantage that strengthened pelvic musculature increases urethral resistance in stress urinary incontinence (SUI) patients, intra-vaginal electrical stimulation (iVES) has been shown in preclinical studies to improve bladder capacity via the pudendal-hypogastric mechanism. This study investigated whether iVES also benefits bladder storage in SUI patients by focusing on compliance, a viscoelastic parameter critically defining the bladder’s storage function, in a clinical study. Moreover, the potential involvement of stimulation-induced neuromodulation in iVES-modified compliance was investigated by comparing the therapeutic outcomes of SUI patients treated with iVES to those who underwent a trans-obturator tape (TOT) implantation surgery, where a mid-urethral sling was implanted without electric stimulation.Patients and methodsUrodynamic and viscoelastic data were collected from 21 SUI patients treated with a regimen combining iVES and biofeedback-assisted pelvic floor muscle training (iVES-bPFMT; 20-min iVES and 20-min bPFMT sessions, twice per week, for 3 months). This regimen complied with ethical standards. Data from 21 SUI patients who received TOT implantation were retrospectively analyzed. Mean compliance (Cm), infused volume (Vinf), and threshold pressure (Pthr) from the pressure-flow/volume investigations were assessed.ResultsCompared with the pretreatment control, iVES-bPFMT consistently and significantly increased Cm (18/21; 85%, p = 0.017, N = 21) and Vinf (16/21; 76%, p = 0.046; N = 21) but decreased Pthr (16/21; 76%, p = 0.026, N = 21). In contrast, TOT implantation did not result in consistent or significant changes in Cm, Vinf, or Pthr (p = 0.744, p = 0.295, p = 0.651, respectively; all N = 21).ConclusionOur results provide viscoelastic and thermodynamic evidence supporting an additional benefit of iVES-bPFMT to bladder storage in SUI patients by modifying bladder compliance, possibly due to the potentiated hypogastric tone, which did not occur in TOT-treated SUI patients.Clinical trial registration:ClinicalTrials.gov, NCT02185235 and NCT05977231.

Objective: This study is aimed to compare the impact on bladder function and symptoms between robotic sacrocolpopexy (RSC) and transvaginal mesh surgery (TVM) in women with pelvic organ prolapse. Materials and methods: This prospective controlled study enrolled patients who received RSC or TVM at our hospital between March 2020 and June 2022. We compared preoperative and postoperative bladder function between two groups by using a questionnaire of lower urinary tract symptom (LUTs) for subjective assessment and urodynamic study for objective assessment. Results: A total of 60 patients were enrolled, of whom 30 received RSC and 30 received TVM. In LUTs analysis, the RSC group had a higher risk of de novo stress urinary incontinence than the TVM group (33.3% vs. 3.3%, p = .007). Urodynamic studies showed that both groups had a deterioration in maximal urethral closure pressure postoperatively (RSC: 56.9 ± 17.1 vs. 44.2 ± 15.5 cmH2O; and TVM: 61.2 ± 29.4 vs. 47.6 ± 19.7 cmH2O, p

The objective benefit of transvaginal mesh with concomitant total hysterectomy (TVM-HTX) repair to high-grade uterine prolapse (UP) patients has not been fully established. This study aimed to clarify the impact of TVM-HTX on the voiding function of high-grade UP patients by comparing pre- and post-operatively measured pressure–flow and pressure–volume investigations. Urodynamic and thermodynamic studies were conducted on 15 high-grade UP patients (stage III/IV, POP-Q system) who underwent TVM-HTX (January 2019–December 2022) in a tertiary-care university hospital. The parameters analyzed included voiding resistance (Rvod), voiding pressure (Pvod), voiding flow (Fvod), voided volume (Vvod), voiding time (Tvod), and the trajectory-enclosed area of the pressure–volume loop (Apv). Post-operative results showed a significant reduction in Rvod (p < 0.001, N = 15), Pvod (p = 0.021, N = 15), and Apv (p = 0.006, N = 15), along with an increase in Fvod (p = 0.003, N = 15) and a decrease in Tvod (p < 0.001, N = 15). The operation-associated changes in Rvod (ΔRvod) correlated with alterations in Pvod and Fvod (ΔPvod and ΔFvod, r = 0.444, p = 0.004, r = 0.717, p = 0.003, respectively; both N = 15); ΔFvod correlated with the change in Tvod (ΔTvod, r = 0.629, p = 0.012, N = 15) but not with that in ΔVvod (r = 0.166, p = 0.555, N = 15). Changes in Apv (ΔApv) correlated with ΔPvod (r = 0.563, p = 0.029, N = 15) but not with ΔVvod (r = 0.353, p = 0.197, N = 15). Collectively, TVM-HTX reduced the voiding resistance, which improved the voiding efficacy and decreased the pressure gradient required for driving urine flow, thereby lessening the bladder’s workload.