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Purpose: Urinary incontinence after radical prostatectomy is a significant clinical problem. In this prospective study we investigate the effectiveness of early pelvic floor muscle training (PFMT) on a large population, that had undergone radical retropubic prostatectomy (RRP) at our department., Methods: 300 consecutive patients who had undergone RRP for clinically confined prostate cancer were randomized in two groups after catheter removal. One group of 150 patients took part in a structured PFMT program. This began before discharge and consisted of Kegel exercises. The remaining 150 patients constituted the control group, they were not formally instructed in PFMT. Incontinence was assessed objectively using the 1 hour and 24 hour pad test, as well as with the ICS-Male questionnaire. All patients who were incontinent after 6 months underwent urodynamic evaluation., Results: In the treated group, 19% (29 patients) achieved continence after 1 month, and 94.6% (146 patients) after 6 months. In the control group 8% (12 patients) achieved continence after 1 month, and 65% (97 patients) after 6 months (p<0.001). Patient age did not correlate with continence in the control group (p>0.05), although a significant correlation was revealed within the treated group (p<0.01). Overall, 93.3% of the total population achieved continence after one year., Conclusions: After RRP an early supportive rehabilitation program like PFMT significantly reduces continence recovery time.

BSTRACT Introduction. Urinary incontinence is a common condition that negatively impacts on female sexuality (FS). Aim. To evaluate FS before and after a mid-urethral sling (MUS) procedure using the Female Sexual Function Index (FSFI). We included women that were both sexually and nonsexually active at baseline. Methods. One hundred fifty-seven women complaining of urodynamic stress incontinence underwent a MUS procedure and were enrolled in the study. All patients answered the Italian translation of FSFI, before and 12 months after surgery. To understand the real impact of the MUS on female sexual function, for the first time in the literature, we also monitored and included in the final analysis all the women who are nonsexually active at baseline. We evaluated the prevalence of female sexual dysfunction according to the FSFI cutoff point (26.55). Main Outcome Measures. FSFI total score, pads use, and stress test presurgery and postsurgery. Results. One hundred thirty-three patients completed the study protocol: 105 out of 133 underwent to a trans-obturator procedure, while 28 out of 133 had a retropubic procedure. After the 12-month follow up, 115 out of 133 patients (86%) were dry, 10 improved their symptoms, and the remaining 8 were unchanged. Seventy-nine out of 133 (59%) patients reported an active sexual life before surgery. Fifty-four (41%) reported they were not sexually active before surgery. Twelve months after surgery, 22 out of 54 nonsexually active women (40%) reestablished sexual activity, whereas only 6 out of 79 (7.5%) patients, sexually active at baseline, were not sexually active 1 year after surgery ( P < 0.05). After adjusting for multiple testing, only age, menopause, and storage symptoms remained significantly correlated with the FSFI total score postsurgery as independent variables. Conclusions. Our data showed that after a MUS procedure, female sexual function improves. We also found that a very relevant percentage of nonsexually active women reported renewed sexual activity after MUS. Filocamo MT, Serati M, Frumenzio E, Li Marzi V, Cattoni E, Champagne A, Salvatore S, Nicita G, and Costantini E. The impact of mid-urethral slings for the treatment of urodynamic stress incontinence on female sexual function: A multicenter prospective study. J Sex Med 2011;8:2002-2008. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Determine long-term effect of English botulinum neurotoxin type A (BoNTA; Dysport®) for refractory neurogenic detrusor overactivity (NDO) for possible reduction of BoNTA efficacy after repeated injections. Methods: Between 1999 and 2005, 199 patients with spinal cord lesions with refractory NDO were treated with Dysport. All patients underwent a clinical examination, urinalysis, and videourodynamic study at baseline and at 3, 6, and 12 mo after each treatment, as well as a visual analogue scale (VAS) assessment and a bladder diary checked for 1 wk before each visit. We used 1000, 750, 500 IU BoNTA at the beginning of our experience, and thereafter we mainly used 750 IU. Outcome measures included frequency of urge urinary incontinence (Incontinence Episode Frequency [IEF] test); urodynamic parameters including maximum cystometric bladder capacity (MCBC), reflex volume (RV), bladder compliance (BC); number of pads/condoms; antimuscarinic drug consumption; short- and long-term side-effects; and quality of life measured with VAS. Results: No statistically significant differences were found in efficacy duration with the three Dysport doses (p =0.5274). The difference between the intervals of injections was not statistically significant (p =0.2659). MCBC, RV, and BC improved significantly after treatment compared with baseline values (p <0.001) and there were no statistically significant differences after each retreatment or regarding Dysport dose (p >0.05). There was a significant improvement in patient satisfaction after each retreatment as expressed on the VAS (p <0.001). There was a significant reduction in IEF score and pads/condoms use in the first 4 wk after each treatment (p <0.0001). Conclusion: After repeated injections the effect of BoNTA remained constant. [Copyright &y& Elsevier]

Abstract Introduction Coital urinary incontinence (CUI) is not much explored during clinical history, and this could lead to an underestimation of the problem. Aim To evaluate the prevalence and clinical risk factors of CUI in women with urinary incontinence (UI), and to measure the impact of CUI on women's sexuality and quality of life. Methods This was a multicenter international study, conducted in Italy, Greece, the United States, and Egypt. Inclusion criteria were: sexually active women with UI and in a stable relationship for at least 6 months. Exclusion criteria were: age <18 years and unstable relationship. The UI was classified as stress UI (SUI), urgency UI (UUI), and mixed UI (MUI). Women completed a questionnaire on demographics and medical history, in particular on UI and possible CUI and the timing of its occurrence, and the impact of CUI on quality and frequency of their sexual life. Main Outcome Measures To evaluate the CUI and its impact on sexual life we used the open questions on CUI as well as the International Consultation on Incontinence questionnaire and Patient Perception of Bladder Condition questionnaire. Results In this study 1,041 women (age 52.4 ± 10.7 years) were included. In all, 53.8% of women had CUI: 8% at penetration, 35% during intercourse, 9% at orgasm, and 48% during a combination of these. Women with CUI at penetration had a higher prevalence of SUI, women with CUI during intercourse had higher prevalence of MUI with predominant SUI, and women with CUI at orgasm had higher prevalence of UUI and MUI with predominant UUI component. Previous hysterectomy was a risk factor for CUI during any phase, while cesarean delivery was a protective factor. Previous failed anti-UI surgery was a risk factor for CUI during penetration and intercourse, and body mass index >25 kg/m2 was a risk factor for CUI at intercourse. According to International Consultation on Incontinence questionnaire scores, increased severity of UI positively correlated with CUI, and had a negative impact on the quality and frequency of sexual activity. Clinical Implications This study should encourage physicians to evaluate the CUI; in fact, it is an underestimated clinical problem, but with a negative impact on quality of life. Strengths & Limitations The strength of this study is the large number of women enrolled, while the limitation is its observational design. Conclusion CUI is a symptom that can affect sexual life and should be investigated during counseling in all patients who are referred to urogynecological centers. Illiano E, Mahfouz W, Giannitsas K, et al. Coital Incontinence in Women With Urinary Incontinence: An International Study. J Sex Med 2018;15:1456–1462. [ABSTRACT FROM AUTHOR]