[Stress urinary incontinence in female athletes: a taboo topic]. / Incontinence urinaire d'effort chez les sportives : un tabou.

STRESS URINARY INCONTINENCE IN FEMALE ATHLETES: A TABOO TOPIC. Stress urinary incontinence (SUI) has a high prevalence (between 20% and 81%) in sportswomen, all the more so if they practice a sport at risk for the perineal function, including jumping, running, strong abdominal contraction in combat sports, and if their practice is intensive and/or repeated with a dose effect. Making sportswomen aware of the importance of an educational prevention program is key, as the impact on performance in top-level sportswomen is real. In leisure activities, or in sports without repeated impact, regular activity is protective against SUI. This review examines the mechanisms of SUI, its prevalence in different sports, and prevention in young sportswomen.

INCONTINENCE URINAIRE D'EFFORT CHEZ LES SPORTIVES : UN TABOU. L'incontinence urinaire d'effort (IUE) a une prévalence qui reste élevée (de 20 % à 81 %) chez la sportive, d'autant plus qu'elle pratique un sport à risque pour la fonction périnéale ­ incluant saut, course, forte contraction abdominale comme dans les sports de combat ­ et que la pratique est intensive et/ou répétée. La sensibilisation des sportives à un programme éducatif de prévention est importante car l'impact sur la performance chez les sportives de haut niveau est réel. Dans une pratique de loisir ou d'un sport sans impacts répétés, une activité régulière est protectrice de l'IUE.

Preoperative Prostate Magnetic Resonance Imaging-based Anatomical Predictors of Early Urinary Continence Following Single-port Transvesical Robot-assisted Radical Prostatectomy.

BACKGROUND AND OBJECTIVE: The introduction of the single-port (SP) robotic system has led to new approaches in robot-assisted radical prostatectomy (RARP), such as the transvesical (TV) approach, offering high rates of early urinary continence. While previous studies of SP TV RARP have identified perioperative factors influencing continence outcomes, the impact of anatomical factors remains unexplored. This study aims to assess magnetic resonance imaging (MRI)-based anatomical predictors of urinary continence after SP TV RARP. METHODS: A retrospective analysis of consecutive SP TV RARP cases (November 2020 to June 2023) with preoperative prostate MRI was performed. Two urogenital radiologists independently evaluated ten anatomical parameters to distinguish patients achieving urinary continence within 1 wk and 3 mo. Nonparametric methods estimated receiver operating characteristic curves (area under the curve [AUC]) and inter-reader agreement. KEY FINDINGS AND LIMITATIONS: In 120 cases, 40% achieved continence within 1 wk, rising to 71.7% by 3 mo. Membranous urethra length (MUL) alone was significantly associated with continence at 3 mo (AUC: 0.67, p = 0.003). At 1 wk, several parameters, including anteroposterior diameter of the prostate, coronal membranous urethra length, prostate volume, and transverse diameter of the prostate, showed promise in predicting continence. CONCLUSIONS AND CLINICAL IMPLICATIONS: A longer preoperative MUL was significantly associated with better odds of an early return to urinary continence after SP TV RARP. Each 1-mm increase in coronal MUL was associated with a 27% increase in the odds of continence at 3 mo. This information can aid in patient counseling and expectations preoperatively. PATIENT SUMMARY: Urinary incontinence is a common outcome after prostate cancer surgery, particularly in the early months. Recently, the single-port (SP) robotic system has emerged, localizing surgery to the diseased area. With the SP robot, accessing the prostate via the bladder leads to high rates of early continence. Our study reveals that the longer the urethral portion beneath the prostate, the higher the likelihood of regaining continence within 3 mo after surgery.

European Board and College of Obstetrics and Gynaecology (EBCOG) position statement on the use of laser vaginal devices for treatment of genitourinary syndrome of menopause, vaginal laxity, pelvic organ prolapse and stress urinary incontinence.

One in three women will experience pelvic floor disorders in her lifetime and nearly 60 percent of postmenopausal women are affected by vaginal dryness. Conservative management is recommended as first line treatment for pelvic organ prolapse and stress urinary incontinence. Also, vaginal estrogens are often prescribed for symptomatic vaginal atrophy. Lasers have been used in cosmetic industry for connective tissue remodeling and repair of skin. Their use in the last decade for treating genitourinary symptoms of menopause, pelvic organ prolapse and stress urinary incontinence has gained popularity but there is lack of robust evidence to support its use in routine practice. The European Board and College of Obstetrics and Gynaecology calls for high quality evidence with patient related outcome measures before adopting to routine clinical practice.

Autologous rectus abdominis fascia sling surgery following unsuccessful synthetic midurethral sling.

Introduction: We performed autologous rectus abdominis fascia sling surgery using Advantage™ following an unsuccessful synthetic midurethral sling. Case presentation: At the age of 76 years, the patient experienced stress urinary incontinence recurrence. A 1-h pad test resulted in 259 g of leakage. A pressure flow study verified urine leakage while coughing and straining without detrusor overactivity. Abdominal leak point pressure was 10 cmH2O. Autologous rectus abdominis fascia sling surgery was performed using Advantage™. One month postoperatively, a 1-h pad test resulted in 0 g of leakage. Conclusion: We believe that this method will allow the fascia sling procedure to be performed reliably even if one is unfamiliar with conventional autologous rectus abdominis fascia sling surgery.

A Full Bladder Is Not Needed for the Male Stress Incontinence Grading Scale.

INTRODUCTION: Our objectives were to evaluate the Male Stress Incontinence Grading Scale to stratify male patients with stress urinary incontinence for either artificial urinary sphincter or sling using a standing cough test and determine if an emptier bladder at the time of assessment carries increased risk of treatment failure. METHODS: Retrospective chart review of male patients undergoing sling and artificial urinary sphincter placement. The standing cough test score and bladder scan results were documented at initial evaluation. RESULTS: Forty patients underwent sling and 43 underwent naïve artificial sphincter placement. Median follow-up was 7.11 months. Thirty-six/forty slings had complete incontinence resolution or reduction to a safety pad vs 40/43 after sphincter (90% vs 93%, P = .62). Four sling patients (10%) had persistence or recurrence of incontinence. Cough test scores were similar between sling failure (67% grade 0, 33% grade 1) and success groups (83% grade 0, 3% grade 1, 14% grade 2). Bladder scan mean was 18.5 cc in the sling failure (SD 21.1) and 38.0 cc in the success groups (38.3), with 32% of success patients having bladder scans of 0 cc, and 63% of < 50 cc. Mean for sphincter patients was 45 cc (56.9). Ten patients with scan = 0 and 7 patients with scans < 30 cc demonstrated grade 4 incontinence. CONCLUSIONS: Cough test is a noninvasive, reliable tool to assess stress urinary incontinence severity. Our data suggest it is reliable even when bladders are nearly empty and can effectively stratify patients for sling vs artificial urinary sphincter with a high rate of success.

Continence Is Not Affected after Sling Revision with Transvaginal Tape Elongation for Post-Sling Voiding Dysfunction.

Voiding dysfunction (VD) after sling operation is not uncommon. Sling revisions by incision/excision are usually effective; however, they may result in recurrent stress urinary incontinence (SUI). We aimed to evaluate continence status after an innovative sling revision procedure that preserves the integrity of the sling. Patients who underwent either a single-incision (AJUST) or a trans-obturator (TVT-O) mid-urethral sling were studied. Transvaginal tape elongation (i.e., sling midline incision and mesh interposition) was performed on patients with post-sling VD. Factors that may affect recurrent SUI were investigated by statistical analyses. Of 119 patients, 90 (75.6%) (45 AJUST and 45 TVT-O) were available for long-term (median 9; 8-10 years) follow-up. A significantly higher rate (17.2% vs. 3.3%, p = 0.014) of VD was noted after AJUST (N = 10) than after TVT-O (N = 2). After sling revision, four (33%) of the 12 cases reported recurrent SUI, which was not significantly different (p = 1.000) from the rate (37%, 29/78) of patients who did not undergo sling revision. Further statistical analyses revealed no significant predisposing factors affecting the recurrence of SUI. Surgical continence did not seem to be affected by having had sling revision with transvaginal tape elongation for post-sling VD.

Obesity is not an independent risk factor for peri- and post-operative complications following mid-urethral sling (MUS) surgeries for the treatment of stress urinary incontinence (SUI).

OBJECTIVE: To inquire whether obesity is a risk factor of peri- and post-operative complications following Mid-urethral sling (MUS) surgeries for SUI repair using the Clavien-Dindo classification system (CDcs). METHODS: This retrospective cohort included 304 women who undergone a MUS in a 1000 beds tertiary University medical center between the years 2012-2018. Univariate analysis was conducted to compare clinical and operative traits by BMI group and to examine associations of obesity and complications rates and severity according to the CDcs. Multivariate analysis was conducted to assess the risk for post-operative complications and adjust to potential confounders. RESULTS: The study group included 106 (34.9%) women with BMI 30 or higher and the comparison group included 198 (65.1%) women with BMI lower than 30. In the study group we found a significantly higher prevalence of hypertension (P = 0.019), previous abdominal surgeries (P = 0.012) including cesarean section (P = 0.025), previous pelvic floor surgeries (P = 0.005) and pelvic organ prolapse (P = 0.02). In the control group we found a significantly higher rates of concomitant hysterectomy which performed during the MUS (P = 0.005). Obesity was not associated with increased rates of peri and post-operative complications (P = 0.973). CONCLUSIONS: In our study, obesity was not associated with peri- and post-operative complications following MUS.

Foreign body granuloma development after calcium hydroxylapatite injection for stress urinary incontinence: A literature review and case report.

Objectives: To present a case of foreign body granuloma (FBG) development after injection of calcium hydroxylapatite as a urethral bulking agent and to review all documented cases of this phenomenon in the literature. Methods: We analyzed a new case of calcium hydroxylapatite-induced FBG. We also conducted a literature review of the PubMed, Embase, CINAHL, and Web of Science databases through March 2022. Reports were included if they contained stress urinary incontinence patients that developed an FBG after calcium hydroxylapatite injection. The cases were reviewed for presenting symptoms, patient demographics, granuloma details, and surgical treatment. Results: We screened 250 articles and included six articles between 2006 and 2015 in addition to the present case. The median age of the patients was 65.5 years (range 45-93), and all patients were female. The most common presenting symptoms and the proportion of patients affected were difficulty voiding (4/8), recurrent urinary incontinence (3/8), and dyspareunia (2/8). The median time between the first CaHA injection and discovery of the FBG was 5 months (range 1-50). The median longest dimension of the FBGs was 1.85 cm (range 1.0-3.0). The 8 masses observed were evenly distributed throughout the urethra, with 3 in the bladder neck, 2 in the midurethra, and 3 in the distal urethra. Surgical excision was the predominant management choice, with some variation in technique. Conclusions: Severe, persistent lower urinary tract symptoms after calcium hydroxylapatite injection may indicate an FBG, which has been successfully managed with surgical excision.

Urethral bulking with native tissue during artificial urinary sphincter surgery.

The artificial urinary sphincter (AUS) is the "gold standard" surgical treatment for severe stress urinary incontinence.  However, a subset of patients with frail urethras may require technical adjuncts to ensure optimal cuff function.  Our objective is to provide a detailed tutorial of our institution's method for performing urethral bulking with native tissue in patients with frail urethras during AUS surgery. We have found that urethral bulking with native tissue provides a cost-efficient and durable technique for improved AUS cuff coaptation.  Our experience demonstrates adequate short and intermediate term efficacy with limited complications.  These techniques equip surgeons with an alternative surgical approach for appropriate patients receiving AUS surgery who have been previously exposed to pelvic radiation and/or significant surgical morbidity resulting in frail urethral tissue.

Ambulatory peri-bulbar implantation, revision and replacement of Artificial Urinary Sphincter in neurogenic and non-neurogenic male patients: A preliminary feasibility study over a one-year experience.

INTRODUCTION: Our goal was to determine the rate of complications, early revision and removal after full ambulatory implantation of bulbar AUS in men; secondly, to describe satisfaction and short-term continence rate. MATERIAL AND METHODS: Between April 2018 and April 2019, 28 consecutive patients underwent AUS implantation in a newly organised ambulatory setting. A prospective database of all included patients was established with comprehensive data collected on medical history, aetiology and severity of SUI, surgical procedures, postoperative complications and patient satisfaction. RESULTS: Twenty-eight patients were included (30 consecutive procedures: 22 primary AUS placement, 6 complete revisions, 2 partial revisions), with a mean follow up of 223±220.5 days. Fourteen patients had prior radiotherapy. Readmission rate was 6.7% in the first 30 days after surgery. Both revision and removal rates were 6.7%. Complications were reported in 26.7% of procedures, mainly Clavien-Dindo I. Patient satisfaction of ambulatory surgery organisation and experience was high (87/5% satisfied or very satisfied). Full continence & social continence were achieved for, respectively, 55.6% and 88.9% of procedures. CONCLUSION: Ambulatory placement of AUS is safe and can be performed successfully. Larger patient cohorts and randomised trials are crucial to improve knowledge on non-indications for full ambulatory AUS implantation in men.

Impact of Urinary Incontinence on Quality of Life Among Women of Childbearing Age in Al Madinah Al Munawara, Saudi Arabia.

Introduction Urinary incontinence (UI) is a widely prevalent problem with a great impact on quality of life. It affects a person's physical, social, occupational, and phycological aspects of life. Our study aimed to estimate prevalence, risk factors, effect on life, and help-seeking behaviors among women with urinary incontinence.  Methods  This is a cross-sectional analytic study conducted in primary health care centers among women of childbearing age in Al Madinah Al Munawara, Saudi Arabia. A total of 342 women aged between 18 to 50 years were included and interviewed using a previously validated and pretested Arabic version of the King's Health Questionnaire (KHQ).  Result Out of 342 patients, 71 (20.8%) had UI. The mean age of the patients was 31.51 +9.36 years. Risk factors associated with UI were: BMI (p = 0.022, odds ratio = 1.06), multiparity (p = 0.027, odds ratio = 1.16), smoking (p = 0.018, odds ratio = 4.71), and chronic constipation (p = 0.013, odds ratio = 5.83). Only 28.2% of the affected women sought medical consultation. The main reasons for not seeking medical advice were the belief that UI is a common, normal aging process in 45%, while 14.1% were embarrassed by the condition, and 5.6% did not know that there was a treatment. Overall, there was a limitation in all domains of quality of life among patients who suffer from UI. The majority of limitations were slight to moderate. The most affected domain was sleep and energy. Conclusion  UI is common and adversely affects the quality of life of women of childbearing age in Al Madinah Al Munawara. Obesity, multiparity, smoking, and chronic constipation are significant risk factors. Less than half of patients with UI sought medical care.

Effects of transobturator tape procedure on female sexual function at 2-year follow-up: A prospective cohort study with matched control group.

OBJECTIVES: We aimed to compare the effect of elapsed time on sexual function in women who underwent a transobturator tape (TOT) procedure for stress urinary incontinence (SUI) with continent controls. METHODS: Urinary and sexual function of 70 females were assessed preoperatively at month 6 and postoperatively at month 24 in the study group. Forty-five patients without urinary incontinence and demographically matched with the study group were assessed for sexual function at first administration and 24 months later in the control group. The Female Sexual Function Index (FSFI) was used. RESULTS: The baseline total FSFI score (23.4 ± 3.2 vs 27.0 ± 4.3, P < .001) was significantly lower in patients with SUI. There was a slight increase (24.0 ± 3.0, P = .167) in sexual function at the end of 2 years in the study group, whereas in the control group, the total FSFI score (25.0 ± 4.5, P < .001) decreased significantly within 2 years. The success of the incontinence surgery was associated with higher long-term sexual function scores. CONCLUSIONS: Successful TOT surgery can improve sexual function in women with SUI. This improvement decreases less over time compared to healthy controls.

Comparison of Autologous Rectus Fascia and Synthetic Sling Methods of Transobturator Mid-Urethral Sling in Urinary Stress Incontinence.

OBJECTIVE: This study aims to compare the efficacy and complications between mesh obtained from the autologous rectus fascia and synthetic mesh used in transobturator tape procedure in the surgical treatment of urinary stress incontinence. METHODS: A total of 62 female patients who underwent operation due to urinary stress incontinence were included in the study. From these, 31 patients underwent autologous rectus fascia with mid-urethral sling (Group 1), and the remaining 31 patients underwent the same operation using synthetic multilaminar propylene sling (Group 2). The groups were compared preoperative and postoperative according to results of Urogenital Distress Inventory-Short Form (UDI-6) and Incontinence Impact Questionnaire-Short Form (IIQ-7). Demographic characteristics, surgical features, and complications were also compared between the groups. P < 0.05 values were considered statistically significant. RESULTS: The mean age was found as 54.74 ± 0.87 in Group 1 and 55.58 ± 0.76 in Group 2. There was no significant difference between the groups in terms of the preoperative and postoperative UDI-6 results ​​(p=0.258, p=0.349). Similarly, the preoperative and postoperative IIQ-7 results did not show a significant difference between the groups (p=0,483, p=0,367). There was also no significant difference in demographic characteristics and complications between the groups. Only the mean operational time was significantly longer in Group 1 (p=0.029). CONCLUSION: Transobturator tape procedure with autologous rectus fascia is as effective and safe as synthetic mesh. This procedure provides an inexpensive and consumable option without posing a risk of mesh erosion and with low complication rates.

Impact of obesity on perioperative, functional and oncological outcomes after robotic-assisted radical prostatectomy in a high-volume center.

OBJECTIVE: To compare surgical, oncological and functional outcomes between obese vs. normal-weight prostate cancer (PCa) patients treated with robotic-assisted radical prostatectomy (RARP). MATERIALS AND METHODS: We assessed 4555 consecutive RARP patients from a high-volume center 2008-2018. Analyses were restricted to normal-weight vs. obese patients (≥ 30 kg/m2). Multivariable cox regression analyses (MVA) assessed the effect of obesity on biochemical recurrence (BCR), metastatic progression (MP), erectile function and urinary continence recovery. Analyses were repeated after propensity score matching. RESULTS: Before matching, higher rates of pathological Gleason Grade group ≥ 4 (14 vs. 18%; p = 0.004) and pT3 stage (33 vs. 35%; p = 0.016) were observed in obese patients, with similar observations for surgery time, blood loss and 30-day wound- and surgical complication rates. For normal-weight vs. obese patients, BCR- and MP-free rates were 86 vs. 85% (p = 0.97) and 97.5 vs.97.8% (p = 0.8) at 48 months. Similarly, rates of erectile function at 36 months and urinary continence at 12 months were 56 vs. 49% (p = 0.012) and 88 vs. 85% (p = 0.003), respectively. Before and after propensity score matching, obesity had no effect on BCR or MP, but a negative effect on erectile function (matched HR 0.87, 95%CI 0.76-0.99; p = 0.029) and urinary continence recovery (matched HR 0.91, 95%CI 0.84-0.98; p = 0.014). CONCLUSIONS: Obesity did not represent a risk factor of BCR or MP after RARP despite higher rates of adverse pathological features. However, obesity was associated with higher risk of perioperative morbidity and impaired functional outcomes. Such information is integral for patient counselling. Thus, weight loss before RARP should be encouraged.

The prevalence of urinary incontinence in female CrossFit practitioners: A systematic review and meta-analysis. / La prevalencia de incontinencia urinaria en mujeres practicantes de CrossFit: revisión sistemática y metaanálisis.

OBJECTIVE: CrossFit is a popular sportamong women. It has numerous benefits, but it is unclearwhat effects it has on the pelvic floor, since physicalexercise may be a risk factor for urinary incontinence.The aim of this study was to determine theoverall prevalence of urinary incontinence in femaleCrossFit practitioners. METHODS: A systematic review and meta-analysiswere conducted (PROSPERO, 2020: CRD42020199479).We searched cross-sectional studies in databases (Pub-Med, CINAHL, WOS, Scopus, ProQuest) and search engines,from inception to 17 June, 2020. The AdaptedNewcastle-Ottawa Scale for Cross-Sectional Studies wasused to assess the risk of bias. Pooled prevalence wascalculated using random-effects models. Heterogeneitywas investigated by meta-regression and subgroupanalysis. RESULTS: A total of 282 records were identified, ofwhich 13 were included in the qualitative and quantitativesynthesises. The prevalence of urinary incontinenceamong female CrossFit practitioners was 32.1%(95% CI = 22.2-43.8%, n = 2187) and of stress urinaryincontinence was 35.8% (95% CI = 19.4-56.4%, n =1323). The prevalence of urinary incontinence was higher among women over 35 years old, with previouspregnancies and vaginal deliveries (P = 0.004). TheCrossFit exercises associated with higher stress urinaryincontinence were rope jumping, double under,weightlifting, and box jumps. Some preventive strategieswere pelvic floor training, using pads, emptyingthe bladder before workouts, and wearing dark pants. CONCLUSIONS: These results show that the prevalenceof urinary incontinence in female CrossFit practitionerswas similar to that found among women whopractice sport.

OBJETIVO: El CrossFit es un deportepopular entre mujeres. Tiene múltiples beneficios,sin embargo, se desconoce su efecto sobre el suelopélvico, considerando que el ejercicio puede ser unfactor de riesgo para la incontinencia urinaria. El objetivode este estudio es determinar la prevalencia deincontinencia urinaria entre las mujeres practicantesde CrossFit. MÉTODOS: Se realizó una revisión sistemática y unmetaanálisis (PROSPERO, 2020: CRD42020199479).Se buscaron estudios transversales en las bases dedatos (PubMed, CINAHL, WOS, Scopus, ProQuest) yen motores de búsqueda desde su concepción hastajunio de 2020. La Escala Newcastle-Ottawa para EstudiosTransversales se usó para evaluar los potencialessesgos. La prevalencia se calculó usando elModelo de Efectos Aleatorios. La heterogeneidad seinvestigó usando la meta regresión y el análisis desubgrupo. RESULTADOS: Se identificaron 282 registros delos cuales 13 fueron incluidos en los análisis cualitativosy cuantitativos. La prevalencia de incontinenciaurinaria entre mujeres practicantes de CrossFit fue35,8% (95% CI = 22,2­43,8%, n = 2187) y de incontinenciaurinaria de esfuerzo 3,8% (95% CI = 19,4­56,4%. La prevalencia fue mayor en mujeres mayoresde 35 años con embarazos previos y partos vaginales(P = 0,004). Los ejercicios de CrossFit más asociadoscon incontinencia urinaria de esfuerzo fueron saltarla comba, levantamiento de peso y salto al cajón. Algunasestrategias de prevención fueron los ejerciciosde suelo pélvico, el uso de protectores, micción programadaantes del entrenamiento y el uso de pantalonesoscuros. CONCLUSIONES: Estos resultados muestran que laprevalencia de incontinencia urinaria entre mujerespracticantes de CrossFit fue similar a aquella entremujeres que practican otros deportes.

The prevalence of urinary incontinence in female crossfit practitioners: a systematic review and meta-analysis

OBJECTIVE: CrossFit is a popular sportamong women. It has numerous benefits, but it is unclear what effects it has on the pelvic floor, since physical exercise may be a risk factor for urinary incontinence. The aim of this study was to determine theoverall prevalence of urinary incontinence in femaleCrossFit practitioners.METHODS: A systematic review and meta-analysiswere conducted (PROSPERO, 2020: CRD42020199479).We searched cross-sectional studies in databases (PubMed, CINAHL, WOS, Scopus, ProQuest) and search engines, from inception to 17 June, 2020. The AdaptedNewcastle-Ottawa Scale for Cross-Sectional Studies wasused to assess the risk of bias. Pooled prevalence wascalculated using random-effects models. Heterogeneity was investigated by meta-regression and subgroupanalysis.RESULTS: A total of 282 records were identified, ofwhich 13 were included in the qualitative and quantitative synthesises. The prevalence of urinary incontinence among female CrossFit practitioners was 32.1%(95% CI = 22.2–43.8%, n = 2187) and of stress urinaryincontinence was 35.8% (95% CI = 19.4–56.4%, n =1323). The prevalence of urinary incontinence was higher among women over 35 years old, with previouspregnancies and vaginal deliveries (P = 0.004). TheCrossFit exercises associated with higher stress urinary incontinence were rope jumping, double under,weightlifting, and box jumps. Some preventive strategies were pelvic floor training, using pads, emptyingthe bladder before workouts, and wearing dark pants.CONCLUSIONS: These results show that the prevalence of urinary incontinence in female CrossFit practitioners was similar to that found among women whopractice sport. (AU)

OBJETIVO: El CrossFit es un deportepopular entre mujeres. Tiene múltiples beneficios,sin embargo, se desconoce su efecto sobre el suelopélvico, considerando que el ejercicio puede ser unfactor de riesgo para la incontinencia urinaria. El objetivo de este estudio es determinar la prevalencia deincontinencia urinaria entre las mujeres practicantes de CrossFit.MÉTODOS: Se realizó una revisión sistemática y unmetaanálisis (PROSPERO, 2020: CRD42020199479).Se buscaron estudios transversales en las bases dedatos (PubMed, CINAHL, WOS, Scopus, ProQuest) yen motores de búsqueda desde su concepción hastajunio de 2020. La Escala Newcastle-Ottawa para Estudios Transversales se usó para evaluar los potenciales sesgos. La prevalencia se calculó usando elModelo de Efectos Aleatorios. La heterogeneidad seinvestigó usando la meta regresión y el análisis desubgrupo. RESULTADOS: Se identificaron 282 registros delos cuales 13 fueron incluidos en los análisis cualitativos y cuantitativos. La prevalencia de incontinenciaurinaria entre mujeres practicantes de CrossFit fue35,8% (95% CI = 22,2–43,8%, n = 2187) y de incontinencia urinaria de esfuerzo 3,8% (95% CI = 19,4–56,4%. La prevalencia fue mayor en mujeres mayoresde 35 años con embarazos previos y partos vaginales(P = 0,004). Los ejercicios de CrossFit más asociadoscon incontinencia urinaria de esfuerzo fueron saltarla comba, levantamiento de peso y salto al cajón. Algunas estrategias de prevención fueron los ejerciciosde suelo pélvico, el uso de protectores, micción programada antes del entrenamiento y el uso de pantalones oscuros.CONCLUSIONES: Estos resultados muestran que laprevalencia de incontinencia urinaria entre mujerespracticantes de CrossFit fue similar a aquella entremujeres que practican otros deportes.

Male sling placement for post-prostatectomy incontinence can involve a lengthy learning curve: A multi-outcome assessment via cumulative sum failure analysis.

PURPOSES: Little research exists on potential learning curve for male sling procedures. We aimed to perform a learning curve analysis of a single surgeon's experience of sling placement evaluating multiple outcomes and using the cumulative sum failure methodology. METHODS: The study included 65 consecutive patients that underwent implantation of a fixed transobturator sling (TiLOOP Male) for post-radical prostatectomy stress incontinence at our institution from January 2013 to December 2018. Dichotomous outcomes evaluated with cumulative sum failure analysis included 12-months continence defined based on Patient Global Impression of Improvement (PGI-I) questionnaire (primary outcome), 24 h pad test and, 24 h pad use, operative time (⩽/>60 min), and complications (yes/no). Univariate and multivariate logistic regression analyses were performed to evaluate the association of the procedures' chronological sequence number with the outcomes. RESULTS: Cumulative sum failure curves revealed a clear and lengthy learning curve effect for most of subjective and quantitative continence outcomes and for operative time. For the primary outcome (at least much improved at PGI-I), 62 procedures were required to overcome the learning curve. Accordingly, multivariate analyses showed that the sequence number was statistically significant for predicting failures based on PGI-I (adjusted OR 0.95; 95% CI: 0.91-0.99; p = 0.02), objective outcomes, and operative time. CONCLUSIONS: An evident and lengthy learning curve was observed in our series of male sling placement to achieve the end level of proficiency, independently from case-mix. Individualized structured training on male sling surgery will benefit patients treated in the initial surgeon's experience. Surgical experience should be considered when reporting studies on male slings.

[Voiding dysfunction after TVT: A 20-year experience TVT-placement under local anesthesia and sedation]. / Troubles mictionnelles après pose de TVT : 20 ans d'expérience de pose sous diazanalgésie et anesthésie locale.

BACKGROUND: Trans-vaginal tape has become the gold standard for the cure of urinary stress incontinence, but post-operative voiding dysfunction is frequently reported. The purpose of this study is to assess the incidence of voiding dysfunction, dysuria, chronic urinary retention, and necessity of reoperation after retropubic TVT placement under local anaesthesia and sedation. MATERIAL AND METHOD: We perform a retrospective study of a cohort of patient treated with the placement of a retropubic TVT under local anaesthesia and sedation between 1999 and 2019 for a SUI. Post-operative voiding dysfunction and necessity of reoperation were reviewed to access the principal aim of this study. RESULTS: Three hundred and two patients who met the eligibility criteria were included in the study. At 3 months, the dysuria rate and chronic urinary retention rate was 4.3% and 1%. At 12 months it was 2.6% and 0.3% respectively. The 12-month sling section rate was 1% and long-term self-catherization rate was 0.3%. The objective cure rate was 93% and subjective cure was 92%. CONCLUSION: TVT placement under local anaesthesia and sedation resulted in few voiding dysfunctions at medium/long-term, necessity of re-operation for refractory obstructive disorder and well functional results. Even if these results support more frequent use of this type of anaesthesia, it would be interesting to be able to follow them in a prospective study to conclude. LEVEL OF EVIDENCE: 4.

2021 opinion from the CUROPF on THE efficacy and safety of mid-urethral slings used in women WITH urinary stress incontinence.

OBJECTIVE: To determine the usefulness of mid-urethral slings (MUS) in the surgical management of women presenting with urinary stress incontinence (USI) METHOD: A consensus committee of multidisciplinary experts (CUROPF) was convened and focused on PICO questions concerning the efficacy and safety of MUS surgery compared to other procedures and concerning which approach (retropubic (RP) vs transobturator (TO)) should be proposed as a first-line MUS surgery for specific subpopulations (obese; intrinsic sphincteric deficiency (ISD); elderly) RESULTS: As compared to other procedures (urethral bulking agents, traditional slings and open colposuspension), the MUS procedure should be proposed as the first-line surgical therapy (strong agreement). MUS surgery can be associated with complications and proper pre-operative informed consent is mandatory (strong agreement). Mini-slings (SIS/SIMS) should only be proposed in clinical trials (strong agreement). Both RP and TO approaches may be proposed for the insertion of MUS (strong agreement). However, if the woman is willing to accept a moderate increase in per-operative risk, the RP approach should be preferred (strong agreement) since it is associated with higher very long-term cure rates and as it is possible to completely remove the sling surgically if a severe complication occurs. The RP approach should be used for the insertion of MUS in a woman presenting with ISD (strong agreement). Either the RP or TO approach should be used for the insertion of MUS in an obese woman presenting with USI (strong agreement). In very obese women (BMI ≥35-40kg/m2), weight loss should be preferred prior to MUS surgery and bariatric surgery should be discussed (strong agreement) CONCLUSION: The current Opinion provides an appropriate strategy for both the selection of patients and the best therapeutic approach in women presenting with USI.