Effects of Pure Barre Exercise on Urinary Incontinence Symptoms: A Prospective Observational Cross-Sectional Study.

IMPORTANCE: Pure Barre is a form of physical exercise using low-impact, high-intensity, pulsatile isometric movements that may serve as a treatment option for urinary incontinence. OBJECTIVE: The objective of this study was to measure the effects of the Pure Barre workout on urinary incontinence symptoms and sexual function. STUDY DESIGN: This was a prospective observational study of new, female Pure Barre clients with urinary incontinence. Eligible participants completed 3 validated questionnaires at baseline and at follow-up after 10 Pure Barre classes within 2 months. Questionnaires included the Michigan Incontinence Symptoms Index (M-ISI), the Pelvic Floor Distress Inventory-20, and the Female Sexual Function Index-6. Matched differences in domain questionnaire scores between baseline and follow-up were analyzed. RESULTS: All questionnaire domains significantly improved for all 25 participants after 10 Pure Barre classes. Median M-ISI severity domain scores decreased from 13 (interquartile range, 9-19) at baseline to 7 at follow-up (interquartile range, 3-10; P < 0.0001). Mean ± SD M-ISI urgency urinary incontinence domain scores decreased from 6.40 ± 3.06 to 2.96 ± 2.13 ( P < 0.0001). Mean ± SD M-ISI stress urinary incontinence scores decreased from 5.24 ± 2.71 to 2.48 ± 1.58 ( P < 0.0001). Mean ± SD Urinary Distress Inventory domain scores decreased from 42.17 ± 17.15 to 29.67 ± 13.73 ( P < 0.0001). Matched rank sum analysis indicated increasing Female Sexual Function Index-6 scores from baseline to follow-up ( P = 0.0022). CONCLUSION: The Pure Barre workout may be an enjoyable, conservative management option that improves symptoms of urinary incontinence and sexual function.

Comparison of Urinary Tract Infection Incidence Following Intradetrusor OnabotulinumtoxinA in Office Versus Operating Room Settings.

IMPORTANCE: Urinary tract infection (UTI) is a known complication of intradetrusor onabotulinumtoxinA (BTX) injection. However, whether administering intradetrusor BTX in different clinical settings affects the risk of postprocedural UTI has not been investigated. OBJECTIVES: The objective of this study was to assess differences in the incidence of postprocedural UTI in women who received intradetrusor BTX in an outpatient office versus an operating room (OR). STUDY DESIGN: We performed a retrospective chart review of intradetrusor BTX procedures at a single institution between 2013 and 2020. Demographic data, comorbidities, and perioperative data were abstracted. The primary outcome was UTI defined as initiation of antibiotics within 30 days following BTX administration based on clinician assessment of symptoms and/or urine culture results. Univariate analysis of patients with and without UTI was performed. RESULTS: A total of 446 intradetrusor BTX procedures performed on female patients either in an outpatient office (n = 160 [35.9%]) or in an OR (n = 286 [64.1%]) were included in the analysis. Within 30 days of BTX administration, UTI was diagnosed after 14 BTX procedures (8.8%) in the office group and 29 BTX procedures (10.1%) in the OR group ( P = 0.633). De novo postprocedural urinary retention occurred in more women who were treated in the office than in the OR (13 [9.6%] vs 3 [1.3%], P < 0.001). CONCLUSIONS: Selecting the appropriate setting for BTX administration is dependent on multiple factors. However, the clinical setting in which intradetrusor BTX is administered may not be an important factor in the development of postprocedural UTI, and further research is warranted.

Effect of Morbid Obesity on Midurethral Sling Efficacy for the Management of Stress Urinary Incontinence.

OBJECTIVES: The aim of our study was to assess midurethral sling (MUS) failure rate in the morbidly obese (body mass index [BMI] ≥40 kg/m) population as compared with normal-weight individuals. Our secondary objective was to assess the difference in complication rates. METHODS: This is a retrospective cohort study. We included all patients who underwent a synthetic MUS procedure from January 1, 2008, to December 31, 2015, in our health system. Failure was defined as reported stress urinary incontinence symptoms or treatment for stress urinary incontinence. Variables collected were BMI; smoking status; comorbidities; perioperative (≤24 hours), short-term (≤30 days), and long-term (>30 days) complications; and follow-up time. Statistics include analysis of variance, χ test, logistic regression, Kaplan-Meier method, and Cox regression. RESULTS: There were 431 patients included in our analysis. Forty-nine patients were in class 3 with a BMI mean of 44.9 ± 5.07 kg/m. Median follow-up time was 52 months (range, 6-119 months). Class 3 obesity (BMI ≥40 kg/m) was the only group that had an increased risk of failure when compared with the normal-weight group (P = 0.03; odds ratio, 2.47; 95% confidence interval, 1.09-5.59). Obesity was not a significant predictor of perioperative, short-term, or long-term postoperative complications (P = 0.19, P = 0.28, and P = 0.089, respectively) after controlling for other comorbidities. CONCLUSIONS: Patients in the class 3 obesity group who are treated with an MUS are 2 times as likely to fail when compared with those in the normal-weight category on long-term follow-up with similar low complication rates.

Short-term efficacy and complications of posterior intravaginal slingplasty.

This study was performed to evaluate the efficacy and complications of the posterior intravaginal slingplasty (IVS). A retrospective chart review was performed. Ninety IVS procedures were performed from January 2004 to June 2005. The group consisted of predominantly nonsmoking, Caucasian, postmenopausal women with a median age of 62 years and a median parity of 3. The mean follow-up was 33 +/- 23.2 weeks with a median of 31.9 weeks. There were no intraoperative bladder, bowel, or vascular injuries. Overall, 11 out of 90 patients developed recurrent or de novo prolapse; 4.4% of these had recurrent apical prolapse. There was a 17.8% incidence of mesh erosion. Only 1 of the 11 patients with recurrent prolapse had concomitant mesh erosion. The procedure demonstrated an unacceptably high erosion rate. The adoption of newer mesh techniques based on the slingplasty concept or the use of the multifilament polypropylene tape should be scrutinized.

Suture erosion and wound dehiscence with permanent versus absorbable suture in reconstructive posterior vaginal surgery.

OBJECTIVE: This study was undertaken to determine the incidence of wound disruption after reconstructive posterior vaginal surgery with braided permanent versus absorbable suture. STUDY DESIGN: A retrospective cohort study of women undergoing posterior vaginal surgery. Outcomes included suture erosion, wound dehiscence, and additional surgical procedures. RESULTS: Ninety-nine procedures were performed with permanent sutures, followed by 111 with absorbable sutures. There were no differences in demographics or comorbidities between patient groups. Suture erosion/wound dehiscence occurred in 31.3% of the permanent suture group versus 9% of the absorbable suture group (P = .003, odds ratio [OR] = 7.5, 95% CI 2-28). The need for additional surgical intervention was 16.1% among permanent suture group versus no patients with absorbable suture. Performing a concomitant anal sphincteroplasty with permanent sutures significantly increased the incidence of suture erosion (P = .003, OR = 4.7, 95%CI 1.7-13.3). CONCLUSION: Permanent sutures increase the incidence in wound disruption and the need for additional surgical intervention in posterior colporrhaphy and anal sphincteroplasty.