Evaluation of women's sexual quality of life, depression, and sexual functions in the pregnancy and postpartum periods: A multi-centered study.

AIM: This multi-centered, longitudinal, and prospective study aims to identify women's sexual functions, sexual quality of life, and depression and their relationships with each other in the pregnancy and postpartum periods. METHODS: The participating pregnant women (n = 113) were interviewed six times: once in each trimester, and once in the eighth week third month, and sixth month postpartum. This study was conducted in three regions of Turkey including Marmara, Mediterranean, and Central Anatolia regions. Data were collected through the "Socio-demographic Form," "Female Sexual Function Index (FSFI)," Sexual Quality of Life-Female Questionnaire (SQLQ-F), and "Center for Epidemiologic Studies-Depression Scale (CES-D)." While the first interviews were administered face to face, successive ones were administered via phone. RESULTS: The sexual dysfunction rates of the participants were found to be high in the pregnancy and postpartum periods, and their sexual quality of life, which decreased as the pregnancy months progressed, was found to increase significantly with the progress in the postpartum period. The sexual dysfunction increased and sexual quality of life decreased significantly with the increase in depression symptoms in the pregnancy and postpartum periods. When the depressive symptoms decreased especially in the sixth month postpartum, sexual quality of life was also found to increase. CONCLUSIONS: As a result, in the pregnancy and postpartum periods, it is highly important to provide women with diagnosis through a holistic approach by creating available environments to assess their psychological health and sexual functions and refer them to the related physicians when necessary.

Complete labial fusion causing urinary retention in a postmenopausal woman.

Labial fusion or labial adhesion can rarely be encountered postmenopausal and may be diagnosed in advanced stages especially in sexually inactive women. It may be a rare cause of voiding dysfunction or urinary retention. We present a case of a postmenopausal woman presenting with urinary retention due to complete labial fusion. The patient was treated both with topical estrogen and surgical separation of labial fusion. No recurrences developed after the procedure. Topical estrogen treatment may not resolve adhesions in postmenopausal women and invasive procedures may be necessary to resolve urinary retention.

External validation of a model predicting de novo stress urinary incontinence after pelvic organ prolapse surgery.

AIMS: De novo stress urinary incontinence (SUI) may develop after surgical correction of advanced pelvic organ prolapse (POP) in otherwise continent women. Prediction of which women with POP will develop SUI after the prolapse is corrected is difficult. We aimed to externally validate a previously described prediction model for de novo SUI after performing vaginal surgery for POP and to assess its clinical performance when used as a diagnostic test. METHODS: This retrospective cohort study included all continent women with ≥ stage 2 POP according to the POP-Quantification System who underwent reconstructive surgery for symptomatic POP. Surgical correction for prolapse of the anterior and/or apical compartment was performed using native tissue or vaginal mesh repair. Seven parameters of the prediction model including age at surgery, number of vaginal births, body mass index, preoperative stress test, previous continence procedure history, urine leakage associated with a feeling of urgency, and diagnosis of diabetes for each patient was provided from the medical records, and the predicted probability of de novo SUI after POP surgery was calculated. The primary outcome used to validate the prediction model was the presence of SUI 1 year after surgery. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive accuracy. A cut-off point of ≥ 50% was used to evaluate its clinical performance as a diagnostic test. RESULTS: Two hundred twenty-five women were suitable for analysis. The rate of de novo SUI was 5.3%. The predictive accuracy of the model in our population using the area under the ROC curve was 0.56 (95% confidence interval = 0.35-0.77). Its performance as a diagnostic test was poor (positive likelihood ratio = 1.20 and negative likelihood ratio = 0.89). CONCLUSIONS: Our clinical validation of this model showed that it did not have good clinical performance. We need future prospective studies to identify and incorporate additional markers of de novo SUI to improve the prediction capacity.

Contraception counselling during gynecology visit - does a questionnaire help?

OBJECTIVES: Women are at risk of unplanned pregnancy and inappropriate choice of contraception if not given effective contraception counselling. We aimed to understand the contraceptive needs of women, improve effective contraception counselling promoting modern contraception methods during gynecology outpatient visit using a contraception counselling questionnaire. MATERIAL AND METHODS: All reproductive-age women over 18 were given Contraception Counselling Project Form to fill in while in the waiting room. The form consisted of 15 questions evaluating patients' characteristics and contraceptive method used. Physicians evaluated these forms during the examination and an appropriate method was chosen. Forms of pregnant, postmenopausal and sexually inactive patients as well as forms with more than one answer missing were excluded. RESULTS: 778 questionnaires were accepted for evaluation. 340 women (43.8%) used modern contraception, 112 (14.4%) used interrupted coitus, 3 (0.4%) used calendar method. 738 women could be given adequate contraception counselling by the physicians. 215 women among 323 women (66.5%) who did not use modern contraception and did not desire pregnancy, were convinced to use modern contraception and 103 (91.9%) among 112 women who used interrupted coitus for contraception were convinced to use modern contraception. There was a significant relationship between age, education, working state, parity, number and type of delivery, previous OCP usage, resources of contraception and the preferred contraception method. CONCLUSIONS: More than half the women preferred to use modern contraception methods by means of contraception counselling questionnaire. Women's backgrounds significantly affected their choice of contraception method.

Turkish inappropriate medication use in the elderly (TIME) criteria to improve prescribing in older adults: TIME-to-STOP/TIME-to-START.

PURPOSE: To improve prescribing in older adults, criterion sets have been introduced from different countries. While current criterion sets are useful to some extent, they do not meet the need in some European countries. Turkish inappropriate medication use in the elderly (TIME) criteria was planned to meet this need. METHODS: In phase 1, the user friendly sets: STOPP/START version2 and CRIME criteria were combined. National experts composed of geriatricians and non-geriatricians were invited to review and comment. In phase 2, thorough literature review was performed and reference-based revisions, omissions, and additions were made. Explanatory additions were added to some criteria to improve application in practice. In phase 3, all working group members reviewed the criteria/explanations and agreed on the final content. RESULTS: Phase 1 was performed by 49 expert academicians between May and October 2016. Phase 2 was performed by 23 working group academicians between October 2016 and November 2018 and included face-to-face interviews between at least two geriatrician members and one criterion-related specialist. Phase 3 was completed between November 2018-March 2019 with review and approval of all criteria by working group academicians. As a result, 55 criteria were added, 17 criteria were removed, and 60 criteria were modified from the first draft. A total of 153 TIME criteria composed of 112 TIME-to-STOP and 41 TIME-to-START criteria were introduced. CONCLUSION: TIME criteria is an update screening tool that differs from the current useful tools by the interactive study of experts from geriatrics and non-geriatrics, inclusion of practical explanations for some criteria and by its eastern European origin. TIME study respectfully acknowledges its roots from STOPP/START and CRIME criteria. Studies are needed whether it would lead improvements in older adults' health.

Validation of the Turkish version of the ICIQ-FLUTS, ICIQ-FLUTS long-form, ICIQ-LUTS quality-of-life, and ICIQ-FLUTS sexual functions.

AIMS: To enable the use of ICIQ-FLUTS, ICIQ-FLUTS-long-form (ICIQ-FLUTS-LF), ICIQ-LUTS-quality-of-life (ICIQ-LUTSqol), and ICIQ-FLUTS sexual functions (ICIQ-FLUTSsex) in Turkish speaking women, questionnaires were translated into Turkish and validity, reliability, and sensitivity to change were evaluated in women suffering from urinary incontinence (UI). MATERIALS AND METHODS: Permissions were obtained from ICIQ Advisory Board, English versions of the questionnaires were initially translated into Turkish, then back-translated into English and translations were modified according to recommendations of ICIQ Advisory Board. Pilot testing was performed in 10 women. Validity (content/face validity and discriminant validity), reliability (test-retest reliability and internal consistency), and sensitivity to change were evaluated. RESULTS: A total of 58 women with UI completed ICIQ-FLUTS, ICIQ-LUTSqol, and the ICIQ-FLUTS-LF, and 37 who were sexually active completed ICIQ-FLUTSsex. All women completed same questionnaires 15 days later. More than 90% of women thought that the questions were clear, unequivocal, and comprehensive. Missing data were less than 1% indicating adequate content/face validity. Cronbach's α coefficients were .933 (ICIQ-FLUTS), .979 (ICIQ-LUTSqol), .865 (ICIQ-FLUTS-LF), and .863 (ICIQ-FLUTSsex), representing adequate internal consistency. Kappa values and intraclass correlation coefficient for individual items were over 0.70, indicating adequate test-retest reliability. A total of 52 healthy volunteers completed ICIQ-FLUTS and ICIQ-FLUTS-LF, 30 completed ICIQ-LUTSqol, and 30 sexually active healthy volunteers completed ICIQ-FLUTSsex. All four questionnaires had good discriminant validity. Twenty-eight women with UI were analyzed 3 months after treatment. There was significant improvement in four questionnaires in correlation with pre- and posttreatment bladder diary results showing good sensitivity to change. CONCLUSION: Turkish versions of four ICIQ modules were shown valid and reliable and can be used in Turkish speaking women in the evaluation of UI.

Sexual functions and quality of life of women over 50 years with urinary incontinence, lower urinary tract symptoms and/or pelvic organ prolapse.

Sexual function is important for health and quality of life. We evaluated effects of lower urinary tract symptoms (LUTS), urinary incontinence (UI) and coital incontinence, and/or pelvic organ prolapse (POP) on sexual functions and quality of life of women over 50 years of age. Secondary objectives were to compare rate of sexual activity, effects of type of UI and coital incontinence on sexual functions and quality of life among age groups. Female-Sexual-Function-Index (FSFI), Pelvic-Organ-Prolapse/Urinary-Incontinence Sexual-Function-Questionnaire-12 (PISQ-12), and King's-Health-Questionnaire (KHQ) were used for evaluation. Between 2013 and 2018, 1256 women were included. 565 women were 50-59 years (Group 1), 440 were 60-69 (Group 2), 251 were over 70 (Group-3). 763 women (60.7%) suffered from LUTS, 141 women (11.2%) suffered from POP only, and 352 women (28%) suffered from POP + LUTS. Younger women were more sexually active (p = 0.001). FSFI and PISQ-12 scores of women suffering from LUTS, POP + LUTS, and POP only were similar. Lubrication and orgasm scores were worse in Group 3 (p = 0.006 and 0.037). Type of UI did not affect FSFI and PISQ-12 scores. Coital incontinence was correlated with mixed UI in Groups 1 (p = 0.01) and 2 (p = 0.03). There was no association with coital incontinence and type of UI in Group 3. Coital incontinence had adverse effect in FSFI, PISQ-12 scores. In younger women, coital incontinence had an adverse effect on desire and arousal domains. KHQ scores were worse in women having LUTS in comparison to women suffering from POP only (p = 0.00) and were worse in Groups 1 and 2 (p = 0.002 and 0.013). KHQ scores were worse in women suffering from urge or mixed UI (p = 0.00). Coital incontinence had adverse effect in KHQ scores. In conclusion, aging, LUTS, UI, and coital incontinence have detrimental effects on sexual functions and quality of life. Urge or mixed UI have more adverse effects on quality of life. Quality of life is worse in younger women suffering from UI and coital incontinence.

Sexual function and urinary incontinence complaints and other urinary tract symptoms of perimenopausal Turkish women.

Urinary incontinence (UI) and other lower urinary tract symptoms (LUTS) which are quite common among women, have a significant level of impact on women's sexual function. Improving sexual function improves the quality of life. The purpose of this study is to evaluate the relationship between UI complaints with comorbid LUTS and sexual functions in Turkish women. The study is cross-sectional and descriptive. A total of 436 women was included in the study. Data were collected through Personal Information Form, The Bristol Female Lower Urinary Tract Symptom Questionnaire (BFLUTS) and The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The mean total of BFLUTS score was 31.99 ± 11.46, while the mean total of PISQ-12 score was 28.72 ± 6.92 in women. The most common symptoms were identified as storage and incontinence. There was a negative significant correlation between the total PISQ-12 scores and sub-dimension of BFLUTS scores (p < 0.01). Results of the study suggest that sexual function is negatively affected as the severity of symptoms increases.

Investigation of resistin 420 and 62 gene polymorphism in patients with endometrial cancer.

OBJECTIVE: We aimed to assess resistin gene polymorphisms, namely 420C > G and 62G > A and their effect on the risk of endometrial cancer (EC). MATERIALS AND METHODS: Between January 2012 and January 2015, of the total of 183 patients diagnosed with EC, 94 patients were enrolled into the study. Patients with diabetes mellitus, hypertension and history of any other cancer were excluded. To identify the importance of nucleotide polymorphism including 420C > G and 62G > A in the resistin gene, 94 healthy volunteers were included as the control group. RESULTS: Among the Resistin 420 gene polymorphism profiles, 420 GC (47.9%) was the most common gene polymorphism in the EC group. Also, the polymorphism of 420 CC (57.7%, p: 0.002) lead the list in the control group followed by the 420GC (37.5%) polymorphism. Resistin 62 gene polymorphism analysis demonstrated that the 62GC polymorphism was significantly more common in the EC group (p < 0.01), while 62 AG (52.9%) was observed most frequently in the control group bringing about a reduction in the risk of EC (p < 0.01, Odds Ratio:0.37). Additionally, the alleles of 420G+ and 62A + were significantly more common in the EC group and the control group, respectively (p:0.02 and p<:0.01). Multivariate regression analysis revealed that the presence of 420G + allele increased the EC risk 1.99 fold while the presence of 62A + allele was shown to decrease the risk of EC (p<:0.01 Odds Ratio:0.038). CONCLUSION: Our study for the first time had demonstrated that Resistin 420G > C and 62G > A gene polymorphisms play a role in EC development.

Long-Term Follow-Up of a Patient with Spondylodiscitis after Laparoscopic Sacrocolpopexy: An Unusual Complication with a Review of the Literature.

Sacrocolpopexy is the gold standard treatment for apical compartment prolapse with reported success rates of 78-100%. Spondylodiscitis is a rare complication of sacrocolpopexy and includes a spectrum of spinal infections such as discitis, osteomyelitis, epidural abscess, meningitis, subdural empyema, and spinal cord abscess. Here we report a case of spondylodiscitis following laparoscopic sacrocolpopexy with long-term follow-up and discuss management of spondylodiscitis after abdominal sacrocolpopexy, with a review of the literature.

Quality of life and sexual function in obese women with pelvic floor dysfunction.

This prospective study was conducted in the urogynecology and gynecology outpatient clinics of Istanbul Faculty of Medicine from December 2014 to March 2015. The objective was to identify the association between obesity and sexual function and quality of life in women with pelvic floor dysfunction (PFD). A total of 387 sexually active women diagnosed with urinary incontinence and/or pelvic organ prolapse were included and categorized as obese (n = 200) or nonobese (n = 187). Mean body mass indexes were 25.7 ± 2.41 kg/m2 for nonobese women and 34.9 ± 3.92 kg/m2 for obese women. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 total score was significantly lower in obese (27.66 ± 7.12) than in nonobese women (30.18 ± 6.54) (p < .05). Quality of life mean scores were higher in obese women for both the Incontinence Impact Questionnaire total score (67.24 ± 26.8 versus 49.12 ± 27.5) and Urogenital Distress Inventory total score (65.02 ± 21.4 versus 55.07 ± 24.7) (p < .001). Obese women with PFD had symptoms for longer durations, had more frequent urinary incontinence, and worse sexual function and quality of life than nonobese women. Health-care professionals caring for obese women should be aware of the coexistence of obesity and PFD. Future studies should evaluate whether obesity-associated PFD can be reduced through successful weight reduction interventions.

Transobturator Tape Operation for the Treatment of Stress Urinary Incontinence in Postmenopausal Women Aged Over 65 Years.

OBJECTIVE: We compared success rates and complication rates in women aged less then and equal to or more than 65 years who had undergone transobturator tape (TOT) surgery for stress urinary incontinence (SUI). METHODS: This was a retrospective cohort study that included patients who underwent surgery to treat SUI. We separated patients into two groups according to age: younger than 65 years and equal to or older than 65 years. Exclusion criteria were patients with history of incontinence surgery, history of radical pelvic surgery, concomitant pelvic organ prolapse repair, detrusor overactivity, and less than 1 year of postoperative follow-up. The surgical procedures and pre- and postoperative evaluations including urodynamics were performed in a tertiary center. The primary objective was to assess the success rate, patient-reported satisfaction after surgery, and improvement in quality of life (QOL). The secondary outcome the assessment of complications. RESULTS: A total of 123 women, including 53 (43.1%) women aged less than 65 years, and 70 (56.9%) women aged 65 years and over with SUI who underwent TOT surgery between January 2004, and March 2013. After a median follow-up of 52 (IQR 31) months for the older patients and 54 (IQR 42) months for younger patients, cure rates and patients satisfaction rates were similar in both group (82.9 vs. 81.1%, P = 0.81 and 87.2 vs. 88.6%, P = 0.79, respectively). The improvement in QOL, which was confirmed with changes in Kings Health Questionnaire (KHQ) scores, was similar in both the older and younger women -209.6 (IQR 420.9) vs. -191.1 (IQR 379.4), P = 0.62, respectively). Postoperative complications were similar in both age groups. CONCLUSIONS: Transobturator tape surgery in the management of SUI is safe and efficient in improving QOL, has high success and patient satisfaction, and low postoperative morbidity rates even in women aged ≥65 years.

Effects of Transobturator Midurethral Sling Surgery on Sexual Functions: One-Year Follow-Up.

AIM: To evaluate sexual functions of women having stress urinary incontinence (SUI) preoperatively and 6 months and 12 months after undergoing a transobturator tape (TOT) ± pelvic organ prolapse (POP) surgery. METHODS: One hundred-ninety-five women with SUI ± POP were recruited and 150 sexually active women who had clinical ± urodynamic SUI and underwent TOT ± POP surgery were included in this prospective study. Urogynecologic symptoms were evaluated preoperatively, at 6 months, and 12 months by Female Sexual Function Index (FSFI). RESULTS: One hundred fifty women completed the study. Seventy-four underwent TOT-only and 76 underwent TOT + concomitant surgery. Mean total scores of FSFI were 21.7 ± 7.8, 22 ± 8.7, and 22.1 ± 8 in the preoperative period, postoperative 6, and 12 months, respectively. There was significant improvement in desire and total scores in the TOT-only group, whereas there was no significant difference in the TOT + concomitant surgery group except for significant worsening in the lubrication domain. The frequency of sexual intercourse increased while that of coital incontinence decreased after surgery. CONCLUSIONS: In our study, TOT was associated with decrease in coital incontinence and significant improvement in desire. In addition, there was significant improvement in FSFI desire and total scores in the TOT-only group, whereas no significant difference was observed in the TOT + concomitant surgery group except for the worsening of lubrication.

Coping and Help-Seeking Behaviors for Management of Urinary Incontinence.

OBJECTIVES: To describe the coping strategies and help-seeking behaviors of women and men with urinary incontinence (UI). METHODS: In cross-sectional study, 156 women and 106 men Turkish with UI were interviewed using a questionnaire covering 29 questions. RESULTS: It was determined that 50.6% of women and 34.0% of men seek help in first for treatment of UI. Forty eight percent of men consulted a physician in the first 6 months after the UI occurred, 44.9% of women consulted a physician 2-5 years later after the UI occurred. Coping behaviors of both groups for management of the UI were as follows: keeping feet warm, performing hot application to perineum, reducing the amount of daily drinking water, using pad, cloth pads, restricting physical activity, refraining from social life and praying etc. CONCLUSIONS: While women mostly do not prefer to seek medical advice for UI, men tend to go to doctors more often than women. Except for treatment seeking behaviors, both men and women are practicing coping methods for the management of UI such as going frequently to the toilet, keeping feet warm, hot application to perineum etc.

5-year experience in the diagnosis and treatment of occult urinary incontinence in women with pelvic organ prolapse.

OBJECTIVE: Our aim was to analyze our five-year experience in the diagnosis and treatment of occult urinary incontinence in women with pelvic organ prolapse. STUDY DESIGN: The medical records of all patients who were admitted to the Division of Urogynecology of Istanbul Faculty of Medicine between January 2008 and December 2013; in total, 1600 patients were retrospectively evaluated. The study population included 287 patients who had prolapse beyond the hymen and underwent two consecutive urodynamic studies with and without prolapse reduction. Demographic data, medical records, physical examination, full urogynecologic examination, urodynamic investigations, treatment modality, the results of the treatment and King's Health Questionnaire scores before treatment and at one-year follow-up were recorded. RESULTS: Eighty-five of 287 patients (29.6%) were continent, 20 (23.5%) of whom had occult stress urinary incontinence during cystometry. Among these 20 patients, 17 underwent anti-incontinence surgery; 12 were satisfied with their surgery and had no postoperative urinary leakage. Twenty (23.5%) patients had overactive bladder symptoms during urodynamic studies after prolapse reduction. King's Health Questionnaire scores before and after the operation, showed that health status of 12 patients was better, 1 patient was unsatisfied after the treatment, 2 patients' scores did not change and 2 patients were lost to follow up. CONCLUSIONS: In conclusion, the prevalence of occult urinary incontinence was 23.5% when using urodynamics with prolapse reduction. 12 of the 17 patients diagnosed with occult urinary incontinence were satisfied with surgery and had no postoperative urinary leakage.

Approaches to Cope with Stress and Depression in Individuals with Urinary Incontinence.

AIM: The aim of study was to assess individuals with urinary incontinence (UI) with respect to depression and to determine coping mechanisms with stress. METHODS: One hundred sixty female and 110 male participants that applied to Istanbul Faculty of Medicine, Urology and Urogynecology Department with UI complaints and accepted to participate in the study were included in the study. Depressive symptoms were assessed with Center for Epidemiological Studies Depression Scale (CES-D). The mechanisms of coping with stress were evaluated using Ways of Coping with Stress Inventory (WCSI). RESULTS: Females (57.5%) scored 16 points and more from the CES-D scale, while the rate was significantly higher in males (79.1%). The scores obtained in 5 subdimensions of the WCSI showed that females utilized a desperate approach (female 1.39 ± 0.63, male 1.11 ± 0.51, p < 0.000), self-confident approach (female 1.98 ± 0.60, male 1.70 ± 0.42, p < 0.000), and social support approach (female 1.90 ± 0.57, male 1.48 ± 0.44, p < 0.000) statistically and significantly more than males in coping with stress. CONCLUSION: Males experienced more depression symptoms when compared to females. Females were significantly more self-confident and utilized social support mechanisms and desperate approaches more than males in order to cope with stress.

Lower Urinary Tract Symptoms in Women With Type 2 Diabetes Mellitus.

PURPOSE: The aim of the study was to compare lower urinary tract symptoms (LUTS) in women with and without type 2 diabetes mellitus (DM). SUBJECTS AND SETTING: The sample was drawn from community-dwelling women in the province of Istanbul who were cared for in the diabetes outpatient clinic of Istanbul Medical School between January and June 2012. Two hundred forty-nine women with DM were compared to 255 women without DM cared for in the obstetrics and gynecology department of the same university hospital. The mean ages of the groups were 55.1 and 53.7 years, respectively. METHODS: Participants completed a questionnaire that queried sociodemographic and clinical characteristics; the Bristol Female Lower Urinary Tract Symptoms-Short Form (BFLUTS-SF) was used to evaluate LUTS. The questionnaire required 10 to 15 minutes to complete; participants completed the questionnaire in a private room of each of the respective outpatient clinics. RESULTS: No statistically significant differences were found when groups (women with and without DM) were compared based on age and cigarette smoking (P > .05). In contrast, BMI scores were significantly higher in the women with DM (P < .001). The cumulative BFLUTS scores and the filling and incontinence symptoms subscale sores (P < .001) were significantly higher in women with DM. No differences were observed in voiding symptoms (P = .347), sexual function (P = .380), and health-related quality of life (P = .142) subscale scores. The prevalence of storage symptoms nocturia, voiding frequency, urge incontinence, stress incontinence, frequency of incontinent episodes were higher among women with DM. In addition, women with DM were more likely to report the need to change clothing because of urinary leakage, effect of incontinence on daily tasks, and overall interference with daily activities of living. CONCLUSIONS: Women with type 2 DM are more likely to experience LUTS as compared to women without DM. Women with type 2 DM should routinely be assessed for LUTS.

Effect of Reflexology to Depressive Symptoms in Women With Overactive Bladder.

This study is to determine the effect of foot reflexology on the level of depression in women with OAB. Study findings included in the study showed foot reflexology as a part of OAB treatment relieved urinary and depressive symptoms and had a positive effect on quality of life.

A Valuable Option in the Management of Female Recurrent Stress Urinary Incontinence: Re-Adjustable Sling (Remeex Sling System).

INTRODUCTION: This study was conducted to evaluate the effectiveness and safety of adjustable slings in the treatment of recurrent stress urinary incontinence (SUI) after mid-urethral sling (MUS) failure. MATERIALS AND METHODS: A prospective study was performed among women with recurrent SUI at the Urogynecology Division of Istanbul School of Medicine between February 2010 and March 2015. All women were preoperatively evaluated with detailed urogynecologic evaluations, which included pelvic examination, Q-tip test, pad test, urodynamic studies and a compilation of the Kings Health Questionnaire (KHQ). Postoperative follow-up was performed at 1, 6 and 12 months and annually thereafter. Our primary outcome was objective cure and patient's satisfaction with treatment. Secondary outcomes included perioperative complications and adverse events. RESULTS: Nineteen women were included in the study. The patients' mean age was 55.3 ± 6.9 years (range 43-66 years). The median follow-up time was 20.7 ± 14.0 months (range 6-55 months). The overall cure and improvement rates were 84.2 and 10.5%, respectively. In the satisfaction questionnaire, 15 (79%) patients responded that they were very satisfied and 3 (15.7%) were moderately satisfied. Sling tension re-adjustment was needed during follow-up in 1 patient (5.3%), 13 months after the initial surgery. The preoperative mean KHQ score was 545.9 ± 243.0 and changed to 237.0 ± 217.5 (p < 0.05). Postoperative complications were slight and easily manageable. CONCLUSIONS: Recurrent SUI is a challenging condition in urogynecology. The Regulation Mechanical External (Remeex) system has been found to be effective in the treatment of recurrent SUI after MUS failure with acceptable adverse effects. The Remeex system has the advantage of re-adjustment as a valuable option in the long-term management of patients.