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Objective: To evaluate the effect of mesh-urethra distance on sexual function in continent patients who underwent transobturator tape (TOT) surgery due to isolated stress urinary incontinence (SUI). Material and Methods: Continent patients who had undergone TOT surgery for SUI were eligible. Objective treatment for SUI was defined as the absence of urine leakage during a stress test. Translabial perineal ultrasound was performed six months after surgery. The successful surgical group was split into two subgroups based on the distance from the posterior of the urethra at the bladder neck to the nearest proximal edge of the tape: <5 mm and >5 mm. In addition to these, band percentile, the descent of bladder neck and urethra length measured by perineal ultrasound, pubo-urethral distance, urethral thickness, detrusor thickness, cystocele descent, rectal descent, and uterine descent were evaluated. Preoperative and postoperative results of the standardized and internationally valid incontinence questionnaires Incontinence Questionnaire Urinary Incontinence Short Form and Female Sexual Function Index (FSFI) were compared between groups. Results: Eighty-two patients were included. The postoperative FSFI scores for the >5 mm group were significantly lower than those of the <5 mm group, including the postoperative FSFI average, all subscales except lubrication, and average change scores due to the operation (p<0.001). There was no statistically significant relationship between the percentile occupied and postoperative FSFI score (p=0.553), and the FSFI preoperative-postoperative difference was not significant (p=0.905). Conclusion: Sexual functions are more affected in patients with a mesh-urethra distance >5 mm as measured by perineal ultrasound. [ABSTRACT FROM AUTHOR]

Objective: To compare needleless mini-slings placed in a retropubic (U-shape) or trans-obturator (hammock-shape) configuration for treating stress urinary incontinence at 60th month. Methods: All surgeries, conducted by a senior surgeon, involved objective and subjective assessments preoperatively and at 6, 12, 18, and 60 months postoperatively using cough-stress tests, ICIQ-SF, PGI-I, and a Likert scale. Results: After 60 months, no significant differences were found in cure rates, mesh complications, or reinterventions between U-shaped and hammock-shaped groups. However, a significant decrease in cure rates was observed at 18 and 60 months in both groups. Notable differences in ICIQ-SF, Likert scale, and PGI-I scores were seen in the hammock-shaped group, while the U-shaped group showed differences in ICIQ-SF and PGI-I scores, but not in the Likert scale. Conclusion: Given the lack of significant differences, asserting the superiority of either retropubic (U-shape) or transobturatorly (hammock-shape) needleless mini-slings for treating stress urinary incontinence is challenging. [ABSTRACT FROM AUTHOR]

Introduction: There is no guideline or clinical consensus concerning the mid‐urethral sling (MUS) operation for stress urinary incontinence (SUI) and future pregnancies. The aim of this systematic review and metanalysis is to evaluate the impact of pregnancy and of delivery on SUI in women who previously sustained a MUS surgery. Methods: We performed a systematic review and meta‐analysis, according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 guidelines, and selected seven publications for inclusion in the analysis. Results: Recurrence of SUI after childbirth in women previously submitted to MUS was 22% (95% confidence interval [CI]: 18.0%−26.0%; I2 = 0%) while the reintervention rate for SUI the 5% (95% CI: 2.0%−8.0%; I2 = 47.34%) in the included studies. There was not statistically significant difference between women who delivered (both vaginally and by caesarian section) or not after MUS in SUI recurrence (RR 1.01, 95% CI 0.73−1.40; p = 0.96 and I2—test of 41% p = 0.18) and in SUI reintervention (RR 1.45, 95% CI 0.91−2.30; p = 0.12 and I2—test of 0% p = 0.38) with homogeneity among studies. There was no difference between women who delivered vaginally or by caesarian section both for recurrence of SUI (RR 1.24, 95%CI 0.77‐2.01; p = 0.37 and I2—test of 0% p = 0.60) and reintervention (RR 1.61, 95% CI 0.76−3.42; p = 0.22 and I2—test of 0% p = 0.47). BMI ≥ 30 kg/m2, urinary incontinence (UI) before and during pregnancy emerged as risk factors for postpartum UI relapse. Conclusion: Childbirth do not affect SUI relapse or reintervention in women previously submitted to MUS. In the same population of patients, no difference was highlighted concerning the mode of delivery for the outcome SUI relapse or reintervention. Previous MUS surgery may not be an appropriate indication for cesarean birth in subsequent pregnancy. [ABSTRACT FROM AUTHOR]

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

Introduction: Transobturator techniques are frequently used for the surgical treatment of female stress urinary incontinence (SUI), due to their high success rates and few intraoperative complications. However, controversial results have been reported in the literature regarding their incidence. The aim of this study is to analyze the real incidence and trend over time of such complications, especially voiding dysfunctions and overactive bladder (OAB) symptoms. Methods: A comprehensive search using PubMed/MEDLINE, Scopus, and Cochrane databases was performed. The search string used was the following: (female stress urinary incontinence) AND (complication) AND ((midurethral sling) OR (transobturator tape) OR (TVT-O) OR (voiding dysfunctions) OR (de novo OAB) OR (recurrent UTI) OR (vaginal erosion)). We included randomized controlled trials, prospective controlled studies, prospective and retrospective observational studies. All selected articles were screened based on titles and abstracts. Relevant data were extracted and tabulated. Results: A total of 39 studies were included in our analysis. Transobturator tape procedures show a high objective cure rate for SUI, from 76.9% to 100%. Postoperative voiding dysfunctions are shown to be quite common, ranging from 0–22% of cases. Despite that, this percentage decreases to 0–1% after 12 months. De novo OAB incidence ranges from 3% to 14% at 12 months, with variability over time due to multiple factors. Tape-related complications usually occur after 12 months, with a variable incidence up to 7%. Urinary tract infections (UTIs) are quite common in the immediate postoperative period but sometimes can be recurrent, requiring long-term prophylactic antibiotic treatment. Conclusions: Voiding dysfunctions are generally transient complications, while de novo OAB may persist over time. An adequate preoperative counseling, along with accurate written informed consent, could enhance patient tolerance of these issues and contribute to long-term patient satisfaction. [ABSTRACT FROM AUTHOR]

To evaluate the impact of a standardized perioperative pain management pathway on postoperative opioid prescribing practices following male perineal reconstructive surgery at our institution. Patients undergoing perineal reconstructive surgery (urethroplasty, artificial urinary sphincter, urethral sling) by a single surgeon from July 2022 to June 2023 were prospectively followed. A standardized nonopioid pathway was implemented in the perioperative period. Intraoperative local anesthetic included liposomal bupivacaine mixed with 0.25% bupivacaine. Opioids are administered in the recovery room at the discretion of anesthesiology providers. As of July 2022, our standard practice does not include a postoperative opioid prescription unless pain is poorly controlled in the recovery area. Postoperative communication encounters and opioid prescriptions were tracked through the electronic health record (EHR) in order to assess the efficacy of an opioid-free pathway. Sixty-seven patients met the criteria during the study period, 64/67 performed in an outpatient setting. 6/67 (9%) patients were prescribed an opioid postoperatively; 4 related to post-surgical pain, and 2 related to chronic pain. No refills were prescribed. Of the 26 patients who received an opioid in the recovery area, 2 (7.6%) were prescribed an opioid at discharge. 15/67 (22%) patients had a communication encounter related to pain within 30 days, most commonly related to bladder spasm management. Only 2 of these encounters resulted in an electronic opioid prescription. An opioid-free pathway is appropriate for opioid naive men undergoing perineal reconstructive surgery. When necessary, electronic opioid prescribing should be employed following discharge for breakthrough pain. [ABSTRACT FROM AUTHOR]

Introduction: High body mass index (BMI) is a risk‐factor for stress urinary incontinence (SUI). Mid‐urethral sling (MUS) surgery is an effective treatment of SUI. The aim of this study was to investigate if there is an association between BMI at time of MUS‐surgery and the long‐term outcome at 10 years. Material and Methods: Women who went through MUS surgery in Sweden between 2006 and 2010 and had been registered in the Swedish National Quality Register of Gynecological Surgery were invited to participate in the 10‐year follow‐up. A questionnaire was sent out asking if they were currently suffering from SUI or not and their rated satisfaction, as well as current BMI. SUI at 10 years was correlated to BMI at the time of surgery. SUI at 1 year was assessed by the postoperative questionnaire sent out by the registry. The primary aim of the study was to investigate if there is an association between BMI at surgery and the long‐term outcome, subjective SUI at 10 years after MUS surgery. Our secondary aims were to assess whether BMI at surgery is associated with subjective SUI at 1‐year follow‐up and satisfaction at 10‐year follow‐up. Results: The subjective cure rate after 10 years was reported by 2108 out of 2157 women. Higher BMI at the time of surgery turned out to be a risk factor for SUI at long‐term follow‐up. Women with BMI <25 reported subjective SUI in 30%, those with BMI 25—<30 in 40%, those with BMI 30—<35 in 47% and those with BMI ≥35 in 59% (p < 0.001). Furthermore, subjective SUI at 1 year was reported higher by women with BMI ≥30, than among women with BMI <30 (33% vs. 20%, p < 0.001). Satisfaction at 10‐year follow‐up was 82% among women with BMI <30 vs 63% if BMI ≥30 (p < 0.001). Conclusions: We found that higher BMI at the time of MUS surgery is a risk factor for short‐ and long‐term failure compared to normal BMI. [ABSTRACT FROM AUTHOR]

Introduction: There has been increasing concern about potential negative impact of mid‐urethral slings (MUS) on sexual life. Our aim was to study sexual activity 10–20 years after MUS surgery and changes in impact of incontinence on sexual life over time and to compare subjective cure, pain, satisfaction, and incontinence between sexually active and inactive women 10–20 years after MUS. Material and Methods: Historical cohort study using the Norwegian Female Incontinence Registry to identify women who underwent MUS between 2001–2006 and 2011–2012. They answered validated questionnaires about sexual activity, incontinence, pain, and satisfaction with MUS. We assessed changes in urinary incontinence during intercourse and compared symptoms and satisfaction between sexually active and inactive women. The study was registered in Clinical Trials (NCT04912830). Results: In total, 1210/1903 (64%) responded. Of women responding to questions about sexual activity, 63% (735/1166) were sexually active. 31.3% experienced negative impact of incontinence on sexual life preoperatively, decreasing to 5.9% at 10–20 years follow‐up. A higher proportion of sexually inactive vs sexually active women had urinary incontinence (63.5% vs. 47.5%, aOR 1.60 [1.18–2.17]). In a subanalysis, only urgency and mixed urinary incontinence remained significant. A higher proportion of sexually inactive were dissatisfied with MUS (30.1% vs. 12.9%, aOR 2.53 [1.82–3.51]). Persistent pain after MUS was similar for sexually inactive and active women (4.0% vs. 3.2%, aOR 1.10 [0.55–2.19]). Furthermore, 3.4% of sexually inactive had persistent pain after MUS and stated pain as a reason for not being sexually active, whereas 1.7% of sexually active women had persistent pain after MUS and pain during intercourse. Conclusions: Negative impact of incontinence on sexual life was less prevalent at 10–20 years follow‐up after sling surgery compared to preoperative assessment. A higher proportion of sexually inactive had urgency and mixed urinary incontinence and were dissatisfied with MUS. Only 3%–4% of sexually active and inactive women had persistent pain after MUS and this was not associated with sexual activity. This indicates that incontinence has a greater negative impact on sexual activity than persisting pain after MUS at long‐term follow‐up. [ABSTRACT FROM AUTHOR]

AbstractThe tension uniformity and surface accuracy of mesh antenna cable net are two well-accepted evaluation criteria for form finding. Traditional form finding techniques often rely on single-objective optimization and weighting factors. Although the Non-dominated Sorting Genetic Algorithm II (NSGA-II) can address the limitation, there are still challenges of wide distribution and insufficient precision of solutions. In the present work, a novel multi-objective optimization method based on an improved NSGA-II is introduced to conduct mesh antenna cable net form finding optimization. Based on the preference region (PR), a self-adaptive penalty function is proposed. The function is designed to steer the optimization process toward the PR, and enhancing the precision of the solutions. The extent of penalization for an individual solution depends on its positioning relative to the PR and is modified by a penalty coefficient that adapts dynamically to the population number within the PR. Additionally, a form finding method considering flexible frames is developed. The initial population for the flexible frame optimization is sourced from results of rigid frames, with the maximum truss node position error as the convergence criterion. Benchmark tests and case studies confirm that the improved NSGA-II enhances distributivity and convergence, while also providing form-finding results with higher surface accuracy and more uniform tension distribution. [ABSTRACT FROM AUTHOR]

Objective: To evaluate rates of subjective and objective cure, treatment satisfaction, pain, and the correlation between cure and body mass index (BMI), at 10 and 20 years after tension‐free vaginal tape (TVT) surgery. Design: Retrospective cohort study. Setting: Multicentre study including 19 units in Norway. Population: Women undergoing TVT surgery for stress urinary incontinence (SUI) during 2001–2006 (20‐year cohort) and 2011–2012 (10‐year cohort). Methods: The Norwegian Female Incontinence Registry was used to identify women eligible for the study, who answered validated questionnaires about urinary incontinence, pain and satisfaction. Main outcome measures: Subjective cure of SUI (with stress index of <3, range 0–12), objective cure (<3 g on stress test) and persisting pain and satisfaction after TVT (scored on a five‐point Likert scale). Results: In total, 1210 of 1903 (64%) patients responded. The subjective cure rate was 68% after 10 years, versus 59% after 20 years, and did not significantly differ after adjusting for age, BMI, parity and preoperative stress index (adjusted OR 1.27, 95% CI 0.82–1.94). The objective cure rate was 100% versus 93% (P < 0.001), with 89% versus 76% reporting subjective satisfaction (P < 0.001), and with 4.7% versus 2.7% reporting persisting pain (P < 0.001), after 10 versus 20 years, respectively. Women in obesity classes I and II, compared with women of normal weight, had an increased risk of not being subjectively cured (crude OR 2.02, 95% CI 1.42–2.90; OR 2.95, 95% CI 1.60–5.46, respectively). Conclusions: Tension‐free vaginal tape (TVT) provided high rates of subjective and objective cure at 10 and 20 years after surgery, with no significant difference between the two cohorts. Although 3%–5% of women experienced persisting pain, most women were satisfied with TVT surgery. Obesity was associated with a lower cure rate. [ABSTRACT FROM AUTHOR]

Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Simple Summary: Atresia Ani (AA) is a rare congenital anomaly affecting rectal and anal development in companion animals, with its occurrence in cats being poorly documented. This study investigated Type IV Atresia Ani (which includes a recto-vaginal fistula) in female cats, focusing on surgical intervention as the primary treatment. Over 2 years, nine female cats with Type IV Atresia Ani were analyzed for age, body condition, and fistula length. Statistical analysis revealed that a body condition score of 3, an age range of 3 to 4 weeks, and a fistula length of 1 to 2 mm influenced fecal incontinence and anal stenosis development during the perioperative period. Incidence of this condition was 4.7% among the 192 cats evaluated. Cats with a body condition score of 3, an age of 3 to 4 weeks, and a fistula size of 1 to 2 mm showed better surgical outcomes. This study is the first to report the disease incidence in cats undergoing surgery, according to the authors' knowledge. Atresia Ani (AA) is a rare congenital anomaly in companion animals affecting rectal and anal development. Its incidence in cats remains unreported. This retrospective study aimed to characterize age, body condition, fistula size, and perioperative outcomes in Type IV Atresia Ani (with recto-vaginal fistula) in female cats. Surgical intervention is the primary treatment. Conducted over 2 years, the study included nine female cats diagnosed with Type IV Atresia Ani and recto-vaginal fistula undergoing surgery. Statistical analysis used the R program (version 4.2.1) with Rstudio®® extension. Significant results were observed at a 95% confidence interval and p < 0.05. The condition had an incidence of 4.7% among the 192 cats evaluated over a 2-year period. The findings suggest that a body condition score of 3, an age of 3 to 4 weeks, and a fistula length of 1 to 2 mm correlated with better surgical outcomes, reducing the likelihood of fecal incontinence and anal stenosis development, and enhancing defecation awareness during the perioperative period. This study is the first to report the disease incidence in cats undergoing surgery, according to the authors' knowledge. [ABSTRACT FROM AUTHOR]

Objective: This study compared the outcomes of the bulking agent polyacrylamide hydrogel (PAHG) with a single-incision sling (SIS) for treating occult stress urinary incontinence (SUI) in association with vaginal prolapse surgery. Methods: This was a retrospective study of patients who underwent transvaginal surgical correction of pelvic organ prolapse and received either SIS or urethral bulking with PAHG for occult SUI. Demographic and perioperative data were extracted from the charts. The primary outcomes were Urinary Distress Inventory–6 (UDI-6) scores, Incontinence Impact Questionnaire–7 (IIQ-7) scores, and incontinence episodes documented by 3-day bladder diaries collected 24 months after surgery. Secondary outcomes included complications such as adverse events, rates of urine retention with prolonged catheterization, and urinary-tract infections. Results: Thirty patients had the bulking agent using PAHG with the prolapse surgery for occult incontinence and 23 patients has SIS. Twenty-two patients from each group completed the postoperative questionnaires. UDI-6 scores were low in both groups with bulking versus SIS value (19 versus 11; p = 0.096). The stress subscale median value for bulking versus SIS was 33 versus 0; p = 0.009. IIQ-7 median value was 0 for both groups. The median Foley catheter duration for the bulking group versus the SIS group was 1 versus 5 days (p = 0.015). Conclusions: SIS and PAHG were equally satisfactory for treating occult SUI with similar total UDI-6 and IIQ-7 scores; yet, the UDI-6 stress subscale was significantly better for the SIS group, but with more short-term voiding dysfunction. (J GYNECOL SURG 20XX:000) [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objective was to investigate the relationship between mesh exposure and persistent stress urinary incontinence (SUI) post-midurethral sling (MUS) surgery. Methods: Extensive data collection including patient demographics, obstetric history, existing medical conditions, previous surgeries, and surgical outcomes, encompassing both perioperative and postoperative complications. Results: Out of 456 patients who underwent the MUS procedure within the specified period, the persistence of SUI was noted in 6.4% of cases. Mesh exposure was observed in 8.8% of these cases. Notably, 25% of patients with mesh exposure suffered from persistent SUI, in stark contrast to 4.6% of those without mesh exposure (p < 0.0001). Further, multivariate analysis indicated that patients with mesh exposure had an approximately 6.5-fold increased likelihood (95% CI: 2.71—15.44) of experiencing persistent SUI compared with those without mesh exposure. Conclusions: Mesh exposure is a significant independent risk factor for persistent SUI post-MUS surgery. Patients with mesh exposure are about 6.5 times more prone to persistent SUI than those without. Although mesh exposure is typically managed with expectant measures, vaginal estrogen or mesh excision, current evidence does not support surgical revision of MUS affected by mesh exposure or additional incontinence procedures during mesh excision. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effectiveness of a long-acting anesthetic injection into the obturator membrane for pain relief in women undergoing trans-obturator tension-free vaginal tape. Methods: A total of 22 women were randomized for the intra-operative injection of bupivacaine into one of their obturator membranes: the left or right side. All the participants were asked to define their groin pain on a visual analog scale (scored 0–10 cm) at 1, 6, 12, and 24 h post-operative. For each woman, pain scores were compared between the local anesthetic-injected side and the opposite side. Results: Statistically significant differences were not observed in groin pain scores between the bupivacaine injection side and the no injection side at 1 h (p = 0.76), 6 h (p = 1), 12 h (p = 0.95), and 24 h (p = 0.82) post-operative. Conclusion: In women who undergo trans-obturator tension-free vaginal tape procedures, intra-operative intra-obturator injection of local anesthetics is not effective in alleviating the characteristic post-operative groin pain. Trial registration: This study is registered on ClinicalTrials.gov (NCT03479996). [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the sexual function and quality of life in female patients diagnosed with stress urinary incontinence (SUI) and pelvic organ prolapse (POP) after undergoing transobturator tape (TOT) or TOT with POP surgery and perineoplasty. Material and Methods: This prospective study population (n=86) consisted of sexually active women who had been diagnosed with SUI. Forty-six patients diagnosed with SUI with no POP (group 1) underwent TOT procedure only. Forty patients had a diagnosis of stage 2 and higher POP, based on POP quantification system with SUI (group 2). The second group was randomized as TOT-POP surgery (n=20) and TOT-POP surgery with perineoplasty (n=20). Prior to and six months after the surgical procedure, all female participants underwent assessment using the validated Urinary Distress Pre-Operative Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ). Results: Post-operative IIQ-7 and UDI-6 scores were significantly lower for all three groups compared to the preoperative period, while a significant increase was observed in PISQ scores (p<0.01). The dissimilarity in preoperative and postoperative IIQ-7 and UDI-6 scores exhibited comparable results across the groups, whereas the variance in PISQ scores was notably greater in the TOT + POP surgery + perineoplasty group (p=0.03). Conclusion: Women with SUI or SUI with POP have better quality of life and sexual dysfunction after surgery. Perineoplasty may enhance sexual life in patients with perineal defect and vaginal enlargement. [ABSTRACT FROM AUTHOR]

A recent clinical trial investigation conducted by the Apisith team explores the use of autologous platelet‐rich plasma (A‐PRP) for stress urinary incontinence (SUI) in women. While A‐PRP has been extensively studied in other contexts, its application in SUI remains limited. The study suggests that A‐PRP injections may be a valuable addition to pelvic floor muscle training (PFMT) programs. Other injectable treatments, such as autologous mesenchymal stem cell (MSC) injections and polyacrylamide hydrogel injections (PAHG), have also shown promise in alleviating urinary incontinence. This study highlights the potential of injection therapy as a non-surgical option for managing SUI. [Extracted from the article]

Purpose of Review: Managing neurogenic stress urinary incontinence (NSUI) remains a significant challenge. Multiple issues contribute to this, including challenges in accurate diagnosis, coexistence of bladder and bowel dysfunctions, lack of robust scientific evidence supporting various treatment modalities, the diverse preferences of patients, and the need to tailor interventions to an individual's social circumstances. This review aims to update the current alternatives for the surgical management of patients with NSUI. Recent Findings: The scientific landscape in the field of neurogenic stress urinary incontinence (NSUI) remains constrained in terms of both volume and quality of research. In recent years, only a handful of studies have emerged, most of which are retrospective and report on a few patients and relatively short follow-up periods. These studies frequently involve heterogeneous populations and employ varied definitions of success, further complicating the interpretation of results. For women, studies have shown promising results with the use of synthetic midurethral slings and the robotic technique of implanting the artificial urinary sphincter (AUS). Autologous fascial slings continue to be viewed as one of the most appropriate techniques. For men, the robotic technique for AUS implantation at the bladder neck has become the preferred method for AUS implantation in this population. Reasonable results have been shown with male slings. While the AUS has demonstrated efficacy, there is a notable rate of device-related complications. Very limited and poor results have been reported with bulking agents and adjustable continence devices. Summary: Managing NSUI necessitates a multidisciplinary, individualized, patient-tailored approach. Continence rates may decrease over time, and complications must be monitored. Overall, understanding the nuances of surgical options and tailoring treatments to patient needs is paramount to improve quality of life and preserve urinary tract function. [ABSTRACT FROM AUTHOR]

Background: Obstetric fistula is a serious and debilitating problem resulting from tissue necrosis on the reproductive and urinary and/or lower gastrointestinal tract organs due to prolonged labor. Primary studies of the treatment of obstetric fistulae report significantly variable treatment outcomes following surgical repair. However, no systematic review and meta-analysis has yet estimated the pooled proportion and identified the determinants of successful obstetric fistula surgical repair. Objective: To estimate the proportion and identify the determinants of successful surgical repair of obstetric fistulae in low- and middle-income countries. Methods: The protocol was developed and registered at the International Prospective Register of Systematic Reviews (ID CRD42022323630). Searches of PubMed, Embase, CINAHL, Scopus databases, and gray literature sources were performed. All the accessed studies were selected with Covidence, and the quality of the studies was examined. Finally, the data were extracted using Excel and analyzed with R software. Results: This review included 79 studies out of 9337 following the screening process. The analysis reveals that 77.85% (95%CI: 75.14%; 80.56%) of surgical repairs in low and middle-income countries are successful. Women who attain primary education and above, are married, and have alive neonatal outcomes are more likely to have successful repair outcomes. In contrast, women with female genital mutilation, primiparity, a large fistula size, a fistula classification of II and above, urethral damage, vaginal scarring, a circumferential defect, multiple fistulae, prior repair and postoperative complications are less likely to have successful repair outcomes. Conclusion: The proportion of successful surgical repairs of obstetric fistula in low and middle-income countries remains suboptimal. Hence, stakeholders and policymakers must design and implement policies promoting women's education. In addition, fistula care providers need to reach and manage obstetric fistula cases early before complications, like vaginal fibrosis, occur. [ABSTRACT FROM AUTHOR]

Background: Surgical interventions are more effective than nonsurgical approaches in providing a cure for stress urinary incontinence (SUI). In this study, we aimed to assess the benefits of tension-free vaginal tape (TVT) abbrevo by comparing its efficacy and complications to those of TVT obturator. Methods and results: 49 and 47 patients at The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University between January 2013 and December 2016 were included in the TVT-O and TVT-A groups, respectively. We evaluate the success rate and perioperative complications associated with TVT-O and TVT-A. A questionnaire that utilized the Patient Global Impression of Improvement (PGI-I) Scale was employed to assess the impact of surgery. Patients were followed up at 1 year, and 5 years after surgery. There were no statistically significant differences found in the efficacy of the TVT-A group and TVT-O group during both the one-year (p = 0.4) and five-year (p = 0.32) follow-up periods. In the period of one-year follow-up, 95.9% (n = 47) of patients in the TVT-O group and 95.8% (n = 45) of patients in the TVT-A group demonstrated improvement. During the period of five-year follow-up, 87.8% (n = 43) of patients in the TVT-O group and 93.6% (n = 44) of patients in the TVT-A group demonstrated improvement. Conclusions: Based on our findings, TVT-A and TVT-O procedures exhibited similarly high success rates and low frequencies of complications. [ABSTRACT FROM AUTHOR]

Objective: To investigate the outcomes of artificial urinary sphincter (AUS) placement in patients with post‐prostatectomy urinary incontinence (PPUI) with or without a prior male sling. Patients and Methods: We performed a retrospective chart review of patients who underwent AUS for PPUI from 2007 to 2022. The primary endpoint was to determine the proportion of patients who achieved social continence, defined as self‐reported use of 0–1 pad/day. The secondary endpoints were device failure rates and device failure‐free survival. Results: The analysis included 210 patients, with 30 (14.3%) having had prior slings and 180 (85.7%) without prior slings. After AUS insertion, 80.0% of patients with prior slings and 76.7% of those without prior slings achieved continence (0–1 pad/day). There were six (20.0%) and 53 (29.4%) device failures in patients with and without prior slings, respectively. The median device failure‐free survival was not reached in patients with prior slings and was 8.9 years in patients without prior slings (P = 0.048). Limitations include retrospective nature and small sample size. Conclusions: The efficacy and safety of AUS in patients with prior slings are similar to those without. Prior sling is associated with a longer device failure‐free survival. AUS remains a viable option in patients who have persistent PPI after prior slings. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to review the literature regarding the effects of trans obturator tape surgery (TOT) on sexual functions in women with stress urinary incontinence (SUI) to reveal compact data and to reach more consistent and reliable results. Methods: PRISMA statement was used in the current review. The databases of PubMed (Medline), Science Direct, and Cochrane Central Register of Controlled Trials were detected independently. We evaluated the studies comparing the preoperative and postoperative sexuality parameters related to the TOT procedure in females. Studies presenting the mean and standard deviation(SD) of global and sub-item Female Sexual Function Index(FSFI) were included in the current study. Results: We identified 783 studies in full publications or abstract forms using the methodology above and the search terms. Finally, eight studies were included in the meta-analysis. The pooled analysis of the mean difference demonstrated that the total sexual function scores of the patients improved after TOT surgery. Conclusion: The data collected from the current meta-analysis suggest that TOT surgery improves female sexual function. [ABSTRACT FROM AUTHOR]

Women who had a passive trial of void had lower rates of failed voiding trial than those who had an active trial of void after midurethral sling surgery. OBJECTIVE: To compare active with passive voiding trials on the rate of passing a trial of void and discharge rates with catheter in women who have undergone midurethral sling for treatment of stress urinary incontinence (SUI). DATA SOURCES: MEDLINE, EMBASE, and ClinicalTrials.gov were searched through February 24, 2023. METHODS OF STUDY SELECTION: Our population included women undergoing midurethral sling, with or without anterior or posterior repair, for treatment of SUI. Our two primary outcomes were rate of passing voiding trial and rate of discharge with a catheter. Our secondary outcome was the rate of delayed postoperative urinary retention, when a patient initially passes a trial of void but then subsequently presents in retention. TABULATION, INTEGRATION, AND RESULTS: Abstracts were doubly screened; full-text articles were doubly screened; and accepted articles were doubly extracted. In single-arm studies evaluating either passive or active voiding trial, random-effects meta-analyses of pooled proportions were used to assess outcomes. Of 3,033 abstracts screened, 238 full-text articles were assessed, and 26 met inclusion criteria. Ten studies including 1,370 patients reported active trial of void. Sixteen studies including 3,643 patients reported passive trial of void. We included five randomized controlled trials, five comparative retrospective studies, five prospective single group studies, and 11 retrospective single group studies. Five of the studies included patients with a concomitant anterior or posterior colporrhaphy. On proportional meta-analysis, the active trial of void group was less likely to pass the voiding trial (81.0%, 95% CI, 0.76–0.87% vs 89.0%, 95% CI, 0.84–0.9%3, P =.029) with high heterogeneity (I 2=93.0%). Furthermore, there were more discharges with catheter in active trial of void compared with passive trial of void (19.0%, 95% CI, 0.14–0.24% vs 7.0%, 95% CI, 0.05–0.10%, P <.01). The rates of delayed postoperative urinary retention were low and not different between groups (0.6%, 95% CI, 0.00–0.02% vs 0.2%, 95% CI, 0.00–0.01%, P =.366) with low heterogeneity (I 2=0%). Sling revisions were statistically lower in the active trial of void group (0.5%, 95% CI, 0.00–0.01% vs 1.5%, 95% CI, 0.01–0.02%, P =.035) with low heterogeneity (I 2=10.4%). CONCLUSION: Passive trial of void had higher passing rates and lower discharge with catheter than active trial of void. Rates of most complications were low and similar between both groups, although passive trial of void had higher sling revisions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42022341318. [ABSTRACT FROM AUTHOR]

Background Urinary incontinence is a common presentation in general practice and can significantly affect a patient's quality of life. Stress urinary incontinence (SUI) is defined by the International Continence Society as 'the complaint of any involuntary loss of urine on effort or physical exertion (eg sporting activities), or on sneezing or coughing'. There is a key role for primary care providers in the assessment and management of female SUI. Objective To highlight the key diagnostic and management principles of female SUI in general practice and discuss management options. Discussion SUI can usually be diagnosed based upon clinical history and targeted physical examination. Pelvic floor physiotherapy and lifestyle interventions, including weight modification and management of co-morbidities, are important first-line therapies. Surgical options for both persistent or complex SUI include urethral bulking agents, Burch colposuspension and pubovaginal fascial slings. Synthetic (mesh) mid-urethral slings remain a viable surgical option for women suffering SUI. [ABSTRACT FROM AUTHOR]

In this study, we applied graph theory to clinical decision-making for Stress Urinary Incontinence (SUI) treatment. Utilizing discrete mathematics, we developed a system to visually understand the shortest path to the desired treatment outcomes by considering various patient variables. Focusing on women aged 35–50, we examined the effectiveness of Tension-free Vaginal Tape (TVT) surgery and Vaginal Erbium Laser (VEL) treatment for over 15 years. The TVT group consisted of 102 patients who underwent surgery using either the Advantage Fit mid-urethral sling system (Boston Scientific Co., MA, USA) or the GYNECARE TVT retropubic system (Ethicon Inc., NJ, USA). The VEL group included 113 patients treated with a non-ablative Erbium: YAG laser (FotonaSmooth™ XS; Fotona d.o.o., Ljubljana, Slovenia), and there were 112 patients in the control group. We constructed a network diagram analyzing the correlations between health, demographic factors, treatment methods, and patient outcomes. By calculating the shortest path using heuristic functions, we identified significant correlations and treatment effects. This approach supports patient decision making by choosing between TVT and VEL treatments based on individual objectives. Our findings provide new insights into SUI treatment, highlighting the value of a data-driven personalized approach for clinical decision-making. This interdisciplinary study bridges the gap between mathematics and medicine, demonstrating the importance of a data-centric approach in clinical decisions. [ABSTRACT FROM AUTHOR]

Despite the established safety and efficacy of midurethral slings (MUS), which are the current gold standard treatment for stress urinary incontinence (SUI), the potential for postoperative complications remains a significant concern for both healthcare professionals and patients. Meanwhile, sonography has emerged as a significant diagnostic tool in urogynecology, and one of the applications of this imaging modality may be the evaluation of complications arising from MUS procedures. This review, based on a comprehensive literature search, focuses on the use of pelvic floor ultrasound (US) in the context of MUS complications. It includes analyses of randomized controlled trials, prospective, and retrospective studies, covering preoperative and postoperative investigations, to assess complications such as persistent and recurrent SUI, urinary retention and obstructive voiding, de novo urgency/overactive bladder, vaginal exposure, sling erosion, pain, and hematoma. The review critically examines the existing literature, with a particular focus on recent publications. Despite the variability in findings, it appears that for each of the discussed complications, the application of pelvic floor US can significantly support the diagnostic and therapeutic process. The paper also identifies potential future directions for the development of US applications in diagnosing MUS complications. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis (BV) is a most common microbiological syndrome. The use of molecular methods, such as multiplex real-time PCR (mPCR) and next-generation sequencing, has revolutionized our understanding of microbial communities. Here, we aimed to use a novel multiplex PCR test to evaluate the microbial composition and dominant lactobacilli in non-pregnant women with BV, and combined with machine learning algorithms to determine its diagnostic significance. Methods: Residual material of 288 samples of vaginal secretions derived from the vagina from healthy women and BV patients that were sent for routine diagnostics was collected and subjected to the mPCR test. Subsequently, Decision tree (DT), random forest (RF), and support vector machine (SVM) hybrid diagnostic models were constructed and validated in a cohort of 99 women that included 74 BV patients and 25 healthy controls, and a separate cohort of 189 women comprising 75 BV patients, 30 intermediate vaginal microbiota subjects and 84 healthy controls, respectively. Results: The rate or abundance of Lactobacillus crispatus and Lactobacillus jensenii were significantly reduced in BV-affected patients when compared with healthy women, while Lactobacillus iners, Gardnerella vaginalis, Atopobium vaginae, BVAB2, Megasphaera type 2, Prevotella bivia, and Mycoplasma hominis were significantly increased. Then the hybrid diagnostic models were constructed and validated by an independent cohort. The model constructed with support vector machine algorithm achieved excellent prediction performance (Area under curve: 0.969, sensitivity: 90.4%, specificity: 96.1%). Moreover, for subjects with a Nugent score of 4 to 6, the SVM-BV model might be more robust and sensitive than the Nugent scoring method. Conclusion: The application of this mPCR test can be effectively used in key vaginal microbiota evaluation in women with BV, intermediate vaginal microbiota, and healthy women. In addition, this test may be used as an alternative to the clinical examination and Nugent scoring method in diagnosing BV. [ABSTRACT FROM AUTHOR]

Objective: Retropubic midurethral sling placement (MUS) is a surgical procedure for treating stress urinary incontinence (SUI) in females that uses mesh to support the urethra to prevent leakage during episodes of increased abdominal pressure. Hematoma is a documented risk of MUS placement. The location of relevant pelvic vasculature was compared to pelvic bony dimensions with the aim of measuring these anatomic relationships in order to prevent hematomas during MUS placement. Materials and Methods: The superficial epigastric, inferior epigastric, external iliac, and obturator arteries were dissected bilaterally from 13 formalin-embalmed cadavers. Distance was measured to a retropubic trocar placed in the typical fashion. Anteroposterior pelvic (AP) diameter and ischial interspinous distance were recorded. SPSS was used for statistical analyses. Results: All arteries were identified lateral to the trocar site. Obturator arteries were the closest (30.60 ± 5.19 mm) and external iliac arteries were the furthest (48.08 ± 9.64 mm). There was a significant correlation between artery–trocar distance and AP diameter, but not interspinous distance. Conclusions: Major vascular structures lie in close proximity to the path of the trocar used in MUS placement for treating SUI. The female AP diameter is correlated with the distance between these vessels and the trocar—and may be a clinically useful measure to determine which patients are at increased risk for hematomas during MUS. (J GYNECOL SURG 40:145) [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Retropubic midurethral sling (MUS) placement is the gold standard for the treatment of stress urinary incontinence in the USA. The procedure can be approached from either a top-down or a bottom-up direction, but there is a paucity of contemporary data regarding outcomes between these approaches. The aim of this study was to provide updated clinical outcomes data. Methods: This was a retrospective cohort study of women undergoing the retropubic MUS procedure alone or at the time of pelvic organ prolapse repair between 2010 and 2020 at a single academic medical center. The electronic medical record was used to extract demographic data, operative approach, and perioperative complications. The primary outcome was a composite incidence of any perioperative complication. Results: Of the 309 patients analyzed, 140 (45.3%) underwent top-down and 169 (54.7%) underwent bottom-up retropubic MUS placement. Patients undergoing top-down MUS placement were more likely to be older (mean age 58 vs 54, p=0.02), have a history of diabetes mellitus (20% vs 8.9%, p=0.004), and have had a prior hysterectomy (27% vs 16%, p=0.02). They were less likely to have a concurrent anterior (p<0.001) or posterior repair (p<0.001). Patients undergoing the top-down procedure were less likely to experience sling exposure (p=0.02); complications in the two groups were otherwise similar. Conclusions: The top-down approach to retropubic MUS placement was associated with lower rates of mesh erosion in this population of patients. Neither approach is associated with an increased overall risk of complications or de novo overactive bladder symptoms. [ABSTRACT FROM AUTHOR]

• Stress urinary incontinence is a common condition that affects a significant group of postmenopausal women, lowering their quality of life, and leading to embarrassment, social isolation, and decreased physical activity. • This study aimed to assess the changes in quality of life, acceptance of illness, and impact of physical activity, in patients undergoing the transobturator tape procedure following long-term assessment. • Thirty-six months after surgery for stress urinary incontinence, using a transobturator tape procedure showed a significant improvement in health acceptance and the number of patients with a high level of acceptance, according to the AIS. Stress urinary incontinence (SUI) is a common condition that affects a significant group of postmenopausal women, lowering quality of life, leading to embarrassment, social isolation, and decreased physical activity. SUI can be treated with medication, behavioral changes, pelvic floor muscle exercises, or surgical intervention. This study aimed to assess the changes in quality of life, acceptance of illness, and impact on physical activity, in patients after the transobturator tape (TOT) procedure following long-term assessment. Forty-five women aged 71.52 ± 4.12 years took part in our follow-up project at 12 and 36 months after surgical intervention. The World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), Acceptance of Illness Scale Questionnaire (AIS), and International Physical Activity Questionnaire (IPAQ) were used in the study. At 36 months after surgery, SUI using TOT showed a significant improvement in health acceptance. Also, there was a number of patients who reported a high level of acceptance according to the AIS. Elderly women with SUI, after treatment by TOT, showed a significant improvement in health acceptance 3 years after the procedure. [ABSTRACT FROM AUTHOR]

Introduction This study aimed o evaluate the efficacy of onabotulinumtoxin A (onaBTX-A) intradetrusor injections in women with refractory de novo overactive bladder (OAB) following midurethral sling (MUS) placement. Material and methods A retrospective single-center study was conducted. We screened 372 women who underwent MUS surgery between August 2009 and January 2022. 54/372 women diagnosed with pharmacologically refractory de novo OAB following MUS were evaluated using cystoscopy and urodynamics, and after tape erosion and obstructive voiding were excluded, they received on a BTX-A therapy. Outcomes were the reduction of self-reported OAB symptoms and leakage episodes, improvement of validated OAB scores and adverse events of the procedure after a follow-up of 3, 6, and 12 months. Results Successful results were reported in 81%, 68%, and 43% at 3, 6 and 12 months respectively. Postoperatively, median voiding frequency and median nocturia episodes were significantly improved in 70% and 77% of women, respectively, with a decrease in daily number of voids (-4.1, p = 0.0001) and nocturia episodes (-2.2, p = 0.005). At 3 months, 80% of women reported an >25% reduction in urgency severity and episodes following injection. The median number of pads used was significantly reduced after injection (-2 pads; p = 0.03). Repeat injections of onaBTX-A were performed in 61% of patients after a median of 11 months. Conclusions Intravesical onaBTX-A injections are clinically effective at 3- and 6-month follow-up for the treatment of refractory de novo OAB after MUS placement. Over 60% of the patients opted for retreatment with onaBTX-A due to a high level of satisfaction. [ABSTRACT FROM AUTHOR]

Aims: To assess and compare 30‐day perioperative adverse events following suburethral sling surgery using synthetic mesh, autologous rectus fascia, and autologous fascia lata in women. Methods: This was a retrospective cohort study of patients who underwent fascial or synthetic sling placement for stress urinary incontinence between 2008 and 2021 using the American College of Surgeons' National Surgical Quality Improvement Program database. Current Procedural Terminology codes were used to identify patients undergoing each type of sling procedure. Multivariable regression analysis with stepwise regression was used to assess the odds of composite adverse events (e.g., urinary tract infection, surgical site infection, pulmonary embolism, and other reportable events) between cohorts. Results: Of the 41 533 female patients who underwent isolated suburethral sling placement without concurrent procedures, 41 292 (99.4%) received a synthetic mesh sling, and 241 (0.6%) received an autologous facial sling. In the fascial sling cohort, 160 (66.4%) underwent rectus fascia harvest and 81 (33.6%) underwent fascia lata harvest. Sling surgeries involving autologous fascia were associated with increased odds of adverse events compared to those involving synthetic mesh, even after adjusting for confounders (adjusted odds ratio [aOR]: 3.63, 95% confidence interval [CI]: 2.56–5.15). Compared to fascial slings from rectus fascia, slings from fascia lata were associated with increased odds of composite adverse events (aOR: 2.11, 95% CI: 1.03–4.04). However, with the exclusion of urinary tract infections, the adverse event rate was similar between slings using the two fascial harvest techniques (aOR: 1.93, 95% CI: 0.81–4.63). Conclusions: In this retrospective database study, suburethral sling surgeries using autologous fascia were independently associated with a 3.6‐fold increase in odds of 30‐day perioperative adverse events compared to sling surgeries using synthetic mesh. [ABSTRACT FROM AUTHOR]

Introduction: The study aims to compare the efficacy and safety of bulking agents and single-incision slings in the treatment of urinary incontinence in 159 patients during a 29-month follow-up period. Material and methods: Of the 159 patients suffering from stress urinary incontinence, 64 were treated with bulking agents (PAHG Bulkamid®) and 75 with a single-incision sling (Altis®). The ICIQ-UI-SF (Incontinence Questionnaire-Urine Incontinence-Short Form), PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaires short form), FSFI (Female Sexual Function Index), FSDS (Female Sexual Distress Scale), and PGI-I (Patient Global Improvement Index) were used to assess efficiency and quality of life. Results: The bulking agents showed high efficacy and safety during the 29-month follow-up. Post-operative complications were recorded in both groups, with only two significant differences. The Bulkamid group experienced no pain, while 10.8% of the ALTIS group experienced groin pain and 5% experienced de novo urgency. Furthermore, patients treated with bulking agents experienced reduced nicturia (0.78 vs. 0.92 in patients treated with single-incision slings.). In both groups, we noticed a significant improvement in QoL (quality of life), with a halved ICIQ-UI-SF (International Consultation on Incontinence Questionnaire-Urine Incontinence-Short Form) score which was completed to assess the impact of urine symptoms. After 24 months of therapy, the Bulkamid group saw a decrease from 14.58 ± 5.11 at baseline to 5.67 ± 1.90 (p < 0.0001), whereas the ALTIS group experience a decrease from 13.75 ± 5.89 to 5.83 ± 1.78. Similarly, we observed an improvement in sexual function, with the number of sexually active patients increasing from 29 to 44 (56.4%) in the Bulkamid group (p = 0.041) and from 31 to 51 (61.7%) in the ALTIS group (p = 0.034). According to the most recent statistics, the PISQ-12, FSFI, and FSDS scores all demonstrated an improvement in women's sexual function. Conclusions: In terms of efficacy and safety, bulking agents had notable results over the 29-month follow-up period. Furthermore, the patients treated with bulking agents reported a lower incidence of postoperative complications and a no discernible difference in terms of quality of life and sexual activity compared to the ones treated with single-incision slings. Bulking agents can be considered a very reliable therapeutic option based on accurate patient selection. [ABSTRACT FROM AUTHOR]

The presence of a vaginal calculus is a rare clinical entity which may develop in the setting of vaginal urinary stagnation. Numerous factors contribute to stone formation, and management can be complicated by variations in size, location of the stone, and location of adjacent structures. Generally, once diagnosed, vaginal calculi should be removed and surrounding anatomy should be evaluated thoroughly for secondary fistula, erosion, or presence of an instituting foreign body. This report presents a case of vaginal calculus formation on exposed midurethral sling mesh in an elderly patient with hemorrhagic cystitis. This report emphasizes contributing pathophysiology, diagnostic factors, and treatment. [ABSTRACT FROM AUTHOR]

Objective: To inquire whether obesity is a risk factor of peri- and post-operative complications following Mid-urethral sling (MUS) surgeries for SUI repair using the Clavien-Dindo classification system (CDcs). Methods: This retrospective cohort included 304 women who undergone a MUS in a 1000 beds tertiary University medical center between the years 2012–2018. Univariate analysis was conducted to compare clinical and operative traits by BMI group and to examine associations of obesity and complications rates and severity according to the CDcs. Multivariate analysis was conducted to assess the risk for post-operative complications and adjust to potential confounders. Results: The study group included 106 (34.9%) women with BMI 30 or higher and the comparison group included 198 (65.1%) women with BMI lower than 30. In the study group we found a significantly higher prevalence of hypertension (P = 0.019), previous abdominal surgeries (P = 0.012) including cesarean section (P = 0.025), previous pelvic floor surgeries (P = 0.005) and pelvic organ prolapse (P = 0.02). In the control group we found a significantly higher rates of concomitant hysterectomy which performed during the MUS (P = 0.005). Obesity was not associated with increased rates of peri and post-operative complications (P = 0.973). Conclusions: In our study, obesity was not associated with peri- and post-operative complications following MUS. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are of interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed literature search using the keywords "incontinence" and "bulking" or "laser". Although the two approaches are less effective than sling insertions, there are specific conditions in which one or the other technique is more advantageous. Injecting bulking agents into the urethra only takes some minutes and works without general anesthesia. The method is particularly suited for elderly, frail, or obese patients with multiple comorbidities, but is also applicable for all patients and in combination with other therapies. Generally, the safety profile is good but differs between bulking materials. Two laser types—the Erbium:YAG laser with SMOOTH-mode and the fractional ablative CO2 laser—deliver heat into the tissue to induce tissue tightening and regeneration. Intravaginal laser therapy improves mild to moderate SUI, while studies describe how intraurethral laser therapy is also beneficial for severe SUI. Young women between childbirths, as well as postmenopausal women, may benefit from laser therapy. The method is safe, can be performed on an outpatient basis, and does not require any artificial material. [ABSTRACT FROM AUTHOR]

To examine the efficacy, safety, and long-term durability of the autologous pubovaginal sling for stress incontinence over a 29-year period. A total of 192 consecutive female patients with stress urinary incontinence who underwent autologous pubovaginal sling from 1993 through 1999 were analyzed over a 29-year period. Intermediate and ultra long-term follow-up were obtained at a mean of 4 and 23 years, respectively. A total of 51 patients had sufficient data at both time intervals and were evaluated using a standardized questionnaire for resolution of stress incontinence, the primary endpoint, as well as resolution of urge incontinence, overall dryness, and voiding dysfunction. At intermediate-term follow-up (mean 45.3 months), 96% of 51 patients reported no stress incontinence. In addition, 76% of patients experienced resolution of their preoperative urge incontinence. Overall dryness occurred in 84%. At ultra long-term follow-up (mean 22.9 years), 84% reported no stress incontinence and an overall dryness rate of 53%. Postoperative voiding dysfunction included de novo urge incontinence (3 patients) and persistent urinary obstruction requiring urethrolysis (1 patient). The autologous pubovaginal sling is effective, safe, and durable at a mean of 23 years, the longest known follow-up in the literature. Given the U.S. Food and Drug Administration (FDA) warnings regarding transvaginal mesh and growing concerns with the synthetic midurethral sling, the autologous pubovaginal sling should be offered as an option to those women seeking treatment for stress urinary incontinence. [ABSTRACT FROM AUTHOR]

Objective: This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two prominent surgical techniques for treating Stress Urinary Incontinence (SUI): the modified laparoscopic Burch colposuspension and the transobturator tape (TOT) procedure. Material and Methods: A prospective cohort study was conducted on 145 patients who recieved surgical treatment for SUI, of which 71 patients (49%) underwent the modified laparoscopic Burch procedure, while 74 patients (51%) received the TOT procedure. Data on clinical characteristics, treatment success rates, and postoperative outcomes were collected and analyzed to understand patient preferences and real-world clinical effectiveness. Results: This study revealed notable differences in patient demographics and clinical characteristics between the two groups. At the 2-year follow-up, a success rate of 100% was reported in the modified laparoscopic Burch group and 86.48% in the TOT group. A total of 99 patients (68.28%) were considered cured postoperatively, with 47 (66.20%) in the modified laparoscopic Burch group and 52 (70.27%) in the TOT group (p = 0.598). A significant difference was found in the incidence of dyspareunia, with six cases (8.10%) reported in the TOT group, compared to none reported in the modified laparoscopic Burch group (p = 0.028). The median operation time was significantly shorter in the TOT group, namely 15 min, compared to the modified laparoscopic Burch group, which had a median equal to 27 min (p < 0.001). Despite these differences, patient preference for either surgical technique was observed, along with similar success rates and varied postoperative outcomes. Conclusions: The findings provide a comprehensive overview of patient preferences and factual clinical outcomes for the two surgical techniques in SUI treatment. This study contributes to understanding the factors influencing patient choice and offers valuable insights into the real-world application of these techniques, enhancing patient-centered care in SUI management. [ABSTRACT FROM AUTHOR]

Background: Tension-free mid-urethral sling procedures are next to bulking agents, fascial slings and colposuspension a possible treatment in stress urinary incontinence with high success rates up to 90%. This is an unusual and unique case of delayed presentation of a tension-free vaginal tape (TVT) complication involving the pubic bone. It shows an unusual possible cause of bladder outlet obstruction by a reactive inflammatory myofibroblastic pseudotumor. We discuss the diagnosis and management of this unique case of bladder outlet obstruction. Case presentation: We present an exclusive case of a 66-year woman with a rare cause of bladder outlet obstruction (BOO) after midurethral sling placement for recurrent stress urinary incontinence. Nine years after successful midurethral sling (MUS) insertion with relief of incontinence symptoms, the patient complained of spraying stream and prolonged micturition. Bladder outlet obstruction caused by a large retropubic myofibroblastic pseudotumor was detected by clinical examination and MRI. After removal of the mass and part of the pubic bone a plate osteosynthesis was performed. The patient received physiotherapy and local estrogen therapy. Patients’ symptoms improved reporting non-bothering intermittent incontinence episodes. The patient showed up recently and received again physiotherapy. Conclusions: Although bladder outlet obstruction after midurethral sling placement is mainly caused by an overtightened sling other factors should be considered. [ABSTRACT FROM AUTHOR]

Neurogenic lower urinary tract dysfunction (NLUTD) encompasses a broad spectrum of neurological conditions affecting the lower urinary tract. Managing NLUTD requires a tailored approach focused on preserving kidney function and enhancing patients' quality of life. Clinical guidelines provide valuable guidance for healthcare professionals, but discrepancies in recommendations arise among other factors due to limited high-quality clinical evidence. Prominent guidelines from organisations like the International Consultation of Incontinence, the European Association of Urology, the American Urological Association, and the National Institute for Health and Care Excellence offer varying recommendations for NLUTD management. This study reviews and summarizes the recommendations for conservative, pharmacological, and surgical management options across these guidelines. [ABSTRACT FROM AUTHOR]

Purpose: To examine efficacy and safety of ReMEEX implantation in patients with female stress urinary incontinence (SUI) associated with detrusor underactivity (DU), recurrence, or intrinsic sphincter deficiency (ISD). Materials and Methods: Retrospective cohort study included 303 females who underwent ReMEEX system (March 2008 to May 2021). Patients were stratified into three groups by purpose of surgery (SUI with DU, reoperation, and SUI with ISD) and evaluated with following criteria: cure (absence of subjective complaint of leakage and objective leakage in the stress test), improvement (rare leakage subjectively, but satisfaction regardless of stress test), and failure. Primary outcome was success rate of surgery assessed through patient interviews and a stress test. Surgical outcomes and complications were evaluated. Results: Mean follow-up was 34.4 months (range, 6.0-145.0 months). At the final follow-up visit, 42.9% and 49.2% of patients were cured and improved. Twenty-one point five percent required tension readjustment (mean number, 1.2). The total complication rate was 19.5% (none for grade =4). Preoperative Qmax was significantly higher in the ISD group (p<0.001) and preoperative total International Prostate Symptom Score (IPSS) score was significantly higher in the DU group (p=0.044). Moreover, at postoperative 1 year, both total IPSS score and IPSS quality of life score were significantly higher in the DU group (both p=0.001). Conclusions: The success rate of ReMEEX system was 92.1% at mean follow-up of 34.4 months in female SUI with DU, reoperation, or ISD. It also enabled postoperative readjustment of sling tension, as needed, up to 130 months after surgery. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence (SUI) is a significant global health issue that particularly affects females, leads to notable societal and economic challenges and significantly affects the quality of life. This study focuses on the comparative analysis of two established surgical interventions, tension-free vaginal tape (TVT) and transobturator tape (TOT), at a single center and applied to 455 women suffering from SUI, with a mean follow-up period of 102 ± 30 months for TVT and 80.4 ± 13 months for TOT. Our findings indicate that, in comparison to TVT, the TOT procedure demonstrates fewer early and late post-operative complications in patient outcomes (1.41% vs. 17.64% and; 5.66% vs. 12.74%, both respectively). However, the TVT procedure shows a modestly favorable outcome in the risk of recurrence of SUI, compared to TOT (0% vs. 3.7%); the TOT procedure has also proven to be more effective in alleviating of urgency symptoms, although not at a statistically significant level (p = 0.072). Univariable and multivariable analysis of factors that predict late complications showed that only obesity can predict a worse outcome [OR]: 1.125 CI 95%: 1.105–1.533, p = 0.037), when adjustments are made for symptoms presented before surgery and procedure type. While both methods are safe and effective, the choice between them should be based on the specific characteristics of each case. [ABSTRACT FROM AUTHOR]

Introduction: The synthetic mid‐urethral slings are currently considered to be the most widely used technique for the surgical treatment of stress urinary incontinence (SUI). The most challenging aspect of the existing approaches is to achieve the optimal tension of the sling which treatment results are directly dependent on. To solve this problem, sling systems enabling an adjustment of the tension in the early postoperative period were created. A comparative study of the effectiveness and safety of such a system and a nonadjustable sling seems to be a relevant task. Materials and Methods: A double‐blind, randomized, multicenter trial enrolled 320 patients with a mean age of 55.2 ± 11.2 years and confirmed SUI. Patients were randomized into two groups: the first group underwent a standard synthetic suburethral sling (transobturator tape [TOT]) procedure and the second group underwent a tunable tension tape sling (TTT) procedure. All patients underwent stress test, uroflowmetry and ultrasound scan to determine the postvoid residual volume. Urinary Distress Inventory Short Form 6, International Consultation on Incontinence Questionnaire—Short Form, Pelvic Organ Prolapse Incontinence Sexual Questionnaire 12 questionnaires were used to assess subjective efficacy. Results: Enhancement of prosthesis tension in the second group was required in 44 (28%) patients. Due to the possibility of tightening of the sling in the early postoperative period, the operation was effective in 143 (89%) patients in the adjustable sling group and in 109 (68%) patients in Group 1, p < 0.001. Loosening of the sling tension was performed in 25 (16%) patients in Group 2. The signs of obstructive voiding symptoms at the follow‐up time of 36 months remained in Group 1 in 13 (8%) patients. Subjective satisfaction with treatment on the PGI‐I scale was higher in Group 2: 100 (62%) versus 132 (82%), p < 0.001. Conclusion: A synthetic mid‐urethral TTT is superior to a standard nonadjustable sling in long‐term effectiveness and safety. [ABSTRACT FROM AUTHOR]

Voiding dysfunction (VD) after sling operation is not uncommon. Sling revisions by incision/excision are usually effective; however, they may result in recurrent stress urinary incontinence (SUI). We aimed to evaluate continence status after an innovative sling revision procedure that preserves the integrity of the sling. Patients who underwent either a single-incision (AJUST) or a trans-obturator (TVT-O) mid-urethral sling were studied. Transvaginal tape elongation (i.e., sling midline incision and mesh interposition) was performed on patients with post-sling VD. Factors that may affect recurrent SUI were investigated by statistical analyses. Of 119 patients, 90 (75.6%) (45 AJUST and 45 TVT-O) were available for long-term (median 9; 8–10 years) follow-up. A significantly higher rate (17.2% vs. 3.3%, p = 0.014) of VD was noted after AJUST (N = 10) than after TVT-O (N = 2). After sling revision, four (33%) of the 12 cases reported recurrent SUI, which was not significantly different (p = 1.000) from the rate (37%, 29/78) of patients who did not undergo sling revision. Further statistical analyses revealed no significant predisposing factors affecting the recurrence of SUI. Surgical continence did not seem to be affected by having had sling revision with transvaginal tape elongation for post-sling VD. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objective was to assess whether midurethral slings (MUS) can improve both stress urinary incontinence (SUI) and cystoceles. MUS with anterior colporrhaphy (AC) as a treatment for SUI with cystocele is more invasive and carries greater risk than MUS alone. Methods: This is a prospective randomized study involving women with stage 1 or 2 cystocele and SUI, who were > 21 years of age, who had had no previous surgery for SUI. Predominant SUI, symptomatic anterior pelvic organ prolapse, and informed consent were mandatory. Patients were randomized as to whether AC had been performed. The sling procedure was left to the surgeon's discretion: pubovaginal sling, tension-free vaginal tape, or trans-obturator tape. Success was defined as a negative stress test and no evidence of cystocele upon local examination. Results: Ninety-eight patients were enrolled, 48 underwent MUS, and 50 underwent MUS and AC. Mean age ± SD was 44.96 ± 8.13 years. Baseline characteristics were similar. Operative time and blood loss were significantly higher in the MUS/AC group (p = 0.01 and 0.02 respectively). At 3 months, success was 79.1% and 77.8% in the MUS and MUS/AC groups respectively. This was maintained until 6 months (79.1% and 77.8% respectively). At 1 year, the results were comparable with success rates of 96.2% and 87.0% in the MUS and MUS and AC groups respectively. Symptom scores were comparable at 6- and 12-month evaluations. Conclusion: Midurethral slings correct symptomatic stage 1 or 2 cystoceles without the need for AC, which carries the risk of a significantly longer procedure and more significant blood loss. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Pelvic organ prolapse (POP) is caused by an imbalance in the stability of the pelvic organs, resulting in loss of support. The most common types of POP, anterior and apical, are associated with lower urinary tract symptoms (LUTS) such as bladder outlet obstruction and detrusor overactivity (DO). Vaginal surgery may improve LUTS and overall urinary symptoms. We assessed urodynamic (UD) parameters and urinary symptoms before and after vaginal surgery for POP correction. Methods: A prospective cohort of 59 women with symptomatic anterior and/or apical POP associated with urinary symptoms and with indications for vaginal surgery were included. POP surgeries included anterior colporrhaphy and vaginal hysterectomy with culdoplasty (VH) and with/without concomitant posterior colporrhaphy and mid-urethral sling (MUS). All participants underwent UD evaluation and answered urinary symptom questionnaires pre- and 3 months post-surgery. Results: Anterior colporrhaphy was performed in all patients: 45.7% with associated VH and 54.2% with concomitant MUS. Preoperative ICIQ-OAB score >8 points was significantly associated with DO (p<0.02) and decreased after surgery (9±4.3 to 3.2±3.0, p<0.001). All other questionnaires demonstrated improvements in urinary symptoms. Stress urinary incontinence rate decreased from 59.6% to 21% (p<0.001). Post-void residual (PVR) volume and Valsalva maneuver also decreased (p<0.001). Conclusions: Pelvic organ prolapse surgery reduced the prevalence of urgency symptoms, and all questionnaires on urinary symptoms showed clinically significant improvement. Vaginal surgery for POP, even combined with MUS, significantly reduced PVR volume and improved urgency symptoms. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: There is a paucity of information assessing whether race/ethnicity is associated with differences in surgical treatment of stress urinary incontinence (SUI). The primary objective was to assess for racial/ethnic disparities in SUI surgeries. Secondary objectives were to assess for surgical complication differences and trends over time. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program database, we conducted a retrospective cohort analysis of patients undergoing SUI surgery from 2010 to 2019. Chi-squared or Fisher's exact test and ANOVA were used for categorical and continuous variables respectively. Breslow day score and multinomial and multiple logistic regression models were used. Results: A total of 53,333 patients were analyzed. Using White race/ethnicity and sling surgery as references, Hispanic patients underwent more laparoscopic surgeries (OR1.17 [CI 1.03, 1.33]) and anterior vesico-urethropexy/urethropexies (OR 1.97 [CI 1.66, 2.34]); Black patients underwent more anterior vesico-urethropexy/urethropexies (OR 1.49 [CI 1.07, 2.07]), abdomino-vaginal vesical neck suspensions (OR 2.19 [CI 1.05–4.55]), and inflatable urethral slings (OR 4.28 [CI 1.23–14.90]). White patients had lower rates of inpatient stay (p < 0.0001) and blood transfusion (p < 0.0001) compared with patients who were Black, indigenous, people of color (BIPOC). Over time, Hispanic and Black patients were more likely to undergo anterior vesico-urethropexy/urethropexies than White patients (RR 2.03:1 [CI 1.72–2.40]) and (RR 1.59 CI [1.15–2.20]) respectively. Adjusting for possible confounders, Hispanic and Black patients had a greater chance of having a nonsling surgery, 37% (p < 0.0001) and 44% (p = 0.0001) greater chances respectively. Conclusion: We observed racial/ethnic differences in SUI surgeries. Although causality cannot be proven here, our results confirm previous findings suggesting inequities in care. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The mid-urethral sling (MUS) has been used for more than 30 years to cure stress urinary incontinence. The objective of this study was to assess whether surgical technique affects the outcome after more than ten years, regarding dyspareunia and pelvic pain. Methods: In this longitudinal cohort study we used the Swedish National Quality Register of Gynecological Surgery to identify women who underwent MUS surgery in the period 2006–2010. Out of 4348 eligible women, 2555 (59%) responded to the questionnaire sent out in 2020–2021. The two main surgical techniques, the retropubic and the obturatoric approach, were represented by 1562 and 859 women respectively. The Urogenital Distress Inventory-6 (UDI-6) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), as well as general questions concerning the MUS surgery, were sent out to the study population. Dyspareunia and pelvic pain were defined as primary outcomes. Secondary outcomes included PISQ-12, general satisfaction, and self-reported problems due to sling insertion. Results: A total of 2421 women were included in the analysis. Among these, 71% responded to questions regarding dyspareunia and 77% responded to questions regarding pelvic pain. In a multivariate logistic regression analysis of the primary outcomes, we found no difference in reported dyspareunia (15% vs 17%, odds ratio (OR) 1.1, 95% CI 0.8–1.5) or in reported pelvic pain (17% vs 18%, OR 1.0, 95% CI 0.8–1.3) between the retropubic and obturatoric techniques among study responders. Conclusion: Dyspareunia and pelvic pain 10–14 years after insertion of a MUS do not differ with respect to surgical technique. [ABSTRACT FROM AUTHOR]