Supplementing pelvic floor muscle training with attention training can more effectively relieve women′s stress urinary incontinence / 中华物理医学与康复杂志

Objective:To explore any effect of pelvic floor muscle training and/or attention training on pelvic floor function and women′s symptoms of stress urinary incontinence (SUI).Methods:Fifty incontinent women were divided into a control group ( n=25) and an experimental group ( n=25). Both groups received conventional pelvic muscle rehabilitation training, but the experimental group was additionally provided with attention training for 6 weeks. Before and after the 6 weeks of treatment, both groups were evaluated using surface electromyography of the pelvic floor. The short form of the International Urinary Incontinence Advisory Committee′s urinary incontinence questionnaire (ICIQ -SF) was used to assess the severity of incontinence and quality of life (I-QOL). Results:Before the treatment there was no significant difference between the 2 group′s pelvic floor myographs, nor in their average ICIQ-SF and I-QOL scores. After the treatment, however, compared with the control group, significant improvement was observed in experimental group′s peak amplitude during rapid contraction, average EMG in tonic contraction and endurance contraction. Their average ICIQ-SF and I-QOL scores were also better.Conclusion:Supplementing pelvic floor muscle training with attention training can effectively improve the urinary continence and the life quality of women with stress urinary incontinence.

Artificial urinary sphincter surgery in the special populations: neurological, revision, concurrent penile prosthesis and female stress urinary incontinence groups / 亚洲男科学杂志(英文版)

The artificial urinary sphincter (AUS) remains the standard of care in men with severe stress urinary incontinence (SUI) following prostate surgery and radiation. While the current AUS provides an effective, safe, and durable treatment option, it is not without its limitations and complications, especially with regard to its utility in some "high-risk" populations. This article provides a critical review of relevant publications pertaining to AUS surgery in specific high-risk groups such as men with spinal cord injury, revision cases, concurrent penile prosthesis implant, and female SUI. The discussion of each category includes a brief review of surgical challenge and a practical action-based set of recommendations. Our increased understandings of the pathophysiology of various SUI cases coupled with effective therapeutic strategies to enhance AUS surgery continue to improve clinical outcomes of many patients with SUI.

Artificial urinary sphincter surgery in the special populations: Neurological, revision, concurrent penile prosthesis and female stress urinary incontinence groups / 亚洲男科学杂志(英文版)

The artificial urinary sphincter (AUS) remains the standard of care in men with severe stress urinary incontinence (SUI) following prostate surgery and radiation. While the current AUS provides an effective, safe, and durable treatment option, it is not without its limitations and complications, especially with regard to its utility in some 'high-risk' populations. This article provides a critical review of relevant publications pertaining to AUS surgery in specific high-risk groups such as men with spinal cord injury, revision cases, concurrent penile prosthesis implant, and female SUI. The discussion of each category includes a brief review of surgical challenge and a practical action-based set of recommendations. Our increased understandings of the pathophysiology of various SUI cases coupled with effective therapeutic strategies to enhance AUS surgery continue to improve clinical outcomes of many patients with SUI.

The role of trans obturator tape as a surgical procedure for female stress urinary incontinence and its impact on quality of life in Jammu region

Background: Stress incontinence is one of the most common but debilitating health issue among women. It has a detrimental effect on overall health and quality of life of women. Trans obturator tape (TOT) has emerged as a promising treatment modality. The aim of present study was to assess the usefulness of TOT in terms of change in quality of life of stress incontinence patients.Methods: The study was performed at Department of Obstetrics and Gynecology, Acharya Shri Chandler of Medical Sciences (ASCOMS), Jammu. A total of 50 symptomatic women were enrolled in the study and underwent TOT procedure using outside-in technique. The quality of life of women was assessed at enrolment and 12 months after the procedure using King’s Health Questionnaire (KHQ). Change in QOL was assessed using paired ‘t’-test.Results: After 12 months follow-up, a total of 27 (54%) patients were entirely symptom free. As compared to pre-treatment QOL assessment on KHQ for general health/incontinence impact, quality of life and symptom scores a % decline of 73.2%, 79.8% and 78.4% was observed. For all the three parts, the change in scores was significant statistically. No other complications and side effects were reported.Conclusions: TOT is a useful procedure which provided symptomatic relief as well as QOL enhancement.

Modified transobturator tape for female stress urinary incontinence / 中华泌尿外科杂志

Objective To explore the efficacy and safety of modified transobturator tape (TOT) for female stress urinary incontinence (SUI).Methods From June 2015 to June 2017,a total of 87 SUI patients,including 35 patients underwent standard TOT operation (standard TOT group) and 52 patients underwent modified TOT operation (modified TOT group),were retrospectively reviewed.There was no statistical difference of age [(59.7 ± 10.3) yea~ vs.(56.3 ± 9.1) years],BMI [(24.I ± 9.7) kg/m2 vs.(24.6 ± 9.3) kg/m2],diabetes history [31.4％ (11/35) vs.26.9％ (14/52)],mixed urinary incontinence [45.7％ (16/35) vs.48.1％ (25/52)] and the daily amount of urine pad [(4.3 ±2.7) vs.(3.9 ± 2.1)] between the two groups (P ＞ 0.05).The operative time,intraoperative complications,and postoperative complications were collecteded in two groups.Patients were followed up at 3 months,6 months,and 1 year after surgery.Results There was no significant difference in operation time [(21.1 ± 4.3) min vs.(20.5 ± 5.7) min],intraoperative hemorrhage [(18.3 ± 9.1) ml vs.(25.7 ± 8.3) ml] and postoperative incidence of urinary retention [2.9％ (1/35) vs.3.8％ (2/52)] between the two groups (P ＞ 0.05).The incidence of postoperative leg pain was significantly lower in modified TOT group than in TOT group[1.9％ (1/52) vs.20.0％ (7/35),P ＜ 0.05].There was no significant difference in subjective cure rate and objective cure rate between the two groups at 3 months,6 months and 1 year after surgery (P ＞ 0.05).Conclusions Compared with the standard TOT,the modified TOT of modified puncture port has a similar cure rate and efficiency.However,the use of modified TOT can significantly reduce the incidence of postoperative short-term leg pain,but the long-term efficacy still needs to be further followed-up.

Pelvic floor muscle training protocol for stress urinary incontinence in women: A systematic review / Protocolo de treino dos músculos do pavimento pélvico em mulheres com incontinência urinária de esforço: revisão sistemática

Summary Introduction: Strengthening exercises for pelvic floor muscles (SEPFM) are considered the first approach in the treatment of stress urinary incontinence (SUI). Nevertheless, there is no evidence about training parameters. Objective: To identify the protocol and/or most effective training parameters in the treatment of female SUI. Method: A literature research was conducted in the PubMed, Cochrane Library, PEDro, Web of Science and Lilacs databases, with publishing dates ranging from January 1992 to March 2014. The articles included consisted of English-speaking experimental studies in which SEPFM were compared with placebo treatment (usual or untreated). The sample had a diagnosis of SUI and their age ranged between 18 and 65 years. The assessment of methodological quality was performed based on the PEDro scale. Results: Seven high methodological quality articles were included in this review. The sample consisted of 331 women, mean age 44.4±5.51 years, average duration of urinary loss of 64±5.66 months and severity of SUI ranging from mild to severe. SEPFM programs included different training parameters concerning the PFM. Some studies have applied abdominal training and adjuvant techniques. Urine leakage cure rates varied from 28.6 to 80%, while the strength increase of PFM varied from 15.6 to 161.7%. Conclusion: The most effective training protocol consists of SEPFM by digital palpation combined with biofeedback monitoring and vaginal cones, including 12 week training parameters, and ten repetitions per series in different positions compared with SEPFM alone or a lack of treatment.

Resumo Introdução: Os exercícios de fortalecimento dos músculos do pavimento pélvico (EFMPP) são considerados a primeira intervenção no tratamento da incontinência urinária de esforço (IUE); porém, não existe evidência sobre os parâmetros de treino. Objetivo: Identificar o protocolo e/ou os parâmetros de treino mais eficazes no tratamento da IUE feminina. Método: A pesquisa bibliográfica foi realizada entre janeiro de 1992 e março de 2014 nas bases de dados PubMed, Cochrane Library, PEDro, Web of Science e Lilacs. Os artigos incluídos eram de língua inglesa, estudos experimentais, comparando EFMPP com tratamento placebo, usual ou sem tratamento, com idade compreendida entre 18 e 65 anos e diagnóstico de IUE. A avaliação da qualidade metodológica foi realizada por meio da escala PEDro. Resultados: Sete artigos de elevada qualidade metodológica foram incluídos na presente revisão. A amostra foi constituída por 331 mulheres, com idade média de 44,4±5,51 anos, duração média das perdas urinárias de 64±5,66 meses e gravidade da IUE variando entre ligeira e grave. Os programas de EFMPP eram distintos relativamente aos parâmetros de treino dos MPP. Alguns estudos incluíram treino abdominal e técnicas adjuvantes. A taxa de cura da quantidade de perda urinária variou entre 28,6 e 80%, enquanto o aumento da força dos MPP variou de 15,6 a 161,7%. Conclusão: O protocolo de treino mais eficaz consiste nos EFMPP por palpação digital e supervisão combinados com biofeedback e cones vaginais, incluindo os parâmetros de treino de 12 semanas de duração, dez repetições por série e em distintas posições comparados com os EFMPP isolados ou sem tratamento.

Long-term Outcome of the Retrourethral Transobturator Male Sling After Transurethral Resection of the Prostate / 대한배뇨장애요실금학회지

PURPOSE: To evaluate long-term outcomes of AdVance and AdVanceXP male slings in patients with persistent stress urinary incontinence (SUI) after transurethral resection of the prostate (TURP). METHODS: A total of 18 consecutive patients received AdVance (n=14) or AdVanceXP (n=4) male sling implantation between 2007 and 2013. Continence was determined by pad use, 24-hour pad testing and validated questionnaires (International Consultation on Incontinence Questionnaire Short Form, ICIQ-SF). Quality of life was evaluated by International Quality of Life (IQoL) score. Patient satisfaction was measured with patient’s global impression of improvement score. Cure was defined as 0–5 g in the 24-hour pad test. Statistical analysis included Fisher exact and Wilcoxon test (P<0.05). RESULTS: Follow-up was available for 15 patients who underwent further analysis. After a median follow-up of 70 months (range, 18–83 months), mean daily pad usage was 1.8±2.1 pads (P=0.015 vs. baseline level). Mean IQoL score was 66.4±31.6 (P=0.050 vs. baseline level), and mean ICIQ-SF score was 9.5±6.6 (P=0.077 vs. baseline level). Based on 24-hour pad testing, mean daily urine loss was 31.2±64.5 g (median, 0 g; range, 0–209 g). Cure rate was 46.7%, and cure-and-improved rate was 60.0%. Assessing predictive features for success, better results were found in patients who needed up to 4 pads preoperatively (P=0.041) as well as for patients ≤71 years at the time of implantation (P=0.041). CONCLUSIONS: The findings indicate that AdVance and AdVanceXP implantation can be performed effectively and safely in men suffering from SUI after TURP. However, long-term success rates seem to be lower compared to SUI after radical prostatectomy and patients should be counseled accordingly.

Effect of Preoperative Flow Rate on Postoperative Retention and Voiding Difficulty After Transobturator Tape Operation

PURPOSE: Controversy exists over the preoperative risk factors for postoperative urinary retention after the midurethral sling procedure for stress urinary incontinence (SUI). We intended to analyze the effect of preoperative flow rate on postoperative urinary retention after the transobturator tape (TOT) operation. MATERIALS AND METHODS: A total of 322 patients who underwent TOT from June 2006 to May 2012 were included in this retrospective study. All patients were preoperatively investigated for urinary symptoms and underwent preoperative urodynamic studies including urine flow rate. Postoperative urinary retention, voiding difficulty, and uroflowmetry were checked. Urinary retention was defined as the need for additional catheterization longer than 1 day. Patients were divided by preoperative peak flow rate (Qmax) of 15 mL/s (low Qmax group and normal Qmax group). RESULTS: There were 3 cases of postoperative urinary retention (0.9%) and 52 cases of voiding difficulty (16.1%). The low Qmax group included 40 patients (12.4%) and the normal Qmax group included 282 patients (87.5%). Between the two groups, there were no significant differences in age, previous pelvic surgery history, or past medical history. The low Qmax group had higher scores for voided volume and detrusor pressure at Qmax. However, there was no significant difference in postoperative voiding difficulty between the two groups. Furthermore, three patients who experienced postoperative retention showed high flow rates preoperatively. CONCLUSIONS: Our results suggest that voiding difficulty in the group with low preoperative flow was tolerable and the treatment success rate was comparable to that in patients in the normal flow group. According to our analysis, patients with a low flow rate preoperatively can be safely treated with TOT for SUI.

Cincha transobturatriz con anestesia local para incontinencia urinaria de esfuerzo / Tansobturator tape under local anesthesia for urinary stress incontinence

Evaluar la técnica de cura de incontinencia urinaria de esfuerzo con cincha transobturatriz bajo anestesia local. Estudio descriptivo y prospectivo en 22 pacientes con incontinencia urinaria de esfuerzo de la consulta de piso pélvico del Hospital Universitario de Caracas entre abril y noviembre de 2010, a las que se les colocó cincha transobturatriz con anestesia local y sedación consciente complementaria en la mayoría de los casos. El tiempo quirúrgico promedio fue 9,57 min. Dos pacientes toleraron el procedimiento quirúrgico con anestesia local exclusiva, mientras que las otras 20 (90,9 por ciento) requirieron sedación endovenosa, similar a lo descrito en la literatura. El dolor intraoperatorio en promedio fue de 3,18 puntos en la escala visual análoga. El 100 por ciento de las pacientes estuvo satisfecha con el procedimiento anestésico y el 95,5 por ciento lo recomienda. La anestesia local con sedación consciente constituye una técnica tolerable, segura, y rápida para la cura de incontinencia urinaria de esfuerzo con cincha transobturatriz

To evaluate the transobturator tape procedure for urinary stress incontinence under local anesthesia. Prospective and descriptive study of 22 patients with urinary stress incontinence from the Pelvic Floor Unit of Universitary Hospital of Caracas, between April and November 2010, in whom the transobturator tape procedure was performed under local anesthesia and sedation. Mean surgical time was 9.57 min. Two patients tolerated the surgical procedure with local anesthesia without sedation, while the other 20 (90.9 percent) required intravenous sedation, as described in most publications. Mean intraoperative pain was 3.18 points in the Visual Analogue Scale. One hundred percent of the patients were satisfied with the anesthetic technique, and 95.5 percent would recommend it. Local anesthesia with sedation is a well-tolerated, safe, and fast technique for the surgical treatment of urinary stress incontinence with transobturator tape

Complications Following Outside-in and Inside-out Transobturator-Tape Procedures with Concomitant Gynecologic Operations / 전남의대학술지

This study was undertaken to compare the complications of outside-in transobturator tape procedures (TOT) and inside-out transobturator tape procedures (TVT-O) with concomitant gynecologic surgery for the treatment of female stress urinary incontinence (SUI). A retrospective review of 206 consecutive patients who underwent either TOT or TVT-O with concomitant gynecologic operations between March 2008 and February 2011 was conducted. The incidence of perioperative complications was compared. For statistical analysis, chi-squared tests were used. There were no reports of intraoperative complications such as vaginal injury or bladder perforation. Postoperative complications were noted in 23 procedures (11.2%). These included 6 cases of urinary retention (2.9%), 2 cases of vulva hematoma (1.0%), 7 cases of urinary tract infection (3.4%), 4 cases of de novo urgency (2.9%), and 4 cases of vaginal erosion (2.9%). There were no significant differences in complication rates between the two groups. Our results suggest that inside-out and outside-in procedures are simple and safe techniques that may have a low rate of complications when used with a concomitant gynecologic operation.

Efficacy and Safety of the TVT-SECUR(R) and Impact on Quality of Life in Women with Stress Urinary Incontinence: A 2-Year Follow-Up

PURPOSE: As recently reported, the short-term results of the tension-free vaginal tape SECUR(R) (TVT-S) procedure seem to be similar to those of the conventional transobturator tape (TOT) procedure. However, results of efficacy and satisfaction with TVT-S are insufficient in patients with more than 1 year of follow-up. Therefore, we evaluated the results of the TVT-S procedure in women with stress urinary incontinence (SUI) during 2 years. MATERIALS AND METHODS: We evaluated 51 patients with clinical and urodynamic diagnoses of SUI who underwent the TVT-S procedure from March 2008 to February 2009. Preoperative evaluation included a history, cough stress test with full bladder, urodynamic study, and incontinence quality of life (I-QoL) questionnaire. Following the postoperative period, urinary incontinence status was examined through a physical examination and the I-QoL questionnaire was completed in an outpatient setting or by telephone. RESULTS: Data from 2 years of follow-up were available for 46 of 51 patients. The cure rate was 80.4% at 1 month after TVT-S and 76.0% at 2 years after TVT-S. The cure or improvement rate was 93.5% at 1 month after TVT-S and 86.8% at 2 years after TVT-S. The mean total I-QoL score increased by 42 points at 1 month after TVT-S (p<0.026) and by 32 points at 2 years after TVT-S (p<0.013). Most patients reported significant improvements in quality of life. At the 2-year follow-up, there were no significant complications related to TVT-S. CONCLUSIONS: The results of this study suggest that TVT-S is an efficient and safe procedure for the improvement of both the quality of life of the patients and the SUI itself.

Complications Following Outside-in and Inside-out Transobturator-Tape Procedures with Concomitant Gynecologic Operations / 전남의대학술지

This study was undertaken to compare the complications of outside-in transobturator tape procedures (TOT) and inside-out transobturator tape procedures (TVT-O) with concomitant gynecologic surgery for the treatment of female stress urinary incontinence (SUI). A retrospective review of 206 consecutive patients who underwent either TOT or TVT-O with concomitant gynecologic operations between March 2008 and February 2011 was conducted. The incidence of perioperative complications was compared. For statistical analysis, chi-squared tests were used. There were no reports of intraoperative complications such as vaginal injury or bladder perforation. Postoperative complications were noted in 23 procedures (11.2%). These included 6 cases of urinary retention (2.9%), 2 cases of vulva hematoma (1.0%), 7 cases of urinary tract infection (3.4%), 4 cases of de novo urgency (2.9%), and 4 cases of vaginal erosion (2.9%). There were no significant differences in complication rates between the two groups. Our results suggest that inside-out and outside-in procedures are simple and safe techniques that may have a low rate of complications when used with a concomitant gynecologic operation.

The Influence of Preoperative Bladder Outlet Obstruction on Continence and Satisfaction in Patients with Stress Urinary Incontinence after Midurethral Sling / 대한배뇨장애요실금학회지

PURPOSE: We studied the influence of preoperative bladder outlet obstruction (BOO) on postoperative continence rates and patient satisfaction after the midurethral sling procedure. METHODS: A total of 159 women who underwent the midurethral sling procedure were evaluated. Using the Blaivas-Groutz nomogram, we assigned the patients were assigned to Group I (n=37, no obstruction), Group II (n=89, mild obstruction), or Group III (n=33, moderate to severe obstruction). Continence rates, patient satisfaction, urinary sensation scale and uroflowmetry were evaluated postoperatively. RESULTS: There were no significant differences in continence rates, satisfaction, or postoperative maximal flow rate between the 3 groups. Postoperative urgency was improved after surgery in Groups I and II (P<0.05) but not in Group III. CONCLUSIONS: BOO does not seem to be a risk factor for failure after the midurethral sling procedure. However, BOO may be considered as a potential factor for persistent storage symptoms after the midurethral sling.

Tape Shortening for Recurrent Stress Urinary Incontinence After Transobturator Tape Sling: 3-Year Follow-up Results / 대한배뇨장애요실금학회지

PURPOSE: Recently, as the number of transobturator tape (TOT) procedures has increased, recurrence after this procedure has been frequently reported. However, there are no standard guidelines for treatment. We describe our experience with shortening the previously implanted tape in patients with recurrent stress urinary incontinence after the TOT procedure. MATERIALS AND METHODS: We enrolled 10 women who underwent shortening of the previously implanted tape and were followed up for 3 years. Shortening of the previously implanted tape was done by a figure-eight suture with 1-0 Prolene. One year after TOT shortening, we investigated continence status, patient satisfaction by means of a questionnaire, maximal flow rate (Qmax), and postvoid residual urine volume. Three years after TOT shortening, we evaluated continence status and patient satisfaction. RESULTS: The mean period of TOT shortening was 4.2 months (range, 1-12 months) after the TOT procedure. One year after TOT shortening, 7 patients showed complete dryness, 2 patients showed improvement, and 1 patient reported failure. Eight patients were very satisfied or satisfied with the 1-year result after TOT shortening. The mean preoperative and postoperative Qmax were 23.8 and 26.7ml/s, respectively, and there was no significant difference. Three years after TOT shortening, 6 patients showed complete dryness, 2 patients showed improvement, and 2 patients reported failure. Among them,1 had failed from 1 year after TOT shortening and the other had shown 1 year of complete dryness. Eight patients were very satisfied or satisfied and 2 patients were dissatisfied with the 3-year result after TOT shortening. CONCLUSION: Most of the patients who underwent TOT shortening reported satisfaction as well as improvement of incontinence after a 3-year follow up. Therefore, we suggest that TOT shortening may be recommended primarily in patients with recurrent stress urinary incontinence after the TOT sling procedure.

Acute and Serious Myositis with Abscess in Thigh Muscle after Transobturator Tape Implantation / 대한배뇨장애요실금학회지

The complications of transobturator tape (TOT) were known as lower urinary tract injury, postoperative urinary retention, urge incontinence, vaginal erosion, and etc. A 63-year-old woman presented with new onset of severe pain, heating, and swelling of the left thigh and perineum. She had undergone TOT implantation for stress urinary incontinence (SUI) 4 days previously in an outside clinic. Painful left thigh swelling and skin erythema were noted on the physical examination. A computed tomography (CT) scan showed multiple, large left medial thigh and obturator abscesses. Removal of the implanted tape and abscess drainage were performed immediately and two additional operations were needed for proper abscess drainage. We believe this case to be one of the most serious complications to occur since the introduction of the TOT procedure. Here we report this case and discuss its initial management along with a review of the literature.

Comparison of Efficacy and Satisfaction between the TVT-SECUR(R) and MONARC(R) Procedures for the Treatment of Female Stress Urinary Incontinence

PURPOSE: The tension-free vaginal tape SECUR(R) (TVT-S) is a new, minimally invasive sling procedure for treating female stress urinary incontinence (SUI). However, results of comparisons of the TVT-S with the transobturator tape (TOT) sling are lacking. Therefore, we investigated outcome and satisfaction of the TVT-S procedure compared with the TOT procedure. MATERIALS AND METHODS: We included 64 patients with SUI who underwent the TVT-S (n=31) or TOT (MONARC(R), n=33) procedure and were followed up for more than 1 year. The preoperative evaluation included history taking, pelvic examination, consecutive 3-day voiding diary, and urodynamic study including Valsalva leak point pressure. Postoperatively, continence status and subjective patient satisfaction were evaluated. Cure was defined as the absence of any episodes of involuntary urine leakage during stressful activities and a stress cough test. RESULTS: The TVT-S group (71.0%) showed a slightly lower cure rate than did the MONARC group (84.8%); however, there was no significant difference between the 2 groups (p=0.179). Nine of the patients who underwent the TVT-S showed incontinence postoperatively. Among them, the H approach was used in 7 patients and the U approach was done in 2 patients. Following TVT-S and MONARC, the patients' reported satisfaction was 80.6% and 78.8%, respectively. Patient satisfaction did not differ significantly between the two groups (p=0.854). CONCLUSIONS: Our results showed that the TVT-S and MONARC procedures may be comparable in terms of cure rate and patient satisfaction after more than 1 year of follow-up.

The Miniarc® sling system in the treatment of female stress urinary incontinence

AIMS: To assess the technical feasibility of a new mini-invasive sling procedure (MiniArc®) and present short-term results in the treatment of female urinary incontinence. MATERIAL AND METHODS: A total of 97 women with mixed or stress urinary incontinence (SUI) were treated by placement of the new single-incision sling. Pelvic organ prolapse was graded using the POP-Q system (pelvic organ prolapse quantification system). Preoperative workup included urodynamic evaluation, cough stress test and introital ultrasound. Postoperatively, introital ultrasound was performed to determine residual urine and check tape position. Quality of life was measured using King's Health Questionnaire. A voiding diary and pad count served to verify the patients' subjective complaints. RESULTS: The MiniArc® single-incision sling procedure was the initial intervention in 37 (38.2 percent) patients and the second intervention in 60 (61.7 percent) patients with recurrent incontinence. The cough stress test was negative in 79 (83.1 percent) women 6 weeks after the sling procedure and in 74 (77.8 percent) at 12 months. De novo urge occurred in 32 (36.8 percent) women. Quality of life was significantly improved at 12-month follow-up in 65 (69.1 percent) patients (p < 0.001). The number of pads decreased significantly from 2.2 to 0.6 (p < 0.001) after the procedure. One patient developed an hematoma and bladder perforation occurred in another. CONCLUSIONS: Our short-term clinical results suggest that the MiniArc® is a safe and effective minimally invasive sling procedure for treating female SUI. Randomized comparative controlled trials and long-term results are still required to define the role of the new sling system in comparison to established mid-urethral tape techniques for treating incontinence.

Cabestrillo subtrigonal con aponeurosis abdominal en el tratamiento de incontinencia urinaria de esfuerzo compleja / Subtrigonal sling with abdominal fascia for treatment of complex stress urinary incontinence

Objetivo: Describir la técnica de cabestrillo subtrigonal con fascia abdominal y demostrar su utilidad en la resolución de la incontinencia urinaria de esfuerzo compleja. Material y métodos: Estudio de cohorte longitudinal y observacional en mujeres adultas que acudieron al Servicio de Urodinamia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, para tratamiento de incontinencia urinaria de esfuerzo recidivante o con factores de riesgo para recidiva, asociada o no a incontinencia urinaria de urgencia. Resultados: Entre 1995 y 2006 incluimos 40 pacientes; el seguimiento fue de 41.95 meses (rango 9 a 106) y el promedio de edad de 55 años. En 35 pacientes (87.5 %) fue resuelta la incontinencia urinaria de esfuerzo, dos pacientes mejoraron (5 %) y tres persistieron (7.5 %) con la incontinencia. De las 40 pacientes, 18 presentaban incontinencia urinaria de urgencia y solo en siete de éstas (39 %) se resolvió después de la cirugía. La incontinencia urinaria de urgencia de novo se presentó en 12 (30 %). Una tuvo hernia crural, dos hernia posincisional y dos requirieron transfusión sanguínea. Ninguna evidenció problemas de vaciamiento urinario posterior a la cirugía. Conclusiones: Los resultados con la técnica descrita son eficaces y duraderos en pacientes con incontinencia urinaria de esfuerzo recidivante o factores de riesgo para recidiva. No se observó disfunción de vaciamiento vesical, sin embargo, hubo hernias abdominales. El abordaje de mínima invasión para colocar las cintas sintéticas en posición subtrigonal podría mantener la eficacia con mínima morbilidad.

BACKGROUND: The aim of this study was to describe the technique of subtrigonal sling with abdominal fascia and demonstrate its usefulness in resolving complex stress urinary incontinence (SUI). METHODS: We performed a cohort, longitudinal, observational study in adult females who attended the Urodynamics Department of the Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, with recurrent SUI or with risk factors for recurrence, whether or not associated with urge urinary incontinence (UUI). RESULTS: Between 1995 and 2006, 40 patients were included. Mean follow-up was 41.95 months (9-106), and the average patient age was 55 years. In 35 patients (87.5%) SUI was resolved, in two patients (5%) it improved, and in three patients (7.5%) it persisted. Of the 40 study patients, 18 had UUI and in only 7/18 patients (39%) was it resolved postoperatively. UUI de novo was noted in 12/40 patients (30%). One patient presented crural hernia, two patients presented postincisional hernia and two patients required blood transfusion. No patient presented acute urinary retention or urinary voiding problems postoperatively. CONCLUSIONS: Results obtained by this surgical technique are effective and long-lasting in patients with complex SUI. We did not observe bladder emptying dysfunction but there were formations of abdominal wall hernias. The minimally invasive approach consisting of the subtrigonal placement of synthetic tapes may maintain efficacy with minimal morbidity.

Complicaciones de técnicas con cinta suburetral en el tratamiento de la incontinencia urinaria de esfuerzo / Complications of suburethral sling techniques in the treatment of urinary stress incontinence

Introducción: Revisamos las complicaciones de TVT, TOT y CSUSA (cinta sub-uretral sin aguja) en pacientes operadas de incontinencia de esfuerzo en nuestro Servicio. Método y Pacientes: Se consideraron las primeras 42 pacientes operadas de TVT, 15 de TOT y 41 de CSUSA. El período de observación fue 49,7; 21 y 12,5 meses respectivamente. Resultados: Complicaciones menores: TVT (28 por ciento): 8 pacientes con aguja intravesical, 2 pacientes dolor hipogástrico durante cuatro meses y 2 durante un año. TOT (27 por ciento): 4 pacientes con dolor de muslos. CSUSA: sin complicaciones. Complicaciones mayores: TVT: 5 pacientes (12 por ciento), 2 con extrusión de cinta, 1 retención urinaria crónica, 1 rotura uretral, 1 cinta intravesical. TOT: 2 pacientes (13 por ciento), 1 hematoma perivesical importante y 1 rotura uretral. CSUSA sin complicaciones. Todas las complicaciones fueron resueltas y las pacientes están continentes. Conclusiones: Las tres técnicas resuelven con éxito la IOE. No hay diferencia significativa entre las complicaciones de TVT y TOT. La técnica CSUSA no ha tenido complicaciones hasta el momento.

Introduction: We reviewed the complications of TVT, TOT and the suburethral sling without needle(STWN) in patients operated of stress incontinence at our institution. Methods: The first 42 patients operated with TVT, 15 with TOT and 41 patients operated with STWN technique. Follow-up time was 49,7; 21 and 12,5 months for each technique respectively. Results: Minor complications for TVT were: 8 patients with bladder perforation, 2 had hipogastrial pain during 4 months and 2 for a year. TOT: 4 patients with thigh pain. STWN: Without any complications. Mayor complications for TVT were: 5 patients (12 percent), 2 with mesh extrusion, 1 chronic urine retention, 1 intrasurgical urethral break, 1 intravesical mesh. TOT: 2 patients (13 percent) 1 mayor perivesical haematoma and 1 intrasurgical urethral break. STWN: without complications. All complications were resolved and patients are continent. Conclusions: The three techniques achieve success to resolve stress incontinence; there are no significant differences between the complications of TVT and TOT. STWN technique has had no complications until this moment at our institution.

Parâmetros da urofluxometria e do estudo fluxo/pressão em pacientes uroginecológicas / Uroflowmetry and flow pressure study parameters in urogynecology patients

OBJETIVO: Avaliar as taxas de fluxo no estudo urodinâmico (EUD) em pacientes com disfunção do trato urinário inferior e registrar os efeitos do diagnóstico final do EUD e da idade das pacientes sobre estas variáveis. MÉTODOS: Estudo retrospectivo que incluiu 205 mulheres. As pacientes foram divididas em três grupos: menos de 45 anos; entre 45 e 60 anos e mais que 60 anos. Estudamos os comportamentos dos fluxos máximo, médio e da pressão de abertura do detrusor (Padet) com o evoluir da idade. De forma semelhante, realizamos comparações das variáveis fluxos máximo e médio, Padet e vesical no fluxo máximo, consoante o diagnóstico final do EUD. RESULTADOS: Há forte declínio dos fluxos máximo, médio e da Padet com o evoluir da idade, sendo que a queda dos fluxos máximo e médio é significante quando comparamos as mulheres com mais de 65 anos (21,8 ml/s e 9,2 ml/s, respectivamente) com aquelas entre 45 e 60 anos (29 ml/s e 12,6 ml/s, respectivamente) e as demais (27,9 ml/s e 11,7 ml/s, respectivamente). Observamos redução significativa da Padet no grupo com mais de 60 anos (13,4 cmH2O) quando comparadas àquele com menos de 45 anos (21,2 cmH2O). A Padet teve redução significativa nas pacientes com incontinência urinária de esforço (IUE) associada a defeito esfincteriano (13,8 cmH2O) diagnosticados no EUD quando comparadas aquelas assintomáticas (20,7 cmH2O). CONCLUSÃO: Há diminuição das taxas de fluxo com o aumento da idade. Mulheres com IUE têm micção com menor Padet.

OBJECTIVE: The purpose was to evaluate urine flow rates in an urodynamic study (US) of patients with symptoms of lower urinary tract dysfunction and to record effects of final urodynamic diagnosis and age on these variables. METHODS: Retrospective analysis of 205 women who had undergone urogynecological investigation. Patients were divided into three age groups: A (< 45 years); B (45 - 60 years) and C (> 60 years). Comportment of urine flow rates and opening detrusor pressure with increasing age were studied and resulting charts recorded. Comparison of maximum and average urine flow rates, opening detrusor pressure and detrusor pressure at the maximal flow according to final urodynamic diagnostic were also made. RESULTS: There was a decline of urine flow rates with increase of age, which was more significant between groups A X C and B X C. There was also a decline in opening detrusor pressure with aging, which was significant between groups A X C. When analyzing opening detrusor pressure according to final urodynamic diagnosis, a significant decline of this variable was observed in patients with urinary stress incontinence and intrinsic sphincter deficiency in relation to those who were asymptomatic. CONCLUSION: Urine flow rates decreased with age. Women with urinary stress incontinence and intrinsic sphincter deficiency void at a lower detrusor pressure.