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Introduction. Sling urethropexy is considered the «gold standard» surgical treatment for stress urinary incontinence in women. However, the long-term results of such operations have not yet been fully studied.Purpose of the study. To evaluate the results of using various options for sling operations at different periods of postoperative follow-up.Materials and methods. In 698 women aged 42 - 68 years (median — 54 years) suffering stress incontinence were used 4 variants of sling operations according to the database of the S.P. Botkin City Clinical Hospital: TVT retropubic technique; transobturator technique TVT-O («inside-out»); transobturator technique TOT («outside-in»); mini sling system. The period of postoperative follow-up was 6 - 139 months (median 79 months). Evaluation of treatment results was carried out according to the following periods of postoperative follow-up: short-term (up to 1 year inclusive); mediumterm (a period from 1 to 5 years inclusive); long-term (over 5 years). The success of the treatment was determined by the criterion of the absence of urine involuntary loss during the cough test and the 1-hour pad test.Results. Treatment success in the entire sample of patients was 96.1% (671 / 698) for the short-term criterion, 93.1% (591 / 635) for the medium-term criterion and 86.2% for the long-term criterion (467 / 642). The effectiveness of short-term treatment after TVT was 97%, TVT-O — 95.8%, TOT — 96.2%, mini-sling system — 95.5%, in medium-term — 92.2%, 93.1%, 90.9% and 92.3%, respectively, for long-term — 87.1%, 86.2%, 85.2% and 85%, respectively. There were no significant differences between the indicated variants of sling operations in terms of treatment efficacy for all observation periods (p > 0.05). Intra and early postoperative complications were noted in 51 (7.3%) cases, late — in 79 (11.3%). There were no significant differences in the incidence of both categories of complications between the surgical techniques used (p > 0.05). Only surgical experience significantly affects the risk of recurrent urinary incontinence after surgery, early and late postoperative complications.Conclusions. The success of surgical treatment for stress urinary incontinence in women does not significantly depend on the type of sling surgery but depends mainly on the surgical experience. Therefore, it is advisable to use sling operations in hospitals with extensive experience in this area.

Burch urethropexy is one of the earliest and most effective surgeries for stress urinary incontinence. Minimally invasive robotic surgery is becoming more popular in the field of urogynecology. Herein, we present the safety and efficacy of a large case series of robotic-assisted Burch urethropexy. A retrospective chart review was performed on robotic-assisted Burch urethropexy cases performed between 2013 and 2019. Patient characteristics, perioperative data and follow-up outcomes were collected at a single teaching institution. A total of 76 women underwent robotic-assisted Burch urethropexy for pure stress urinary incontinence. Fifty of them had concomitant robotic procedures at the time of the Burch. We performed the robotic-assisted Burch urethropexy alone on 26 patients. The mean age was 55 years old. The overall treatment success rate was 85% with a mean follow-up time of 134 (±157.8) days. Complications included cystotomy (3%), urinary tract infection (16%) and postoperative voiding dysfunction (10%). Our study reveals that robotic-assisted Burch urethropexy is a feasible option in the treatment of stress urinary incontinence in terms of operative outcomes and short-term efficacy.Impact statement

Urinaire incontinentie is een vaak voorkomende aandoening bij gesteriliseerde teven met een gerapporteerde prevalentie tussen 3,1% en 20,1%. Bij de meeste honden met verworven urinaire incontinentie is er sprake van een onderliggende urethrale sfinctermechanisme-incompetentie. Ongeveer 15% van de teven die initieel verbeteren met medicamenteuze behandeling, wordt uiteindelijk refractair. Chirurgische interventie is aangeraden wanneer patienten niet verbeteren ondanks medicamenteuze behandeling of refractair worden aan medicamenteuze behandeling. Gebaseerd op de huidige literatuur biedt de plaatsing van een artificiele urethrale sfincter, dit is een opblaasbare “cuff” rondom de proximale urethra die verbonden is met een subcutane injectiepoort, een zeer betrouwbare en langdurige oplossing voor incontinentie bij teven, waarbij zelden complicaties optreden.

Las enfermedades del tracto urinario incluyen diferentes condiciones que pueden afectar a los riñones, uréteres, vejiga urinaria y la uretra, causando en algunos casos fibrosis o estenosis. Una de las condiciones es el prolapso uretral en machos, que puede tener causas hereditarias, anomalías estructurales, uretritis por excitación sexual excesiva, traumas infringidos durante la masturbación frecuente, infecciones urinarias, cálculos urinarios o a una combinación de causas. Este reporte evidencia el manejo médico que se le dio a las complicaciones que se presentaron pos uretropexia en paciente Bulldog Inglés de tres años de edad con prolapso uretral crónico. El paciente presentó un proceso congestivo crónico caracterizado por agrandamiento del glande acompañado de cambios de coloración y dolor al tacto, cinco días post-cirugía. El tratamiento instaurado fue local y sistémico por 60 días, con el fin de evitar la amputación peneana y uretrostomía. Finalizado el tratamiento, se evidenció estenosis uretral casi completa; optándose por la dilatación con balón como opción menos invasiva para la resolución de la misma. El relato de caso presenta una alternativa de tratamiento para estenosis uretral utilizando una sonda de balón con resultados favorables. TITULO RESUMEN PALABRAS CLAVES ABSTRACT KEYWORDS INTRODUCCION REPORTE DE CASO DISCUSION CONCLUSION REFERENCIAS BIBLIOGRAFICAS Especialización Especialista en Medicina y Cirugía en Animales de Compañía Artículo

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).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.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.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.NCT02934490.

Objective To evaluate 1- and 2-year urinary continence rates after Burch retropubic urethropexy compared with a retropubic midurethral sling for women with urinary incontinence undergoing sacrocolpopexy. Methods We conducted a planned secondary analysis of a multicenter, randomized, single-blind trial comparing Burch with a sling that enrolled participants from June 2009 to August 2013. Objective outcome measures of continence were assessed at 1- and 2-year follow-up through office visits and validated questionnaires. Overall continence was defined as a negative stress test, no retreatment for stress incontinence, and no self-reported urinary incontinence (International Consultation on Incontinence Questionnaire, Short Form, score, 0). Stress-specific continence was defined as fulfillment of the first two criteria and no self-reported stress-related incontinence. Primary outcomes were assessed with intention-to-treat and within-protocol analyses. Comparisons between groups were evaluated using χ or Fisher exact test. Results The two groups were similar in all measured baseline features. Outcome assessments at 2 years were available for 48 of 57 patients (84%) in the sling group and 45 of 56 patients (80%) in the Burch group. With intention-to-treat analysis, the sling group had significantly higher rates of overall continence than the Burch group (49% [28/57] vs 29% [16/56]; 95% CI for absolute risk difference 3.0-38.1; P=.03) at 1- but not 2-year follow-up (47% [27/57] vs 32% [18/56]; 95% CI for absolute risk difference -2.6 to 33.1; P=.10). The sling group had significantly higher rates of stress-specific continence than the Burch group at 1-year (70% [40/57] vs 46% [26/56]; 95% CI for absolute risk difference 6.1-41.4; P=.01) and 2-year (70% [40/57] vs 45% [25/56]; 95% CI for absolute risk difference 7.9-43.2; P=.006) follow-up. No difference was detected in prolapse recurrence, voiding dysfunction, antimuscarinic medication use, urgency incontinence, or patient satisfaction. Conclusion Among women with baseline urinary incontinence undergoing sacrocolpopexy, the retropubic midurethral sling resulted in higher stress-specific continence rates than Burch retropubic urethropexy at 1- and 2-year follow-up.

Introduction Urinary incontinence (UI) is more common than any other chronic disease with the prevalence of approximately 23 and 55%. Among the various forms of UI, stress incontinence (SUI) is the most common (49%), with urgency incontinence (UUI) representing 21% and mixed type (MUI) at 29%. As it affects the quality-of-life of women, the restoration of urinary continence is one of the greatest challenges. Aim To review the cases of genuine SUI treated surgically by Burch retropubic urethropexy. Results We have managed surgically eight cases of genuine SUI by Burch retropubic urethropexy. On 1-year follow-up, none of the patients had any urinary complaints. All had responded well to surgery and patient's satisfaction index was good. Conclusion Since SUI is the commonest among incontinences, it is a challenge to diagnose and treat to improve quality-of-life of patients. Burch retropubic urethropexy is the gold standard treatment for SUI, especially if other indications exist for abdominal surgery. Even in the present era of less invasive vaginal procedures, results are comparable. How to cite this article Rajput DA, Valecha SM, Sarwade M, Dhumale S. Burch Retropubic Urethropexy for Genuine Stress Urinary Incontinence: A Review of Eight Cases. J South Asian Feder Menopause Soc 2017;5(2):129-132.

Conventional methods to treat urinary stress incontinence, including the Sling, Burch, and Pereyra modification methods, are limited by several shortcomings due to disrupted nerve and vaginal wall integrity. The nerve-sparing Burch-Sling method represents a surgical advancement through the use of a nerve-sparing sling to treat genuine stress urinary incontinence. The procedure involves retropubic urethropexy using the FDA-approved Burch-Sling device. In this technique, the vagina is elevated bilaterally at the urethrovesical junction to the mid-urethra toward Cooper’s ligament above the base of the bladder. Then, the anterior vaginal wall and fascia are used as an endogenous suburethral sling without dissection. Two hundred twenty cases were included in this study; two hundred patients underwent the outpatient nerve-sparing sling method, and the other twenty underwent the novel abdominal Burch method. There were no major complications. The follow-up duration ranged from 6 months to eight years. All procedures were performed at the U.S. Women’s Institute at a 400-bed hospital in Fountain Valley, CA.

OBJECTIVE To compare efficacy and safety of retropubic Burch urethropexy and a midurethral sling in women with stress urinary incontinence (SUI) undergoing concomitant pelvic floor repair with sacrocolpopexy. METHODS Women were randomly assigned to Burch retropubic urethropexy (n=56) or retropubic midurethral sling (n=57) through dynamic allocation balancing age, body mass index, history of prior incontinence surgery, intrinsic sphincter deficiency, preoperative incontinence diagnosis, and prolapse stage. Overall and stress-specific continence primary outcomes were ascertained with validated questionnaires and a blinded cough stress test. RESULTS Enrollment was June 1, 2009, through August 31, 2013. At 6 months, no difference was found in overall (29 midurethral sling [51%] compared with 23 Burch [41%]; P=.30) (odds ratio [OR] 1.49, 95% confidence interval [CI] 0.71-3.13) or stress-specific continence rates (42 midurethral sling [74%] compared with 32 Burch [57%]; P=.06) (OR 2.10, 95% CI 0.95-4.64) between groups. However, the midurethral sling group reported greater satisfaction (78% compared with 57%; P=.04) and were more likely to report successful surgery for SUI (71% compared with 50%; P=.04) and to resolve pre-existing urgency incontinence (72% compared with 41%; P=.03). No difference was found in patient global impression of severity or symptom improvement, complication rates, or mesh exposures. CONCLUSION There was no difference in overall or stress-specific continence rates between midurethral sling and Burch urethropexy groups at 6 months. However, the midurethral sling group reported better patient-centered secondary outcomes.

Background: Genital prolapse is one of the most difficult-to-solve problems of gynecology. Rates of relapse after surgical correction of this disorder amounts to 33–40%. Aim: To analyze the use of alloplastic materials for correction of severe forms of ptosis and prolapse of internal genitals in the elderly. Materials and methods: 228 females aged from 60 to 70 with genital prolapse grade III–IV (according to classification by Baden-Walker) were divided into 3 groups depending on the leading anatomical structure in the prolapse. In all patients, extraperitoneal colpopexy with a prolene mesh was performed, with additional perineal plastics, in 165 patients from Group 1 (mean age, 63 years) being an anterior plastics, in 47 patients from Group 2 (mean age, 65 years) – posterior, in 12 patients from Group 3 (mean age, 68 years) – total. Efficacy of surgery was assessed at 2 to 4 months according to degree of genital prolapse, absence of erosions of vaginal walls and absence of the alloplast shrinkage and/or displacement. Results: Almost in 50% patients, a latent form of urine incontinence was diagnosed that required an urethropexy by a free synthetic loop through a transobturator approach. Frequency of intraoperational complications was low (n = 1). Among post-operation complications, 60% patients from Groups 1 and 3 had urination disorders that resolved by days 4–5 after surgery with anti-inflammatory treatment and with the use of agents increasing the detrusor tone. Frequency of vaginal wall erosions and of a partial prosthesis expulsion was 4.2% each in Groups 1 and 2. There were no vaginal wall erosions in Group 3. Clinically insignificant partial shrinkage of the prolene mesh was noted in 4.5, 4.2 and 5.9% of cases in Groups 1, 2 and 3, respectively. After the surgical correction, in 100% of patients from Groups 1 and 3 and in 70.6% of patients from Group 2 their genital prolapse was assessed as having grade I according to Baden-Walker, and in 29.4% of patients from Group 2, as grade II. However, there were many cases of prolapse progression of the contralateral vaginal wall: in 72 (44%) of patients in Group 1 and in 4 (23,5%) in Group 2, that in some cases (18,4%) necessitated the surgery to be repeated. Conclusion: The use of prolene mesh for extraperitoneal strengthening of the pelvic fundus in the elderly is an effective way of treatment. With strict adherence to proper surgical technique it is associated with a minimal number of complications that are mainly easily eliminated.

OBJECTIVE The aim of this study was to evaluate reasons and factors associated with patient calls in the postoperative period after female pelvic medicine and reconstructive surgery. METHODS A retrospective review using electronic medical records was performed on consecutive patients who underwent surgery within our academic female pelvic medicine and reconstructive surgery practice during a 6-month period. Calls after postoperative discharge until first scheduled postoperative visit were included. Reasons and number of calls were tabulated. Clinical and surgical factors were extracted. Continuous data were evaluated with a Student t test or analysis of variance; categorical data were evaluated with a χ test. P < 0.05 was considered significant. RESULTS During the designated period, 302 patients underwent surgery, and 173 (57.3%) patients made 345 calls (mean ± SD, 2.0 ± 1.5 calls). Reasons were categorized under 6 distinct domains: bowel, pain, activity, medication regimen, urinary, and bleeding. The most frequent concern within each domain was constipation (11.6%), abdominal pain (6.4%), physical activity (8.7%), pain regimen (14.5%), urinary catheter related (13.3%), and vaginal bleeding (12.1%), respectively. A greater number of phone calls were recorded among patients discharged home with catheters (P = 0.015), and patients who underwent posterior colporrhaphy (P = 0.005) and retropubic urethropexy (P = 0.014). Patients discharged with home nursing (11, 6.4%) demonstrated a significantly higher number of phone calls (3.8 ± 2.5, P < 0.001). Evaluations were required for 37% of callers. Twelve patients were seen in the emergency department, of whom 3 (1.7%) were readmitted to the hospital. CONCLUSIONS Postoperative patient-initiated telephone calls after pelvic reconstructive surgery are common. Bowel-, urinary-, and medication-based phone calls account for the highest frequency and volume.

Objective To describe the surgical treatment and short- and long-term outcome of young pot-bellied pigs with penile prolapse. Study design Short case series. Animals Five young castrated Vietnamese pot-bellied pigs. Methods Five Vietnamese pot-bellied pigs presented with penile prolapse of several weeks duration. No other abnormalities were found at physical examination. Under general anesthesia, phallopexy with or without combined urethropexy was performed successfully in all cases. Results All pigs were discharged from the hospital. One pig required a second urethropexy the day after the initial surgery to improve positioning of the penis in the prepuce. Long-term outcome was available in 4 cases. Penile prolapse resolved in the 4 cases available for follow-up, and the owners were satisfied with the cosmetic outcome of the procedure. Conclusion Penile prolapse was successfully corrected in 5 pot-bellied pigs by using 2 different phallopexy techniques. The procedure was combined with urethropexy in 3 pigs. Long-term outcome was excellent in the 4 cases available for follow-up. Clinical impact This is the first report describing the use of phallopexy with or without urethropexy for successful treatment of penile prolapse in young pot-bellied pigs. Two different phallopexy techniques were effectively used in this report. The etiology of penile prolapse in pot-bellied pigs remains unknown.

Stress urinary incontinence (SUI) is a major problem affecting more than 20% of the nation's female population, with increasing prevalence as our population continues to age. Incontinence places a great burden on individuals, and the economic effect is large. Stress urinary incontinence occurs when there is involuntary leakage of urine during coughing, laughing, sneezing, or physical activity. It can be diagnosed during physical examination and by using low-cost office diagnostics. Although nonsurgical treatments provide some benefit, surgical interventions have demonstrated superiority with respect to subjective and objective cure and better long-term improvement. Corrective surgeries for SUI can be grouped into four categories: 1) slings (midurethral slings and slings placed at the ureterovesical junction), 2) retropubic urethropexy, 3) urethral bulking agents, and 4) artificial sphincters. The success and failure of each approach needs to be assessed in the context of individual patients and their circumstances. Slings and retropubic urethropexy are considered first-line surgical options. Since the advent of minimally invasive retropubic midurethral slings such as the tension-free vaginal tape, transobturator tension-free vaginal tape, and single-incision sling, retropubic urethropexy have fallen out of favor. Warnings about mesh use may contribute to a resurgence of retropubic urethropexy procedures such as the Burch procedure. A Burch procedure should still be considered for patients who have an aversion to mesh or if they are undergoing concurrent abdominal approach surgery. Urethral bulking agents are usually reserved for patients with a fixed, nonmobile urethra who cannot tolerate an operative experience or have failed previous antiincontinence procedures. Artificial sphincters should be considered an operation of last resort.

The combination of urethropexy and colposuspension for the management of urinary incontinence associated with urethral sphincter mechanism in bitches has recently been described. The success rate for this procedure (70%) is considerably more favourable than has been reported for either individual technique, and is associated with a low rate of complications.

Aims Using the National Health Insurance (NHI) database in Taiwan, the study aimed to evaluate the rates and associated factors for reoperation of female stress incontinence. Methods Records of female patients who had received a primary surgical treatment for stress incontinence from January 2000 to December 2006 were retrieved. Among these, patients who had reoperations during follow-up till December 2010 were identified. The data were analyzed for reoperation rates, surgery methods, patient demography, surgeon, and hospital attributes. Results Among 14,613 patients with a mean follow-up of 86.28 ± 26.76 months, 563 (3.85%) had reoperations, an incidence rate of 54.37 per 10,000 person year (PY). Injection procedures had the highest reoperation rate of 893.30/10,000 PY. The adjusted hazard ratio (HR) of reoperation was higher for mid-urethral sling when compared to pubovaginal sling (HR 1.54, 95% CI 1.16–2.05) or retropubic urethropexy including Burch operation (HR 1.30, 95% CI 1.04–1.61). Surgeons with high service volumes tended to have fewer reoperations. No correlations were noted between the reoperation rate with patient age, surgeon age/gender, year of operation and hospital status. However, urologists had higher reoperation rates than gynecologists. For repeat surgery, the majority of patients chose the same specialty but different surgical types. Mid-urethral sling was used most commonly in 48.85% of reoperations. Conclusions Substantial number of patients need reoperation for stress incontinence. The choice of primary surgery type and surgeon specialty may affect the reoperation rates. Mid-urethral sling is the most common reoperation choice. Neurourol. Urodynam. 34:???–???, 2015. © 2014 Wiley Periodicals, Inc.

Objective To evaluate the signalment, clinical signs, treatment, and outcome of dogs with urethral prolapse and identify risk factors associated with prolapse or treatment. Study Design Retrospective case series. Animals Dogs (n = 48) with urethral prolapse. Methods Medical records (May 1995–June 2010) from 2 referral centers were reviewed. Retrieved data included signalment, clinical signs, laboratory findings, treatment, complications, results of long-term follow-up. Records from Veterinary Medical Data Base (VMDB) were evaluated to determine odds ratios. Results Odds ratio for urethral prolapse in English bulldogs compared to all breeds was 366.99 (95% CI: 265.83, 506.65). Of 48 affected dogs, 46 had either resection and anastomosis (43 dogs) or urethropexy (3 dogs). The most common early postoperative complication was hemorrhage (39%); postoperative hemorrhage was less common when a simple continuous pattern was used for resection and anastomosis. Prolapse recurred in 57% of dogs available for long-term follow-up; recurrence was less common in dogs that were administered postoperative butorphanol or acepromazine. Gender was not associated with urethral prolapse or postoperative complications. Conclusions Urethral prolapse occurs most commonly in English bulldogs. Postoperative hemorrhage and prolapse recurrence may be reduced with use of a simple continuous pattern for urethral anastomosis and by administration of postoperative sedation, respectively. Castration status did not appear to affect prolapse development or outcome.

Both LigaSure (LS) and Harmonic Scalpel (HS) are new surgical technologies that have been used to secure hemostasis in various fields of surgery. There is little information in the literature about the use of LS and HS in thyroid surgery. The aim of this study was to report our experience with LS and HS in thyroid surgery. Materials and methods: In this nonrandomized retrospective study 326 consecutive patients who underwent primary thyroid surgery were reviewed. HS was used in 136 patients and LS was used in 126 patients. A conventional technique was used in 64 patients. The were 42 male patients (12.9%) and 284 female patients (87.1%); their ages varied between 19 and 72 years (mean 42.8 ± 12.4). Data regarding each patient's demographics, thyroid pathology, operation time, and complications were collected throughout the study. Results: The 3 study groups had similar demographics (age, female/male ratio) and thyroid pathology. Permanent hypocalcemia developed in 2 (1.6%) patients in the patient group operated on through LS, of which 1 was male and the other was female. In the HS group, postoperative hematoma developed in 2 (1.5%) patients. Conclusion: The results of this retrospective clinical study showed that LS and HS thyroidectomy can be a useful and fast alternative for conventional thyroidectomy. The main advantage of these devices is that they simplify the procedure and eliminate the need for clips and suture ligations while achieving efficient hemostasis.

Video Objective To showcase a new approach to treatment of chronic pelvic pain after transobturator mesh placement. Setting A community based academic institution. Interventions A robotic approach to an excision of transobturator mesh causing chronic pelvic pain and a robotic retropubic urethropexy for stress urinary incontinence. Conclusion Robotic technology can be used in combination to a vaginal approach to explore the obturator space and removed improperly placed mesh in appropriate candidates. While performing this procedure, it is also possible to perform a robotic urethropexy in patients with persistent stress urinary incontinence symptoms.

Objective To report 1) a combined technique of urethropexy and colposuspension; 2) intra- and postoperative complications; and 3) medium term outcome. Study design Retrospective case series. Animals Female dogs (n = 30) with urinary incontinence associated with urethral sphincter mechanism incompetence (USMI) unresponsive to medical management. Methods Through a ventral median celiotomy, the bladder was positioned abdominally to permit the urethra to be anchored with single interrupted polypropylene sutures to the prepubic tendon and linea alba. The vagina was freed from the vesicovaginal and rectovaginal attachments and advanced cranially by traction before attachment to the prepubic tendon with polypropylene mattress sutures. Bitches were re-examined 2 weeks postoperatively; medium term outcome (>6 months) was evaluated by telephone interview of owners. Results At a median follow up of 39.5 months, 21 bitches (70%) were considered to have an “excellent” medium term outcome with complete resolution of their urinary signs; 8 (26.6%) had a “good” outcome, and 3 (10%) had mild transient dysuria postoperatively. Conclusion Combined urethropexy and colposuspension resulted in complete resolution of urinary incontinence in 70% of bitches with USMI and was not associated with major complications.

Objective: To characterize the changing trend and variables of either open or laparoscopic retropubic urethropexy (RPU) in treating female stress urinary incontinence (SUI) in Taiwan. Materials and methods: Using the National Health Insurance Research Database (NHIRD), a total of 8977 female patients with SUI during the period between 1997 and 2007 were identified. The differences in distribution of open and laparoscopic RPU in the context of different years, patient age, surgeon age and gender, and hospital accreditation level and ownership were examined using Chi-square tests. Results: An upward trend of annual RPU was found between 1997 (377 procedures per year) and 2004 (1060), followed by a downward trend between 2004 and 2007 (705). In the meantime, an upward trend of using laparoscopy for SUI was found between 1997 and 2002 (annual percentage change, APC ¼ 24.86, p ¼ 0.001), followed by a downward trend from 2002 to 2007 (APC ¼� 41.88, p ¼ 0.001), which was evidenced by joinpoint regression analysis. In year 2007, only 10 laparoscopic RPU procedures were performed. Patient age, surgeon age, hospital accreditation level, and ownership were shown to have statistically significant associations with the types of RPU chosen (all p values for the Chi-square tests were less than 0.0001). Surgeon gender was not associated with the choices of surgical types (p ¼ 0.85). Conclusion: The vicissitudes of laparoscopic RPU, with an initial increase followed by a decrease around the year of 2002, happened during the past 11 years in Taiwan. The evolution of the surgical methods for SUI may affect the trend of the choices of RPU approaches significantly. The increased and decreased demands on laparoscopic RPU before and after the emergence of tension-free vaginal tape denote the need for more minimally invasive procedures. Nevertheless, the long-term value of novel surgical modalities for SUI is yet to be defined.

Objective To provide general gynaecologists and urogynaecologists with clinical guidelines for the management of recurrent urinary incontinence after pelvic floor surgery. Options Evaluation includes history and physical examination, multichannel urodynamics, and possibly cystourethroscopy. Management includes conservative, pharmacological, and surgical interventions. Outcomes These guidelines provide a comprehensive approach to the complicated issue of recurrent incontinence that is based on the underlying pathophysiological mechanisms. Evidence Published opinions of experts, and evidence from clinical trials where available. Values The quality of the evidence is rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table). Recommendations 1.Thorough evaluation of each patient should be performed to determine the underlying etiology of recurrent urinary incontinence and to guide management (II-3B). 2.Conservative management options should be used as the first line of therapy (III-C). 3.Patients with a hypermobile urethra, without evidence of intrinsic sphincter deficiency, may be managed with a retropubic urethropexy (e.g., Burch procedure) or a sling procedure (e.g., mid-urethral sling, pubovaginal sling) (II-2B). 4.Patients with evidence of intrinsic sphincter deficiency may be managed with a sling procedure (e.g., mid-urethral sling, pubovaginal sling) (II-3B). 5.In cases of surgical treatment of intrinsic sphincter deficiency, retropubic tension-free vaginal tape should be considered rather than transobturator tape (I-B). 6.Patients with significantly decreased urethral mobility may be managed with periurethral bulking injections, a retropubic sling procedure, use of an artificial sphincter, urinary diversion, or chronic catheterization (III-C). 7.Overactive bladder should be treated using medical and/or behavioural therapy (II-2B). 8.Urinary frequency with moderate elevation of post-void residual volume may be managed with conservative measures such as drugs to relax the urethral sphincter, timed toileting, and double voiding. Intermittent self-catheterization may also be used (III-C). 9.Complete inability to void with or without overflow incontinence may be managed by intermittent self-catheterization or urethrolysis (III-C). 10.Fistulae should be managed by an experienced physician (III-C).

Minimally invasive procedures for urinary incontinence and pelvic organ prolapse have gained increasing popularity in the past decade. The advantages of minimal access through laparoscopic and vaginal routes include smaller incisions, shortened hospital stay, decreased analgesia, rapid recovery and rapid return to work. The laparoscopic Burch colposuspension and the tension-free vaginal tape procedure were at the forefront of minimal access antiincontinence procedures. The most recent and significant publications regarding laparoscopic Burch colposuspension and tension-free vaginal tape procedure are highlighted in this article.The laparoscopic Burch is time-consuming and requires a steep learning curve in laparoscopic suturing, thwarting its adoption and staying power. The advantages and success of the retropubic midurethral sling procedures such as tension-free vaginal tape have largely replaced all other antiincontinence procedures and have ignited the development and adoption of transobturator midurethral sling procedures and vaginal 'kit' procedures for pelvic organ prolapse.Clinical trials show that laparoscopic Burch cure rates are equal or inferior to tension-free vaginal tape cure rates. Publications regarding laparoscopic Burch colposuspension have tapered significantly in the past year, which may represent the ebb of its utilization. Tension-free vaginal tape and other midurethral sling procedures may become the new 'gold standard' antiincontinence therapy.

Stamey bladder neck suspension is thought to be an excellent procedure for stress urinary incontinence in selected groups of patients. However we must not ignore the complications of this procedure. We report a case of a patient who developed a delayed reaction with bladder wall erosion to the Dacron buttress used in Stamey urethropexy 19 years before. She was presented with pelvic pain and persisting irritative bladder symptoms. The treatment of choice was cystoscopic removal of suture and buttress. Tissue intolerance is a common problem with the use of different kinds of biomaterials in incontinence surgery. Careful cystourethroscopy is essential for early diagnosis and treatment if pain, infections and severe irritative symptoms occur postoperatively.

Aims: To evaluate the differences in urodynamic study (UDS) and the perineal ultrasonography parameters between stress urinary incontinence (SUI) patients with or without urethrovesical junction (UVJ) hypermobility. Treatment outcomes following a retropubic urethropexy were also compared. Methods: The records of 164 SUI patients (≤stage II), treated with retropubic urethropexy at our department between January 2001 and February 2004 were reviewed. The patients were categorized into a hypermobility group when the measured Q-tip angle was ≥30, and a non-hypermobility group when

Objective More than 20,000 women, aged 70 years or older, undergo surgery for stress urinary incontinence each year. Our objective was to review the published randomized trials of the surgical treatment of stress urinary incontinence and estimate the proportion of women 70 years or older enrolled in those trials. Data sources MEDLINE and Cochrane Databases of Clinical Trials were searched from January 1966 through December 2003 with the terms "urinary incontinence," "stress incontinence," "urethropexy," "needle suspension," "pubovaginal sling," "tension-free vaginal tape," "urethral injection," "collagen injection," "anterior colporrhaphy," and "clinical trial," "controlled trial," or "randomized trial" as both subject headings and words contained in article titles. We supplemented this search with manual searches of meta-analyses and review articles from 2000 to 2003. Methods of study selection All studies that included at least one group undergoing an invasive treatment for stress incontinence (including urethral bulking injections) were reviewed. We excluded reports without sufficient data to estimate the number of women aged 70 and older who participated, those published only in abstract form, and those studies in languages other than English, French, German, Italian, or Spanish. Twenty studies met our inclusion criteria. Tabulation, integration, and results The number of women aged 70 or older in each study was estimated using the demographic data provided. The median percentage of subjects aged 70 or older was 3.8% (interquartile range 0.37-15%). There was no significant difference in the proportion of subjects 70 years of age or older based on the year of publication. Conclusion Our review of the published literature suggests that elderly women are underrepresented in clinical trials of stress incontinence surgery. Efforts should be made to include more elderly women in clinical trials of stress incontinence surgery.

Laparoscopic colposuspension (LC) was first described in the early 1990s as a technique distinct from open Burch colposuspension. Subsequently, however, LC was closely modelled along the lines of the Burch technique, and the distinct features of the original urethropexy (UP) were largely disregarded. In this case-control series the authors aimed to compare symptoms and anatomical outcomes after standard LC and urethropexy +/- paravaginal repair. The design was a clinical retrospective case-control trial. The setting was the urogynaecology and endogynaecology services of tertiary hospitals. Fifty patients after LC and 50 women after UP surgery, matched for age, body mass index, previous surgery, pre-existing urge incontinence and length of follow-up (1.01 year, range 0.02-3.54 years) for LC and 0.98 years (range 0.06-3.55 years) for UP). Intervention consisted of standardised interview and translabial ultrasound imaging. There were no significant differences for subjective cure of stress incontinence (80% for UP vs. 74% for LC), postoperative urge incontinence, frequency and nocturia. Significantly more UP patients complained of voiding dysfunction (p=0.01). Significant differences were found for urethral rotation, position of the bladder neck on Valsalva and bladder neck descent on Valsalva (all p0.001). Both procedures were shown to be effective in curing stress incontinence. The incidence of bladder symptoms was comparable, with the exception of voiding difficulty. Significant differences were observed regarding anatomical appearances, with urethropexies showing more recurrent bladder neck hypermobility and cystocele.

A case-control study was performed in two departments performing tension-free urethropexy for the treatment of stress urinary incontinence. During a period of 4.5 years, 127 cases of tension-free vaginal tape operations (TVT) and 42 cases of intravaginal slingplasty (IVS) were performed. In the TVT group one case of urethral erosion was observed, but in the IVS group six cases of defective healing, erosion or extrusion were observed. It is considered that the complications might be due to the multifilamentous nature of the IVS tape in contrast to the monofilamentous nature of the TVT tape.

The goal of this study was to determine the efficacy of retropubic urethrolysis without resuspension for the surgical treatment of postoperative urinary retention.A retrospective chart review was done of six women with posturethropexy urinary retention or voiding dysfunction who underwent retropubic urethrolysis between July 1999 and June 2000.An average of 27.0 (+/- 19.6) months elapsed between obstructive incontinence procedure and urethrolysis. The mean maximum detrusor pressure during voiding was elevated at 52.7 (+/- 31.7) cm H2O. The mean maximum flow rate during voiding was decreased at 16.3 (+/- 10.8) cm H2O. The average postvoid residual volume was 152.9 +/- 71.6 mL, significantly decreased postoperatively to 36.9 +/- 40.0 mL (t = 3.37, p = 0.043). Postoperative cystourethroscopy showed a completely free and mobile urethra. In the short-term, all patients had resolution of their symptoms. No patient had return of stress incontinence in a mean clinical follow-up of 3.3 +/- 2.3 months.Our results are comparable to other series of urethrolyses, despite omission of resuspension. Retropubic urethrolysis offers favorable relief of persistent postoperative urinary retention and voiding dysfunction, particularly after retropubic urethropexy.

The aim of this study was to compare the long-term results of a modified Burch procedure with a sling procedure for the treatment of stress incontinence with a low-pressure urethra. Thirty-six women with urodynamic stress incontinence, low-pressure urethra, urethral hypermobility and no significant pelvic organ prolapse were randomly assigned to undergo either a modified Burch procedure ( n=19) or a sling placement ( n=17). Cure of the stress incontinence (defined as a negative stress test and negative pad-weight test) was the primary long-term endpoint. Secondary endpoints included subjective cure of stress incontinence (defined as no incontinence episodes on a 1-week voiding diary) and voiding function studies. Comparisons of group means were performed with the Mann-Whitney U-test, pooled variance t-tests and separate variance t-tests. Proportions were compared with Fisher's exact test. A logistic regression analysis was performed to control for covariates that differed in our two groups despite randomization. Long-term follow-up (mean=72.6 months) was available for 82% (28/34) of the original study group. The objective cure rates for the Burch and sling groups were 84.6% and 100%, respectively ( P=0.17). Mean uroflowmetry rates for the Burch and sling groups were 7.38 and 6.8 ml/s, respectively ( P=0.58, 95%CI -2.5, 4.4). Mean postvoid residual volumes for both groups were 35 ml ( P=0.97, 95% CI -23.8, 65.9). Two sling patients (12%) required partial resection of their slings because of erosion. Both patients remained continent. In terms of voiding function and stress incontinence cure, there were no differences between groups undergoing modified Burch or sling procedures for treatment of urodynamic stress incontinence with low-pressure urethra.

Objective : To describe the results after colpourethropexy with a REMEEX prosthesis in the treatment of stress urinary incontinence with associated genital prolapse. Materials and methods : A prospective analysis of all patients treated in our Urogynaecology Unit between November 2000 and March 2001. Results : There were 29 patients with mean age of 62 and mean body mass index of 28. All but one patients had stress incontinence (genuine or mixed) associated with a genital prolapse. The other patient was a failed past technique (Marshall–Burch). Cystometry was performed in 80% of the patients. Of these 93% had genuine stress incontinence and 7% mixed incontinence. The average operating time was 119min (CI: 60–310), and the mean hospital stay 5 days (CI: 3–13). There was one case of severe haemorrhage during surgery, four cases of wall seroma and one postoperative urinary infection. Concerning patient satisfaction, 90% of our patients felt they were cured, 8% were much better and 2% had a slight improvement. No patient had a worsening of symptoms after surgery. Conclusion : We propose colpourethropexy by suburethral sling with a REMEEX prosthesis as suitable treatment for stress incontinence with associated genital prolapse.

SummaryThe development of a new operation for certain types of urinary incontinence has been described. A preoperative test, consisting essentially of temporary elevation and fLxation of the vesical neck and urethra, has permitted the selection of those candidates who have an excellent chance for improvement by the operation, and which at the same time seems to indicate those whose postoperative result will not be good. The operation is a simple elevation and immobilization of the vesical neck and urethra by suturing them to the pubis and rectus muscles. Of 44 suitable cases excellent results were obtained in 36 (82%), significant improvement in 3 (7%), and no improvement in 5 (11%). The causes of most of the failures seem evident and are discussed. The most significant group reported consisted of 25 patients with the common variety of female stress incontinence which had failed to be corrected by one or more standard gynecological procedures for incontinence. Of these 25 patients, 19 have normal control ...

Urethral prolapse is an uncommon condition affecting young male dogs, most commonly English bulldogs. Current described techniques for surgical treatment of urethral prolapse involve manual reduction of prolapsed mucosa and placement of a temporary purse-string suture at the penile tip, or resection of the prolapsed tissue and apposition of urethral and penile mucosa. The incidence of recurrence of urethral prolapse following resection of the prolapse is not known. This report describes a technique for surgical treatment of urethral prolapse in the male dog that minimizes surgical and anesthetic time, is simple to perform, requires minimal equipment, is effective, and is not associated with significant complications or recurrence. Three cases are described.

The purpose of our study was to describe the surgical trends for female stress urinary incontinence (SUI) during 2006–2010, and a time-frame comparison with 1997–2005, based upon the National Health Insurance (NHI) claims data in Taiwan. Women who underwent various primary surgeries for SUI during 2006–2010 were identified, with a total of 15,099 inpatients. The variables included surgical types, patient age, surgeon age and gender, specialty, and hospital accreditation levels. Chi-squared tests and SAS version 9.3.1 were used for statistical analysis. During the follow-up study, midurethral sling (MUS) application increased significantly from 53.09 % in 2006 to 78.74 % in 2010. It was associated concomitantly with a decrease in retropubic urethropexy (RPU) from 29.68 % to 12.99 %, and pubovaginal sling treatment (PVS) from 9.33 % to 3.46 %. MUS was most commonly used among all patients’ and surgeons’ age groups, and different accreditation hospital levels. MUS was more commonly used by gynecologists (71.38 %) than urologists (57.91 %); while PVS and periurethral injection were more commonly performed by urologists than gynecologists. Similar surgical trends were found during time-frame comparison, 2006–2010 vs 1997–2005. SUI surgeries increased in patients aged ≥60, surgeons aged ≥ 50, and in regional hospitals. This follow-up study depicts the increase in popularity of MUS and offers evidence of surgical trends and a paradigm shift for female SUI surgery. More older women were willing to seek healthcare and undergo surgery. The surgical skills and knowledge spread from medical centers into regional hospitals. The time-frame shift may have a profound impact on patients, as well as the healthcare providers.

Laparoscopic urethropexy was introduced in the early 1990s, and the first robot-assisted sacral colpopexy was reported in 2004. Over the past 10–15 years, laparoscopic and robot-assisted laparoscopic techniques have been applied to many prolapse and incontinence procedures. After the United States Food and Drug Administration approved its use in gynecologic surgery in 2005, the da Vinci Surgical System (Intuitive Surgical, Inc.; Sunnyvale, CA) gave gynecologic surgeons another minimally invasive option for surgeries that had been previously performed by laparotomy, vaginally, or by the traditional laparoscopic technique.

OBJECTIVE: To describe trends in the management of prolonged voiding dysfunction and urinary retention after anti-incontinence procedures. METHODS: Physician members of the American Urogynecologic Society were queried by means of a two-page questionnaire regarding the management of prolonged voiding dysfunction and urinary retention after anti-incontinence procedures. RESULTS: A total of 344 (42%) of 825 questionnaires were completed and returned. Of the 344 respondents, 61% identified themselves as urogynecologists, 50% worked in a university-affiliated practice, and 26% had been in practice for 11–20 years. Respondents rarely encountered prolonged urinary retention after anti-incontinence procedures. Among the respondents, 30% allowed 3–6 months for resumption of spontaneous voiding before performing surgical revision, and 90% performed multichannel urodynamic studies before surgical revision. However, 66% performed surgical revision transabdominally when urinary retention occurred after retropubic urethropexy, and 61–81% of respondents performed surgical revision transvaginally when urinary retention followed needle suspension, pubovaginal sling, or tension-free vaginal tape procedures. A total of 90–96% did not perform an anti-incontinence procedure concomitantly with surgical revision. The majority of respondents reported spontaneous voiding in greater than 80% of patients, and recurrent stress urinary incontinence in less than 10% of patients after surgical revision. CONCLUSION: Although certain trends in the management of prolonged urinary retention after anti-incontinence procedures were identified, there was no clear consensus on the method of surgical revision used, nor the management of recurrent stress urinary incontinence after surgical revision. Randomized clinical trials are required to determine the optimal management of prolonged urinary retention after anti-incontinence procedures.

Objective: The purpose of this study was to evaluate the independent effect of suburethral sling placement on the risk of cystocele recurrence after pelvic reconstructive operation. Study Design: One hundred forty-eight women with cystoceles to or beyond the hymenal ring underwent pelvic reconstructive operation, with or without incontinence procedures, and were evaluated at 12 and 52 weeks after operation with a standardized pelvic examination. Rates of recurrent prolapse, at all sites, were statistically compared between subjects with and without suburethral slings. A multiple regression analysis was used to determine the independent effect of sling placement on the risk of recurrent cystoceles. Results: Suburethral sling placement was associated with a 54.8% reduction in the mean rate of postoperative cystocele recurrence ( P =.004). This protective effect was observed as early as 12 weeks and remained significant at 1-year follow up (42% vs 19%). A markedly reduced risk of cystocele recurrence was observed when women with sling procedures were compared with all other women, with those women who underwent other incontinence operations, and even with those women who had undergone prolapse repair with no incontinence procedure. The protective effect of the sling procedure remained highly significant (odds ratio, 0.29; P =.0003), even after controlling for potentially confounding variables in a multiple logistic regression model. Conclusion: Suburethral sling procedures appear to significantly reduce the risk of cystocele recurrence after pelvic reconstructive operation, in contrast with the effect of retropubic urethropexy and needle suspensions. These findings should be considered when the surgical treatment of stress incontinence that accompanies pelvic organ prolapse is being planned. (Am J Obstet Gynecol 2001;185:1307–13.)