Occult urinary incontinence treatment: systematic review and meta-analysis-brazilian guidelines / Tratamento de incontinência urinária oculta: revisão sistemática e metanálise - diretrizes brasileiras

Abstract Objective To evaluate if performing anti-incontinence procedures during surgical anterior and/or apical prolapse correction in women with asymptomatic urinary incontinence (UI) may prevent stress urinary incontinence (SUI) postoperatively. Methods We have performed a systematic review of articles published in the PubMed, Cochrane Library, and Lilacs databases until March 31, 2016. Two reviewers performed the data collection and analysis, independently. All of the selected studiesweremethodologically analyzed. The results are presented as relative risk (RR), with a 95% confidence interval (CI). Results After performing the selection of the studies, only nine trials fulfilled the necessary prerequisites. In the present review, 1,146 patients were included. Altogether, the review included trials of three different types of anti-incontinence procedures. We found that performing any anti-incontinence procedure at the same time of prolapse repair reduced the incidence of SUI postoperatively (RR = 0.50; 95% CI: 0.28-0.91). However, when we performed the analysis separately by the type of anti-incontinence procedure, we found different results. In the subgroup analysis with midurethral slings, it is beneficial to perform it to reduce the incidence of SUI (RR = 0.08; 95% CI: 0.02-0.28). On the other hand, in the subgroup analysis with Burch colposuspension, there was no significant difference with the control group (RR = 1.47; 95% CI: 0.28-7.79]). Conclusion Performing any prophylactic anti-incontinence procedure at the same time as prolapse repair reduced the incidence of SUI postoperatively. The Burch colposuspension did not show any decrease in the incidence of SUI postoperatively.

Resumo Objetivo: Avaliar se a realização de procedimentos anti-incontinência durante a correção cirúrgica do prolapso anterior e/ou apical em mulheres assintomáticas para incontinência urinária (IU) pode prevenir a incontinência urinária de esforço (IUE) no pós-operatório. Métodos: Foi realizada uma revisão sistemática dos artigos publicados nas bases de dados PubMed, Cochrane Library e Lilacs até o dia 31 de março de 2016. Dois revisores realizaram a coleta e a análise de dados, de forma independente. Todos os estudos selecionados foram analisados metodologicamente. Os resultados estão apresentados como risco relativo (RR), com 95% de intervalo de confiança (IC). Resultados: Após a seleção do estudo, apenas nove estudos preencheram os prérequisitos necessários. Nesta revisão, 1.146 pacientes foram incluídos. No total, a revisão incluiu ensaios de três tipos diferentes de procedimentos anti-incontinência. Descobrimos que realizar qualquer procedimento anti-incontinência ao mesmo tempo que o reparo do prolapso reduziu a incidência de IU no pós-operatório (RR = 0,50; IC 95%: 0,28-0,91). No entanto, quando fizemos a análise separadamente pelo tipo de procedimento antiincontinência, encontramos resultados diferentes. Na análise de subgrupos com slings miduretrais, é benéfico realizá-lo para reduzir a incidência de IU (RR = 0,08; IC 95%: 0,02- 0,28). Por outro lado, na análise de subgrupo com colposuspensão de Burch, não houve diferença significativa com o grupo controle (RR = 1,47; IC 95%: 0,28-7,79]). Conclusão: A realização de qualquer procedimento profilático anti-incontinência ao mesmo tempo que o reparo do prolapso reduziu a incidência de IUE no pós-operatório. A colposuspensão de Burch nãomostrou diminuição na incidência de IUE no pós-operatório.

Tension-free vaginal taping in Pakistani women with stress urinary incontinence

Objective: To evaluate the effectiveness and determine the peroperative and postoperative complications of tension-free vaginal tape [TVT] sling for urinary stress incontinence [USI] and contributing factors to complications

Study Design: Descriptive study

Place and Duration of Study: Kidney Centre Postgraduate Institute, Karachi, from January 2009 to December 2010

Methodology: One hundred consecutive patients underwent TVT as per Ulmsten Technique for urinary stress incontinence and patients were followed for 3 years. The subjective cure rate and improvement rate was based on the international consultation on incontinence questionnaire for evaluating female lower urinary tract symptoms [ICIQ - PLUS]

The subjective cure was defined as the statement of the woman not experiencing any loss of urine upon physical stress and improvement rate was defined as occasional leakage during stress

Results: Patients at 1- and 3-year up follow-up showed subjective cure rate and improvement rate of 98% and 2%, and 95% and 5%, respectively. Mean operative time was 32 minutes. UTI was the commonest complication observed in 7 [7%] patients

Women with voiding dysfunction preoperatively had 9-fold odds of difficulty postoperatively [0<0.001]

There was a significant association of preoperative symptoms of overactive bladder [OAB] with the same postoperative symptoms [p<0.0001]

Preoperative hysterectomy had a significant [p< 0.005] 15.63 fold odds of intraoperative bladder perforation

Conclusion: Tension-free vaginal tape sling is an efficacious and secure surgical procedure for the treatment of urinary stress .incontinence. Bladder perforation, voiding dysfunction, supra-pubic discomfort and UTI are the commonest complications. Risk factors for perforation include preoperative hysterectomy. Pre-existing voiding dysfunction and UTI lead to persistent similar postoperative problems

Patients lost to follow-up after midurethral sling surgery: How are they?

Purpose To assess the ratio of patients lost to follow-up (FU) after midurethral sling surgery, to evaluate their success rate and current status, and to identify the reasons for FU loss. Materials and Methods Two-hundred thirty-eight patients who received trans-obturator tape (TOT) surgery were reviewed. For patients lost to FU within 3 months, Stamey’s outcome questionnaire and questions regarding the reasons for FU loss were submitted via phone interview. Results One hundred forty-three (60.1%) patients (FU loss group) were lost to FU within 3 months postoperatively. In the FU loss group, phone interviews were conducted with 117 (81.8%) patients. Aside from the urgency rate (59.3% vs. 72.3%, p=0.049), there were no significant statistical differences in preoperative profiles between two group. The success rate of the FU loss group (80.3%, 94 of 117 patients) was lower than that of the FU group (95.8%, 91 of 95 patients) (p=0.001). The success rates in the FU loss group with mixed urinary incontinence (MUI) were significantly lower than in the FU group with MUI. As for the reason for FU loss, 74 patients (62.7%) were lost due to incontinence improvement, 19 patients (16.1%) cited personal problems, and 5 patients forgot the next follow-up date. Only 10 patients gave up further treatment despite their persisting incontinence. Conclusions In our study, more than half of patients were lost to follow-up after midurethral sling surgery. The FU loss group showed a lower surgical success rate, particularly with MUI. Close FU is recommended for better consultation of patients’ incontinence. .

comparison between TVT and TVTO as regards Safety

The aim of the study is to compare between the efficacy and Safety of the retropubic tension-free vaginal tape [TVT] and the transobturator suburethral Sling [TVT-O] in the surgical treatment of stress urinary incontinence infemales. a prospective randomized study. Urogynaecology unit - Department of Gynaecology and Obstetrics. Ahmad Maher Teaching Hospital. 120 cases were assigned to the study. Between the first of March 2003 and end of November 2006, 60 patients underwent TVT by the retropubic approach and 60 patients underwent TVT-O through the transobturator approach for surgical treatment of stress urinary incontinence. Patients with Primary urodynamic stress incontinence and urethral hypermobility were subjected to surgical treatment by either TVT or TVT-O. The pre-operative and post-operative protocol included the following: a detailed urogynsecological history, a thorough physical examination, urine analysis, a stress test with a filled bladder [300 ml], urodynamic evaluation, cystometry and urethral pressure profile. The outcome measures were the rate of success and the occurrence of complications. Intra-operative data were collected as those of post-operative course. The outcome of surgical treatment was estimated using the same tools before surgery. There was no difference between the two groups as regards pre-operative, demographic characteristics, clinical and uro-dynamic parameters. The rate of success was similar in both group 91.6% in the TVT and 90% in the TVT-O group. There was an incidence of 4% bladder perforation in TVT group compared with none in the TVT-O group. The mean operative time 35 min versus 20 min was significantly higher in TVT group .However more patients had wound aching/pain in the TVT-O group 10 versus 2 in TVT group. It was concluded that both procedures are equally effective for the treatment of female urinary incontinence, while TVT-O is a simpler procedure with a less rate of complications

Male slings for postprostatectomy urinary incontinence

Incontinence after prostatectomy for benign or malignant disease is a well-known and often feared outcome. The objective of this study was to evaluate the role of bulbourethral slings in the treatment of post prostatectomy incontinence, as being a fast, less expensive and reliable method in comparison to other modalities. This study was conducted on 40 patients in the period from May 2003 till October 2005 [median 12 months], who have underwent prostatectomy, and have established total or severe stress incontinence after a period of at least 6 months postoperatively. All patients included in the study were subjected to full history taking, physical examination, laboratory preoperative investigations, radiological study in the form of ascending urethrocystography, micturating films, and Urodynamic study including uroflowmetry, filling cystometry and pressure flow study, urethral pressure profile and estimation of the abdominal leak point pressure. EMG was done for all patients. Uretherocystoscopy was used to exclude anastomotic or urethral stricture. All patients underwent sling operation and were divided into two groups. In Group 1 Slings were applied by a perineal approach and in Group 2 Slings were applied by a combined abdomino-perineal approach using synthetic material or rectus sheath: Exclusion criteria included; urethral strictures, vesical causes including atonic bladder causing urinary retention with overflow, or overactive bladder due to either a neurogenic cause or infection leading to bladder irritability and uninhibited bladder contractions. A total of 40 patients 50 to 78 years old [median 68 years] underwent male sling placement. The mean operative time was 45 minutes without confrontation with intraoperative complications. Postoperative complication rate was 42.5%. This rate can be further divided according to the fate of complications into permanent [irreversible] being about 5% of the total complications and 37.5% of the total complication being temporary [reversible]. The total cure rate in the study was an average of 67.5.% and the total improvement rate was an average of 12.5%, giving a mean cure/ improvement value of 80%. The overall failure rate was 20% of patients involved. The male bulbourethral sling is a quick, safe, simple and effective option in the treatment of postprostatectomy incontinence, and considered to be an alternative to other methods such as artificial urinary sphincter, periurethral injection. Yet longer follow up and further experience will be needed to establish its long-term efficacy