A prospective randomized study of TOT and TVT procedure for female intrinsic sphincter deficiency(ISD) / 中华泌尿外科杂志

Objective To compare the outcomes of TOT and TVT procedure treating female intrinsic sphincter deficiency (ISD).Methods From May 2010 to September 2015,42 stress urinary incontinence (SUI) patients whose abdominal leak point pressure was less than 60 cmH2O were enrolled in this study.Thirty-five patients were followed up.The mean age was (56.8 ±10.5) years,with a range of 30-80 years.The mean history was(10.5 ± 9.1)years,with a range of 4 months to 30 years,with 26 (74.3％) of them being postmenopausal,5 (14.3％) having a history of pelvic surgery,and no pelvic organ prolapsed or hormone replacement.All of them were randomly divided into 2 groups to undergo either TVT operation (13 cases) or TOT operation (22 cases).The baseline characteristics of the two groups including age,length of history,urodynamic parameters and scale scores showed no significant difference.The scales including urinary incontinence severity score (UISS),detrusor instability score (DIS),Quality of Life Scale Evaluation (I-QOL),lower urinary tract symptoms affect score (UDI-6) were used.The outcomes between TVT group and TOT group were compared.Result After procedure,patients in TVT group got a lower UISS score than TOT group(17.2 ± 2.2 vs.17.7 ± 3.1),and their severity of urinary incontinence improved significantly (P ＜ 0.05).Patients from TVT group got a lower DIS score than TOT group (12.6 ± 4.2 vs.14.2 ± 3.5),and their detrusor instability symptoms improved more significantly (P ＜ 0.05).Patients from TVT group got a higher I-QOL score than TOT group(17.5 ± 14.5 vs.16.1 ± 13.0),and their quality of life improved more significantly (P ＜ 0.05).Patients from TVT group got a lower UDI-6 score than TOT group (10.1 ± 3.0 vs.11.2 ± 3.4),and their lower urinary tract symptoms improved more significantly (P ＜ 0.05).Conclusion Urinary incontinence of female ISD patients were improved greater by TVT than TOT procedure.

Long-term Outcome of the Readjustable Sling Procedure for Female Stress Urinary Incontinence With Intrinsic Sphincter Deficiency or Recurrence

PURPOSE: We evaluated the long-term outcome of a readjustable midurethral sling system (Remeex) in the treatment of recurrence of stress urinary incontinence (SUI) after surgical treatment or SUI with intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS: This study included 19 patients who underwent the Remeex procedure with a mean of 45.6 months of follow-up. The patients had responded to a telephone questionnaire. Thirteen patients had ISD, four patients had SUI recurrence, and two patients had both. The questionnaire included subjective cure and satisfaction surveys and also recommended surgery to some patients. RESULTS: The mean patient age was 69.1 years (range, 50-85 years), the mean parity was 2.79 times (range, 2-5 times), and the mean follow-up period was 45.6 months (range, 21-72 months). The long-term follow-up cure rate was 79%, the improvement rate was 21%, and the fail rate was 0%. The long-term follow-up "very satisfactory" rate was 26.3%, the "satisfactory" rate was 73.7%, and the "usual" and "unsatisfactory" rates were both 0%. In addition to these results, 16 patients (84.2%) would recommend the Remeex procedure to other patients with SUI recurrence or ISD. After the procedure, four patients had urinary retention, three patients had difficulty emptying, and one patient had SUI recurrence. Furthermore, all of the patients subsequently endured sling readjustments. CONCLUSIONS: After long-term follow-up, the Remeex system showed good cure rates and subjective satisfaction rates that were similar to the results found at the 1-year follow-up, and minimal complications were reported. Therefore, the Remeex system is effective in treating patients with SUI recurrence or ISD.

Human Umbilical Cord Blood Mononuclear Cell Transplantation in Rats with Intrinsic Sphincter Deficiency

To evaluate the effectiveness of the human umbilical cord blood (HUCB) transplantation for the treatment of intrinsic sphincter deficiency (ISD), we analyzed the short term effects of HUCB mononuclear cell transplantation in rats with induced-ISD. ISD was induced in rats by electro-cauterization of periurethral soft tissue with HUCB mononuclear cell injection after 1 week. The sphincter function measured by mean leak point pressure was significantly improved in the experimental group compared to the control group at 4 weeks. (91.75+/-18.99 mmHg vs. 65.02+/-22.09 mmHg, P=0.001). Histologically, the sphincter muscle was restored without damage while in the control group it appeared markedly disrupted with atrophic muscle layers and collagen deposit. We identified injected HUCB cells in the tissue sections by Di-I signal and Prussian blue staining. HUCB mononuclear cell injection significantly improved urethral sphincter function, suggesting its potential efficacy in the treatment of ISD.

Human Cord Blood Stem Cell Therapy for Treatment of Stress Urinary Incontinence

Our objective in this study was to evaluate the safety and efficacy of transurethral cord blood stem cell injection for treatment of stress urinary incontinence in women. Between July 2005 and July 2006, 39 women underwent transurethral umbilical cord blood stem cell injection performed by one operator at a single hospital. All patients had stress urinary incontinence. The patients were evaluated 1, 3, and 12 months postoperatively. No postoperative complications were observed. 28 patients (77.8%) were more than 50% satisfied according to the Patient's Satisfaction results after 1 month, 29 patients (83%) were more than 50% satisfied according to the Patient's Satisfaction results after 3 months, and 26 (72.2%) continuously showed more than 50% improvement after 12 months. Intrinsic sphincter deficiency and mixed stress incontinency improved in the ten patients evaluated by urodynamic study. Our results suggest that transurethral umbilical cord blood stem cell injection is an effective treatment for women with all types of stress urinary incontinence.

Comparison of symptoms and characteristics in patients with urethral hypermobility and intrinsic sphincter deficiency (ISD) in female stress urinary incontinence / 대한산부인과학회지

OBJECTIVE: To evaluate how patients in the four diagnosis groups differ in their symptoms and other characteristic levels in female stress urinary incontinence METHOD: A retrospective chart review of 240 patients with stress urinary incontinence was performed. Patients were categorized as intrinsic sphincter deficiency (ISD) or stress urinary incontinence (SUI). Within these groups, patients with hypermobility were separated from those without hypermobility. And then just patients with hypermobility were compared. Information on several types of symptoms and characteristics were captured for all patients. RESULTS: There are nothing to do with among 4 each groups and 6 symptoms (frequency, urgency, postvoid dribbling, voiding difficulty, hematuria, recurrent infection) in stress urinary incontinence. Only in diabetic status and antiincontinence surgery did the diagnosis groups differ statistically. In diabetes, patient in the ISD without hypermobility tended to have a higher prevalence of diabetes than the other 3 groups (p=0.007). Patients in the ISD with hypermobility group were more likely to have antiincontinence surgery than thosein the SUI with hypermobility group (p=0.046). No other statistical comparisons were significant at the 0.05 level, although there is some evidence that patients in the ISD with hypermobility group were more likely to have a previous hysterectomy than those in the SUI with hypermobility group (p=0.072). Patients in the ISD without hypermobility group had the largest mean and median age among the four groups, and a statistically significant difference in age was detected across all groups (p<0.001). More specifically, the ISD without hypermobility group was significantly older than the SUI with hypermobility group. CONCLUSION: There was no statistically significant among 4 each group according to each 6 symptom in stress urinary incontinence. Of the variables, diabetes, antiincontinence surgery history, hormonal use, parity and age tended to have a statistically significant difference.

Treatment outcome of tension-free vaginal tape in stress urinary incontinence: Comparison of intrinsic sphincter deficiency and non-intrinsic sphincter deficiency patients / 대한산부인과학회지

OBJECTIVE: The object of this study is to compare treatment outcomes of tension free vaginal tape (TVT) for intrinsic sphincter deficiency (ISD) and non-intrinsic sphincter deficiency (NISD) patients in stress urinary incontinence (SUI), and to evaluate whether TVT can be effectively used in both groups of SUI patients. METHODS: 111 women with SUI treated by TVT at the Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, the Yonsei Medical Center from Jun. 2003 to Jun. 2005 were included in this study. The patients were divided into two groups; 31 patients with ISD, and 80 patients with NISD. SUI was diagnosed according to the result of urodynamic tests. Urodynamic studies (UDS) include uroflowmetry, multi-channel cystometry and urethral pressure profilometry. The Patients were followed up at 1, 3, 6, and 12 months postoperatively, and those with any follow-up loss were excluded from this study. RESULTS: There were no significant differences found in demographics between ISD and NISD groups; mean age, parity, BMI, menopausal status and HRT (P>0.05). Maximum urethral closure pressure (MUCP)(46.8124.29 vs.75.7+/-32.61 cmH2O; P<.0001) and Vasalva leak-point pressure (VLPP)(53.48+/-10.12 vs 107.23+/-42.95 cmH2O; P<0.0001) showed significant difference between the two groups. However, other parameters of UDS except MUCP and VLPP showed no statistical difference. The cure rates of the two groups at 1 month follow up (87.0% vs 100%; p=0.0053) showed significant difference. No significant differences were found at 3, 6 and 12 months. There were no differences in postoperative complication rate (voiding difficulty, de novo urgency, urinary tract infection) between two groups irrespective of follow-up months. CONCLUSION: Tension-free vaginal tape is effective for stress urinary incontinence in both ISD and NISD patients.

Factors Predicting Intrinsic Sphincter Deficiency in Female Stress Urinary Incontinence

PURPOSE: This study was conducted to investigate whether predictive factors are associated with stress urinary incontinence due to intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS: We reviewed retrospectively the records of 254 women with the diagnosis of genuine stress incontinence. All women had undergone a detailed history by questionnaire and interview, physical examination and multi-channel urodynamic study, including the determination of VLPP. The patients were classified into three groups according to VLPP regardless of the presence of hypermobility; 1) ISD: VLPP90cmH2O. The ISD group was compared with the AI group using 15 clinical factors. Univariate (t-test, chi-square test) and multivariate (logistic regression test) analyses were performed to determine which clinical factors were associated with ISD. RESULTS: The mean patient age was 51 years (range 25 to 77). Eighty-two women (32%) were in the ISD group and 98 (38%) in the AI group. The results of univariate and multivariate analyses found that women with ISD had a higher symptom grade than women with AI (p=0.001 and 0.0001, respectively). The number of patients in the ISD and AI group in accordance with the symptom grade were 11 (15%) and 61 (85%) in grade I, 53 (62%) and 33 (38%) in grade II, and 18 (82 %) and 4 (18%) in grade III respectively. There was no correlation between VLPP and other clinical factors. CONCLUSIONS: The only clinical factor that predicted the presence of ISD, as defined by VLPP of 60cmH2O or less, was the symptom grade. Higher grades of stress urinary incontinence have a higher possibility of ISD. One should consider this factor when evaluating patients, especially in the equivocal group.

Implantable Microballoons: An Alternative in the Treatment of Stress Urinary Incontinence Associated with Intrinsic Sphincter Deficiency / 대한비뇨기과학회지

PURPOSE: All current bulking agents employed for treating intrinsic sphincter deficiency (ISD) have some limitations due to various side effects, technical difficulties and inadequate long-term results. Self-detachable balloon system (SDBS) was tested as a new therapeutic modality for female urinary incontinence. MATERIALS AND METHODS: SDBS which consists of the self-detachable cross-linked silicone balloon, biocompatible filler material and a delivery system was implanted. Fourteen famale patients with ISD were included in the prospective trials. Two to five balloons were implanted per patient. Patients were followed up with incontinence questionnaire, pad tests and determination of Valsalva leak point pressure (VLPP) at 1, 3, 6, 12 and 18 months. RESULTS: The biocompatibility of the microballoons was excellent. With a mean follow-up of 10.1 months, 28.9% (4/14) of the patients were completely dry. 21.1% (3/14) of the patients showed socially dry and 3 patients (21.1%) showed improvement. 28.9% (4/14) of patients were deteriorated during follow-up. Three patients had spontaneous delivery of SDBS. The pad test improved from a preoperative mean of 102.1g to a postoperative mean of 22.4g. The VLPP increased from a preoperative mean of 49.7cmH2O to a postoperative mean 89.8cmH2O. CONCLUSIONS: The implantation of microballoons is a safe, well-tolerated, minimally invasive and clinically effective modality for the treatment of ISD.

Results of Anterior Vaginal Wall Sling Operation for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: To review the short-term result of Raz`s anterior vaginal wall sling as a treatment for intrinsic sphincter deficiency(ISD) and urethral hypermobility. MATERIALS AND METHODS: Twenty-three women who had intrinsic sphincter deficiency and urethral hypermobility were treated by AVL which employed an island of in situ anterior vaginal wall as a sling to support the bladder neck and mid-urethra. RESULTS: After a mean follow-up of 4.7(3-6)months, urinary incontinence was disappeared completely after the AVL. Complications included urinary retention in 6 patients, residual urine sensation in 5 patients which improved after intermittent catheterization. The other complication was low abdominal pain in 5 patients. CONCLUSIONS: It is suggested that AVL was effective treatment of ISD and urethral hypermobility with simple technique, low morbidity and high cure rate.

Gortex Patch Sling Operation for Patient with Intrinsic Sphincter Deficiency / 대한비뇨기과학회지

PURPOSE: We evaluated the early outcomes of Gortex patch sling operation in the management of women with intrinsic sphincter deficiency(ISD). MATERIALS AND METHODS: 20 women underwent Gortex patch sling operation to treat genuine stress urinary incontinence and all patients had ISD. Patients were interviewed by telephone for incontinence, self-catheterization, and voiding symptoms at a mean of 16.6 months(range 6-35) after surgery. RESULTS: The mean age of the patients was 54.2 years and mean parity was 2. Mean operation time was 55 minutes(range 45-90) and mean duration of postoperative catheterization was 7.0 days(range 5-12). Success rate(complete dry) was 90% and de novo urge incontinence occurred in 3(15%). CONCLUSIONS: Gortex patch sling operation is a safe, simple and effective procedure for the treatment of stress incontinence due to ISD. However, further follow-up of longterm results is needed.

Clinical Usefulness of Valsalva Leak Point Pressure as a Diagnostic Tool in Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The valsalva leak Point pressure(VLPP) has been suggested as an objective tool for diagosing female stress urinary incontinence(SUI) accompained by intrinsic sphictor deficiency(ISD) Our aims were to determine the predictive value of VLPP in patients with ISD and correlation between VLPP and other parameters as a diagnostic tool for ISD. MATERIAL AND METHODS: Sixty-seven patients with stress urinary incontinence were evaluated propectively with symptom grade(Stamey grade). Q-tip test, 1hr pad test, and VLPP. Correlations of VLPP and these clinical parameters were computed. VLPP of 60cm H2O was determined as a cut-off value of ISD and compared with other parameters(symptom grade, hypermobility). RESULTS: Of the total 67 patients, SUI was grade lin 20(29.8%) ll in 32(47.8%) and lllin 15(22.4%). Of the 67 patients, 48 had VLPP of more than 60cmH2O. Among these, SUI was grade l in 20(100%), ll in 26(81.3%) and lllin 2(13.3%). There were significant differences in the incidence between grade llland grade l or ll (P<0.01). Of the 19 patients with VLPP of 60cmH2O or less, SUI grade lllin 77 in 13(86.7%); where SUI was grade lin 0(0%) and ll in 6(18.7%) with statistical significance between grade llland grade l or ll. Urethral hypermobility was noted in 56(83.6%); this was l in 20(100%), ll in 26(81.8%) and lllin 10(67%). Among the SUI patients without hypermobility, none had symptoms of grade l: whereas 33.3% of grade lllpatients didn't show hypermobility. There appeared significant correlation(p<0.001) between the VLPP and symptom grade(correlation coefficient=0.68). Moderate correlations were present between either symptom grade or VLPP and amount of urine leakage(correlation coefficient=0.5). No statistically significant relationship existed between either VLPP or symptom grade and urethral hypermobility. CONCLUSION: subjective degree(such as symptom severity or amount of urine loss) of stress incontinence seems useful in predicting the likelihood of low valsalva leak point pressure which suggests intrinsic sphinctor deficiency. By the result that some women of grade ll incontinence with urethral hypermobility exhibited low VLPP, measurement of VLPP could be a valuable tool in choosing the treatment modality of stress urinary incontinence.

Collagen Injection Therapy in Urinary Incontinence with ISD (Intrinsic Sphincter Deficiency) / 대한비뇨기과학회지

Bovine collagen (Contigen(R), Bard Inc.) injection has been used for treating urinary incontinence caused by intrinsic sphincter deficiency (ISD) with relatively high success rate and fewer complication. Retrospective analysis was made for 11 urinary incontinent patients who have undergone collagen injection. Of the total, stress urinary incontinence (SUI) associated with ISD were noted in six, myelodysplasia in one, short bladder neck in one, cauda equina syndrome in one and, two with pelvic bone fracture. Average duration of symptoms was 10.8 years. Four patients had history of failed surgery to correct incontinence (two with Raz operations and two with plication of bladder neck). Transurethral injections of 4~12 ml of collagen were made at 4 and 8 o'clock position of the bladder neck with the bevelled portion of needle facing the urethral lumen. After the first injection, cure and improvement of incontinence were noted in 3 (SUI) and 6 (3 with SUI, 1 with short bladder neck, 1 with myelodysplasia and 1 with pelvic bone fracture) respectively. After the repeated injection for 3 patients who had improved after first injection, all became dry. At 13 months of follow-up, total success rate was 82% (5 with cure and S with improvement of the incontinence). Two patients who showed failure were all males with periurethral scar formation. Collagen injection seemed an effective therapeutic method in female SUI with ISD or myelodysplasia provided repeated injection is to be made However, it was suggested that the male patients or one with extensive scar formation were not good candidate for injection therapy.