RESUMO
ABSTRACT Introduction: This study aimed to evaluate the effects of transobturator tape (TOT) on overactive bladder (OAB) symptoms and quality of life. Materials and Methods: Patients with stress-predominant mixed urinary incontinence (MUI) who had undergone TOT procedures were considered candidates for this research. Preoperative assessment included anamnesis, pelvic examination, cough stress test (CST), and validated symptom severity and quality of life (QoL) questionnaires. The primary outcome, improvement and cure rates of OAB symptoms were determined based on the patient's baseline scores in symptom-related questions in OAB-V8. Secondary outcomes included the success rates of SUI, changes in the QoL score and patient satisfaction rates. Results: A total of 104 patients were included in the study. Sixty-two patients underwent TOT placement alone, and 42 patients underwent TOT placement along with prolapse surgery. The mean follow-up period of the patients was 30.47 months range: 13-52 months. At the first-year follow-up, 52 patients (50.0%) and 59 patients (56.7%) reported cure in preoperative urgency and urgency incontinence, respectively. The objective and subjective cure rates were 96.2% and 56.7%, respectively. A total of 80.7% of the cases had a 15-point improvement in QoL scores. Conclusions: MUS is not only a gold standard treatment in SUI but also presents as a promising treatment modality in stress-dominant MUI. Although the improvement rates of OAB symptoms significantly decrease over time, QoL and patient satisfaction rates remain higher than any other treatment in this patient group at the third-year follow-up.
Assuntos
Humanos , Feminino , Adulto , Idoso , Adulto Jovem , Qualidade de Vida , Incontinência Urinária por Estresse/cirurgia , Bexiga Urinária Hiperativa/cirurgia , Incontinência Urinária de Urgência/cirurgia , Slings Suburetrais , Período Pós-Operatório , Fatores de Tempo , Incontinência Urinária por Estresse/fisiopatologia , Estudos Prospectivos , Inquéritos e Questionários , Análise de Variância , Seguimentos , Resultado do Tratamento , Satisfação do Paciente , Estatísticas não Paramétricas , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Período Pré-Operatório , Medidas de Resultados Relatados pelo Paciente , Pessoa de Meia-IdadeRESUMO
Objective To improve the model for establishment and evaluation of detrusor overactivity in female Wistar rats. Materials and Methods We ligated the perineal urethra of female Wistar rats and then performed filling cystometry. The probability of detrusor overactivity, bladder capacity, peak voiding pressure and histological changes were investigated. Results Detrusor overactivity ratio of the obstruction group was 32.4%. Bladder capacity increased from 0.273 ± 0.036mL in control group to 0.89 ± 0.19mL in detrusor overactivity group (P < 0.001), and peak voiding pressure increased from 45.9 ± 4.1 cm.H2O to 63.5 ± 17.4cm.H2O (P = 0.007). For obstruction group, compared to no detrusor overactivity rats, detrusor overactivity rats had higher bladder capacity (0.89 ± 0.19mL versus 0.43 ± 0.09mL, P < 0.001) and higher peak voiding pressure (63.5 ± 17.4cm.H2O versus 44.8 ± 6.2cm.H2O, P = 0.005). Detrusor overactivity rats were classified according to peak voiding pressure (49.2 ± 4.2cm.H2O versus 80.8 ± 7.1cm.H2O, P < 0.001). Moreover, bladder weight increased significantly in detrusor overactivity rats (P = 0.003, P = 0.028) and detrusor histological hypertrophy was observed. Conclusions Ligating perineal urethra and filling cystometry with intra-urethral cannula approach is a simple and easily reproducible method to establish and evaluate the model of detrusor overactivity in rats. .
Assuntos
Animais , Feminino , Modelos Animais de Doenças , Obstrução Uretral/etiologia , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/cirurgia , Ligadura , Pressão , Ratos Wistar , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Tempo , Cateterismo Urinário , Urodinâmica , Obstrução Uretral/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologiaRESUMO
OBJECTIVE: Our purpose was to determine if women with mixed urinary incontinence (MUI) and urodynamic detrusor overactivity (DO) have less improvement in urinary symptoms after pubovaginal sling surgery (PVS), compared to MUI without DO. MATERIALS AND METHODS: Women with preoperative MUI symptoms prior to PVS were identified through retrospective review. DO was defined as a symptomatic 5 cm H20 detrusor pressure or greater rise during urodynamics. MUI patients with and without DO before PVS were divided into Groups A and B, respectively. All patients had returned a completed Urogenital Distress Inventory 6 (UDI-6) questionnaire and a 3-day diary of pad usage before surgery and at each postoperative visit. Study endpoints included change in total UDI-6 score, and change in number of pad use/day after PVS. RESULTS: 73 patients were identified, 31 in Group A and 42 in Group B. Mean follow-up after PVS was 15 and 16 months, respectively (p = 0.59). Preoperative total UDI-6 scores were 11.8 and 12.7 (p = 0.30) for Group A and B. Mean changes in total UDI-6 after PVS were - 8.0 and - 10.2 (p = 0.030), respectively. After PVS, both groups reported similar mean reduction in pad/day usage from preoperative baseline (-2.57 vs. --2.49, p = 0.83). There were no differences between the groups when comparing demographic, urodynamic, or operative data. CONCLUSION: MUI patients had improved continence and quality of life after PVS. However, MUI patients with DO had less improvement in UDI-6 scores after PVS, despite a similar reduction to pad use/day.