Acute post-partum urinary retention: analysis of risk factors, a case-control study.

PURPOSE: The aim of this retrospective case-control study was to assess clinical factors that can predict the occurrence of post-partum urinary retention (PPUR) and evaluate their influence as independent risk factors. METHODS: Between January 2008 and December 2010, 11,108 vaginal deliveries were performed. 105 women who suffered from PPUR were detected by retrospective data analysis. PPUR was defined as the inability to have spontaneous micturition within 6 h after vaginal delivery. RESULTS: Data analysis detected six risk factors for PPUR on-set: primiparity, vacuum-assisted delivery, uterine fundal pressure during the second stage of labor (Kristeller's maneuver), a longer second stage of labor, medio-lateral episiotomy, initial higher dose of epidural analgesia. Nevertheless, logistic regression showed that only vacuum-assisted delivery and Kristeller's maneuver were significant independent risk factors (P = 0.001 and 0.009, respectively). CONCLUSIONS: Our study identified these risk factors as the cause of mechanical and neurological damage, which can lead to post-partum urinary retention. By early diagnosis, a prompt and appropriate management of PPUR can be established in order to assure a rapid return to normal bladder function after vaginal delivery.

Short-term outcomes with the Ajust™ system: a new single incision sling for the treatment of stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: To evaluate the efficacy and safety of the minimally invasive Ajust™ system in the treatment of stress urinary incontinence. METHODS: This was a prospective multicentre study. All patients with primary urodynamic stress urinary incontinence were prospectively selected to receive the Ajust™ procedure. The International Consultation on Incontinence-Short Form (ICI-SF), Women Irritative Prostate Symptoms Score (W-IPSS), PGI-S, and PGI-I questionnaires were used to evaluate the impact of incontinence and voiding dysfunction on QoL and to measure patient's perception of incontinence severity and improvement. RESULTS: From January 2009 to October 2009, 111 consecutive subjects were enrolled in the study. At 6 months, 102 were available for outcomes analysis. The subjective and objective cure rates were 85.7% and 91.4%, respectively. The ICI-SF and W-IPSS questionnaires showed a statistical significant improvement in symptom scores. CONCLUSIONS: In the short-term follow-up, the Ajust™ system was effective in restoring continence in more than 85% of subjects with a highly significant improvement in QoL.

Prospective clinical and functional results of combined rectal and urogynecologic surgery in complex pelvic floor disorders.

BACKGROUND: The aim of this prospective study was to evaluate the results of combined rectal and urogynecologic surgery in women with associated obstructed defecation, urinary incontinence, or genital prolapse. METHODS: One hundred forty-two selected patients with obstructed defecation in isolation or associated with urinary incontinence, enterocele, or genital prolapse were consecutively operated on by stapled transanal rectal resection alone or associated with transobturator tape, vaginal repair of the enterocele, or vaginal hysterectomy, respectively, and followed up by clinical controls and defecography. RESULTS: At 2 years, all symptom, quality-of-life, and defecographic parameters had significantly improved in all groups (P < .001). The association with hysterectomy showed higher risk for severe complications, longer operative time, hospital stay, and time of inability (P < .001). Recurrence of urinary incontinence was observed in 3 of 24 patients, while 2 of 21 showed residual vaginal prolapse. CONCLUSION: The combination of rectal and urogynecologic surgery is effective, with higher morbidity in the association with vaginal hysterectomy. Randomized trials comparing surgery in 1 and more stages and longer follow-up are necessary for a definitive conclusion.

Tension-free vaginal tape (TVT) for treatment of stress urinary incontinence in women with low-pressure urethra.

OBJECTIVE: To assess the results of TVT in patients with urinary stress incontinence, urethral hypermobility, and low-pressure urethra. STUDY DESIGN: We retrospectively analysed 265 consecutive women who underwent a TVT procedure for urodynamic stress urinary incontinence over a 31-month period. Women were divided into two groups depending on their preoperative maximum urethral closure pressure (MUCP). Group 1 (61 women with MUCP20 cm H2O. Subjective and objective outcome data were assessed from routine postoperative visits. Office and hospital records were reviewed to check patients' characteristics, intraoperative findings, and surgical outcomes. RESULTS: Women with low-pressure urethra were older than those with MUCP>20 cm H2O; they were more likely to have had a hysterectomy or anti-incontinence surgery. The mean duration of follow-up was 31 (+/-11) months. Cure rates among patients with low- or normal-pressure urethra were similar (77% and 86%, P=0.70). Nevertheless, the former were more likely to complain of voiding dysfunction. CONCLUSION: TVT is a highly effective treatment even in women with intrinsic sphincter deficiency.

A randomized comparison of tension-free vaginal tape and endopelvic fascia plication in women with genital prolapse and occult stress urinary incontinence.

OBJECTIVE: The purpose of this study was to compare 2 anti-incontinence procedures in women who had severe genital prolapse and potential stress incontinence. STUDY DESIGN: In addition to vaginal reconstructive surgery, 50 patients with stage II or higher anterior defect and a positive stress test result with prolapse reduction received either tension-free vaginal tape or plication of the endopelvic fascia. Preoperative evaluation included history, physical examination, stress test, and urodynamic assessment. Data were analyzed with the Student t test, the Fisher's exact test, and the Wilcoxon signed-rank test. RESULTS: The median follow-up time was similar for both groups, 26 and 24 months. Subjective (96% vs 64%; P=.01) and objective (92% vs 56%; P<.01) continence rates were higher after the tension-free vaginal tape procedure. Time for the resumption of spontaneous voiding, rates of urinary retention, or de novo urge incontinence were similar in the 2 groups. CONCLUSION: Tension-free vaginal tape can be recommended for patients with prolapse and occult stress incontinence.

Prevalence of anal incontinence in women with symptoms of urinary incontinence and genital prolapse.

OBJECTIVE: To investigate risk factors and prevalence of anal incontinence among women with pelvic floor dysfunctions. METHODS: We evaluated 881 women with symptoms of urinary incontinence and/or genital prolapse. Each completed a bowel questionnaire and underwent a detailed medical, surgical, obstetric, and gynecologic history, and a pelvic examination. Additional testing, when indicated, included office cystometry or multichannel urodynamic evaluation. Multivariable analysis using logistic regression was used to test the overall significance of all variables significantly associated with anal incontinence, using univariate analysis. RESULTS: A total of 178 women had anal incontinence (20%). These patients were on average older, had a greater body mass index, and had larger birth weight infants than their anal-continent counterparts; 511 were diagnosed with urinary incontinence, and 122 (24%) also had anal incontinence. Women with urinary incontinence were more likely to report anal incontinence events than women continent of urine (24% versus 15%, P =.002). The following associations were found with anal incontinence: infant with birth weight 3800 g or greater (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1, 2.2), rectocele greater than grade 2 (OR 1.9, 95% CI 1.1, 3.3), urinary incontinence (OR 1.9, 95% CI 1.3, 2.8), hemorrhoidectomy (OR 2.7, 95% CI 1.1, 7.0), irritable bowel syndrome (OR 6.3, 95% CI 3.5, 11.5). CONCLUSION: Among women with symptoms of urinary incontinence and pelvic organ prolapse, the prevalence of anal incontinence was 20%. Urinary incontinence and severe rectocele were found to be associated with anal incontinence.