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Base teórica A incontinência urinária (IU) é um sintoma comum, afetando mulheres em todas as idades, com prevalência estimada em 30%. A incontinência urinária aos esforços (IUE) pode representar cerca de metade dos casos. O treinamento da musculatura do assoalho pélvico (TMAP), associado a medidas comportamentais e reeducação vesical constitui a primeira linha de tratamento. Apesar dos bons resultados em curto e médio prazo, pode haver perda de motivação e adesão ao tratamento em longo prazo. Técnicas complementares como o biofeedback (BIO) podem auxiliar no treinamento inicial e contribuir para melhores resultados, mas permanece indefinido o perfil de casos que pode realmente se beneficiar desta abordagem. Novos estudos e a implementação de dispositivos facilitadores do tratamento são necessários, pois a adesão é etapa fundamental para manutenção dos resultados. Objetivo Determinar o efeito do TMAP associado ao BIO comparados ao treinamento vesical (TV), considerando resultados com questionários de sintomas, qualidade de vida (QV) e função sexual (FS). Investigação adicional a partir de dados do diário miccional (DM), avaliação da funcionalidade dos músculos do assoalho pélvico por meio de palpação manual e perineométrica do assoalho, gerando informações adicionais sobre o efeito de ambos os tratamentos. Métodos Ensaio clínico randomizado, paralelo, aberto, incluindo mulheres acima de 18 anos com IUE na ausência de prolapso genital. Recrutamento de casos de forma consecutiva em ambulatório de uroginecologia, com alocação aleatória para TV ou BIO, sendo comparadas a resposta aos sintomas, força muscular, escores de QV e FS ao final de 3 meses de tratamento supervisionado com fisioterapeuta. Para o cálculo amostral foi considerada a detecção de uma diferença de 42 pontos percentuais entre os grupos e estimadas 26 pacientes em cada grupo para um α=0,05 e β-80%. Resultados Ao final do estudo, das 53 pacientes inicialmente recrutadas, 28 pacientes foram analisadas, 14 em cada grupo. Ambos os grupos apresentaram melhores resultados em número de perdas diárias (P

Urinary incontinence remains a worldwide problem for both men and women. This lecture will concentrate on the treatment options for female urinary incontinence. The most important decision is determining what type of incontinence the patient has. The two major subtypes are stress incontinence and urge incontinence. The reason for this distinction is that the treatments are very different and using a sling in a patient with urge incontinence can have disastrous consequences. In addition, we will discuss the controversy surrounding the use of synthetic mesh in female incontinence and prolapse surgery. We will touch upon how you should use this material in your clinical practice.

International audience; Our aim was to study risk factors associated with the prevalence, incidence and remission of urinary incontinence (UI) between 4 and 24 months postpartum. Longitudinal study (EDEN cohort). Two French university hospitals. 1643 women completed the questionnaire at 4 months and 1409 at 24 months, including 1354 who completed it both times. Multivariate analyses identified risk factors for UI prevalence at 24 months postpartum, persistent UI versus remission, de novo UI versus continence, de novo UI versus persistent UI, and changes in IU severity between 4 and 24 months postpartum. Postnatal UI and Sandvik UI severity score. UI prevalence was 20.7% (340/1643) at 4 months and 19.9% (280/1409) at 24 months. Significant factors associated with UI at 24 months were older age [OR = 1.07/year (95%CI 1.04-1.11)], BMI [2.35 (1.44-3.85) ≥30 versus

Re: 5-Year Longitudinal Follow-up after Retropubic andTransobturator Midurethral SlingsKenton K, Stoddard AM, Zyczynski H, et alJ Urol. In press. http://dx.doi.org/10.1016/j.juro.2014.08.089Experts’ summary:The observational study by Kenton et al [1] includes a largepercentage of women enrolled in the TOMUS trial, a random-ized equivalence trial of retropubic and transobturator mid-urethral sling (MUS) approaches, published in 2010. In thisarticle, the authors present the 5-yr outcomes for 404 womenin terms of success, satisfaction, symptom-specific distress,quality of life, and adverse events after MUS. Treatmentsuccess was defined as no retreatment and no self-reportedsymptomsofstressurinaryincontinence.Ananswerof‘‘never’’or ‘‘rarely’’ to all stress-specific questions was considered neg-ative for symptoms. Treatment success declined over-time inboth group, and 5 yr after surgery it was 51.3% and 43.4% afterretropubic and transobturator MUS, respectively. In addition,the proportion of women who stated they were ‘‘very muchbetter’’ or ‘‘much better’’ according to a patient global impres-sion of improvement declined over-time in both groups(p < 0.0001). However, a greater proportion of women in thetransobturator group reported that they were ‘‘very muchbetter’’ or ‘‘much better’’ at 5 yr (88% vs 77%, p = 0.01). Theauthorsconcludedthatlong-termtreatmentsuccessandsatis-faction for both retropubic and transobturator MUS declineover time; nevertheless, women undergoing transobturatorMUSreportedagreaterimprovementinurinarysymptoms[1].Experts’ comments:In the present midurethral sling era, the medium- and long-term outcomes for MUS and comparisons between retropubicand transobturator MUS are the two most debated topics.Several randomized or prospective studies showed veryhigh and long-lasting objective cure rates using MUS[2–4]. A recently published randomized control trialcomparing the retropubic tension-free vaginal tape (TVT)procedure with transobturator TVT (TVT-O) showed thatobjective cure rates remained very high forboth approaches(84.7% and 86.2%, respectively) at 5 yr after surgery.Furthermore,subjectivetreatmentsatisfactionwasexcellent(94.2% in the TVT group and 91.7% in the TVT-O group). Nodifferences in terms of objective or subjective cure ratesbetweenretropubicandtransobturatorMUSwerefound[5].The great merit of the study by Kenton et al [1] is that itfocuses attention on these hot topics. However, data on theefficacyofMUStreatmentat5-yrfollow-uparesignificantlylowerincomparisontothosereportedinthevastmajorityoftheliteratureonthisissue.Theauthorsrepeatedlyunderlinethat in their study, pelvic examinations were performed atannual visits to assess for visual and palpable evidence ofmesh exposure and patient symptoms associated withphysical findings. This is a strength of the study, but it isunusual that no objective methods were used during theseannual examinations to assess the efficacy of MUS position-ing. In the study, success was defined as no retreatment andno self-reported symptoms of stress urinary incontinence.However, using this definition, the success rate of MUSappears to be unusually low (43–51%) at 5-yr follow-up; inaddition, the rate is not in agreement with data reported byother authors on this topic or with findings by the sameauthors in terms of patient satisfaction (79–85%).Therefore, we believe that this study offers interestingdataforphysiciansandpatients,butitisnotveryrealistictoattribute a success rate

Introdução: Atualmente, a primeira linha de tratamento para bexiga hiperativa (BH), incontinência urinária de urgência (IUU) e incontinência urinária mista (IUM), envolve medicação, treinamento da musculatura do assoalho pélvico (TMAP) e terapia comportamental. Outra abordagem que vem apresentando resultados positivos no tratamento dessas disfunções é a eletroestimulação do nervo tibial (ENT). Objetivo: Comparar a efetividade das técnicas de ENT e TMAP no tratamento da BH, IUU e IUM, e validar um equipamento portátil para aplicação domiciliar de ENT. Métodos: O estudo apresenta delineamento de Ensaio Clínico Randomizado tipo cross-over. A amostra foi composta por 40 mulheres acima de 18 anos com diagnóstico de BH, IUU e IUM. As participantes foram randomizadas em dois grupos: grupo ENT, iniciou a pesquisa realizando eletroestimulação, e o grupo TMAP, iniciou a pesquisa realizando exercícios pélvicos padronizados, ambos de forma domiciliar. Após 8 semanas, as participantes trocaram suas abordagens terapêuticas, totalizando 16 semanas. Todas foram submetidas a uma anamnese e avaliadas em três momentos por meio dos questionários Índice da Severidade da Incontinência (ISI), King´s Health Questionnarie (KHQ) e dados do diário miccional (DM). Resultados: Para todas as variáveis, o grupo ENT apresentou resultados estatisticamente significativos após a intervenção quando comparado ao grupo TMAP (p

A prospective analysis of 166 women with genuine stress incontinence was performed comparing Valsalva leak-point pressure (VLPP) and maximum urethral closure pressure (MUCP) with age, previous urogynecologic surgery and/or hysterectomy, poor urethral mobility, weight, menopause and vaginal deliveries, to find correlations with intrinsic sphincter deficiency (ISD). Cut-off value for VLPP were 60 cmH2O and for MUCP 30 cmH2O. MUCP < or = 30 cmH2O identifies a group of patients with more severe incontinence, a shorter urethral functional length (UFL) (P = 0.02), more previous urogynecologic operations and the menopause (P = 0.004 and P = 0.000), and older age (P = 0.000). VLPP < or = 60 cmH2O identifies a group of patients with more severe incontinence, a shorter UFL (P = 0.005), more previous urogynecologic surgery (P=0.006) and poorer urethral mobility (P = 0.004). As these two tests measure different components of urethral functions we can hypothesize that they detect different pathogenic processes contributing to ISD. When one or both tests is abnormal incontinence is more severe and the incidence of poor prognostic factors is increased.

Se define incontinencia urinaria «como la pérdida involuntaria de orina, que condiciona un problema social e higiénico». Existen gran variedad de técnicas para el tratamiento de la incontinencia urinaria. El objetivo es conocer la efectividad clínica de los diversos métodos utilizados para el entrenamiento de la musculatura del suelo pélvico como tratamiento de la incontinencia urinaria femenina de esfuerzo o mixta y su contribución a la mejora de la calidad de vida de estas pacientes. Para ello hemos realizado una revisión sistemática de ensayos clínicos controlados. Tras analizar los resultados podemos concluir que el tratamiento de la incontinencia urinaria de esfuerzo o mixta mediante ejercicios de entrenamiento de la musculatura del suelo pélvico contribuye de manera positiva a mejorar los síntomas, la fuerza de la musculatura del suelo pélvico y la calidad de vida de las pacientes afectas. Urinary incontinence «as the involuntary loss of urine, which conditions a social and hygienic problem» is defined. There are a variety of techniques for the treatment of urinary incontinence. The aim is to determine the clinical effectiveness of different methods used to train the musculature of the pelvic floor as treatment for female urinary incontinence, both stress and mixed, and its contribution to improving the quality of life of these patients. For this purpose we performed a systematic review of controlled clinical trials. After analysing the results, we conclude that the treatment of stress or mixed urinary incontinence through training exercises for the musculature of the pelvic floor contributes positively to improving symptoms and strengthening the muscles of the pelvic floor and to the quality of life of affected patients.

International audience; AIMS: Our main objective was to analyze individual determinants that lead middle-aged women to seek medical care for urinary incontinence (UI). METHODS: Observational longitudinal study among GAZEL cohort participants: 2,640 women aged 50-62 completed a self-administered questionnaire at baseline. Eight years later (2008) 2,273 (86%) responded to a follow-up questionnaire. Seeking care for UI was defined as any consultation for UI during the 8-year follow-up period. Individual determinants considered in the regression analysis were social and demographic characteristics, social relations, UI type and severity, and other health factors. RESULTS: Among 1,192 women reporting incontinence at baseline, 24.4% had visited a physician at least once for UI during the follow-up period (56.0% of those reporting severe UI). The care-seeking rate increased with age at baseline. Multivariate analysis showed that women who reported severe UI (OR = 4.1; 95% CI 2.6-6.5), mixed UI (2.0; 1.3-3.0), or neurologic disease (1.6; 1.1-2.6), had weak social support (1.4; 1.0-2.0), or talked about their UI with close friends or family (1.5; 1.0-2.1) were more likely to seek care for UI. A model including these factors had a 78% probability of correctly differentiating women with incontinence who chose to seek care from those who did not. Our analysis could not take factors related to the organization of health services into account. CONCLUSIONS: Women do not always seek care for UI, even when it is severe. Besides UI severity and type, consultation is associated with aging, weak social support, conversation about it with close friends and family, and neurologic disorders. Neurourol. Urodynam. © 2013 Wiley Periodicals, Inc.

Introduction: To evaluate the cost-utility of incontinence treatments, particularly anticholinergic therapy, by examining costs and quality-adjusted life years. Materials and methods: A prospective cohort study of women who were consecutively referred by general practitioners (GPs) to the Urology Department because of urinary incontinence. The primary outcome was evaluation of the cost-utility of incontinence treatments (surgery, medical therapy and physiotherapy) for stress and/or urgency incontinence by examining costs and quality-adjusted life years. Results: 137 consecutive female patients (mean age 60.6 ± 11.6; range 36-81) were enrolled and stratified according to pathologies: SUI and UUI. Group A: SUI grade II-III: 43 patients who underwent mid-urethral sling (MUS); Group B: SUI grade I-II 57 patients who underwent pelvic floor muscle exercise and Group C: UUI: 37 patients who underwent antimuscarinic treatment with 5 mg solifenacin daily. The cost utility ratio (CUR) was estimated as saving more than €1200 per QALY for surgery and physiotherapy and as costing under € 100 per QALY for drug therapy. Conclusions: This study shows that appropriate diagnosis and treatment of a patient with incontinence lowers National Health Service costs and improves the benefits of treatment and quality of life.

The International Continence Society defines stress urinary incontinence (SUI) as involuntary urine leakage on effort, exertion, sneezing, or coughing and defines mixed urinary incontinence (MUI) as involuntary leakage associated with urgency (a sudden, compelling desire to pass urine that is difficult to defer), exertion, effort, sneezing, or coughing [1]. In the fourth edition of the International Consultation on Incontinence (ICI), a review of 36 general population studies from 17 countries reported that prevalence estimates for the most inclusive urinary incontinence (UI) definitions (‘‘ever,’’ ‘‘any,’’ or ‘‘at least once in the past 12 mo’’) ranged from 5% [2] to 69% [3]. SUI is reported to account for 49% of female UI, urgency incontinence for 22%, and MUI for 29%. Although the prevalence of UI may be surprising to many clinicians, women often underreport the problem or delay seeking treatment for several years after the problem has become bothersome. Incontinence has a major impact on quality of life (QoL), which is often not appreciated by health care providers [4]. Surgery for SUI has changed dramatically in the last 2 decades. Since Ulmsten and Petros originally described the tension-free vaginal tape (TVT) procedure [5] for female SUI in 1995, the midurethral tape has become widespread in clinical practice, and many other techniques, materials, and approaches have been proposed [6]. The number of procedures appears to be on the increase, with a remarkable shift in the relative numbers of different devices. Safety and efficacyare confirmedover time [7,8]. Evidenceemerged that the retropubic TVT and the transobturator (TOT)midurethral slings were as effective as traditional fascial sling operations (level of evidence 1/2) [9] and more effective than Burch colposuspension. Operating time, hospital stay, and time to resumption of normal daily activity are shorter with the midurethral tape than with colposuspension. Postoperative

Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:41:54Z No. of bitstreams: 1 Ericka Kirsthine Valentin Dissertacao completa.pdf: 1427331 bytes, checksum: c2b7142e3803d8e18fefc51a23f53ee1 (MD5) Made available in DSpace on 2021-01-05T19:41:54Z (GMT). No. of bitstreams: 1 Ericka Kirsthine Valentin Dissertacao completa.pdf: 1427331 bytes, checksum: c2b7142e3803d8e18fefc51a23f53ee1 (MD5) Previous issue date: 2014-03-31 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior This cross-sectional study of female patients who attended the Department of Urology and Urodynamic of the Endoscopy Department of Urology, Pedro Ernesto University Hospital HUPE/UERJ between December 2009 and December 2012, for performing urodynamic study with medical referral and scheduling prior to investigation of stress urinary incontinence. The study was conducted in female patients, aged between 23 and 86 years with complaints of urinary uncomplicated incontinence. The data used in this study have three origins: (1) the primary assessment formed by the set of questionnaire and loss effort or urgency and International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and standardized history; (2) medical evaluation performed by a resident physician; and (3) urodynamic evaluation, results of urodynamic study conducted by resident physician, with supervision and reports made by one of the Professors of the service. The objective was to analyze whether the use of simpler methods could diagnose uncomplicated urinary incontinence without the need for urodynamic evaluation. Our findings showed that between primary medical evaluation and there is high sensitivity and specificity in addition to strong agreement. The urodynamic study is less likely to make the diagnosis of MUI and higher frequency of false negative. Our findings strengthen the indication of a primary approach before more invasive and costly interventions such as urodynamic evaluation. The realization of a simplified assessment can provide enough to get a drug and physical therapy information. Este é um estudo transversal feito com pacientes mulheres que compareceram ao Setor de Endoscopia Urológica e Urodinâmica do Serviço de Urologia do Hospital Universitário Pedro Ernesto HUPE entre dezembro de 2009 e dezembro de 2012, para a realização de estudo urodinâmico, com encaminhamento médico e agendamento prévio para investigação de queixa de incontinência urinária. O estudo foi realizado nas pacientes do sexo feminino, com idade entre 23 e 86 anos e com queixa de incontinência urinária nao complicada. Os dados utilizados nesse estudo têm três origens: (1) a avaliação primária formada pelo conjunto dos questionário de perda por esforço e ou urgência e International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) e história padronizada; (2) avaliação médica, realizada pelo médico residente; e (3) avaliação urodinâmica, resultado do estudo urodinâmico conduzido por médico residente, com supervisão e laudos feitos por um dos professores do serviço. O objetivo do trabalho foi analisar se o uso de métodos mais simples poderia diagnosticar incontinência urinária não complicada sem a necessidade de realizar a avaliação urodinâmica. Os nossos achados mostraram que entre a avaliação primária e a médica há elevada sensibilidade e especificidade além de forte concordância. O estudo urodinâmico tem menor probabilidade de fazer o diagnostico de IUM e maior frequencia de falso negativo. Os nossos achados fortalecem a indicação de uma abordagem primária antes de intervenções mais invasivas e dispendiosas como a avaliação urodinâmica. A realização de uma avaliação simplificada pode fornecer informações suficientes para começar um tratamento medicamentoso e fisioterapêutico.

Objective. To determine the cost-utility and cost-effectiveness of the surgical treatment of female urinary incontinence using suburethral slings compared with therapeutic abstention. Study Design. An economic analysis was performed on 69 women receiving surgical treatment for urinary incontinence using suburethral slings. To calculate the procedure´s cost-effectiveness, an incremental analysis up to 1 year was performed using the incremental cost-effectiveness ratio (ICER). The costs were calculated using a cost-by-process model. Answers to the health-related quality of life questionnaires EQ-5D (generic) and International Consultation Incontinence Questionnaire Short-form (specific) were collected before the operation and as well as 1 month and 1 year post-operation to calculate the utility, using quality-adjusted life years (QALY), and the effectiveness, respectively. A sensitivity analysis was performed by calculating the Incremental Cost-Effectiveness Ratio (ICER) at 5 years post-operation. To complete the economic evaluation, we derived confidence ellipses and acceptability curves. The analysis was conducted for the entire sample and also for each type of urinary incontinence. Results. In total, 45 women presented with stress incontinence, 15 with mixed incontinence and 9 with incontinence associated with prolapse. The average cost per patient at 1 year post-operation was 1,220 €. The QALY achieved at 1 year was 0.046. The results reveal an ICER at 1 year of 26,288 €/QALY, which is below the cost-effectiveness threshold considered acceptable, and this value was lower for stress incontinence (21,191 €/QALY). To achieve greater temporal perspective, we examined the ICER at 5 years, which was 10,141 €/QALY, demonstrating that the programme is clearly efficient. The cost-effectiveness was 106.5 €/ International Consultation Incontinence Questionnaire Short-form unit. Conclusion. Surgery for female urinary incontinence using slings is cost-effective compared with abstention in our public health environment.

Atualmente a International Continence Society (ICS) define IU como qualquer perda involuntária de urina e é considerada um problema social e/ou de higiene valorizando a queixa das pacientes. A prevalência da IU em mulheres adultas tem sido estimada entre 10 e 40 %, e pode piorar com o envelhecimento, paridade e obesidade. Uma doença de baixa morbidade é responsável por até 30% do movimento cirúrgico de um ambulatório de ginecologia; por isso, a indicação precisa do tratamento é fundamental. O tratamento cirúrgico deve ser oferecido para incontinência moderada a severa ou na falha do tratamento clínico. Vários estudos têm mostrado que a IU está associada com a disfunção sexual, relatados por até dois terços das mulheres, no mundo, com sintomas como dispareunia, ressecamento vaginal e dificuldade para atingir o orgasmo, entre outros. Objetivo: O objetivo deste estudo foi comparar a função sexual de mulheres com incontinência urinária, antes e depois do tratamento cirúrgico. Método: Este estudo foi realizado no Hospital de Clínicas de Porto Alegre e na Irmandade Santa Casa de Misericórdia de Porto Alegre entre agosto de 2009 e novembro de 2011. Tratase de um ensaio clinico controlado não randomizado que avaliou a função sexual de mulheres com incontinência urinária utilizando o instrumento Female Sexual Function Index (FSFI) e submetidas a tratamento cirúrgico (Burch ou Sling). A amostra total se constituiu de 38 mulheres que preencheram o questionário FSFI no pré-operatório e seis meses após Intervenção: Cirurgia de Burch ou Sling Instrumentos: Questionário FSFI, variáveis clínicas e demográficas. Resultados: Trinta e oito mulheres foram incluídas no estudo e assinaram o Termo de Consentimento Livre e Esclarecido. A média de idade das mulheres foi 48 anos, todas sexualmente ativas. Oito mulheres fizeram o procedimento cirúrgico tipo Burch e trinta mulheres tipo Sling. No grupo Sling as mulheres eram mais velhas do que as do grupo Burch tinham maior tempo de vida em comum com seus parceiros (24,3 + 11,9) e um IMC de sobrepeso/obesidade (28,4 + 3,3). Não houve diferença estatisticamente significativa no préoperatório nos domínios do FSFI, porém no pós-operatório o escore geral indicou uma melhora da função sexual. Conclusões: Os domínios desejo e excitação melhoraram significativamente após a cirurgia para toda a amostra estudada. Aquelas que apresentaram cistocele tiveram uma melhora da função sexual no domínio dor e desconforto. Aims: The Female Sexual Function Index (FSFI) is a scale to assess sexual dysfunction in women. This study compared sexual function of women with urinary incontinence before and after surgical treatment. Methods: This nonrandomized clinical controlled trial was conducted in the Hospital de Clínicas de Porto Alegre and in Irmandade Santa Casa de Misericórdia de Porto Alegre from August 2009 to November 2011, to evaluate the sexual function of women with urinary incontinence that underwent surgical treatment (Burch or sling procedure). The sample comprised 38 women that answered the FSFI questionnaire before operation and six months after the intervention. Results: Thirty-eight women were included in the study and signed an informed consent term. Mean age was 48.3 years; all were sexually active, had studied for at least eight years (65.8%), had steady partners whose mean age was 54 years and with whom they had lived for a mean 22.5 years. The desire and arousal domains improved significantly after surgery for all the women included in the study. Conclusions: The patients that had cystocele had an improvement in sexual function in the discomfort and pain domain.

OBJECTIVE: To outline serum estradiol levels in perimenopausal women with stress, mixed or urge incontinence. We believe the majority of urgency symptoms in perimenopausal women to be caused by a pelvic floor dysfunction and a hypermobility of the bladder neck. If this is the case, there would be no difference in estradiol levels between the groups. STUDY DESIGN: Setting: University hospital. In the observational Women's Health in the Lund Area study, a subset of 400/2221 women reporting urinary incontinence completed a detailed questionnaire regarding lower urinary tract symptoms and had their serum steroid hormone levels measured. Statistical analyses were made by Chi-square test, nonparametrical tests, ANOVA, multi- and univariate logistic regression analysis. RESULTS: Stress incontinence was reported by 196, mixed incontinence by 153 and urge incontinence by 43 women; in 369, serumestradiol values were available. Serum estradiol did not differ significantly between stress incontinent (median 49.5pmo/l, range 2.63-875.4), urge incontinent (median 31.6pmol/l, range 2.63-460.7) or mixed incontinent women (median 35.5pmol/l, range 2.63-787.9, p=0.62). Logistic regression analysis correcting for age, parity, hormonal status, smoking, hysterectomy and BMI also failed to show any difference in estradiol levels between the groups (p=0.41-0.58). CONCLUSION: No significant differences in serum estradiol levels between stress, mixed or urge incontinent perimenopausal women could be demonstrated.

Aim: To analyze the sensitivity and specificity of the 1-hour pad test, as suggested by the International Continence Society, in the diagnosis of female urinary incontinence. Methods: 158 female patients, with or without urinary incontinence, underwent a 1-hour pad test. The pad test was assessed as positive or negative and pad weight was recorded. Uni- and multivariate analysis investigated correlation with age, body mass index (BMI), symptoms, prolapse grade, urinary incontinence grade and type, number of pads daily, urodynamic variables and Urogenital Distress Inventory and Incontinence Impact Quality of Life questionnaires. Results: A positive 1-hour pad test was significantly associated with urinary incontinence grade, with a positive stress test, with detrusor overactivity (DO), urine leakage and a positive Valsalva leak point pressure at urodynamics. The association between presence/absence of incontinence and DO, stress test, urine leakage and pad weight had 83% sensitivity and 89% specificity in predicting urinary incontinence. When the 1-hour pad test result was added to stress test and urine leakage versus presence/absence of incontinence, the sensitivity was 90%, and specificity 65%. Conclusions: Our data seem to confirm the 1-hour pad test has poor predictive value in the diagnosis of female urinary incontinence when associated to stress test and urine leakage.

La colposacropexia laparoscópica es una técnica que ha venido a sustituir a la cirugía abierta para el tratamiento de los prolapsos del suelo pélvico. De la misma manera, la cirugía asistida por robot supone un nuevo paso en la evolución de la técnica. En este artículo pretendemos mostrar, tanto nuestra técnica quirúrgica como los resultados preliminares obtenidos con la misma. En el Hospital Clínico San Carlos han sido intervenidas con esta técnica un total de 10 pacientes, desde Noviembre de 2006 hasta la fecha. La principal indicación en nuestro caso ha sido la presencia de prolapsos pélvicos sintomáticos, habiendose intervenido tanto pacientes histerectomizadas como no histerectomizadas, sin poder establecer diferencias significativas entre ambos casos. Como estudio preoperatorio se ha incluido: Cistografía, Ecografía Reno-vesical, Estudio Urodinámico en todos los casos, y tan sólo en aquellos en los que se ha considerado oportuno una Uro-Resonancia. Todas las pacientes han sido intervenidas bajo anestesia general, mediante colocación de un mínimo de tres trócares robóticos (8mm) y uno convencional para el ayudante, aunque en algunos casos, sobretodo al inicio de la serie se precisaron 2 trócares accesorios. Así mismo, en nuestra serie en la mayoría de los casos se ha asociado una técnica anti-incontinencia tipo sling suburetral transobturatriz, bien para tratamiento de la incontinencia urinaria de esfuerzo (IUE), bien para prevenir su posible aparición tras la correción del prolapso. Los resultados obtenidos son comparables a los descritos en otras series más numerosas en cuanto a duración, estancia hospitalaria y complicaciones tanto precoces como tardías. A expensas de realizar una valoración a largo plazo y con series más amplias, podemos incluir la colposacropexia laparoscópica asistida por robot entre el arsenal terapéutico diseñado para la reparación de los prolapsos del suelo pélvico sintomáticos. Laparoscopic colposacropexy has become a substitute for open surgery in the treatment of pelvic organ prolapse. In the same way, robotic assisted surgery is a new step in the evolution of the procedure. In this paper we intend to show our surgical technique and preliminary results. From November 2006 to date, 10 patients have undergone this procedure at the Hospital Clínico San Carlos. The main indication for the operation was existence of symptomatic pelvic prolapse. Both patients with or without hysterectomy have been operated, without making significant differences between them. Preoperative evaluation workout included: cystogram, urinary tract ultrasound and urodynamics in all cases; urinary tract MRI was performed only in selected cases. All patients underwent surgery under general anesthesia, with at least three robotic trocars (8 mm) and one conventional trocar for the assistant; 2 accessory trocars were necessary in some cases, mainly at the beginning of the series. Most procedures in our series were associated with a transobturator suburethral sling for the treatment of stress urinary incontinence or prevention of its appearance after prolapse repair. Our results are comparable to those reported in other larger series in terms of operative time, hospital stay and early or late complications. Pending an evaluation on the long term with larger series, we can include robot assisted colposacropexy among the therapeutic options for symptomatic pelvic floor prolapse repair.

Objetivo: Describir los elementos que componen el sistema Remeex femenino, sus indicaciones y la técnica quirúrgica mediante la que se implanta y ajusta adecuadamente. Método: Indicaciones: Las indicaciones para la utilización del sistema Remeex en incontinencia urinaria femenina son hipermobilidad uretral, uretra fija, disfunción esfinteriana primaria, fracaso de otras técnicas antiincontinencia, incontinencia urinaria en hiperrreflexia vesical 1,2. Protocolo de estudio: El diagnóstico se realiza con una adecuada historia y exploración física y se completa con uretrocistografía y estudio urodinámico, ecografía urológica y opcionalmente uretrocistoscopia. Características de la prótesis Remeex: Este sistema esta compuesto por los siguientes elementos: malla de polipropileno, baritensor, introductor y desacoplador. Técnica: 1. Anestesia El procedimiento puede realizarse bajo anestesia raquídea o general. 2. Preparación y colocación de la paciente. 3. Técnica quirúrgica paso a paso. 1) Acceso Abdominal. Incisión suprapúbica de 4-6 cm, creación de un lecho supraaponeurotico, para alojar el baritensor. 2) Acceso vaginal. Incisión longitudinal a 1cm del meato uretral, disección del plano vésico-vaginal y creación de un lecho que permita colocar la malla de polipropileno. 3) Acceso combinado abdomino-vaginal. Maniobra de punción mediante una aguja pasahilos de 20 cm en sentido abdominovaginal (bilateral), paso de los dos extremos de la malla a través del espacio parauretral, enhebrado de los hilos en el sistema baritensor de la prótesis Remeex y cierre de las incisiones vaginales y abdominales. 3.Uretrocistoscopia -Ajuste de tensión y control postoperatorio. Conclusiones: 1. Es una técnica reproducible y el sistema es fácil de implantar. 2. Esta técnica evita la morbilidad de las técnicas abdominales. 3. Permite realizar. 4. Permite reajuste al cabo del tiempo con anestesia local a través de una pequeña incisión suprapúbica. 5. Se han descrito buenos resultados a corto y medio plazo. Objectives: Currently, there is not agreement about the adequate tension for each patient with female stress urinary incontinence treated with urethral slings. The adjustable tension sling Remeex (external mechanic regulation) allows adjustment to ideal tension tr ying to avoid or minimize possible reoperations. The objective of these paper is to describe the components of the Remeex system, its indications, and the surgical technique to implant and adjust it. Methods: Indications: The Remeex system is indicated female urinary incontinence in cases of urethral hypermobility, fixed urethra, primary sphincteric dysfunction, failure of other incontinence repaired techniques, and urinary incontinence in bladder hyperreflexia. Study protocol: The diagnosis is made with appropriate history and physical examination and completed with voiding cystourethrogram and urodynamic study, urinar y tract ultrasound and, optionally, urethrocystoscopy. Remeex prosthesis characteristics: The system has three elements: polypropylene mesh, pressure tensor, and disconnection tool. Technique: 1. Anesthesia: It maybe performed under general or spinal anesthesia. 2. Preparation and patient position. 3. Surgical technique step-by-step: -Abdominal access: 4-6 cm suprapubic incision and development of a supra-aponeurotic space to place the pressure tensor. -Vaginal access: longitudinal incision 1 cm from the urethra meatus, dissection of the vesicovaginal plane, and development of the space to place the polypropylene mesh. -Combined abdominal-vaginal access: bilateral punction with a 20 cm suture-passing needle from the abdomen to the vagina and passage of the mesh from the paraurethral espace threading its sutures in the pressure tensor system,and closure of the incisions.-Cystoscopy.-Tension adjustment and postoperative control. Conclusions: 1. It is an easy to implant system and a reproducible operation. 2. This technique avoids the morbidity of abdominal operations. 3. It allows the readjustment after surgery through a small suprapubic incision under local anesthesia. 4. Good results have been described in the short and mid-term.

Objetivo: El valor de la Ecografía en el estudio de la Incontinencia Urinaria Femenina (IUF) ha sido redefinido en los últimos anos Métodos: Se revisa la literatura sobre el valor de la Ecografía en el estudio de las mujeres con Incontinencia urinaria, fundamentalmente en la ecografía transperineal en la Incontinencia Urinaria de esfuerzo femenina Resultados: En los últimos años son numerosos los trabajos publicados. La ecografía del TUS tiene poco lugar en la evaluación de la IUF de esfuerzo pura. La ecografía transperineal permite evaluar movilidad del cuello vesical y uretra, grosor de la pared vesical, embudización del cuello, presencia de IUF de esfuerzo, presencia de prolapso de órganos pelvianos (POP), visualización de mallas, ayudar al biofeedback y valorar cambios tras tratamiento quirúrgico. Conclusiones: Los ultrasonidos y en particular la ECO transperineal o translabial esta en proceso de convertirse un metodo diagnostico estandar en uroginecologia. A ello contribuye su amplia disponibilidad, estandarizacion de los parametros y la posibilidad de evaluar no solo la vejiga, sino tambien el elevador del ano o los Prolapsos de órganos pelvianos (POP). Permite obtener, de forma no invasiva datos pre y postratamiento. Objectives: The value of ultrasonography for the study of female urinary incontinence has been redefined over the last years. Methods: We review the literature about the value of ultrasound in the workup of females with urinary incontinence, mainly transperineal ultrasound for the female stress urinary incontinence (SUI). Results: Many papers have been published over the last few years. Upper urinary tract ultrasound has not a place in the workup of genuine female SUI. Transperineal ultrasound allows to evaluate the mobility of the bladder neck and urethra, the thickness of the bladder wall, the funnel shape of the bladder neck, the presence of SUI or pelvic organ prolapse (POP), to visualize mesh implants, to help with biofeedback, and to evaluate changes after surgical treatment. Conclusions: Ultrasounds in general, and transperineal or translabial ultrasound in particular, are in the process of becoming the standard diagnostic method in urogynecology. Their wide availability, the standardization of parameters, the possibility of evaluating not only the bladder but also the levator ani muscle or pelvic organ prolapses (POP) contribute to this fact. It allows to obtain data in a non invasive way before and after therapy.

Though not a life threatening condition, involuntary loss of urine is a miserable situation. It has a multidimensional effect on the afflicted individuals, both men and women — and for the society. The purpose of this study was to evaluate two modern, minimally invasive surgical techniques for the treatment of female stress urinary incontinence (SUI). The techniques evaluated were laparoscopic colposuspension with mesh and staples (LCM) and the tension-free vaginal tape procedure (TVT). The study consisted of four parts. The first part (Study I) was an observational retrospective follow-up study. Data on the first forty patients operated on with LCM at Oulu University Hospital were collected. Patients had SUI or mixed urinary incontinence (MUI) with predominantly stress incontinence. The Studies II–IV were parts of a randomized, multicenter clinical trial, where LCM was compared with TVT. According to the predefined inclusion criteria 128 SUI women were randomly allocated into two treatment groups: 70 patients received TVT treatment as allocated and 51 LCM. There were seven drop-outs after randomization. After one year of follow-up the cure and improvement rate of the patients operated with LCM were ~ 90%. Also a significant improvement was found in Urinary Incontinence Severity Scores (UISS). At base line the score was 12.1 and after one year follow-up 2.7 (p < 0.001). The bladder perforation rate was 15%. In Study II immediate cure rates and complications of LCM and TVT were studied. After six weeks of follow-up there was no difference in cure rates (~ 90%) between the procedures. There was no difference in complication rates. A significant difference was found in the use of anti-inflammatory / opioid drugs in the immediate post-operative period to relief the pain in favour for TVT. Hospital care was also significantly shorter after TVT than LCM. After one year of follow-up (Study III) TVT was found to give better result both objectively and subjectively. Negative stress test result was recorded in 85.7% in the TVT group and 56.9% in the LCM group. A significant difference was also found, when Visual Analoque Scale (VAS), King’s College Health Questionnaire (KHQ) and UISS were used as outcome measures, in the favour of TVT. When 48-hour pad test was used as outcome measure there was no statistically significant difference between the groups. The cost-effectiveness (Study IV) of TVT was found to be better than that of LCM after one year of follow-up. In conclusion, the results of this study suggest, that TVT procedure is on the whole a cost-effective alternative for LCM in the treatment of female SUI.

To investigate by questionnaire the prevalence and characteristics of urinary incontinence (UI) in a female population aged between 18 and 49.Of 44,095 females aged 18-49.9 living in our urban area a sample of 10,000 subjects was sent a questionnaire and 3557 replied. The age-based analysis was performed on 2900 of these.The overall prevalence of UI was 20\%. 11\% had suffered from nocturnal enuresis before 18 years old, 47\% of parous women noted a relationship between the beginning of UI and delivery. Among the incontinent women 83\% lost urine with physical exertion, and 44\% had urge incontinence, 18\% used diapers, 20\% had consulted a physician and half of these had been referred for medical, surgical or rehabilitative therapy, 50\% reported past or present urinary infections, 8\% complained also of faecal incontinence, 22\% considered loss of urine embarrassing and humiliating but only 6\% revealed frustration and 2\% were obliged to stay at home for long periods of time. Of the incontinents 62\% defined themselves anxious or nervous and 22\% of these ascribed an increase of urinary leakage to anxiety or to nervousness, 9\% reported use of antidepressant drugs, 85\% had sexual intercourse and only 2\% considered UI as an impediment to a satisfying sexual activity.UI is a common problem in young women. Urge incontinence seems to be prevalent in

Urinary incontinence is a prevalent condition; nevertheless few women seek professional help. One aim of this study was to investigate all women aged 18-70 years in a Swedish community regarding (a) the prevalence rate and risk factors of urine leakage and (b) the quality of life for women with and without urine leakage, for women with stress incontinence versus urge incontinence, and for women with urine leakage who had or had not sought help. A second aim was to study all women aged 18-46 years from the same population four years later regarding (a) the quality of life and natural history of urine leakage, (b) why some women with persistent urine leakage seek help and others do not, and (c) how they deal with their urine leakage. Every fourth woman aged 18-70 years was found to have urine leakage. The number of women with urine leakage increased with increasing age, the number of deliveries, the presence of urinary tract infection, and the use of oestrogen substitutions. Women with urine leakage had a lower quality of life in all eight dimensions of the SF-36 as compared with women without urine leakage. Furthermore, in women with urge incontinence the quality of life was lower compared with women with stress incontinence in all dimensions of the SF-36. Women with urine leakage who had sought help had lower quality of life in seven of eight SF-36 dimensions as compared with women with urine leakage who had not sought help. At the four-year follow-up the quality of life had deteriorated in five of eight SF-36 dimensions in women aged 18-46 years with persistent urine leakage as compared with women with persistent continence. The mean annual incidence and remission rates of urine leakage were on the same low level (4%). Most women with slight or moderate long-term urine leakage had not sought professional help, largely because they considered their leakage a minor problem. Pelvic floor exercises was the most commonly used management method for all participants.

Apresentamos uma revisão atualizada da literatura científica sobre a utilização da eletroestimulação pélvica no tratamento das formas mais freqüentes de incontinência urinária feminina. Em 2001, no Ambulatório de Ginecologia do Hospital de Clínicas de Porto Alegre (HCPA), realizamos um ensaio clínico controlado comparando a estimulação elétrica transvaginal com placebo no tratamento da incontinência urinária de esforço, de urgência e mista. Nossos resultados foram semelhantes aos de estudos científicos disponíveis, demonstrando que a estimulação elétrica é uma opção terapêutica efetiva para o tratamento da incontinência urinária feminina. This paper presents a literature review on pelvic floor stimulation in the treatment of female urinary incontinence. During 2001, we performed a controlled clinical trial comparing transvaginal electrical stimulation and placebo in the treatment of stress, urgency and mixed incontinence. The results were similar to those from reported trials showing that electrical stimulation may be an ef fective therapeutic option in the treatment of female urinary incontinence.