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Background: Transobturator male sling has gained increasing acceptance for the treatment of male urinary incontinence. Several prospective trials have demonstrated the safety and efficacy of the AdVance and AdVanceXP slings., Objective: To evaluate long-term functional outcomes after AdVance or AdVanceXP sling implant for non-neurogenic male stress urinary incontinence and identify factors associated with a higher risk for incontinence or decreased satisfaction., Design, Setting, and Participants: Patients who underwent AdVance or AdVanceXP implant surgery between June 2007 and April 2018 were retrospectively included in this single-institution, consecutive series., Outcome Measurements and Statistical Analysis: In April 2020, patients were recontacted to evaluate long-term functional outcomes and satisfaction by standardized, validated questionnaires., Results and Limitations: A total of 216 patients were included in this study; 172 of them could be contacted for the assessment of long-term patient reported outcomes. The median follow-up period was 49 mo. Overall social continence (ie, needing no more than one pad per 24 h) at 5-yr follow-up was 66% (confidence interval [CI]: 58-73%). In an ideal population (ie, needing no more than four pads per 24 h and naïve for pelvic radiotherapy, prior incontinence surgery, or urethral stricture surgery), 5-yr social continence rates were markedly better and reached 79% (CI: 69-85%). Overall social continence rates tended to decrease at 10-yr follow-up to 42% (CI: 33-52%). Overall, totally dry rate at 5-yr follow-up was 53% (CI: 46-60%), which again was significantly better in the ideal population (62%, CI: 51-70%). According to the Patient Global Improvement Indices score, 71% (CI: 63-78%) of patients indicated to be satisfied after 5 yr, which improved to 77% (CI: 67-85%) in the ideal patient population. In a multivariate analysis, prior pelvic radiotherapy and previous incontinence or urethral stricture surgery were associated with decreased continence rates and patient satisfaction., Conclusions: In general, long-term continence rates and patient satisfaction after AdVance and AdVance XP sling surgery are acceptable but deteriorate significantly as time from surgery progresses. Especially patients with a history of pelvic radiotherapy, prior incontinence surgery, or urethral stricture surgery should be counseled properly about their higher risk for sling failure., Patient Summary: In this report, we investigated long-term outcomes after Advance and AdvanceXP sling implant for male stress urinary incontinence. We found that, in general, continence and patient satisfaction are acceptable but deteriorate significantly as time from surgery progresses. Patients with previous pelvic radiotherapy, incontinence surgery, or urethral stricture surgery are at higher risk for sling failure., (Copyright © 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objectives: To develop and validate a model to predict 12-month continence status after robot-assisted radical prostatectomy (RARP) from preoperative and 3-month postoperative data; this model could help in informing patients on their individualised risk of urinary incontinence (UI) after RP in order to choose the best treatment option., Patients and Methods: Data on 9421 patients in 25 Belgian centres were prospectively collected (2009-2016) in a compulsory regional database. The primary outcome was the prediction of continence status, using the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ-UI-SF) at 12-months after RARP. Linear regression shrinkage was used to assess the association between preoperative 3-month postoperative characteristics and 12-month continence status. This association was visualised using nomograms and an online tool., Results: At 12 months, the mean (sd) score of the ICIQ-UI-SF questionnaire was 4.3 (4.7), threefold higher than the mean preoperative score of 1.4. For the preoperative model, high European Association of Urology risk classification for biochemical recurrence (estimate [Est.] 0.606, se 0.165), postoperative radiotherapy (Est. 1.563, se 0.641), lower preoperative European Organisation for Research and Treatment of Cancer quality of life questionnaire 30-item core (EORCT QLQ-C30)/quality of life (QoL) score (Est. -0.011, se 0.003), higher preoperative ICIQ-UI-SF score (Est 0.214, se 0.018), and older age (Est. 0.058, se 0.009), were associated with a higher 12-month ICIQ-UI-SF score. For the 3-month model, higher preoperative ICIQ-UI-SF score (Est. 0.083, se 0.014), older age (Est. 0.024, se 0.007), lower 3-month EORCT QLQ-C30/QoL score (Est. -0.010, se 0.002) and higher 3-month ICIQ-UI-SF score (Est. 0.562, se 0.009) were associated with a higher 12-month ICIQ-UI-SF score., Conclusions: Our models set the stage for a more accurate counselling of patients. In particular, our preoperative model assesses the risk of UI according to preoperative and early postoperative variables. Our postoperative model can identify patients who most likely would not benefit from conservative treatment and should be counselled on continence surgery., (© 2020 The Authors BJU International © 2020 BJU International Published by John Wiley & Sons Ltd.)

Aims: The Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) are both well-known. In obstetric fistula (OF) repair outcome is usually assessed by the surgical team. The patient perspective is often neglected. Therefore we translated both questionnaires in Lingala and Kikongo, official languages in DR Congo. Secondly used the questionnaires in an OF population to assess the real life continence status and the impact of fistula repair surgery., Methods: UDI-6 and IIQ-7 were translated and underwent content validity checks using focus groups. The final versions were tested in a normal population and in an OF population (33 for Kikongo, 35 for Lingala) for internal consistency and test-retest reliability. The responsiveness was tested in an OF population and effect sizes were calculated., Results: Both questionnaires showed good internal consistency and reliability. The Cronbach's α for UDI-6 in both languages was 0.47 for the IIQ-7, 0.96 for Lingala and 0.94 for Kikongo in an OF population. The test-retest reliability was high in all cohorts. Both questionnaire scores improved significantly after fistula repair. The effect size for UDI-6 was -1.09 and -1.6 for IIQ-7., Conclusion: Both IIQ-7 and UDI-6 questionnaires have been translated in Lingala and Kikongo, two languages of DR Congo. The questionnaires have been validated in an obstetrical fistula population, showing good content validity and test-retest reliability. The questionnaires show a highly significant effect size, demonstrating the dramatic positive effect of fistula surgery on urogenital symptoms and on the quality of live in an obstetric fistula population., (© 2019 Wiley Periodicals, Inc.)

Context: The incidence and awareness of postprostatectomy incontinence (PPI) has increased during the past few years, probably because of an increase in prostate cancer surgery. Many theories have been postulated to explain the pathophysiology of PPI., Objective: The current review scrutinizes various pathophysiologic mechanisms underlying the occurrence of PPI., Evidence Acquisition: A search was conducted on PubMed and EMBASE for publications on PPI. The primary search returned 2518 publications. Animal and basic research studies, letters, publications on prostatectomy for benign reasons, pathology of prostatic carcinoma, radiotherapy and hormone therapy of prostatic carcinoma, and review articles were all used as criteria for exclusion from the study. A total of 128 publications were selected for final analysis., Evidence Synthesis: Neuromuscular anatomic elements and pelvic support are known to influence PPI as evidenced by multiple publications. A number of non-anatomic and surgical elements have been postulated as contributing factors to PPI. Biological factors and preoperative parameters include: functional bladder changes, age, body mass index (BMI), pre-existing lower urinary tract symptoms (LUTS), prostate size, and oncologic factors. Multiple studies reported the impact of specific anatomic/surgical factors, including fibrosis, shorter membranous urethral length (MUL), anastomotic stricture, damage to the neurovascular bundle, and extensive dissection, all of which have a negative impact on the continence status of patients following radical prostatectomy (RP). Investigation of the impact of techniques to spare the bladder neck and additional procedures to reconstruct the posterior or anterior support structures (eg, the Rocco stitch) on continence status is ongoing., Conclusions: Anatomic support and pelvic innervation appear to be important factors in the etiology of PPI. Biological/preoperative factors including greater age at time of surgery, pre-existing LUTS, high BMI, shorter MUL, and functional bladder changes have a negative impact on continence after RP. Extensive dissection during surgery, damage to the neurovascular bundle, and postoperative fibrosis also have a substantial negative impact on the continence status of men undergoing RP. Sparing of the bladder neck and anterior fixation of the bladder-urethra anastomosis are associated with better continence rates. There is still debate about whether posterior pelvic reconstruction leads to better postoperative continence rates., Patient Summary: Radical prostatectomy is an oncologic procedure and thus requires removal of the entire prostate gland and seminal vesicles, ideally with negative surgical margins. This sometimes results in urinary incontinence. The factors contributing to urinary incontinence are explained in this article., (Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Aims: To compare efficacy and safety of two commercially available single incision slings (SIS) and trans-obturator vaginal tapes (TOT), namely MiniArc™ and Monarc™ slings, and report the results at 5-year follow-up., Methods: A retrospective-observational study of prospectively collected data was conducted on 381 women with primary stress urinary incontinence (SUI) in a single tertiary referral center. Patients treated with MiniArc™ and Monarc™ were compared. Data regarding intraoperative and post-operative outcomes were collected and compared. Kaplan-Meier analyses assessed continence rate (CR), objective cure (OC) rate, de novo overactive bladder symptoms (OAB), surgical failure (SF), and erosion free rates at 1-, 3-, and 5-year follow-up. The log-rank test was used to compare efficacy and complication between patients stratified according to the type of surgery., Results: Median follow-up was 60 months. Of 381 patients, 215 (56%) were treated with Monarc™ slings and 166 (44%) with MiniArc™. The two groups were homogeneous in terms of pre-operative characteristics. At 5-year follow-up, no difference was found in CR between Monarc™ and Miniarc™ patients (87% vs. 89%; P = 0.41). Monarc™ showed better OAB free rates (97% vs. 92%; P = 0.012). No significant differences have been found in terms of SF, erosion, and OC rates. These results are limited by their retrospective nature., Conclusions: We demonstrated that the short-term results of MiniArc™, are maintained over time, defining the comparability of the two slings at 5 years in terms of subjective and objective outcomes and complications. Neurourol. Urodynam. 36:803-807, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Aims: To present satisfaction rates after surgical release of obstructive anti-incontinence surgery, to look for predictive factors for outcome and to define the optimal moment to perform the surgical release., Methods: We reviewed the charts of 87 women at first, second, and last follow-up at a median of 2 (0.5-7), 4 (2-12), and 108 (29-156) months after surgical release. Obstruction was defined as urinary retention, straining to void after overcorrected anti-incontinence treatment or urodynamic bladder outlet obstruction. Patients' satisfaction was assessed using a 4 point Likert scale., Results: Satisfaction rates at first, second, and last follow-up were 66% (n = 54/82), 54% (n = 37/69), and 74% (n = 43/58) respectively. Postoperatively, patients complained about overactive bladder (OAB) symptoms in 37% (n = 30/81) and SUI in 28% (n = 23/81) at first follow-up and in 41% (n = 28/68) and 27% (n = 18/68) at second follow-up for OAB symptoms and stress urinary incontinence (SUI) respectively. When surgical release was performed more than 180 days after original surgery, less SUI (P = 0.008) was reported. When performed within 70 days in patients without pre-operative OAB symptoms, less post-operative OAB symptoms (P = 0.05) were reported., Conclusions: Surgical release can be very successful in relieving obstruction due to bladder outlet obstruction (BOO) after anti-incontinence surgery. Persistent OAB symptoms and recurrent SUI are the main reasons for being dissatisfied. To lower the odds for recurrent SUI, surgical release should be performed more than 180 days after original surgery. Patients without pre-operative OAB symptoms are at higher risk of developing post-operative OAB symptoms when treatment is delayed more than 70 days., (© 2014 Wiley Periodicals, Inc.)

The artificial urinary sphincter (AUS) is considered the 'gold standard' in post-prostatectomy urinary incontinence. However, in recent years, male slings have gained much popularity due to the ease of surgery, good functional results and low complications rates. This review systematically shows the evidence for the different sling systems, describes the working mechanism, and compares their efficacy against that of the AUS. Furthermore subgroups of patients are defined who are not suited to undergo sling surgery., (© 2014 The Authors. BJU International © 2014 BJU International Published by John Wiley & Sons Ltd.)

Objective: To report our long-term experience of sacral neuromodulation (SNM) for various lower urinary tract dysfunctions but with a focus on efficacy, safety, re-interventions and degree of success., Patients and Methods: This is a single tertiary referral centre study that included 217 patients (86% female) who received an implantable pulse generator (IPG) (Interstim™, Medtronic, Minneapolis, USA) between 1996 and 2010. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline, but was further stratified., Results: The mean duration of follow-up was 46.88 months. Success and cure rates were ≈70% and 20% for urgency incontinence, 68% and 33% for urgency frequency syndrome and 73% and 58% for idiopathic retention. In those patients with an unsuccessful therapy outcome, the mean time to failure was 24.6 months after implantation. There were 88 (41%) patients who had at least one device or treatment related surgical re-intervention. The re-intervention rate was 1.7 per patient with most of them (47%) occurring ≤2 years of follow-up., Conclusions: SNM appears effective in the long-term with a success rate after definitive IPG implant of ≈70% and complete cure rates ranging between 20% and 58% depending on indication. Patients with idiopathic retention appear to do best. The re-intervention rate is high with most occurring ≤2 years of implantation. It is likely that with the newer techniques used, efficacy and re-intervention rates will improve., (© 2013 The Authors. BJU International © 2013 BJU International.)

Objective: To validate the Bladder Control Self-Assessment Questionnaire (B-SAQ), a short screener to assess lower urinary tract symptoms (LUTS) and overactive bladder (OAB) in men., Patients and Methods: This was a prospective, single-centre study including 211 patients in a urology outpatient setting. All patients completed the B-SAQ and Kings Health Questionnaire (KHQ) before consultation, and the consulting urologist made an independent assessment of LUTS and the need for treatment. The psychometric properties of the B-SAQ were analysed., Results: A total of 98% of respondents completed all items correctly in <5 min. The mean B-SAQ scores were 12 and 3.3, respectively for cases (n = 101) and controls (n = 108) (P < 0.001). Good correlation was evident between the B-SAQ and the KHQ. The agreement percentages between the individual B-SAQ items and the KHQ symptom severity scale were 86, 85, 84 and 79% for frequency, urgency, nocturia and urinary incontinence, respectively. Using a B-SAQ symptom score threshold of ≥4 alone had sensitivity, specificity and positive predictive values for detecting LUTS of 75, 86 and 84%, respectively, with an area under the curve of 0.88; however, in combination with a bother score threshold of ≥1 these values changed to 92, 46 and 86%, respectively., Conclusions: The B-SAQ is an easy and quick valid case-finding tool for LUTS/OAB in men, but appears to be less specific in men than in women. The B-SAQ has the potential to raise awareness of LUTS. Further validation in a community setting is required., (© 2013 The Authors. BJU International © 2013 BJU International.)

Context: The European Association of Urology (EAU) guidelines on urinary incontinence published in March 2012 have been rewritten based on an independent systematic review carried out by the EAU guidelines panel using a sustainable methodology., Objective: We present a short version here of the full guidelines on the surgical treatment of patients with urinary incontinence, with the aim of dissemination to a wider audience., Evidence Acquisition: Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches based on Population, Intervention, Comparator, Outcome (PICO) questions. The appraisal of papers was carried out by an international panel of experts, who also collaborated in a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system., Evidence Summary: The full version of the guidance is available online (www.uroweb.org/guidelines/online-guidelines/). The guidance includes algorithms that refer the reader back to the supporting evidence and have greater accessibility in daily clinical practice. Two original meta-analyses were carried out specifically for these guidelines and are included in this report., Conclusions: These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where high-level evidence is lacking, they present a consensus of expert panel opinion., (Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Context: The previous European Association of Urology (EAU) guidelines on urinary incontinence comprised a summary of sections of the 2009 International Consultation on Incontinence. A decision was made in 2010 to rewrite these guidelines based on an independent systematic review carried out by the EAU guidelines panel, using a sustainable methodology., Objective: We present a short version of the full guidelines on assessment, diagnosis, and nonsurgical treatment of urinary incontinence, with the aim of increasing their dissemination., Evidence Acquisition: Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches, based on Population, Intervention, Comparator, Outcome questions. Appraisal of papers was carried out by an international panel of experts, who also collaborated on a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system., Evidence Summary: The full version of the guidelines is available online (http://www.uroweb.org/guidelines/online-guidelines/). The guidelines include algorithms that refer the reader back to the supporting evidence, and they are more immediately useable in daily clinical practice., Conclusions: These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where such evidence does not exist, they present a consensus of expert opinion., (Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Autonomous contractile activity (ACA) is a well-known phenomenon in isolated bladders from different species and seems to be important in the physiology of both normal and dysfunctional voiding., Objective: To determine whether ACA is changed in bladders from paraplegic rats at different periods post-spinal cord injury (post-SCI)., Design, Setting, and Participants: ACA was studied in bladders (at least six per group) from normal and paraplegic female Wister rats at different times post-SCI (2 h, 24 h, 1 wk, and 3 wk). A group of normal rats was used as a control group. For measurements bladders were incubated in organ baths under standardised conditions., Measurements: ACA was measured as pressure change, which was defined as either a transient change or a spiked change according to its characteristics. The effects of intravesical volume load and muscarinic agonists were studied., Results and Limitations: Following spinal cord injury (SCI) a clear evolution in ACA was observed. In bladders from SCI rats in the acute areflexive voiding phase (1 wk post-SCI), we observed decreased ACA associated with a highly increased compliance and a changed response to muscarinic agonists. ACA in bladders from SCI rats with renewed voiding reflexes (3 wk post-SCI) was increased, together with a moderately increased compliance and a (moderately) changed response to muscarinic agonists., Conclusions: From these observations it is apparent that SCI leads to alterations in the behaviour and muscarinic response of ACA in the isolated bladder. These changes in ACA may play an important role in the pathophysiology of overactive bladder disease (OAB), and interacting with changed ACA might be promising in the search for newer treatments for OAB.

The overactive bladder symptom complex (OAB) is the commonest cause of urinary incontinence in older people, and is usually due to underlying detrusor overactivity, and as such is a treatable condition. Older people are a heterogeneous group, which includes fit community-dwelling individuals and those with significant medical comorbidity; thus the requirements of care for this group are many and varied. The International Continence Society definition of the frail elderly, those aged >65 years with continence problems, who by virtue of comorbidity are house-bound or living in an institution, is clearly not applicable to all. However, many conditions begin to appear in later life and practitioners need to be aware of the need to manage these, and their treatment, when dealing with older people. Studies of medication for OAB have included the elderly and there is evidence of an equivalent benefit in younger people. The impact of treatment on the cognitively impaired and those receiving acetylcholinesterase inhibitors is discussed.

Objectives: To assess the intra/inter‐observer reliability of cystoscopic sphincter evaluation (CSE) in men undergoing sling surgery for urinary incontinence and if possible to evaluate its correlation with the final clinical decision. Patients and methods: Two expert urologists prospectively filmed and recorded, incontinent patient's cystoscopies according to a standard scenario. Anonymised recordings where randomly offered to the same observer twice. The observers (medical students, urology residents and full urologist with 0–5, 5–10, >10 years of practice, respectively) were asked to assess and score the recordings without knowing any of the patients' characteristics. Results: In total, 37 recordings were scored twice by the 26 observers. The intraclass correlation coefficient (ICC) for intra‐observer reliability of the CSE was 0.54 (moderate), 0.58 (moderate) and 0.60 (substantial) for medical students, residents, and urologists, respectively. However, when stratifying observers according to their experience, the lowest agreement values were found between experts with >10 years of experience. The inter‐observer reliability for the CSE ICCs ranged between 0.31and 0.53, with the lowest ICC value observed between urologists (0.31). Conclusions: The study demonstrates poor intra‐ and inter‐observer reliability of the CSE. According to these results, a CSE does not add valuable information to the clinical evaluation. In this scenario, it should not be considered in isolation from the patient's characteristics. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to evaluate the effect of sub‐sensory amplitude settings of sacral neuromodulation therapy on overactive bladder symptoms in subjects with urinary urge incontinence. Methods: Subjects who qualified for a neurostimulator device implant were randomized to one of three amplitude settings (50% of sensory threshold [ST], 80% of ST, and ST). Subjects completed urinary voiding diaries (3‐day), International consultation on incontinence modular questionnaire—overactive bladder symptoms quality of life questionnaire, and patient global impression of improvement (PGI‐I) to assess change in voiding symptoms and quality of life (QoL) from baseline through 12 weeks. Results: Forty‐eight subjects had a successful test stimulation, 46 were implanted with a neurostimulator device and 43 completed the 12‐week follow‐up visit. The change from baseline to 12 weeks is −3.0 urinary incontinence (UI) episodes/day (95% confidence interval [CI]: −4.4 to −1.7) for the 50% of sensory threshold group, −2.9 UI episodes/day (95% CI: −4.7 to −1.2) for 80% of sensory threshold group, and −3.6 UI episodes/day (95% CI: −5.2 to −1.9) for the sensory threshold group. In each randomized group, improvements were observed in health‐related QoL, its subscales, and symptom interference. Subjects across all three randomization groups reported on the PGI‐I that their bladder condition was better at 12 weeks compared to before they were treated with InterStim therapy. Conclusion: These findings provide insights into possible advancements in the postimplantation phase of therapy with potential for improved patient comfort and increased device longevity. [ABSTRACT FROM AUTHOR]

Purpose These are the final results of the prospective, multicenter, long-term (3.5-year) study of the efficacy/safety of onabotulinumtoxinA for overactive bladder syndrome. Materials and Methods Patients who completed either of 2, 24-week phase 3 trials could enter a 3-year extension and continue treatment with onabotulinumtoxinA 100 U as needed to control overactive bladder symptoms. Data were analyzed by the treatment(s) received (up to 6) and in discrete subgroups that received 1, 2, 3, 4, 5 or 6 treatments (to evaluate the consistency of the response after repeat treatments in the same patient groups). Assessments included the change from baseline in the number of urinary incontinence episodes per day and the proportion of patients who reported improvement/great improvement in urinary symptoms on the TBS (Treatment Benefit Scale) at week 12 as co-primary end points. Other end points were the change from baseline in I-QOL (Incontinence Quality of Life), the number of urgency and micturition episodes per day; duration of effect; the number of adverse events; and the initiation of intermittent catheterization. Results Consistent mean reductions in urinary incontinence were observed following continued onabotulinumtoxinA treatment, ranging from –3.1 to –3.8 in the overall population and –2.9 to –4.5 in the discrete subgroups. Durable improvements were seen in overactive bladder symptoms and quality of life. A high proportion of patients rated their condition as improved/greatly improved. The median duration of effect was 7.6 months. The most common adverse event was urinary tract infection. The rate of de novo catheterization after the first treatment was 4.0% and it ranged from 0.6% to 1.7% after subsequent treatments. Conclusions Long-term onabotulinumtoxinA treatment consistently decreased overactive bladder symptoms and improved quality of life with no new safety signals. [ABSTRACT FROM AUTHOR]

Background: There are many opinions but little firm knowledge about the optimal treatment of neurogenic stress urinary incontinence (NSUI). Objective: To scrutinize the quality and surgical outcomes of the available treatment modalities in the published literature. Evidence Acquisition: A systematic review of the published literature from Pub Med and Web of Science was undertaken for studies describing surgical treatment of NSUI between 1990 and 2013. A checklist of criteria of methodological and reporting quality of interventions in urological publications was applied to assess quality of the retrieved publications. Surgical outcomes of success, failure, and reoperation were calculated. Statistical analyses included one-way ANOVA and post-hoc tests to determine significant differences between groups. Evidence Synthesis: Thirty studies were identified with Level 3 evidence. The quality of reporting was 43-81%, with significantly higher quality noted in studies published after 2002 (64% vs. 45%, P<0.0001). None of the studies followed a randomized controlled trial (RCT) design. Three primary surgical procedures were used in 29 of 30 studies: artificial urinary sphincter (AUS), urethral slings, and urethral bulking agents. One study used a ProACT device. AUS was considered more successful than urethral bulking agents (77±15% vs. 27±20%, P=0.002). Urethral bulking agents reported higher failures than urethral sling procedures (49±16% vs. 21±19%, P=0.016) and AUS (21±19% vs. 10±11%, P<0.002). Conclusions: The quality of evidence obtained from non-RCTs is modest. Surgeries for NSUI have relatively high success rates but also high complication rates in this highly heterogeneous population. More studies using modern techniques are required to update our knowledge. [ABSTRACT FROM AUTHOR]

The article deals with interstitial cells and its role in bladder overactivity. The suburothelial network of interstitial cells of the bladder, functions as a sensing network, receiving information from the urothelium and from the efferent nerve and modulating afferent bladder intervention. Overactive bladder could result from an aberrant pacemaker signal generated by the interstitial cells or from an improper electrical coupling between the interstitial cells.

Objective: To report long-term outcomes after laparoscopic sacrocolpopexy.Methods: We conducted a prospective descriptive cohort study on 331 consecutive patients who underwent laparoscopic sacrocolpopexy for symptomatic prolapse (Pelvic Organ Prolapse Quantification [POP-Q] system stage 2 or greater) at one center, with minimum 1.5 years of follow-up by April 30, 2014. Primary outcome measures were Patient Global Impression of Change score and failure at the apex (C≥-1 cm; POP-Q stage 2 or greater). Secondary outcomes were anatomical failure in other compartments, duration of follow-up, occurrence and time point of complications, reinterventions, and functional outcomes by response to a standardized 24-question interview on prolapse and bladder, bowel, and sexual function. Assessment was by an experienced clinician not involved in patient management.Results: The follow-up rate was 84.6% (280/331); 185 of 331 (55.9%) patients were both physically examined and interviewed, and 95 of 331 (25.7%) were interviewed only. The median age at interview was 72 years (interquartile range 13 years), with a follow-up period of 85.5 months (interquartile range 46 months). Approximately 83% (231/280) reported improvement; 5.7% (16/280) were unchanged, 5.7% (16/280) felt slightly worse, and 6.8% (17/280) reported clear deterioration. Anatomical failure at point-C was 8.6% (16/185); anterior (22.2%, 41/185) and posterior (28.6%, 53/185) prolapse were more common than apical prolapse. Of those with level-I anatomical cure, 10.1% (17/185) felt worse; half of them (9/17) because of prolapse in another compartment. The others had urinary problems (41.2%, 7/17), obstructive defecation (11.8%, 2/17), or dyspareunia (11.8%, 2/17). Conversely, the majority of patients with recurrence at the vault (62.5%, 10/16) self-reported to be improved. The reoperation rate was 17.8% (48/270), including 19 (7.0%) for graft-related complications and nine (3.3%) for prolapse.Conclusion: More than four out of five patients (82.5%) felt improved 86 months after laparoscopic sacrocolpopexy. Of those not improved, two thirds had recurrent prolapse; however, typically mid-vaginal. The other third reported urinary or bowel problems or dyspareunia. Reintervention for prolapse was 3.3%. The most common reasons for reoperation were graft-related complications (7.0%) and urinary incontinence (6.7%). [ABSTRACT FROM AUTHOR]

The article discusses the technological developments in pelvic floor reconstruction for incontinence and vaginal prolapse in women. It cites the use of synthetic mesh as the gold standard for stress urinary incontinence, while biological xenogenic mesh obtained from porcine dermis, or borvine pericardium or small intestine was used in prolapse repair. It cites the focus on tissue engineered or cell based therapy at the current biomaterial research for pelvic floor reconstruction.

The pelvic floor is at an increased risk of damage during the lifespan of women. Pregnancy, vaginal delivery, aging, menopause, previous pelvic surgery, and lifestyle factors have a negative influence on the connective tissue and muscular components of the pelvic floor leading to urinary incontinence (UI). Pregnancy and vaginal delivery have been identified as the most important risk factors for incontinence. Cystocele, rectocele, uterine, vault prolapse, and/or incontinence can occur due to lacerations of the connective tissue support at different levels. Moreover, muscular damage of the levator complex can lead to widening of the levator hiatus, giving way to the descent of pelvic organs resulting in UI. Although some genetic abnormalities have been identified, their clinical implications remain unclear. Diagnostic evaluations should be performed in accordance with established evidence-based guidelines. Although short-term results of single-incision midurethral slings indicate similar efficacy to conventional midurethral slings, their long-term outcome is still not determined. Scientists continue to investigate the exact causes of stress UI as well as the optimum substitute material using the best surgical reconstructive approach. The recent European Association of Urology consensus statement underlines an imperative requirement for an optimal solution using minimal amount of material related to the indication and higher competence of surgeons for this surgery. High-quality trials with a longer follow-up are currently an unmet need. [ABSTRACT FROM AUTHOR]

Background Acute exposure of part of the skin to cold stimuli can evoke urinary urgency, a phenomenon termed acute cold-induced urgency (ACIU). Despite its high prevalence, particularly in patients with overactive bladder, little is known about the mechanisms that induce ACIU. Objective To develop an animal model of ACIU and test the involvement of cold-activated ion channels transient receptor potential (TRP) M8 and TRPA1. Design, setting, and participants Intravesical pressure and micturition were monitored in female mice (wild-type C57BL/6J, Trpa1 −/− , Trpm8 +/+ , and Trpm8 −/− ) and Sprague Dawley rats. Interventions An intravesical catheter was implanted. Localized cooling of the skin was achieved using a stream of air or topical acetone. The TRPM8 antagonist ( N -(3-aminopropyl)-2-{[(3-methylphenyl) methyl]oxy}- N -(2-thienylmethyl)benzamide (AMTB) or vehicle was injected intraperitoneally. Outcome measurements and statistical analysis Frequencies of bladder contractions and voids in response to sensory stimuli were compared using the Mann-Whitney or Kruskal-Wallis test. Results and limitations Brief, innocuously cold stimuli applied to different parts of the skin evoked rapid bladder contractions and voids in anesthetized mice and rats. These responses were strongly attenuated in Trpm8 −/− mice and in rats treated with AMTB. As rodent bladder physiology differs from that of humans, it is difficult to directly extrapolate our findings to human patients. Conclusions Our findings indicate that ACIU is an evolutionarily conserved reflex rather than subconscious conditioning, and provide a useful in vivo model for further investigation of the underlying mechanisms. Pharmacological inhibition of TRPM8 may be useful for treating ACIU symptoms in patients. Patient summary Brief cold stimuli applied to the skin can evoke a sudden desire to urinate, which can be highly bothersome in patients with overactive bladder. We developed an animal model to study this phenomenon, and found that it depends on a specific molecular cold sensor, transient receptor potential M8 (TRPM8). Pharmacological inhibition of TRPM8 may alleviate acute cold-induced urinary urgency in humans. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To develop and validate a short patient self-assessment screening questionnaire: bladder control self-assessment questionnaire (B-SAQ) for the evaluation of lower urinary tract symptoms. This first validation study was undertaken amongst women. Patients and methods: Three hundred twenty-nine women attending general gynaecology and urogynaecology clinics completed both the B-SAQ and Kings Health questionnaire prior to medical consultation, and independent physician assessment of the presence of lower urinary tract symptoms (LUTS) and need for treatment. The psychometric properties of the B-SAQ were subsequently analysed. Results: The B-SAQ was quick and easy to complete, with 89% of respondents completing all items correctly in less than 5min. The internal consistency (Cronbach''s alpha score 0.90–0.91), criterion validity (Pearson''s correlation values of 0.79 and 0.81, p <0.0001 with the incontinence impact domain of the Kings Health questionnaire), and test-retest reliability of the questionnaire were good. The sensitivity and specificity of the questionnaire to identify patients with bothersome LUTS was 98% and 79%, respectively. Conclusions: LUTS are commonly underreported. Empowering patients to self-assess their bladder symptoms and the need for treatment will improve treatment-seeking behaviour. The B-SAQ is a psychometrically robust, short screening questionnaire that offers patients the ability to assess their bladder symptoms and the bother they cause, and the potential benefit of seeking medical help. [Copyright &y& Elsevier]