Impact of bariatric surgery in patients with stress urinary incontinence / Impacto da cirurgia bariátrica em pacientes com incontinência urinária de esforço

ABSTRACT Objective: To examine epidemiologic, anthropometric and clinical variables associated with stress urinary incontinence in obese women, before and after bariatric surgery, and to identify predictive factors of stress urinary incontinence resolution. Methods: Prospective observational study with women enrolled in a bariatric surgery program between 2015 and 2016. Patients were assessed prior to and 6 months after bariatric surgery using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale. Patient assessment also included physical examination and bladder stress tests. Results: A total of 43 women completed the study. There was a 72.7% reduction in stress urinary incontinence (p=0.021). Predictive factors for preoperative diagnosis of stress urinary incontinence included age (p=0.024) and abdominal waist circumference (p=0.048). Urinary symptoms improved after weight loss, especially nocturia (p=0.001) and stress urinary incontinence (p=0.026). Menopause was the most significant predictive factor for persistence of stress urinary incontinence within six months of bariatric surgery (p=0.046). Self-reported outcomes and scores obtained in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale were associated with significant improvement (p=0.012, p=0.025, and p=0.002 respectively). Conclusion: Older women with larger waist circumference have a higher risk of developing stress urinary incontinence prior to bariatric surgery. Menopausal women are highly prone to persistent stress urinary incontinence, even after weight loss. Weight loss achieved through bariatric surgery improved stress urinary incontinence symptoms and mitigated related impacts on quality of life in the vast majority of women.

RESUMO Objetivo: Examinar as variáveis epidemiológicas, antropométricas e clínicas associadas à incontinência urinária de esforço em mulheres obesas antes e após a cirurgia bariátrica e identificar fatores preditivos da resolução desse tipo de incontinência. Métodos: Estudo observacional prospectivo com mulheres de um programa de cirurgia bariátrica, realizado entre 2015 e 2016. As pacientes responderam ao International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, à Clinical Global Impression-Improvement e à Escala Visual Analógica, sendo submetidas ao exame físico e ao teste de incontinência antes e 6 meses após cirurgia bariátrica. Resultados: Completaram o estudo 43 mulheres. Houve redução de 72,7% na incontinência urinária de esforço (p=0,021). Fatores preditivos para o diagnóstico pré-operatório da incontinência urinária incluíram idade (p=0,024) e circunferência abdominal (p=0,048). Todos os sintomas urinários demonstraram melhora após perda de peso, notadamente noctúria (p=0,001) e incontinência urinária de esforço (p=0,026). A menopausa foi o fator mais crítico para predizer a persistência da incontinência urinária de esforço 6 meses após a cirurgia bariátrica (p=0,046). Os resultados relatados do International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, da Patient Global Impression of Improvement e da Escala Visual Analógica tiveram melhora significativa (p=0,012, p=0,025, p=0,002, respectivamente). Conclusão: Mulheres idosas e com maior circunferência abdominal têm maior risco de desenvolver incontinência urinária de esforço antes da cirurgia. Mulheres na menopausa são fortemente propensas a persistir com a incontinência urinária de esforço, mesmo após a perda de peso. A perda de peso após a cirurgia bariátrica melhora os sintomas de incontinência urinária de esforço e seus impactos na qualidade de vida na maioria das mulheres.

Fatores associados à incontinência urinária em mulheres pós-parto / Factors associated with urinary incontinence in postpartum women

Objetivo: Avaliar a prevalência dos tipos de incontinência urinária em mulheres após parto vaginal e cesárea, e identificar os fatores de risco associados à presen- ça e à gravidade da incontinência urinária nessa população. Métodos: Estudo de corte transversal com 120 mulheres, 12 a 18 meses após o parto, entrevistadas por telefone com questionários validados sobre sintomas urinários e vaginais. Para análise estatística, utilizamos qui-quadrado, teste de Mann-Whitney e Kruskal- -Wallis, e regressão uni e multivariada. Resultados: Das 120 mulheres incluídas no estudo, 68 (56,7%) tiveram parto vaginal, 23 (19,2%), cesárea eletiva e 29 (24,1%), cesárea após trabalho de parto. A prevalência de incontinência urinária foi de 52,5% e a de incontinência urinária de esforço, de 40%, sem diferença com relação ao parto (p = 0,945 e 0,770). A maioria apresentava incontinência urinária leve (80%), e não houve diferença nas médias dos questionários de incontinência urinária e sintomas vaginais e sexuais e qualidade de vida entre os tipos de parto (p = 0,691, 0,750, 0,262 e 0,779). A prevalência de incontinência urinária esteve associada com idade ≥ 30 anos (p = 0,046) e incontinência urinária durante a gestação (p < 0,001). Com relação à incontinência urinária de esforço, os fatores associados foram incontinência urinária durante a gestação (p < 0,001) e partos vaginais (p = 0,038). Conclusão: Incontinência urinária e incontinência urinária de esforço são muito prevalentes após 12-18 meses do parto, porém sem diferenças com relação à via de parto. Perda urinária durante a gestação e idade maior que 30 anos são fatores de risco para incontinência urinária e incontinência urinária de esforço. A gravidade da perda urinária está associada também a perda durante a gestação e maiores índices de massa corporal.(AU)

Objective: To evaluate the prevalence of types of urinary incontinence in women after vaginal delivery and cesarean section; and to identify the risk factors associated with the presence and severity of UI in this population. Methods: Cross-sectional study with 120 women, 12 to 18 months after delivery, telephone interviews with validated questionnaires on urinary and vaginal symptoms. For statistical analysis, we used chi-square, Mann-Whitney and Kruskal-Wallis test, uni and multivariate regression. Results: Of the 120 women included in the study, 68 (56.7%) had vaginal delivery, 23 (19.2%) cesarean section and 29 (24.1%) cesarean sections after labor. The prevalence of UI was 52.5% and SUI 40%, with no difference in relation to delivery (p = 0.945 and 0.770). The majority had mild UI (80%) and there was no difference in the mean questionnaires of urinary incontinence and vaginal, sexual and quality of life symptoms among the types of delivery (p = 0.691, 0.750, 0.262 and 0.779). The prevalence of UI was associated with age ≥ 30 years (p = 0.046) and UI during pregnancy (p < 0.001). Regarding SUI, the associated factors were UI during pregnancy (p < 0.001) and vaginal deliveries (p = 0.038). Conclusion: UI and SUI are very prevalent after 12-18 months of delivery, but no differences regarding the route of delivery. Urinary loss during pregnancy and age over 30 years are risk factors for UI and SUI. The severity of urinary loss is also associated with loss during pregnancy and higher BMI.(AU)

Stress urinary incontinence post-holmium laser enucleation of the prostate: a single-surgeon experience

ABSTRACT Purpose To identify incidence and predictors of stress urinary incontinence (SUI) following Holmium laser enucleation of the prostate (HoLEP). Materials and Methods We performed a retrospective review of 589 HoLEP patients from 2012-2018. Patients were assessed at pre-operative and post-operative visits. Univariate and multivariate regression analyses were performed to identify predictors of SUI. Results 52/589 patients (8.8%) developed transient SUI, while 9/589 (1.5%) developed long-term SUI. tSUI resolved for 46 patients (88.5%) within the first six weeks and in 6 patients (11.5%) between 6 weeks to 3 months. Long-term SUI patients required intervention, achieving continence at 16.4 months on average, 44 men (70.9%) with incontinence were catheter dependent preoperatively. Mean prostatic volume was 148.7mL in tSUI patients, 111.6mL in long-term SUI, and 87.9mL in others (p <0.0001). On univariate analysis, laser energy used (p <0.0001), laser "on" time (p=0.0204), resected prostate weight (p <0.0001), overall International Prostate Symptom Score (IPSS) (p=0.0005), and IPSS QOL (p=0.02) were associated with SUI. On multivariate analysis, resected prostate weight was predictive of any SUI and tSUI, with no risk factors identified for long-term SUI. Conclusion Post-HoLEP SUI occurs in ~10% of patients, with 1.5% continuing beyond six months. Most patients with tSUI recover within the first six weeks. Prostate size >100g and catheter dependency are associated with increased risk tSUI. Larger prostate volume is an independent predictor of any SUI, and tSUI.

The impact of perioperative complications on favorable outcomes after artificial urinary sphincter implantation for post-prostatectomy incontinence

ABSTRACT Objective To investigate the effect of perioperative complications involving artificial urinary sphincter (AUS) implantation on rates of explantation and continence as well as health-related quality of life (HRQOL). Materials and methods Inclusion criteria encompassed non-neurogenic, moderate-to-severe stress urinary incontinence (SUI) post radical prostatectomy and primary implantation of an AUS performed by a high-volume surgeon (>100 previous implantations). Reporting complications followed the validated Clavien-Dindo scale and Martin criteria. HRQOL was assessed by the validated IQOL score, continence by the validated ICIQ-SF score. Statistical analysis included Chi (2) test, Mann-Whitney-U test, and multivariate regression models (p <0.05). Results 105 patients from 5 centers met the inclusion criteria. After a median follow-up of 38 months, explantation rates were 27.6% with a continence rate of 48.4%. In the age-adjusted multivariate analysis, perioperative urinary tract infection was confirmed as an independent predictor of postoperative explantation rates [OR 24.28, 95% CI 2.81-209.77, p=0.004). Salvage implantation (OR 0.114, 95% CI 0.02-0.67, p=0.016) and non-prostatectomy related incontinence (OR 0.104, 95% CI 0.02-0.74, p=0.023) were independent predictors for worse continence outcomes. Low visual analogue scale scores (OR 9.999, 95% CI 1,42-70.25, p=0.021) and ICIQ-SF scores, respectively (OR 0.674, 95% CI 0.51-0.88, p=0.004) were independent predictors for increased HRQOL outcomes. Perioperative complications did not significantly impact on continence and HRQOL outcomes. Conclusion Findings show postoperative infections adversely affect device survival after AUS implantation. However, if explantation can be avoided, the comparative long-term functional results and HRQOL outcomes are similar between patients with or without perioperative complications.

Macroplastique for women with stress urinary incontinence secondary to intrinsic sphincter deficiency

ABSTRACT Objective To evaluate the subjective and objective outcomes of Macroplastique® (MPQ) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD). Materials and Methods Following Institutional Review Board (IRB) approval, charts of non-neurogenic women with SUI secondary to ISD who underwent MPQ injection and had 6 months minimum follow-up were reviewed from a prospectively maintained database. Patients were divided into 3 groups: Naïve (Group I), Prior Anti-Incontinence Surgery (Group II), and combined Prior Bulking Agent and Anti-Incontinence Surgery (Group III). Data collected included SUI self-report, Urogenital Distress Inventory (UDI-6) Question 3, and VAS Quality of Life (QoL) Questionnaire scores at baseline and in follow-up. Three-dimensional ultrasound (3DUS) evaluated volume/configuration of MPQ. Success was defined after the last MPQ injection as a UDI-6 Question 3 score of 0 (dry) or 1, and no reoperation for SUI. Results From 2011-2017, 106 of 142 women met study criteria. At a median follow-up of 20 months (mean=26 months; range: 6-71), success rate was 41% for Group I, 40% for Group II, and 65% for Group III (p = 0.22). QoL scores were significantly improved over baseline in all groups. There was no significant difference in clinical outcome between the asymmetrical and symmetrical group on 3DUS. The completely dry rate was highest in Group III at 29%, compared to 4% for Group I and 15% for Group II (p = 0.05). Conclusion Macroplastique® improved subjective and objective outcome measures for SUI secondary to ISD as both a primary and secondary treatment option in women.

Proposal of a new way to evaluate the external sphincter function prior male sling surgey

ABSTRACT Objective: To propose a new way to objectively evaluate the external sphincter function prior to male sling surgery. Materials and Methods: We evaluated the pre-operative sphincter function throughout sphincter pressure at rest (SPAR) and sphincter pressure under contraction (SPUC) obtained throughout urethral profilometry profile (UPP) of 10 consecutive patients (age range, 54-79 years) treated with the retrourethral transobturator sling (RTS) for stress urinary incontinence (SUI) because of prostate surgery. The primary endpoint for surgery success rate was post-operative pad weight test. This was correlated to pre-operative pad test, RT, SPAR and SPUC. Post-operatively patients were classified as continent (no pad use) and those who still were incontinent. Results: Mean SPUC in the continent and incontinent group was respectively 188 + 8.8 (median 185.1, range 181 to 201) and 96.9 + 49.4 (median 109.9, range 35.6 to 163.6) (P = 0.008). Mean 24-hour pad test was 151 + 84.2gm (median 140, range 80 to 245) and 973 + 337.1gm (median 1940, range 550 to 1200) in post-operative continent and incontinent groups respectively (P = 0.008). The repositioning test (RT) was positive in all continent patients except one. The RT was also positive in three incontinence patients (false positive). In all post-operative continent patients SPUC was higher than 180cmH2O and pre-operative pad test was less than 245gm. Conclusions: SPUC seems to be a way for optimizing the sphincter evaluation as well to become a useful tool for patient selection prior to RTS surgery.

Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: results of a single centre

ABSTRACT Purpose: The aim of our study is to evaluate the efficacy and safety of ATOMS® system for the treatment of postoperative male stress urinary incontinence (SUI). Materials and methods: We retrospectively evaluated all patients treated at our institution for postoperative male SUI with ATOMS® implant. We excluded patients with low bladder compliance (< 20 mL / cmH2O), uncontrolled detrusor overactivity, detrusor underactivity (BCI < 100), urethral or bladder neck stricture and low cystometric capacity (< 200 mL). Results: From October 2014 to July 2017 we treated 52 patients, mean age 73.6 years. Most of them (92.3%) had undergone radical prostatectomy, 3.85% simple open prostatectomy, 3.85% TURP; 28.8% of patients had undergone urethral surgery, 11.5% adjuvant radiotherapy; 57.7% had already undergone surgical treatment for urinary incontinence. The average24 hours pad test was 411.6 g (180 - 1100). The mean follow-up was 20.1 months (8.1 - 41.5) 30.8% of patients were dry, 59.6% improved ≥ 50%, 7.7% improved < 50% and 1.9% unchanged. In total 73.1% reached social continence. There was a significant reduction of the 24 hours pad test and ICIQ - UI SF scores (p < 0.01). In the postoperative follow-up we detected complications in 8 patients (19%): 5 cases of displacement of the scrotal port, in 2 cases catheterization difficulties, one case of epididimitis and concomitant superficial wound infection; no prosthesis infection, nor explants. Radiotherapy, previous urethral surgery,previous incontinence surgery were not statistically related to social continence rates (p 0.65;p 0.11;p 0.11). Conclusions: The ATOMS® system is an effective and safe surgical treatment of mild and moderate male postoperative SUI with durable results in the short term.

Telephone - delivered quality of life after 365 male stress urinary incontinence (SUI) operations

ABSTRACT Objectives: To assess patient satisfaction and quality of life and factors that may be related to these outcomes. Materials and Methods: Between 2000 and 2008 a retrospective chart review and telephone survey of all surgeries for male SUI was performed. Average age at times of operation was 69.4 ± 7.4 (median 69). As part of the survey 270 of 365 patients were available (response rate: 74%). The average follow up time (from operation to telephone survey) was 34.8 ± 22.8 months (median 32). Results: Pad use per day improved significantly after operation from 6.23±5.3 to 1.61±2.92 pads/day (p=0.001). 74.7% (n=198) declared to be continent with one safety pad and 87.7% (n=236) confirmed the postoperative improvement of incontinence. 189 (70.5%) patients were “very satisfied” and “satisfied”. In 81% (n=218) the expectation in operation could be met, therefore 84.3% (n=226) would undergo it again and 90.3% (n=243) would recommend it to others. Lower age (rs=0.211), few postoperative pads per day (rs=0.58), high reduction of pads (rs=-0.35) and physical activity level (rs=0.2) correlate significantly with better satisfaction. Conclusions: Eighty-seven pint seven percent (87.7%) of our incontinence operations (n=236) lead to an improvement, which is independent from the number of prior incontinence operations and preoperative pad count. The postoperative quality of life remains constant over the observed follow up time. Certain subgroups of patients (younger age, high physical activity level, large reduction of pads) demonstrated superior satisfaction rates.

Transcorporal artificial urinary sphincter in radiated and non - radiated compromised urethra. Assessment with a minimum 2 year follow-up

ABSTRACT Purpose to assess the efficacy of transcorporal artificial urinary sphincter (AUS) implantation on continence for male stress urinary incontinence in cases of prior surgical treatment or/and radiation failure, and as a first option in radiation patients. Materials and Methods From March 2007 to August 2012, 37 male patients were treated with transcorporal AUS AMS™ 800. Twelve patients had primary placement of transcorporal cuff, a surgical option due to a previous history of radiation and 25 patients had secondary procedure after failure of AUS or urinary incontinence surgery. Functional urinary outcomes were assessed by daily pad use, 24-hour Pad-test and ICIQ-SF questionnaire. Quality of life and satisfaction were assessed based on I-QoL and PGI-I questionnaires. Results After a median of 32 months, the continence rate (0 to 1 pad) was 69.7%. Median pad test was 17.5g (0-159), mean ICIQ-SF score was 7.3/21 (±5.4) and mean I-QoL score was 93.9/110. A total of 88% of the patients reported satisfaction with the AUS. The 5-year actuarial revision-free for AUS total device was 51%. Patients for primary implant for radiation were not more likely to experience revision than non-radiation patients. Preservation of erections was reported in half of the potent patients. Conclusions Transcorporal AUS cuff placement is a useful alternative procedure option for severe male UI treatment, especially in patients with a compromised urethra after prior surgery or radiation. A high continence rate was reported and implantation as first option in radiation patients should be considered.

Assessing variability of the 24-hour pad weight test in men with post-prostatectomy incontinence

ABSTRACT Purpose: Decision-making regarding surgery for post-prostatectomy incontinence (PPI) is challenging. The 24-hour pad weight test is commonly used to objectively quantify PPI. However, pad weight may vary based upon activity level. We aimed to quantify variability in pad weights based upon patient-reported activity. Materials and Methods: 25 patients who underwent radical prostatectomy were prospectively enrolled. All patients demonstrated clinical stress urinary incontinence without clinical urgency urinary incontinence. On three consecutive alternating days, patients submitted 24-hour pad weights along with a short survey documenting activity level and number of pads used. Results: Pad weights collected across the three days were well correlated to the individual (ICC 0.85 (95% CI 0.74–0.93), p<0.001). The mean difference between the minimum pad weight leakage and maximum leakage per patient was 133.4g (95% CI 80.4–186.5). The mean increase in 24-hour leakage for a one-point increase in self-reported activity level was 118.0g (95% CI 74.3–161.7, p<0.001). Pad weights also varied significantly when self-reported activity levels did not differ (mean difference 51.2g (95% CI 30.3–72.1), p<0.001). Conclusions: 24-hour pad weight leakage may vary significantly on different days of collection. This variation is more pronounced with changes in activity level. Taking into account patient activity level may enhance the predictive value of pad weight testing.

A transobturator adjustable system for male incontinence: 30-month follow-up of a multicenter study

Purpose To report long-term results of the Argus T adjustable system for treatment of post-prostatectomy urinary incontinence (PPI). Materials and Methods From October 2007 to August 2008, 37 patients with PPI were included in a prospective, single-arm, multicenter trial of treatment with the Argus T adjustable system (Promedon, Argentina). Preoperative evaluation included urine culture, urethrocystoscopy, urodynamic testing, 24-h pad weight test (PWT) and quality of life questionnaires. Patients were stratified according to baseline degree of incontinence (mild–moderate or severe). Postoperative evaluation included immediate PWT, quality of life questionnaires and daily use of pads at 1, 12 and 30 months. Results and Conclusions One patient was lost to follow-up. At the 30-month follow-up, 24/31 patients (77%) were dry, 3/31 (10%) improved and 4/31 (13%) were failures. In particular, in the mild-moderate group, 8/8 (100%) patients were dry. In the severe group, 20/28 patients (71%) were dry, 3/28 (11%) improved and 5/28 (18%) were failures. Median visual analogue scale (VAS) scores dropped from 9 (4-10) to 0.5 (0-10) and International Consultation on Incontinence Questionnaire Short Form scores from (ICIQ-SF) 19 (12–21) to 1 (0–10). Retrograde leak point pressure increased from 18 (5–29) to 35 (22–45) cm H2O after intraoperative adjustment. Complications included immediate postoperative infection in 2/36 patients (6%) and transient inguinal and/or perineal pain in 22/36 patients (61%). Argus T has a long-term high success rate (86% cure + improvement at the 30-month follow-up). Good outcomes were achieved even in severe incontinence cases and maintained for over 30 months. .

Long-term results of permanent memotherm urethral stent in the treatment of recurrent bulbar urethral strictures

Purpose: To evaluate the long term outcomes of permanent Memotherm urethral stent in the treatment of recurrent bulbar urethral stricture. Materials and Methods: Twenty patients who underwent permanent Memotherm urethral stent implantation due to recurrent bulbar urethral stricture following previous unsuccessful surgical procedure from 1996 to 2002 were included in the study. Long-term outcomes of the patients were evaluated. Results: The overall success rate was 87.5% at the end of the tenth year. There was discomfort in implantation area in eight patients about 1 month following the procedure. These patients were treated with alpha-blocker and anti-inflammatory drugs. Stone formation was observed at the urethral stent implantation area in two patients. Post-void dripping has been observed in 15 patients up to the postoperative 3rd month. Stress urinary incontinence was observed in a patient with a 1-year follow-up. Partial stent migration was observed in two patients. None of the patients experienced pain during erection. Conclusion: Memotherm urethral stent is a minimal invasive surgical procedure which can be safely and effectively used in patients with recurrent urethral stricture. .

Anterior bladder flap neo urethra as treatment for stress urinary incontinence due to developmental urogenital anomaly

Congenital anomalies that involve the distal segment of urogenital sinus [giving rise to female urethra and vagina] may lead to abnormal urethral development ranging from absent to markedly deficient urethra. The abnormal division may also cause a short and patulous urethra. Sphincteric defects are likely to be associated and when combined with the short urethral length is a cause for severe urinary incontinence. Urinary incontinence due to a congenital cause requiring repeated urethral reconstruction to relieve symptoms is presented. A 15 year old girl was referred for bothersome urinary incontinence due to a short, wide, patulous urethra with defective sphincteric mechanism as part of urogenital sinus developmental anomaly. She was initially managed by reconstruction of bladder neck and proximal urethra with sphincter augmentation using autologous pubovaginal sling. Persistent urinary incontinence demanded a second urethral reconstruction using tubularised anterior bladder flap [modified Tanagho]. Surgical reconstruction of the urethra achieved socially acceptable continence.

Lack of association between the ICIQ-SF questionnaire and the urodynamic diagnosis in men with post radical prostatectomy incontinence / Falta de associação entre o questionário ICIQ-SF e o diagnóstico nos homens portadores de incontinência urinária pós-prostatectomia radical

PURPOSE: To analyze the correlation between the "International Consultation on Incontinence Questionnaire-Short Form" (ICIQ-UISF) survey and the urodynamic findings in men with urinary incontinence (UI) following radical prostatectomy (RP). METHODS: 88 men who presented post-RP UI for a minimum of 1 year were enrolled prospectively. All answered the ICIQ-UISF survey and underwent urodynamic testing. Patients were divided in 3 Groups according to their urodynamic diagnosis: Group 1, patients with sphincteric incontinence (SI) alone; Group 2, patients with mixed UI (SI + Bladder Dysfunction (BD)); and Group 3, patients with BD alone. Data were analyzed using SPSS v16.0 software. RESULTS: There were 51 men in Group 1 (57.9%); 30 in Group 2 (34%); and 7 (7.9%) in Group 3. BD was found in 37/88 patients (42%), but it was the main cause of UI in only 14 patients (15.9%). There was no statistically significant difference among the mean ICIQ-UISFs values from groups 1, 2, or 3 (p>0.05). The symptoms of stress incontinence correlated with the urodynamic finding of SI (r = 0.59), and complaints of urinary urgency correlated with the presence of detrusor overactivity (DO) (r = 0.37), but these complaints did not predict the main cause of UI. CONCLUSION: The etiology of UI following RP cannot be predicted by the ICIQ-UISF survey. Symptoms of stress and urge incontinence predict the findings of SI and DO on urodynamic tests, but they cannot ascertain the main cause of UI. Urodynamic testing remains the gold standard to assess the etiology of post-RP UI.

OBJETIVO: Analisar a relação entre as queixas clínicas mensuradas pelo "International Consultation on Incontinence Questionnaire-Short Form" (ICIQ-UISF) e os achados urodinâmicos em homens com incontinência urinária (IU) após a prostatectomia radical (PR). MÉTODOS: 88 homens que apresentavam IU por um período mínimo de 1 ano após a PR foram incluídos prospectivamente. Todos responderam o questinário "ICIQ-UISF" e foram submetidos a avaliação urodinâmica. Os pacientes foram categorizados em 3 grupos de acordo com o diagnóstico urodinâmico: Grupo 1, pacientes com incontinência esfincteriana isolada (IE); Grupo 2, pacientes com IU mista (IE + disfunção vesical (DV)); e Grupo 3, pacientes com DV isolada. Os dados foram analisados utilizando o software SPSS v16.0. RESULTADOS: Dos 88 pacientes avaliados, após a avaliação urodinâmica, 51 homens (57,9%) apresentaram IE isolada (Grupo 1); 30 homens (34%) apresentaram IE associada a DV (Grupo 2) e 7 homens (7,9%) tinham somente DV (Grupo 3). A DV foi encontrada em 37/88 pacientes (42%), mas foi a principal causa de IU em apenas 14 pacientes (15,9%). Não houve diferença estatisticamente significativa entre os valores das médias do "ICIQ-UISFs" entre os grupos 1, 2 ou 3 (p> 0,05). Os sintomas de incontinência de esforço se correlacionaram com o diagnóstico urodinâmico de IE (r = 0,59), e as queixas de urgência miccional se correlacionaram com a presença de hiperactividade do detrusor na avaliação urodinâmica (r = 0,37), entretanto apesar da correlação encontrada, os sintomas não foram capazes de identificar a principal causa da UI . CONCLUSÃO: A etiologia da UI após a PR não pode ser previsto pelo escore de sintomas obtidos através do "ICIQ-UISF". Os sintomas de perda urinária as manobras de estresse e de urgência miccional estão relacionados a presença de IE e hiperatividade detrusora na avaliação urodinâmica, entretanto estes sintomas não conseguem identificar com segurança qual é o principal fator da IU após a PR.O teste urodinâmico continua sendo o padrão ouro para avaliar a etiologia da IU após a PR.

Obesity and smoking: Are they modulators of cough intravesical peak pressure in stress urinary incontinence?

PURPOSE: SUI (Stress Urinary Incontinence) results from sudden increases in intravesical peak pressures exceeding urethral resistance leading to involuntary urine loss. Obesity and smoking are well established reversible risk factors for SUI and may alter intravesical peak pressures. BMI, smoking status, and other clinical factors were studied to determine their relationship to CIPP (maximal Intravesical Peak Pressures generated by Cough) in SUI complaining women. MATERIALS AND METHODS: Three hundred nineteen women complaining of SUI were evaluated with medical history and urodynamics. Age, parity, comorbidities, previous surgery, BMI and history of smoking were obtained. The maximal intravesical peak pressures generated by cough (CIPP) and cough leak point pressure (CLPP) were acquired. Univariate and multivariate analysis were conducted. RESULTS: Current smokers and former smokers had similar CIPP (170cmH2O and 170cmH2O; p = 0.5, respectively); Those individuals who had never smoked had significantly lower CIPP (140cmH2O; p = 0.000 and p = 0.009 respectively). BMI was directly related to CIPP (r = 0.41; p = 0.000). Vaginal deliveries (r = -0.15, p = 0.08) and diabetes (r = 0.15, p = 0.016) were also directly related to CIPP on univariate analysis. Only smoking status (p = 0.000) and BMI (p = 0.000) were independently significantly related to CIPP on multivariate analysis. CONCLUSIONS: Obesity and smoking showed increased CIPP (maximal Intravesical Peak Pressures generated by Cough). While reduced BMI is related to lower CIPP, smoking cessation does not appear to diminish CIPP. These findings suggest that weight loss may reduce incontinence by CIPP modulation. However, the benefits of smoking cessation without additional lifestyle modification, may have no benefit to improve urinary incontinence.

Estudo comparativo da capacidade de contração do assoalho pélvico em atletas de voleibol e basquetebol / Comparative study of the capacity of pelvic floor contraction in volleyball and basketball athletes

As modalidades esportivas de alto impacto podem produzir um aumento exagerado e frequente na pressão intra-abdominal, um dos fatores desencadeadores da incontinência urinária de esforço (IUE) em atletas. Foi realizado um estudo com 20 atletas, sendo 10 de basquetebol e 10 de voleibol, do tipo quantitativo, observacional, transversal e comparativo, no qual foi comparada a capacidade de contração do assoalho pélvico (AP) entre atletas de voleibol e basquetebol, e então correlacionadas com sintomas de IUE. A avaliação das atletas foi composta por um questionário, a avaliação funcional do assoalho pélvico (AFA) e avaliação da capacidade de contração do AP através do Biofeedback Eletromiográfico Fênix®. Após a avaliação, não foi observada diferença estatisticamente significante com relação à capacidade de contração do assoalho pélvico entre atletas de basquetebol e voleibol; porém, ambas as modalidades apresentaram atletas com relatos de perda involuntária de urina mediante esforço físico, com maior proporção no grupo de atletas de basquetebol.

High impact sports can produce exaggerated and frequent increase of the intra-abdominal pressure, one of the triggering factors of stress urinary incontinence (SUI) in athletes. The study was carried out with 20 athletes; 10 of these being basketball and 10 volleyball athletes. The study was quantitative, observational, cross on and comparative, in which the ability of contraction of the pelvic floor (PF) among athletes in volleyball and basketball was compared, and later correlated with symptoms of stress urinary incontinence. The evaluation of the athletes was composed of a questionnaire, the functional evaluation of the pelvic floor (FEPF) and assessment of the ability of contraction of the PF through the Phoenix Electromyographic Biofeedback®. Statistically significant differences were not observed after the evaluation regarding the ability of contraction of the pelvic floor between basketball and volleyball athletes, but both groups presented athletes with reports of involuntary loss of urine due to physical exertion, with higher proportion in the group of basketball athletes.

Posicionamento da pelve e lordose lombar em mulheres com incontinência urinária de esforço / Pelvis position and lumbar lordosis in women with stress urinary incontinence

O objetivo do estudo foi averiguar possível associação do posicionamento da pelve e da lordose lombar com incontinência urinária por esforço (IUE), por meio de análise fotogramétrica e radiográfica, comparando também os resultados dos dois métodos. Vinte mulheres com IUE foram comparadas a 20 mulheres controles, sem IU; de todas foram tiradas fotografias da região pélvica, onde se analisaram a simetria da pelve anterior e posterior, a lordose lombar (LL) e a báscula de pelve (BP). Na radiografia da coluna lombossacra foram mensurados os ângulos de Cobb, o lombossacro e de inclinação sacral. As comparações dos resultados foram tratadas estatisticamente, com nível de significância de 5%. Não foi encontrada diferença significativa na simetria da pelve ou na lordose lombar comparando-se os dois grupos, à exceção do ângulo BP (-3,69 nas incontinentes e -8,18, nas controles), indicando tendência à anteversão pélvica nessas últimas. Dos demais ângulos não houve diferenças entre os grupos, tendo as mulheres com IUE apresentado tantas alterações na pelve quanto as mulheres continentes, sugerindo que a LL e o posicionamento da pelve não influem na IUE. Na comparação dos dados obtidos por radiografia e fotogrametria, no conjunto da amostra, apenas uma fraca correlação foi encontrada entre a medida da lordose lombar por fotogrametria e a do ângulo sacral por radiografia.

The purpose here was to search for associations between lumbar lordosis and pelvis position, on the one hand, and stress urinary incontinence (SUI) on the other, by means of photogrammetry and radiography, also comparing results obtained by the two methods. Twenty women with SUI were compared to 20 continent controls. Lumbar lordosis (LL), pelvis symmetry, and pelvic bascule (PB) were analysed on the photographs taken; on radiographies of the lumbosacral spine, Cobb, lumbosacral and sacral inclination angles were measured. Comparisons between results were statistically analysed and significance level set at 5%. No significant differences were found between groups as to pelvis symmetry or LL, but a difference was found in the PB angle (-3.69 in SUI group, -8.18 in control), pointing to a trend to pelvis anteversion in the latter. As to the other angles, no differences were found between the groups; both women with SUI and controls presented as many pelvic changes, thus suggesting that LL and pelvis position do not interfere in SUI. The comparison between data of the total sample obtained by photogrammetry and radiography showed only a poor correlation between LL as measured by photography and the sacral angle as measured by radiography.

Incontinência urinária oculta: diagnóstico e tratamento / Occult urinary incontinence: diagnosis and treatment

A incontinência urinária oculta (IUO) pode ocorrer em casos avançados de prolapso dos órgãos pélvicos (POP), quando este acarreta compressão externa ou acotovelamento da uretra e, dessa forma, encobre a incontinência urinária de esforço (IUE). Contudo, uma vez corrigido o prolapso, a paciente pode tornar-se incontinente. O diagnóstico de IUO pode ser feito com a redução do POP utilizando pessário, tampão vaginal, espéculo de Sims, pinças diversas com gazes e/ou redução digital durante o estudo urodinâmico. A identificação pré-operatória dessas pacientes pode possibilitar o tratamento concomitante da afecção, evitando um segundo procedimento cirúrgico. Alguns autores recomendam a cirurgia para correção de IUE em pacientes com prolapso estágios III e IV, enquanto outros preconizam avaliar a perda urinária após o tratamento do POP. Todavia, não está bem determinado qual o melhor método para diagnosticar a IUO e se os riscos superam o potencial benefício da cirurgia profilática para IUE nestes casos. Assim, nosso objetivo foi discutir os aspectos controversos relacionados ao diagnóstico e tratamento da IUO.

Occult urinary incontinence (OUI) can occur in advanced cases of pelvic organ prolapse (POP) when it causes external urethral compression or urethral kinking and, therefore, it hides the stress urinary incontinence (SUI). When the POP is surgically corrected, the patient may become incontinent. The diagnosis of OUI is made by the reduction of the POP using pessary, vaginal pack, Sims? speculum, several tweezers with gauze and/or digital reduction during urodynamic investigation. Preoperative identification of these patients allows the treatment of this pathology at the same moment of POP treatment avoiding a second surgery. Some authors recomend a prophylatic anti-incontinence surgery in patients with SUI stage III or IV and others prefer to evaluate urinary incontinence after POP repair. However, it is not determined which is the best method to diagnose OUI, as well as if the risks overtake the potencial benefits of SUI procedure in these cases. The objective of this article was to discuss the controversial aspects of diagnosis and the treatment of OUI.