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Introduction/Background: One side effect of vaginal delivery is urinary incontinence and pelvic organ prolapse due to the weakness and difficulty activating the pelvic floor musculature. The purpose of this case study is to report on the outcomes associated with the addition of blood flow restriction (BFR) to conventional pelvic floor treatments in a patient with relapsing pelvic organ prolapse. Case Description: A 39-year-old woman who was gravida 5 para 3 presented with cystocele, rectocele, and stress incontinence following the birth of her third child. Her primary goal was to return to running without a "falling out"–type feeling. Impairments were consistent with pelvic floor musculature weakness and difficulty with coordination of movement. Blood flow restriction was added as an adjunct to the current evidence-based strategies of pelvic floor exercises, biofeedback, electrical stimulation, and education. Outcomes: The patient had improvements in biofeedback values, increased muscle strength of the pelvic floor via the Modified Oxford Scale, statistically significant scores on the Pelvic Floor Distress Inventory (PFDI-20), reduction of pelvic organ prolapse, and stress incontinence. There was a 75% improvement in her ability to run without symptoms. Discussion: This case report demonstrates that BFR, along with traditional pelvic floor treatment, was associated with improvements in the patient's pelvic floor function. Blood flow restriction training may be a promising addition to pelvic floor rehabilitation for patients with pelvic floor musculature atrophy who do not fully respond to current best practice methods. Informed Consent: Informed consent was obtained for this case report. [ABSTRACT FROM AUTHOR]

Background: Female stress urinary incontinence is effectively treated with pelvic floor physical therapy. However, many of the devices available to therapists necessitate vaginal insertion, which many women perceive as invasive. The Elitone device delivers a noninvasive alternative for delivering electrical muscle stimulation to the pelvic floor, which may promote broader access to this therapeutic modality. Further, the device's configuration enables home use, which may be used to complement in-clinic therapy sessions. Objective: This research investigates the safety and efficacy of surface-applied electrical muscle stimulation in the treatment of female stress urinary incontinence in an at-home, patient-administered use case. Study Design: Cohort study without control group. Methods: Twenty female participants with mild/moderate stress urinary incontinence self-administered daily treatments with the Elitone device for 6 weeks. Participants recorded incontinence episodes and absorbent pad use in a daily log. Pre- and poststudy questionnaires were used to assess quality of life, participant satisfaction, and product usability. Results: Incontinence episode frequency, pad usage, and quality-of-life measures improved to a clinically significant degree for 75%, 85%, and 67% of participants, respectively. The pre- to poststudy changes were statistically significant (P <.001) for all 3 measures. Eighty-three percent of participants were satisfied with the treatment. Conclusion: Participants receiving treatment with the conservative, noninvasive Elitone device achieved meaningful improvement in incontinence symptoms across multiple, patient-centric outcome measures. The degree of improvement aligned with historical performance of more invasive, intravaginal therapies. The therapy may particularly benefit those women who oppose use of vaginally inserted devices. Further, although this study evaluated efficacy as a stand-alone, at-home treatment, physical therapists may realize additional benefits by using the device as an at-home complement to in-office therapy sessions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pregnancy is the main risk factor for the development of Stress Urinary Incontinence (SUI) which is known to have detrimental effects on quality of life in approximately 54.3% of women. The recommended treatment for SUI is to increase pelvic floor muscle strength, however, it is not clear why long-term adherence to pelvic floor muscle exercise (PFME) is poor. OBJECTIVES: To understand multiparous women's experience of incontinence and the prescription of pelvic floor muscle exercise (PFME) in the ante and post-natal period on their first pregnancy, and the differences, if any, that they experienced on subsequent pregnancies. METHODS: Purposive sampling was used to recruit women who had two or more children. The 1 : 1 semi-structured interviews were recorded, transcribed verbatim and anonymised. Thematic analysis was undertaken by both researchers, independently, and the codes and themes were agreed by consensus. RESULTS: Women were not aware that PFME could prevent incontinence, and the education provided was not sufficient to enable adherence to a PFME program. PFME were prescribed by health professionals, but there was a lack of detail, and the importance of PFME was not emphasised on first or subsequent pregnancies. On subsequent pregnancies, women were more aware of PFME and incontinence, however, this education came from informal sources, not the health care professionals providing the ante or post-natal care. CONCLUSIONS: Health care professionals should include more information, and better guidance regarding PFMEs. Most of the information about PFMEs came from informal sources, especially on the second and subsequent pregnancies. [ABSTRACT FROM AUTHOR]

As the rate of prostate cancer detection increases, so does the rate at which radical prostatectomy is performed. Post-prostatectomy incontinence (PPI) or urine leakage affects around 20% of men who undergo this procedure. Although affected individuals must be supported in maintaining hygiene with the use of urine capture devices, definitive treatment should also be offered if appropriate. A range of management options are available, from incontinence pads to artificial urinary sphincters. However, an understanding of the aetiology of the leak as well as patient factors is vital if the correct treatment option is to be selected. This article describes the potential causes of PPI and explores management options for this condition. [ABSTRACT FROM AUTHOR]

Aim. Lower urinary tract symptoms (LUTS) frequently affect patients immediately after midurethral sling (MUS) placement. The objective of the study was to assess if solifenacin or mirabegron decreases incidence of LUTS in women who underwent transobturator MUS. Methods. A prospective randomized trial was conducted on patients undergoing ambulatory transobturator midurethral sling due to stress urinary incontinence (SUI). All participants were questioned before and after surgery for occurrence of bothersome LUTS. A total of 328 patients who underwent transobturator MUS were randomly assigned to one of three groups: prophylaxis with 10 mg of solifenacin, prophylaxis with 50 mg of mirabegron, or without any additional treatment. LUTS evolution and efficacy of solifenacin and mirabegron were analyzed based on results of assessments made during follow-up visits at 1 and 6 weeks after surgery. Comparison of the prevalence of LUTS was done using chi2 test. Results. Prevalence of urgency and frequency episodes increased notably 1 week after sling placement and then came down to baseline levels. Solifenacin and mirabegron significantly reduced the incidence of urgency after 1 week, but after 6 weeks the beneficial effect was observed only in case of solifenacin. Treatment with mirabegron reduced the percentage of patients suffering from frequency after 6 weeks. Although prevalence of nocturia did not raise after sling placement, both treatments significantly reduced the incidence of this complaint after 6 weeks. Pharmacological treatment did not modulate the course of hesitancy and terminal dribbling. Conclusions. Treatment with solifenacin or mirabegron may significantly reduce the incidence of undesired LUTS after MUS. [ABSTRACT FROM AUTHOR]

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Aim. The aim of the study was to compare the incidence of "de novo" overactive bladder (OAB) after sling surgeries and Burch procedure and to analyze the effect of the preoperative bladder volume on the incidence of this condition. Methods. This prospective trial included 290 female patients with stress urinary incontinence (SUI) who were subjected to sling surgeries (TOT or TVT, n=170) or Burch procedure (n=120). Urodynamic testing was performed prior to the surgery and 6 months thereafter. The presence of OAB was diagnosed on the basis of subjective symptoms and urodynamic parameters. Results. The incidence of OAB 3 at 6 months postsurgery was the highest in patients who were subjected to the Burch procedure (14.2% and 17.5%, respectively). The incidence of OAB at 6 months turned out to be significantly higher in patients subjected to the Burch procedure with preoperative bladder volumes greater than 353 ml. We observed the significant postoperative decrease in the bladder volume of women who developed this complication following the Burch procedure. Conclusions. Among surgeries for stress urinary incontinence, Burch procedure is associated with the greatest risk of overactive bladder development. Probably, one reason for the higher incidence of overactive bladder after Burch procedure is the intraoperative reduction of the urinary bladder volume. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of urethral bulking agents for stress urinary incontinence (SUI) in the setting of prior failed sling.Methods: This is a retrospective review of patients who underwent urethral bulking agent injections for a primary complaint of SUI following prior failed sling surgery. The outcomes assessed were patient reported improvement, need for further interventions for incontinence and validated questionnaires. Values for questionnaires were obtained from the patient's preprocedure visit, at the first visit following their last injection and at their most recent visit within our system.Results: Over the study period, 73 patients underwent urethral bulking agent injection following failed sling. Thirty-eight patients received Macroplastique injections and 35 had collagen injections. On average, patients underwent 2.6 injections. Seventy-one percent of patient reported at least partial symptom resolution at first postinjection follow-up. Validated questionnaire responses also improved at short-term follow-up (mean difference in American Urological Association Symptom Index-3.8, Michigan Incontinence Symptom Index-5.1, P <.01). Forty patients had long-term follow-up data available (mean 39.6 months postinjection). Statistically significant improvement persisted on the stress incontinence and quality of life domains of the validated questionnaires.Conclusion: In our cohort of patients with persistent or recurrent SUI following urethral sling procedure, 71% experienced short-term improvement or resolution of symptoms following urethral bulking agent injections, with SUI-specific improvement persisting at an average of 35 months in patients with available data. [ABSTRACT FROM AUTHOR]

Objective: To compare current practice in the management of female pelvic organ prolapse in Australia and New Zealand with that in 2007, and assess the impact on practice of the withdrawal of Prolift® and Prosima® mesh kits in 2015. Materials and Methods: In early 2015, two invitations to participate in a survey, including a link to Surveymonkey, were emailed to 2506 Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees and fellows. The online survey closely resembled a printed survey that was posted to RANZCOG trainees and fellows in 2007 and had additional questions relating to the impact of withdrawal of Prolift® and Prosima® products. Results: Four‐hundred‐and‐three doctors participated, giving a response rate of 16%. Native tissue repair was the procedure of choice for primary and recurrent prolapse of the anterior and posterior vaginal wall. An implant was used to treat 45% of anterior recurrences and 25% of posterior recurrences. Vaginal hysterectomy and repair were the procedures of choice for uterovaginal prolapse. Sacrospinous hysteropexy was the uterine preservation procedure of choice, preferred by 41%. For post‐hysterectomy vault prolapse, sacrospinous colpopexy and vaginal repair was preferred by 65% of respondents. Between 2007 and 2015, there was a substantial decrease in respondents' usage of implants across all indications except for midurethral slings and sacrocolpo/hysteropexy. Forty‐two percent of respondents changed their practice as a result of Prolift® and Prosima® being withdrawn. Conclusion: There is a trend toward increasing use of various native tissue prolapse repair procedures and midurethral slings, and less utilisation of transvaginal mesh for prolapse. [ABSTRACT FROM AUTHOR]

Purpose. The aim of our study is to assess efficacy of noninvasive erbium-doped yttrium aluminium garnet laser (Er:YAG laser) for female stress urinary incontinence (SUI). Materials and Methods. Forty-one women with SUI were included in the study and scheduled for vaginal Er:YAG laser treatment. The procedure was performed with a 2940 nm, Er:YAG laser (Fotona Smooth ™ XS, Fotona, Ljubljana, Slovenia), designed to heat up the vaginal mucosa to around 60°C. All subjects had a baseline and 6 months' posttreatment assessment that included perineal sonography and lower urinary tract symptoms. Results. Significant improvements in both urinary frequency and incontinence were found 6 months after Er:YAG laser treatment when compared to the baseline results (p<0.001). The battery of questionnaires administered to patients, including the UDI-6, IIQ-7, OABSS, and POPDI-6, all showed significant improvement posttreatment (P < 0.001). The treatment efficacy for the vaginal Er:YAG laser for SUI at 6 months posttreatment was 75.5% (31/41). Bladder neck mobility by perineal ultrasonography decreased significantly (16.1 ± 6.4 mm to 10.5 ± 4.6 mm) after treatment (p=0.039). No permanent adverse events were found. Conclusions. The Er:YAG vaginal laser seems to be a safe and efficacious treatment for women with mild to moderate SUI, this being partly related to the decrease of bladder neck mobility following laser treatment. [ABSTRACT FROM AUTHOR]

Background. The aim of this study was to assess anatomical changes in the urethra at rest and during straining following sling surgery with and without transvaginal mesh surgery (TVM) in women with stress urinary incontinence (SUI) with or without pelvic organ prolapse (POP) using three-dimensional ultrasonography. Methods. 76 women with SUI with or without pelvic organ prolapse after sling surgery. They underwent sling surgery alone (S group, n=36) or concomitant TVM (M group, n=40). All patients underwent urinalysis, pelvic examinations, urodynamic study, 3D perineal ultrasonography, and personal interviews before and 1 year after surgery. The urethral area was calculated from the axial plane of perineal ultrasonography by multiplying π by the long and short axes of the urethral lumen. Results. The axial area of the middle and distal urethra during straining was significantly smaller than at rest in both groups (P<0.001). In addition, the length of the short axis of the proximal urethra was significantly shorter in those undergoing sling surgery alone during straining compared with those undergoing concomitant sling and mesh surgery (P<0.001). Conclusions. There was a greater impact on the proximal urethra in women who underwent sling surgery alone than those who underwent sling and TVM surgery together. [ABSTRACT FROM AUTHOR]

Introduction. Urinary incontinence (UI) is a health problem affecting the quality of women's lives (QOL) at various life stages. Stress urinary incontinence (SUI) can be caused by previous vaginal deliveries and is especially likely to occur in the perimenopausal period. The most commonly recommended first-choice treatment methods involve exercises for the pelvic floor muscles (PFM). The aim of this study was to assess the impact of isolated PFM exercises and combined training of the PFM and the m.transversus abdominis (TrA) muscle on the QoL of patients with SUI with regard to the number of vaginal deliveries. Material and Methods. 137 women with SUI were qualified for analysis (mean age 53,1 ± 5,5). To assess the effectiveness of PFM training QOL questionnaire was used (ICIQ-LUTS qol). PFM training for groups A (PFM+TrA) and B (PFM) was intended for 12 weeks. Statistica v. 12.0 PL, StatSoft, USA, was used for statistical calculations. Results. The analysis demonstrated that conservative treatment based on the A training program (PFM + TrA) yielded statistically significantly better results than the B program (PFM), with the improvement observed in such QoL domains as the performance of household duties, physical activity and travelling, social limitations, emotions, sleep problems and fatigue, the frequency of changing panty liners, fluid intake control, and embarrassment. Conclusion. Both the combined training of the PFM and the synergistic (TrA) muscle and the isolated PFM exercises improve the QoL of women with SUI. Nonetheless, the combined PFM and TrA muscle physiotherapy is more effective. The exercises for the PFM and the synergistic muscle give better results in women who have given birth fewer than three times than isolated PFM exercises. [ABSTRACT FROM AUTHOR]

Key content: Pelvic organ prolapse and incontinence are significant health problems; one in nine women are affected by prolapse and one in three by stress urinary incontinence.Pelvic floor muscle training remains the first‐line treatment for stress urinary incontinence.Concomitant surgical correction for coexisting symptomatic prolapse and incontinence is an option for treatment, but persistent postoperative incontinence can be challenging to manage.Delayed or interval continence procedures may be beneficial and should be discussed with women preoperatively. Learning objectives: To understand the health burden and prevalence of pelvic organ prolapse and incontinence in the population.To understand the surgical treatment options available.To learn about the advantages and disadvantages of concomitant surgery in patients with symptomatic or occult stress incontinence and in those who are continent. Ethical issues: Should transvaginal prolapse repair and concomitant synthetic miduretheral sling be offered to women without stress urinary incontinence?Should all women be preoperatively screened for occult stress urinary incontinence, given its prevalence and implications for postoperative outcomes? [ABSTRACT FROM AUTHOR]

Stress urinary incontinence (SUI) is the most prevalent form of incontinence in women. It can negatively impact a woman's physical, mental, and sexual health, as well as her social well-being. A stepwise approach is recommended for the treatment of SUI, beginning with conservative measures and progressing to more invasive treatments until the patient's desired quality of life is attained. Conservative options, such as behavioral changes, pelvic floor muscle training, and intravaginal support devices, are recommended as first-line therapy. Invasive treatments, including urethral bulking agents, bladder neck colposuspension, and sling procedures, should be considered once conservative measures have failed. This article provides an overview of SUI and summarizes the most common nonsurgical and surgical treatment options. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: Pelvic floor dysfunctions (PFD) affect women, men, and children globally. While physical therapy (PT) has been shown to improve PFDs, overall access to PT is limited because of provider shortage and expertise. We hypothesize telerehabilitation (TR) is a novel approach to address access and expertise care for PFD. Study Design: Case series. Case Descriptions: Three pelvic health patients (1 male and 2 females) volunteered to receive initial and follow-up care via TR. The male patient was treated for premature ejaculation, and the female patients were seen for postpartum recovery, stress urinary incontinence, and diastasis recti. A total of 9 visits were completed. Outcomes: Using a HIPAA-compliant, cloud-based, synchronous mobile app, a 14-question survey, and the Premature Ejaculation Diagnostic Tool (for the male health participant), participants rated their experience with TR. The 3 participants rated the TR system as high quality (2/3) and very high quality (1/3). Using a mobile phone was the preferred digital device (2/3) compared with laptop use. All 3 participants felt their needs were met and that they received good care during the session. Summary: Telerehabilitation has the potential to deliver quality care with improved access for patients with PFD for both initial and follow-up visits. This case series presents 3 patients' perceptions of using TR for pelvic health PT care. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence (SUI) is a little-discussed but perhaps surprisingly common condition in elite athletes involved in high-impact sports. This article discusses the possible causes of SUI (which is more complex than simply weak pelvic floor muscles), methods of SUI assessment and the various options for therapy. This will enable you to tailor a training regimen to suit your patient and create the best chances of a successful outcome, allowing your client to continue their sport with confidence and dignity. [ABSTRACT FROM AUTHOR]

Objective: To compare prevalence and risk factors for urinary tract infection (UTI) following midurethral sling surgery with either the GYNECARE ABBREVO Continence System (Ethicon, Somerville, NJ, USA) or a standard transobturator.Methods: A retrospective cohort study was conducted among women who underwent midurethral sling surgery to treat stress urinary incontinence at a single tertiary hospital in Israel between January 1, 2014, and August 11, 2015. Data were retrieved from medical records. The diagnosis of UTI was based on a positive urine culture result.Results: Of 178 patients included, 30 (16.9%) underwent the ABBREVO procedure and 148 (83.1%) underwent the standard transobturator procedure. The mean ± SD BMI at the time of surgery was 28.1 ± 4.5 for the standard transobturator procedures and 30.7 ± 15.2 for the ABBREVO procedures. Women who underwent the ABBREVO procedure had an increased duration of hospitalization (P=0.004), and higher rates of concomitant anterior colporrhaphy procedures (P=0.009) and concomitant hysterectomy (P=0.009). Only 38 (21.3%) women developed UTIs within 12 months of surgery (seven in the ABBREVO procedure group and 31 in the standard transobturator procedure group). No statistically significant between-group differences were found for the risk of UTI or for urinary tract adverse events, such as recurrent UTI and the need for rehospitalization.Conclusions: The two procedures were comparable in terms of prevalence and risk factors for UTI during the postoperative period. [ABSTRACT FROM AUTHOR]

Objective: To assess the long-term outcomes of tension-free vaginal tape obturator (inside-out) (TVTO) with or without anterior colporrhaphy.Methods: The present prospective follow-up observational study included patients attending the 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Greece, between April 3 and December 20, 2017, for follow-up care after treatment for urodynamic stress urinary incontinence (USUI) with or without cystocele. Patients without cystocele had been treated with TVTO only; those with cystocele underwent TVTO with anterior colporrhaphy. The primary outcome was the objective cure rate assessed by the cough stress test during filling cystometry.Results: Follow-up data were available for 70 patients who underwent TVTO only and 38 who underwent TVTO and anterior colporrhaphy. The mean follow-up period was 13 years. Objective cure was achieved for 57 (81%) patients in the TVTO-only group and 32 (84%) patients in the TVTO and anterior colporrhaphy group. Regarding cystocele management, objective cure was recorded for 35 (92%) patients.Conclusion: At 13-year follow-up, anterior colporrhaphy demonstrated a cure rate of 92% in the management of cystocele, and 84% in the management of cystocele and USUI when combined with TVTO. TVTO alone for the management of USUI had an objective cure rate of 81%. [ABSTRACT FROM AUTHOR]

Introduction: Obesity has been shown to negatively impact pelvic floor support and associated urinary incontinence (UI), however little is known regarding the long-term effect of bariatric surgery on urinary incontinence.Objective: The aim of this study is to determine the impact of bariatric surgery on female UI at twelve months post-operatively.Study Design: A prospective cohort study was performed of all patients undergoing bariatric surgery who reported UI between January 2008 to January 2017.Results: Three hundred and sixty-six women undergoing bariatric surgery and filled out the ICIQ-UI SF questionnaire. Of these 44% (151/366) had UI pre-operatively, and of these 40% (61/151) completed the questionnaire at one year post-operatively. The mean pre-operative weight and body mass index (BMI) were 136 (21.3)kg and 51 (7.1) kg/m2 respectively. The percentage excess weight loss was 74%. Sixty-six percent underwent laparoscopic gastric bypass, and the remainder underwent sleeve gastrectomy. Thirty-four percent reported stress incontinence (SUI), 21% reported overactive bladder (OAB), and 44% reported mixed incontinence. The cure rates post-operatively for SUI, OAB and mixed incontinence, were 41%, 38% and 48% respectively, and there was a 40% improvement in UI when assessing pad use (p < 0.001). Using the ICIQ-UI SF, the mean score was reduced by 4.8 (5), from 9.3 (4) pre-operatively to 4.5 (5) post-operatively.Conclusion: Bariatric surgery results in a clinically significant long-term improvement in UI, with a significant cure rate at one year post bariatric surgery. The improvement in severity score, based on the Incontinence Questionnaire used, did not correlate with reduction in post-operative BMI. [ABSTRACT FROM AUTHOR]

Purpose. This study identified noninvasive factors that predict overactive bladder (OAB) after readjustable mid-urethral sling surgery (Remeex system) in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). Materials and Methods. We retrospectively reviewed the medical records of 130 women with SUI due to ISD [Valsalva leak-point pressure (VLPP) <60 cm H2O] who underwent the Remeex procedure between February 2011 and March 2017. Patients were classified according to OAB symptoms before and 6 months after the Remeex procedure: Group 1, without preoperative and postoperative OAB (n=46); Group 2, without preoperative OAB and with postoperative OAB (de novo OAB, n=15); Group 3, with preoperative OAB and without postoperative OAB (n=25); Group 4, with preoperative and postoperative OAB (n=44). Noninvasive clinical and urodynamic factors were evaluated as predictors of de novo OAB. Results. The four groups significantly differed with respect to age (p=0.036), peak urinary flow rate (PUFR) one month after surgery (post-PUFR, p=0.001), and postvoid residual (PVR) one month after surgery (post-PVR, p=0.005). No significant differences were detected for body mass index, diabetes, multiparity, menopause, previous hysterectomy, previous incontinence surgery, previous pelvic organ prolapse surgery, pyuria, preoperative PUFR, preoperative PVR, maximal cystometric capacity, VLPP, maximum urethral closure pressure, detrusor pressure at PUFR, and detrusor overactivity (p>0.05). Post-PUFR decreased significantly compared with preoperative PUFR in Groups 1, 2, and 4 (p=0.002, p=0.001, and p=0.001, respectively). Pairwise comparisons of post-PUFR and post-PVR revealed statistically significant differences between Group 2 and other groups (p<0.0125). Multivariate logistic regression analyses showed that post-PUFR was the only significant predictor of de novo OAB (odds ratio = 0.823, 95% confidence interval 0.727-0.931, p=0.002). Conclusions. Reduced PUFR after the Remeex procedure is a promising predictor of risk for de novo OAB. This metric is noninvasive and easy to measure. [ABSTRACT FROM AUTHOR]

Introduction: Single incision slings (SIS) were introduced in an attempt to decrease the complications associated with retropubic and transobturator slings. The TVT Abbrevo is a modification of the TVT-O with a reduced length and less immediate postoperative pain. The Miniarc SIS has been shown to be equivalent to outside-in transobturator sling, Monarc at 12 month follow-up.Objective: To evaluate objective and subjective outcomes of MiniArc SIS and TVT Abbrevo midurethral sling (MUS) in women with stress urinary incontinence.Methods: Female subjects who were assessed and referred for stress urinary incontinence surgery were eligible to participate in this study. Exclusion criteria included women with intrinsic sphincter deficiency previous failed midurethral or fascial sling, untreated detrusor overactivity or significant voiding dysfunction. Patients' randomisation was performed with computer-generated blocks of 4-8, with concealed allocation. Assuming an objective cure rate of 90% for TVT AbbrevoTMwith a power of 80%, a sample size of 79 in each arm was required to detect a clinical difference of 15%, using a one sided alpha of 0.05. The target recruitment number was 220 allowing for an attrition rate of 15%. Institution ethics approval (11261B) was obtained and the trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611001151921). Routine preoperative assessment was conducted for objective data, whilst patient reported outcome tools (PRO) were utilised for subjective outcomes. These include ICIQ UI SF, ICIQ OAB, IIQ7, EQ5D, PISQ12, PGIs & PGII. TVT AbbrevoTM or MiniarcTMwere performed in a standardized fashion, together with any concomitant prolapse surgery. Review was conducted at 6 weeks and at 6 and 12 months. Objective cure was defined as a negative cough stress test with a comfortably full bladder. Subjective cure was defined as no report of leakage with physical exertion. All Data was collected and outcomes were analysed statistically.Results: Between February 2011 and January 2016,a total of 246 women were randomized to receive MiniArc (121) or TVT Abbrevo (125). Baseline characteristics were clinically balanced in both groups. At 6 months subjective (94.4% vs 95.7% p=0.74) and Objective (92.9% vs 95.9% p=0.49) cure rates were high and not statistically different. At 12 months there were also no differences in subjective (73.6% vs 76.9% p=0.73) or objective (90.5% vs 96.0% p=0.21) cure rates. No differences were found in functional outcomes or when adjusted for potential confounding factors such as age, parity, BMI or menopausal status.Conclusion: We found no significant differences in subjective and objective cure rates at 6 and 12months between MiniArc and TVT Abbrevo. [ABSTRACT FROM AUTHOR]

Objectives: The study aim was to assess the effect of treatment with a ring with support pessary on bothersome symptoms and the quality of life of patients with symptomatic pelvic organ prolapse (POP).Study Design: In this prospective observational study, 142 patients with symptomatic POP were successfully fitted with a ring with support pessary between November 2015 and November 2016 and followed up until December 2017. Prolapse and urinary symptoms were assessed, and the Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) were administered at baseline and at each follow-up visit. Univariate analyses, McNemar's test and paired t-tests were used for data analyses.Main Outcome Measures: Changes in prolapse and urinary symptoms and quality of life after fitting with a ring with support pessary use.Results: The median (range) duration of follow-up was 17 (13-24) months. At the study endpoint, 98 patients (74.8%) continued to use the pessaries. Wider vaginal introitus (≥5 cm) was found to be a predictor of pessary discontinuation. Although de novo stress urinary incontinence occurred in 27.1% of patients, almost all prolapse symptoms and most of the concurrent urinary symptoms were resolved, with voiding difficulty resolved most significantly. Scores on both the PFIQ-7 and PFDI-20 had significantly improved at the study endpoint, with changes in scores on the urinary and prolapse sub-scales of both questionnaires demonstrating clinical significance (effect size>0.5).Conclusions: A ring with support pessary is a safe and effective conservative treatment for POP; it not only relieves bothersome prolapse and urinary symptoms but also significantly decreases their impacts on health-related quality of life. However, the method has a limited effect on defecatory symptoms. [ABSTRACT FROM AUTHOR]

Abstract Stress urinary incontinence is a common problem with 13.6% of women requiring surgery for it in their lifetime. Surgical treatments either create suburethral support or augment urethral closure. Colposuspensions and autologous rectus fascial slings are effective first-line surgical options. The use of midurethral tapes is currently suspended due to concerns with chronic pelvic and vaginal pain. [ABSTRACT FROM AUTHOR]

Importance: There is concern about outcomes of midurethral mesh sling insertion for women with stress urinary incontinence. However, there is little evidence on long-term outcomes.Objective: To examine long-term mesh removal and reoperation rates in women who had a midurethral mesh sling insertion for stress urinary incontinence.Design, Setting, and Participants: This population-based retrospective cohort study included 95 057 women aged 18 years or older who had a first-ever midurethral mesh sling insertion for stress urinary incontinence in the National Health Service hospitals in England between April 1, 2006, and December 31, 2015. Women were followed up until April 1, 2016.Exposures: Patient and hospital factors and retropubic or transobturator mesh sling insertions.Main Outcomes and Measures: The primary outcome was the risk of midurethral mesh sling removal (partial or total) and secondary outcomes were reoperation for stress urinary incontinence and any reoperation including mesh removal, calculated with death as competing risk. A multivariable Fine-Gray model was used to calculate subdistribution hazard ratios as estimates of relative risk.Results: The study population consisted of 95 057 women (median age, 51 years; interquartile range, 44-61 years) with first midurethral mesh sling insertion, including 60 194 with retropubic insertion and 34 863 with transobturator insertion. The median follow-up time was 5.5 years (interquartile range, 3.2-7.5 years). The rate of midurethral mesh sling removal was 1.4% (95% CI, 1.3%-1.4%) at 1 year, 2.7% (95% CI, 2.6%-2.8%) at 5 years, and 3.3% (95% CI, 3.2%-3.4%) at 9 years. Risk of removal declined with age. The 9-year removal risk after transobturator insertion (2.7% [95% CI, 2.4%-2.9%]) was lower than the risk after retropubic insertion (3.6% [95% CI, 3.5%-3.8%]; subdistribution hazard ratio, 0.72 [95% CI, 0.62-0.84]). The rate of reoperation for stress urinary incontinence was 1.3% (95% CI, 1.3%-1.4%) at 1 year, 3.5% (95% CI, 3.4%-3.6%) at 5 years, and 4.5% (95% CI, 4.3%-4.7%) at 9 years. The rate of any reoperation, including mesh removal, was 2.6% (95% CI, 2.5%-2.7%) at 1 year, 5.5% (95% CI, 5.4%-5.7%) at 5 years, and 6.9% (95% CI, 6.7%-7.1%) at 9 years.Conclusions and Relevance: Among women undergoing midurethral mesh sling insertion, the rate of mesh sling removal at 9 years was estimated as 3.3%. These findings may guide women and their surgeons when making decisions about surgical treatment of stress urinary incontinence. [ABSTRACT FROM AUTHOR]

Objective: To establish whether the infusion method trial of void (TOV) after a mid‐urethral sling procedure, in contrast to the standard auto‐fill TOV, permits discharge home from recovery, as these procedures are eminently suited to same day discharge, and the delay in achieving a successful TOV often keeps the patient in hospital overnight. Method: A randomised controlled trial performed between December 2014 and April 2016 at the University Hospital, enrolling 40 women undergoing a mid‐urethral sling procedure for stress urinary incontinence. The women were randomised to infusion method or auto‐fill method TOV. The primary outcome was discharge home from the recovery area of theatre. Results: Discharge from recovery was not different between the two groups (odds ratio (OR) 1.3 95% CI: 0.3–5.9, P = 0.71). The rate of TOV being successfully passed in recovery was higher in the infusion‐fill group compared to the standard auto‐fill group (OR 4.5 95% CI 1.2–17.4, P = 0.025). This means that three women will undergo the infusion‐fill to achieve one more successful TOV in recovery. Conclusions: The infusion method resulted in more women passing their TOV in recovery but this did not translate into more discharges from recovery. [ABSTRACT FROM AUTHOR]

Objective: Most data support the fact that women with symptomatic pelvic organ prolapse (POP) with concomitant symptomatic or occult stress urinary incontinence (SUI) benefit from concurrent POP and anti-incontinence procedure. However some data support a delayed or 2-step approach. The aim of this study was to demonstrate the effectiveness and safety of laparoscopic sacrocolpopexy (SCP) alone with a delayed approach for SUI to prove the justification of a 2-step approach.Study Design: A prospective study from 2014 to 2016 including women with symptomatic POP ≥ stage 2 prolapse and concomitant SUI or occult SUI. Laparoscopic SCP for apical or multi-compartment POP with or without concomitant MUS insertion was performed. Primary outcome measures were asymptomatic regarding SUI after prolapse surgery alone, persisting SUI with or without subsequent anti-incontinence surgery.Results: A SCP alone was performed on 62 women. Stress urinary incontinence was seen in 31% with SCP alone and a third of those women needed an additional midurethral sling for persisting SUI. Women who chose a combined surgery for POP and incontinence with SCP and a suburethral sling the postoperative success rate regarding SUI was 100% with two women needing a sling release.Conclusion: We showed that women with POP with concomitant stress urinary incontinence undergoing sacrocolpopexy benefitted from a two-step approach as only 11% needed an additional incontinence procedure. This study highlights the importance of pre-operative counselling. It should be tailored to the individual woman. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To demonstrate the clinical and urodynamic outcomes of transobturator sling (TOT) with or without concomitant prolapse surgery for the treatment of urodynamic stress incontinence (USI). Methods: We recruited 143 consecutive patients diagnosed with USI, who received outside‐in TOT in a university hospital. Preoperative and postoperative examinations were implemented using structured urogynecological questionnaires, pelvic organ prolapse quantification examination and urodynamic testing. Patient demographics, surgical and urodynamic results were compared between TOT with and without concomitant prolapse surgery. Results: The mean follow‐up was 30.1 months (range 12–57). Postoperative stress urinary incontinence (SUI) occurred in 10 (7%) patients at 3 months and 10 (7%) patients at 12 months postoperatively. There was no significant difference in prevalence of postoperative SUI between groups of TOT only and TOT combined with pelvic surgery. Preoperative urodynamic results demonstrated that TOT only (n = 96) had a higher maximal flow rate and a lower residual urine amount when compared to TOT combined with pelvic surgery (n = 47). A significant decrease in maximal urethral closure pressure (MUCP) was found in 119 patients who received postoperative urodynamic examination. In comparison with preoperative urodynamic data, postoperative urodynamic results showed a significant decrease in MUCP in the TOT combined with prolapse surgery group, but no significant urodynamic changes in the group of TOT only. Conclusion: Both TOT and TOT combined with prolapse surgery can be effective in correcting SUI in patients with USI 12 months postoperatively, with significant changes in MUCP. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objective was to compare the outcomes of the ACT® device with those of the artificial urinary sphincter (AUS) AMS 800 in the treatment of stress urinary incontinence (SUI) due to sphincter deficiency in women.Methods: All the women who underwent surgical treatment for SUI due to intrinsic sphincter deficiency from 2007 to 2017 were included in a single-center retrospective study. The primary endpoint was the functional outcome. Perioperative functional parameters of the two groups were compared.Results: Twenty-five patients underwent an ACT® implantation and 36 an AUS implantation. Patients in the AUS group were younger (62.9 vs 70.4 years; p = 0.03) with less comorbidity (ASA Score = 3 in 12.1% vs 33.3%; p = 0.005). Operative time and hospital stay were shorter in the ACT® group (45.7 vs 206.1 min; p < 0.001; 1.7 vs 7 days; p < 0.001 respectively). There was a higher rate of intraoperative complications in the AUS group (47% vs 8%; p < 0.001) but the rates of postoperative complications were similar between both groups. The ACT® was associated with an increased risk of urinary retention (20% vs 2.8%; p = 0.04). Results were in favor of AUS for: decrease in USP stress incontinence subscore (−7.6 vs −3.2; p < 0.001), number of pads per 24 h (− 4.6 vs −2.3; p = 0.002), PGII scale (PGII = 1: 61.1% vs 12%; p < 0.001), and cure rate (71.4% vs 21.7%; p < 0.001).Conclusions: In the present series, keeping in mind the significantly different baseline characteristics, AUS implantation was associated with better functional outcomes than the ACT® in female patients with SUI due to intrinsic sphincter deficiency, but with a higher intraoperative complications rate, longer operative time, and a longer stay. [ABSTRACT FROM AUTHOR]

Minimally invasive stem cell therapy for stress urinary incontinence may provide an effective nonsurgical treatment for this common condition. Clinical trials of periurethral stem cell injection have been under way, and basic science research has demonstrated the efficacy of both local and systemic stem cell therapies. Results differ as to whether stem cells have a therapeutic effect by differentiating into permanent, functional tissues or exert benefits through a transient presence and the secretion of regenerative factors. This review explores the fate of therapeutic stem cells for stress urinary incontinence and how this may relate to their mechanism of action. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the short- and medium-term effect of vaginal antetheca submucosal-retropubic space with mesh repair through the implantation of organic patch (shortly as new-style vaginal mesh repair) in the treatment of patients with stress urinary incontinence (SUI).Methods: This was a clinical prospective single arm study in a tertiary grade hospital (General Hospital of Jinan Military Region, Jinan, China). From January 2009 to December 2014, 316 female patients were enrolled. 316 female patients with stress urinary incontinence (SUI) underwent the surgery. The treatment effect was evaluated using the urinary incontinence questionnaire (ICIQ-SF), urine pad test and coughing test. The perioperative and postoperative complications were also evaluated. The results were compared with 1-year cure rates of Burch retropubic urethropexy (Burch) and tension-free vaginal tape (TVT) procedure.Results: The mean follow-up period was 25 ± 12 months. The success rate of the new surgical technique was 94.0% (297/316) at 1 month, and 91.5% (289/316) at 1-year postoperation. The ICIQ-SF score significantly decreased at the 1-year follow-up (P < 0.01). There was no significant difference in the 1-year cure rate when compared with the Burch and TVT procedures (P > 0.05). The rates of perioperative urinary tract irritation and mesh exposure were 9.5% (30/316) and 5.38% (17/316), respectively, and no serious complications were found.Conclusions: The surgery demonstrated favorable short-term and medium-term treatment effects. Given its advantages of being minimally invasive, cost efficient and requiring only local anesthesia, this new surgical technique has a potential for broader clinical application.ClinicalTrials.gov ID: NCT02934490. [ABSTRACT FROM AUTHOR]

Introduction: The Urological Society of India guidelines panel on urinary incontinence (UI) conducted a survey among its members to determine their practice patterns in the management of UI. The results of this survey are reported in this manuscript. Methods: An anonymous online survey was carried out among members of the USI to determine their practice patterns regarding UI using a predeveloped questionnaire on using SurveyMonkey®. A second 4-question randomized telephonic survey of the nonresponders was performed after closure of the online survey. Data were analyzed by R software 3.1.3 (P < 0.05 significant). Results: A total of 468 of 2109 (22.2%) members responded to the online survey. Nearly 97% were urologists, 74.8% were working at a private, and 39.4% were in an academic institution. Almost all were managing UI. 84.2% had local access to a urodynamics (UDS) facility. 85.8% would check postvoid residual urine for all the patients. Voiding diary, symptom scores, quality of life scores, pad test, Q-tip test, stress test, uroflow, and cystoscopy were ordered as part of evaluation by 86.0%, 49.8%, 24.4%, 22.0%, 6.0%, 71.8%, 69.2%, and 34.7%, respectively. 47.6% would order a UDS for patients with urgency UI who fail conservative treatment. 36.9% would get UDS prior to all stress UI surgery. Seventy-five percent would make a diagnosis of intrinsic sphincter deficiency. Solifenacin was the first choice for urgency UI in general and darifenacin was preferred in elderly. Botulinum was the first choice for refractory urgency UI. Midurethral sling was the commonest procedure for surgical management of SUI (95.1%). 147 of the 1641 non responders were randomly sampled telephonically. Telephonic respondents had similar access to UDS facility but had performed fewer lifetime number of post-prostatectomy incontinence (PPI) surgeries. Combining data from both surveys, total number of artificial sphincters and PPI surgeries ever performed by USI members was estimated at 375 and 718 respectively. Conclusion: This survey provides important new data and elicits critical differences in management practices based on demographics. [ABSTRACT FROM AUTHOR]

Recent press coverage on vaginal mesh surgery has resulted in a change in how patients are counselled, managed and treated in the UK. For stress urinary incontinence surgical procedures such as insertion of tension-free vaginal tape are commonplace and generally performed as a day-case procedure. Effective and successful management of female urinary incontinence is difficult, even when using diagnostic testing where all conservative managements have failed, and this indicates a need to investigate further. Specialist texts in the fields of urology and urogynaecology argue that urodynamics can help inform the success of surgical intervention for stress urinary incontinence. The aim of this review was to look for evidence of practice where urodynamic findings are used to determine the successful outcome of mid-urethral sling surgery in females. A literature search to identify research on this topic was performed with appraisal of qualifying literature. The qualifying research included attitudes towards urodynamic studies among urogynaecologists and urologists, demonstration that urodynamics has been proven to influence changes in diagnosis and surgical approaches, and the capacity for urodynamics to predict successful outcomes in mid-urethral sling surgery. Analysis of the literature found no evidence to suggest that urodynamic findings can be used to determine successful outcomes following mid-urethral sling surgery. [ABSTRACT FROM AUTHOR]

Objective: To compare the length of the membranous (functional) urethra in male patients who underwent the male transobturator sling (TOS) for postradical prostatectomy urinary incontinence (PPI). The TOS is in established use for treatment of PPI; however, the precise mechanism of action is unknown.Materials and Methods: This is a prospective case-controlled study on men undergoing male TOS surgery from 2008 to 2014. The comparison arm included patients without incontinence after radical prostatectomy. All participants underwent dynamic magnetic resonance imaging (MRI) at baseline and this was repeated after TOS placement for those who underwent the procedure. Three standardized points were measured using MRI and compared in both groups in addition to clinical measures.Results: Thirty-nine patients were enrolled and 31 patients completed the protocols. The controls (N = 14) had a longer vesicourethral anastomosis to urethra measured at the penile bulb (functional urethral length) distance compared to the pre-TOS group at rest (1.92 cm controls vs 1.27 cm pre-TOS, P = .0018) and at Valsalva (2.13 cm controls vs 1.72 cm pre-TOS, P = .0371). Placement of the sling (N = 17) increased the functional urethral length distance at rest (1.92 cm control vs 1.53 cm post-TOS, P = .09) and at Valsalva (1.94 cm post-TOS vs 2.13 cm control, P = .61), so that the difference was no longer statistically significant.Conclusion: We identified that one possible mechanism in improvement in stress urinary incontinence post-TOS placement is the lengthening of the vesicourethral anastomosis to bulbar-urethra distance. This is the first such study utilizing dynamics MRI in post prostatectomy controls, incontinent pre-TOS, and post-TOS to assess and show these findings. [ABSTRACT FROM AUTHOR]

Objective: Pelvic floor disorders, in particular pelvic organ prolapse (POP) and stress urinary incontinence (SUI), are common in women. There is a described higher risk to develop postoperative SUI also in preoperatively continent women: this happens because in 30% of women the relief of the urethral obstruction caused by prolapse, unmasks a pre-existing compromised urethral function and thus an "occult" or potential SUI. The aims of this study were to evaluate the role of Macroplastique® implant, TVT-O or surgery alone in the management of occult urinary stress incontinence during prolapse surgery in terms of success rate and adverse events.Study Design: We enrolled 47 consecutive patients scheduled to vaginal prolapse surgery who did not report symptoms of stress incontinence. We collected surgical data, success and complication rates. Moreover we compared all the data with retrospective ones regarding surgery plus concomitant TVT-O (39 pts) and surgery alone (41 pts).Results: At 12-months follow-up, we reported a success rate of 87,2% in the "macroplastique group", comparable to the "surgery plus TVT-O group", with a statistically significant difference in comparison to the "surgery alone" group. "Surgery + TVT-O" group reported a higher rate of major complications (p<0,01) in comparison to the other groups.Conclusions: Postoperative SUI prevention at the time of prolapse repair remains a challenging issue. In selected patients, Macroplastique may play an interesting role having a good success rate and a low complication rate and for these reasons it may be proposed as A concomitant procedure during POP surgery. [ABSTRACT FROM AUTHOR]

Objective To review measures used in recent randomised controlled trials (RCTs) evaluating stress urinary incontinence (SUI) treatments and to propose the most relevant outcome measure that should be included in future trials. Materials and methods We identified RCTs for SUI interventions published between January 2015 and July 2017. We listed the objective and subjective outcome measures used in eligible trials in the literature search. Using data from our RCT conducted from 2013 to 2016 evaluating pulsed magnetic stimulation for SUI, we analysed the correlation between all measures. Results A total of 45 RCTs were included; 28 (62%) involved surgical interventions. The most frequently used objective and subjective measures were the cough stress test and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), respectively. In all, 24 different validated questionnaires were administered in the 42 studies that used subjective outcome measure. Analyses of measures used in our trial showed that all measures were significantly correlated with each other except for pelvic floor muscle function. The ICIQ-UI SF showed the highest correlation coefficients (0.587-0.733) with all outcome measures. Conclusion The outcome measures used in recent trials were inconsistent. The ICIQ-UI SF had the highest correlation with all measures in our trial; however, further studies evaluating correlation of measures in other patient cohorts are needed to corroborate our present results. We propose the use of ICIQ-UI SF, as the most relevant outcome measure, in future trials evaluating efficacy of SUI interventions. [ABSTRACT FROM AUTHOR]

Objective: To assess the sexuality and quality of life of sexually active women with stress or mixed urinary incontinence (SUI or MUI) after surgery with adjustable tension-free suburethral mesh system (transobturator adjustable tape or transvaginal adjustable tape).Materials and Methods: This intervention study with 2 years of follow-up (visits at 3 months, 1 year, and 2 years) involved 60 women with SUI or MUI who underwent surgery using transobturator adjustable tape or transvaginal adjustable tape during 2008-2014 in a Spanish region. The variables of interest measured pre- and postintervention were the global scores on the following questionnaires: (1) the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12; (2) the International Consultation on Incontinence Questionnaire; and (3) the Incontinence Quality of Life Questionnaire. Mixed linear models were constructed to determine the effect of the intervention on the outcome variables.Results: A significant improvement (P <.001) was seen over time in all the questionnaires, although between the 1- and 2-year visits there was a slight deterioration in all of them.Conclusion: The technique provided an improved quality of life and sexuality, which was maintained at all the postoperative visits compared with baseline. [ABSTRACT FROM AUTHOR]

Urinary incontinence (UI) is a common symptom affecting almost one-third of adult women. UI can occur because of hypermobility or intrinsic sphincter deficiency of the urethra. Regardless its etiology, it is associated with poor quality of life and most of the incontinent women develop symptoms such as anxiety, depression, and social isolation over time. The synthetic midurethral sling (MUS) was first introduced in 1995 and quickly became the gold standard treatment for women with stress UI because of intrinsic sphincter deficiency and/or urethral hypermobility. This session addresses the indications, preoperative preparation, surgical steps, postoperative care, and complications related to synthetic MUSs. Owing to the exponential increase in the prevalence of mesh-related complications, we also developed a rational evidence-based algorithm that will help urologists to diagnose and manage this specific subset of patients. [ABSTRACT FROM AUTHOR]

Objective: Stress urinary incontinence (SUI) is a common complaint in women after childbirth. It affects their quality of life and sexual satisfaction and is one of the major reasons for gynaecological surgery. There is a need for effective non-invasive treatment alternatives. The aim of this study was to evaluate the efficacy and safety of non-ablative Er:YAG laser therapy in the treatment of SUI and improvement of sexual gratification in parous women.Study Design: 114 premenopausal parous women with SUI were randomized in two groups of 57 women; a laser intervention group and sham group. Both groups were treated according to the IncontiLase® clinical treatment protocol for SUI with non-ablative thermal-only Er:YAG laser, except that there was no energy output when treating the sham group. Patients were blinded to the allocation. At baseline and 3 months after treatment patients were clinically examined, answered questionnaires for SUI severity and sexual function assessment and their pelvic floor muscle (PFM) function was assessed with perineometry. Validated International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF) was used as the primary outcome measure. The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and The Female Sexual Function Index (FSFI) were used to assess the sexual function. Patients were monitored for discomfort and side-effects during treatment and follow-up period.Results: 3 months after treatment the ICIQ-UI SF (p < 0.001), PISQ-12 (p = 0.014) and FSFI (p = 0.025) scores were significantly more improved in the laser group than in the sham control group. All perineometry variables improved in the laser group after treatment; duration and maximum pressure had statistically significantly better improvement than the sham group, whereas average pressure did not. 21% of laser treated patients were dry (ICIQ-UI SF = 0) at follow up compared to only 4% of the sham control patients. No serious adverse effects were observed or reported. The treatment was well tolerated by patients.Conclusions: The non-ablative Er:YAG laser therapy improves the impact of SUI symptoms on quality of life and sexual function in premenopausal parous women significantly better than placebo. It provides a promising minimally-invasive safe treatment alternative for SUI. [ABSTRACT FROM AUTHOR]

The urethral closure mechanism in women, which is important in normal and pathophysiological conditions, is incompletely understood. Over the last decade, urethral pressure reflectometry (UPR), a method that measures pressure and the corresponding cross-sectional area along the entire length of the urethra continuously by means of acoustic reflectometry, has been developed and applied mostly in patients with stress urinary incontinence (SUI). The main advantage of UPR is that it is performed without distending the urethra and changing its natural shape, respecting the laws of physics when measuring urethral pressure, which is impossible in conventional methods such as UPP. The paper is to introduce the method and the studies conducted with UPR, and the application possibilities in other urethra conditions in both man and women, in order to keep up the research and clinical trends in the field of urodynamics. [ABSTRACT FROM AUTHOR]

Importance: Uterosacral ligament suspension (ULS) and sacrospinous ligament fixation (SSLF) are commonly performed pelvic organ prolapse procedures despite a lack of long-term efficacy data.Objective: To compare outcomes in women randomized to (1) ULS or SSLF and (2) usual care or perioperative behavioral therapy and pelvic floor muscle training (BPMT) for vaginal apical prolapse.Design, Setting, and Participants: This 2 × 2 factorial randomized clinical trial was conducted at 9 US medical centers. Eligible participants who completed the Operations and Pelvic Muscle Training in the Management of Apical Support Loss Trial enrolled between January 2008 and March 2011 and were followed up 5 years after their index surgery from April 2011 through June 2016.Interventions: Two randomizations: (1) BPMT (n = 186) or usual care (n = 188) and (2) surgical intervention (ULS: n = 188 or SSLF: n = 186).Main Outcomes and Measures: The primary surgical outcome was time to surgical failure. Surgical failure was defined as (1) apical descent greater than one-third of total vaginal length or anterior or posterior vaginal wall beyond the hymen or retreatment for prolapse (anatomic failure), or (2) bothersome bulge symptoms. The primary behavioral outcomes were time to anatomic failure and Pelvic Organ Prolapse Distress Inventory scores (range, 0-300).Results: The original study randomized 374 patients, of whom 309 were eligible for this extended trial. For this study, 285 enrolled (mean age, 57.2 years), of whom 244 (86%) completed the extended trial. By year 5, the estimated surgical failure rate was 61.5% in the ULS group and 70.3% in the SSLF group (adjusted difference, -8.8% [95% CI, -24.2 to 6.6]). The estimated anatomic failure rate was 45.6% in the BPMT group and 47.2% in the usual care group (adjusted difference, -1.6% [95% CI, -21.2 to 17.9]). Improvements in Pelvic Organ Prolapse Distress Inventory scores were -59.4 in the BPMT group and -61.8 in the usual care group (adjusted mean difference, 2.4 [95% CI, -13.7 to 18.4]).Conclusions and Relevance: Among women who had undergone vaginal surgery for apical pelvic organ vaginal prolapse, there was no significant difference between ULS and SSLF in rates of surgical failure and no significant difference between perioperative behavioral muscle training and usual care on rates of anatomic success and symptom scores at 5 years. Compared with outcomes at 2 years, rates of surgical failure increased during the follow-up period, although prolapse symptom scores remained improved.Trial Registration: clinicaltrials.gov Identifier: NCT01166373. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Urine loss during recreational exercise is problematic. We aimed to characterize which activities are most frequently reported as causing leakage for women, adaptive management mechanisms, and awareness and interest in treatment in a cohort of physically active women.Methods: We administered an anonymous questionnaire to 59 physically active women in Canada. Surveys were completed electronically or on paper. Demographic information was obtained. Questions about which specific activities caused leakage, adaptive behaviors to deal with urinary loss, and degree of bother were addressed, and knowledge and interest in therapies for leakage were queried.Results: Activities most likely to cause leakage were skipping, trampoline, jumping jacks, and running/jogging. To decrease leakage, 93.2% voided immediately before exercise, 62.7% reported voiding breaks, and some reported fluid restriction (37.3%). Leakage impacted activity level for 50% of women. Most often, activity intensity was decreased (90.3%) or specific activities avoided (80.7%). Pad use during exercise was common (49.2%). Interest in receiving treatment for urinary incontinence (UI) was high (88.1%) despite a large proportion (35.6%) not knowing of available treatments. Interest was highest for pelvic floor physiotherapy (84.6%), although interest in both pessary and surgical management (63.5% each) was significant.Conclusions: Women experiencing UI during exercise report high-impact activities as most frequently causing loss. Adaptive behaviors are common. Physically active women are interested in treatment, and the high interest in pelvic physiotherapy presents a unique opportunity to link pelvic exercise with recreational exercise to meet both cardiovascular and continence needs in the physically active patient population. [ABSTRACT FROM AUTHOR]

Postprostatectomy urinary incontinence has a significant impact on the quality of life of patients who undergo radical prostatectomy. Stress and overflow incontinence may result from the procedure, with sphincteric incompetence and detrusor hypocontractility implicating their development, respectively. In many cases, treatment begins with conservative approaches, including pelvic floor muscle training or biofeedback. Pharmacotherapy can be used to treat overactive bladder. For stress incontinence, transurethral bulking agents are utilized in select patients; however, artificial urinary sphincter and male slings are the most efficacious options with good success rates. In this review, the various treatment modalities are critically discussed with special emphasis on safety and efficacy. [ABSTRACT FROM AUTHOR]

Background: Pessaries are a treatment option for pelvic organ prolapse, stress urinary incontinence (SUI), and cervical incompetence. An effective pessary is comfortable, corrects the presenting problem, does not cause adverse effects, and is easy to remove. Discomfort and poor fit limit the usefulness of pessaries for many women. Each patient presents with unique anatomy and thus the effectiveness of commercially available pessaries may be limited by lack of customization.Method: A patient presenting with SUI and failed commercial pessary fittings desired nonsurgical treatment. Using a mold fabricated with a three-dimensional printer and polylactic acid filament, a medical-grade silicone pessary was custom-made for the patient.Experience: The silicone pessary was placed vaginally in the patient for a period of 48 hours. The patient did not report any discomfort or bladder leakage. In addition, the pessary did not dislodge with coughing, sneezing, or straining. After removal, a speculum examination showed normal epithelium.Conclusion: We report the successful insertion of a customized three-dimensional-printed pessary in a patient with SUI. Three-dimensional-printed pessaries are feasible and their utility may extend to the patient with anatomy incompatible with commercially available pessaries. [ABSTRACT FROM AUTHOR]

Abstract: Aim: We aimed to measure the effectiveness and quality of life (QoL) 10 years after transobturator suburethral tape surgery. Methods: We carried out a prospective observational study of 42 women assessed 10 years after surgical intervention with the transobturator technique. The main outcome measures were subjective and objective cure or improvement, complications, and changes in QoL. Results: The median abdominal leak point pressure had been 92 (82–113) mL H2O prior to surgery. Thirty‐six women (85.7%) remained cured (negative cough test) and 13 (31%) reported urine leakage during physical activity, percentages which were similar to those at a previous assessment at the 5th year. Urgency urinary incontinence was reported by 18 women (42.9%), 16 of whom required the use of anticholinergic drugs. Nineteen women had undergone some form of surgical pelvic reconstruction concomitantly with the TOT procedure, four of whom presented with relapse. The QoL tests indicated that cure and improvement persisted in 85.7% (n = 36, Urogenital Distress Inventory‐6) and 92.9% (n = 39, Incontinence Impact Questionnaire‐7) of the 42 evaluable women, respectively. Conclusion: Rates of objective and subjective effectiveness remained stable after 10 years of surgery and QoL did not deteriorate significantly during that interval. The increase in urgency incontinence needs to be further investigated. [ABSTRACT FROM AUTHOR]

Aim: To evaluate sexual functions of women having stress urinary incontinence (SUI) preoperatively and 6 months and 12 months after undergoing a transobturator tape (TOT) ± pelvic organ prolapse (POP) surgery.Methods: One hundred-ninety-five women with SUI ± POP were recruited and 150 sexually active women who had clinical ± urodynamic SUI and underwent TOT ± POP surgery were included in this prospective study. Urogynecologic symptoms were evaluated preoperatively, at 6 months, and 12 months by Female Sexual Function Index (FSFI).Results: One hundred fifty women completed the study. Seventy-four underwent TOT-only and 76 underwent TOT + concomitant surgery. Mean total scores of FSFI were 21.7 ± 7.8, 22 ± 8.7, and 22.1 ± 8 in the preoperative period, postoperative 6, and 12 months, respectively. There was significant improvement in desire and total scores in the TOT-only group, whereas there was no significant difference in the TOT + concomitant surgery group except for significant worsening in the lubrication domain. The frequency of sexual intercourse increased while that of coital incontinence decreased after surgery.Conclusions: In our study, TOT was associated with decrease in coital incontinence and significant improvement in desire. In addition, there was significant improvement in FSFI desire and total scores in the TOT-only group, whereas no significant difference was observed in the TOT + concomitant surgery group except for the worsening of lubrication. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence and risk factors of urinary tract infection (UTI) one year following sub-midurethral sling (SMUS) incontinence surgery in a university affiliated medical center in southern Israel.Methods: A retrospective cohort study was conducted to identify and characterize patients who suffered UTI within a year following SMUS surgery. The study population comprised of all patients who underwent a SMUS surgery between the years 2014 and 2015. Demographic and clinical data were retrieved from the patients' medical records, and a comparison between patients with and without a positive urine culture was performed.Results: During the study period, there were 178 SMUS surgeries. Urine culture positive UTI was noted in 21% (38 patients) within the first year following surgery. The mean age and BMI of patients complicated with UTI was 64.8 and 29.1, respectively. The most common pathogen found in urine culture was E. coli that accounted for 55% of all UTIs. When comparing patients with and without UTI, no significant difference was noted in the pre- and intra-operative characteristics. However, duration of hospitalization and readmissions in the first year following surgery, were significantly associated with the risk of UTI (p < 0.026 and p < 0.003, respectively).Conclusions: Approximately one in every five women undergoing a SMUS operation in our population will suffer from UTI within a year from surgery. A significant association was found between the duration of hospitalization and readmissions in the first postoperative year and suffering from UTI. [ABSTRACT FROM AUTHOR]

Objective: In order for a measure to reliably evaluate treatment efficacy, it is important that the measure used has adequate responsiveness. However, the responsiveness of the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire, a highly recommended questionnaire by the International Consultation of Incontinence to assess sexual function in patients with incontinence, has not been established. To enable the use of GRISS to measure change in sexual function following incontinence treatment, we evaluated the short- and long-term responsiveness of the GRISS in couples with female stress urinary incontinence partners.Study Design: Forty-eight couples with female stress urinary incontinence partners were included in the study. The GRISS, a 28-item multidimensional measure, comprises two sets of questionnaires to assess sexual function in both male and female partners. Responsiveness was investigated using data from our recent randomized controlled trials evaluating efficacy of pulsed magnetic stimulation for treatment of female patients with stress urinary incontinence. Effect size index and standardized response mean were used to measure responsiveness of the English and Chinese versions of GRISS.Results: For short-term responsiveness, the overall female and male GRISS scores had effect sizes and standardized response means ranging from 0.60 to 0.83 and 0.44 to 0.78 respectively. For long-term responsiveness, the overall female and male GRISS scores had effect sizes and standardized response means ranging from 0.59 to 0.77 and 0.48 to 0.79 respectively.Conclusion: In conclusion, the English and Chinese versions of GRISS had adequate responsiveness for use in couples with incontinent partners. The GRISS can be a useful measure to detect change in sexual function of couples following treatment of females with stress urinary incontinence. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence (SUI) is a condition characterized by an involuntary loss of urine occurring as result of an increase in intra-abdominal pressure due to effort or exertion or on sneezing or coughing. Estimates of its prevalence in the female population range from 10% to 40%. A literature search of the Medline, Cochrane library, EMBASE, NLH, ClinicalTrials.gov and Google Scholar databases was done up to July 2017, restricted to English-language articles, using terms related to SUI, medical therapy, surgical therapy and treatment options. The search terms included female stress urinary incontinence, mid-urethral sling, tension-free vaginal tape (TVT) and transobturator tape (TOT, TVT-O). Original articles, reviews and meta-analyses were included. Surgical therapy should be considered only after conservative therapies (e.g. an exercise programme or topical estrogens) have failed. Synthetic mid-urethral slings are the gold standard for the surgical treatment of SUI according to the 2016 guidelines of the European Society of Urology (ESU) and the 2017 position statement of the European Urogynaecological Association (EUA). The therapeutic options are numerous but further research into new therapeutic strategies is needed to achieve a better balance between efficacy and adverse events. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of this study was to evaluate the long-term effect of thermoablative fractional CO laser (TACO2L) as an alternative treatment for early stages of stress urinary incontinence (SUI) in postmenopausal women with genitourinary syndrome of menopause. Methods: A total of 161 postmenopausal patients (age 53.38 ± 5.1 years, range 45-65 years) with a clinical diagnosis of mild SUI were prospectively enrolled in the study. Patients received one treatment with TACO2L every 30-45 days, each treatment comprising four sessions, followed in all patients by a yearly treatment session at 12, 24 and 36 months. SUI was evaluated using the International Continence Society 1-h pad test and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before and after TACO2L treatment. Results: TACO2L treatment was associated with a significant improvement in ICIQ-UI SF scores and 1-h pad weight test at 12 months (both p < 0.001), 24 months (both p < 0.001) and 36 months (both p < 0.001). Improvements were maintained for up to 36 months without the need for any further intervention. The results were confirmed by significant histological changes related to trophic restoration of the vagina, responsible for extrinsic and intrinsic mechanisms involved in urinary continence. Conclusions: Our results suggest that TACO2L is an efficient and safe novel treatment strategy in patients with mild SUI. Further investigation to confirm the long-term results presented here is still warranted. [ABSTRACT FROM AUTHOR]