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Zwierzchowska A, Tomasik P, Horosz E, Barcz E. Sonography as a Diagnostic Tool in Midurethral Sling Complications: A Narrative Review. J Clin Med 2024; 13:2336. [PMID: 38673609 PMCID: PMC11051119 DOI: 10.3390/jcm13082336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Despite the established safety and efficacy of midurethral slings (MUS), which are the current gold standard treatment for stress urinary incontinence (SUI), the potential for postoperative complications remains a significant concern for both healthcare professionals and patients. Meanwhile, sonography has emerged as a significant diagnostic tool in urogynecology, and one of the applications of this imaging modality may be the evaluation of complications arising from MUS procedures. This review, based on a comprehensive literature search, focuses on the use of pelvic floor ultrasound (US) in the context of MUS complications. It includes analyses of randomized controlled trials, prospective, and retrospective studies, covering preoperative and postoperative investigations, to assess complications such as persistent and recurrent SUI, urinary retention and obstructive voiding, de novo urgency/overactive bladder, vaginal exposure, sling erosion, pain, and hematoma. The review critically examines the existing literature, with a particular focus on recent publications. Despite the variability in findings, it appears that for each of the discussed complications, the application of pelvic floor US can significantly support the diagnostic and therapeutic process. The paper also identifies potential future directions for the development of US applications in diagnosing MUS complications.
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Affiliation(s)
| | | | | | - Ewa Barcz
- Department of Gynaecology and Obstetrics, Medical Faculty Collegium Medicum, University of Cardinal Stefan Wyszynski, 01-938 Warsaw, Poland; (A.Z.); (P.T.); (E.H.)
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Zhao X, Lu S, Wang B, Zhou X, Liu F, Xu W, Zhou D, Li L, Dong J. Fracture Types Influence the Likelihood of Lower Urinary Tract Injuries in Patients with Pelvic Fractures. J Clin Med 2023; 12:jcm12082967. [PMID: 37109301 PMCID: PMC10145837 DOI: 10.3390/jcm12082967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The combination of pelvic fractures with lower urinary tract injuries (LUTIs) is a severe traumatic injury. This study was performed to determine the relationship between LUTIs and pelvic fracture types. METHODS Patients who sustained pelvic fractures combined with LUTIs between 1 January 2018 and 1 January 2022 in our institution were retrospectively analyzed. The patients' demographics, mechanism of injury, presence of open pelvic fractures, types of pelvic fractures, patterns of LUTIs, and early complications were analyzed. The association between pelvic fracture types and the identified LUTIs was statistically analyzed. RESULTS This study involved 54 patients diagnosed with pelvic fractures combined with LUTIs. The overall incidence of pelvic fractures combined with LUTIs was 7.7% (n = 54/698). All patients had unstable pelvic fractures. The male:female ratio was approximately 2.4:1.0. The incidence of LUTIs was higher in men than women with pelvic fractures (9.1% vs. 4.4%). Bladder injuries occurred at roughly equal rates in men and women (4.5% vs. 4.4%, p = 0.966), but urethral injuries were more frequent in men (6.1% vs. 0.5%, p = 0.001). The most common pelvic injury pattern was a type C fracture according to the Tile classification and a vertical-shear-type fracture according to the Young-Burgess classification. The Young-Burgess fracture classification was related to the severity of bladder injury in men (p = 0.037). There was no significant difference in bladder injury according to the two classifications among women (p = 0.524 vs. p = 1.000) or among the entire cohort (p = 0.454 vs. p = 0.342). CONCLUSIONS Men and women are equally likely to sustain a bladder injury, but a urethral injury with pelvic fracture is more frequent in men. LUTIs tend to be accompanied by unstable pelvic fractures. It is imperative to be vigilant for potential bladder injury when men sustain vertical-shear-type pelvic fractures.
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Affiliation(s)
- Xuehui Zhao
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Shun Lu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Bingzhi Wang
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Xiaofeng Zhou
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Fanxiao Liu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Weicheng Xu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Dongsheng Zhou
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Lianxin Li
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Jinlei Dong
- Department of Orthopaedics Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
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Abouelgreed T, Saleh D, Abdelaal M, Elatreisy A, Elhelaly M, El-Agamy ES, Elgammal A, Moawad A. Urodynamic changes following laparoscopic versus vaginal hysterectomy. Arch Ital Urol Androl 2022; 94:315-318. [DOI: 10.4081/aiua.2022.3.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/17/2022] [Indexed: 11/22/2022] Open
Abstract
Objective: To compare urodynamic changes before and after hysterectomy (laparoscopic vs. vaginal approach) for benign gynecological diseases.Patients and methods: A total of 90 women with a mean age of 56.36-years were enrolled in this study between August 2019 and April 2021. They were divided into two equal groups(45 patients each). Group, I had a vaginal hysterectomy, and Group II had a laparoscopic hysterectomy. All patients were assessed clinically using ICIQ-FLUTS questionnaire and a uro-dynamic study before and six months after surgery. Results: Both vaginal and laparoscopic hysterectomy did not significantly change the maximum flow rate, voiding time, and average flow rate. The increase in residual urine volume in group I was not significant (p = 0.129), as was in Group II(p = 0.217). All the modifications, however, were within permis-sible limits. According to the cystometry result, volume at initial sensation rose in both groups after surgery, with no statistically significant difference (p = 0.364). After both forms of hysterecto-my, maximum bladder capacity did not vary considerably. Preoperatively, all study participants exhibited no overactivity of the detrusor muscle; nevertheless, following surgery, overac-tivity was noted in 9 patients after vaginal hysterectomy com-pared to three patients after laparoscopic hysterectomy, and all the alterations were within a clinically acceptable range. In addition, the ICIQ-FLUTS score was not significantly different between the study groups. Conclusions: According to the urodynamic study, hysterectomy for benign uterine conditions, whether vaginal or laparoscopic did not adversely affect urinary bladder function.
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Aplicabilidad clínica de la ecografía de suelo pélvico en las mujeres con disfunciones miccionales. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2022. [DOI: 10.1016/j.gine.2021.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Impact of Hysterectomy on Quality of Life, Urinary Incontinence, Sexual Functions and Urethral Length. J Clin Med 2021; 10:jcm10163608. [PMID: 34441904 PMCID: PMC8396917 DOI: 10.3390/jcm10163608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 01/01/2023] Open
Abstract
The aim of the study was to evaluate the influence of different types of hysterectomy on UI symptoms, quality of life and sexual functions using dedicated questionnaires. We investigated a correlation between the urethral length (UL), UI symptoms and the length of the cervix (left after LSH and SH) with sexual functions. The study enrolled 500 consecutive women referred for hysterectomy: 121 underwent VH, 171 underwent LSH, 96 underwent SH, 68 underwent TAH, and 44 underwent TLH. The patients filled in the UI-specific questionnaires and FSFI before and 12 months after hysterectomy. The UL was measured by introital ultrasound before and 12 months after hysterectomy. Before surgery, 137 out of 399 (34.3%) patients had UI symptoms; afterwards, 139 (34.8%) indicated the same (p > 0.05). There was no statistically significant difference in the UL in the patients before and after the procedure, and the cervix length did not differ between patients after LSH and SH. When the entire investigated population was analyzed, a significant improvement of the QoL was found on the IIQ-7. Hysterectomy performed due to benign diseases has effects on UI regardless of the surgical technique used. The UI symptoms improved only in the patients after LSH. The UL measured 12 months after hysterectomy did not change.
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Horosz E, Pomian A, Zwierzchowska A, Lisik W, Majkusiak W, Tomasik P, Rutkowska B, Skalska J, Siemion M, Banasiuk D, Barcz E. Epidemiological Features of the Bladder Neck Rest Position and Mobility. J Clin Med 2020; 9:jcm9082413. [PMID: 32731469 PMCID: PMC7464971 DOI: 10.3390/jcm9082413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022] Open
Abstract
The data concerning epidemiological determinants of the bladder neck (BN) mobility are scarce. The aim of the study was to determine epidemiological features and identify factors influencing BN position at rest and BN mobility in patients without pelvic organ prolapse (POP). Seven hundred and ninety-six patients that attended two outpatient clinics were enrolled in the study. Position and mobility of the BN were measured with the use of pelvic floor ultrasound. Demographic and functional factors that were hypothesized to influence BN mobility were assessed. Vaginal deliveries (VDs) and age ≥65 were associated with lower BN position at rest. Higher BN mobility was observed in women with stress urinary incontinence (SUI). In obese women, higher BN position and lower BN mobility was observed compared to non-obese women, and it was correlated with longer urethras in this group of patients. VDs and their number were associated with increased BN mobility, independently of body mass index (BMI). To conclude, obesity, VDs, and age are factors associated with changes in bladder neck position at rest and its mobility. Higher BMI correlates with restricted BN mobility, and, therefore, the incidence of SUI in obese patients is probably not connected to BN hypermobility.
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Affiliation(s)
- Edyta Horosz
- Department of Obstetrics and Gynecology, Multidisciplinary Hospital Warsaw-Miedzylesie, 04-749 Warsaw, Poland; (E.H.); (A.P.); (A.Z.); (W.M.); (P.T.); (B.R.); (J.S.); (M.S.); (D.B.)
| | - Andrzej Pomian
- Department of Obstetrics and Gynecology, Multidisciplinary Hospital Warsaw-Miedzylesie, 04-749 Warsaw, Poland; (E.H.); (A.P.); (A.Z.); (W.M.); (P.T.); (B.R.); (J.S.); (M.S.); (D.B.)
| | - Aneta Zwierzchowska
- Department of Obstetrics and Gynecology, Multidisciplinary Hospital Warsaw-Miedzylesie, 04-749 Warsaw, Poland; (E.H.); (A.P.); (A.Z.); (W.M.); (P.T.); (B.R.); (J.S.); (M.S.); (D.B.)
| | - Wojciech Lisik
- Department of General and Transplantation Surgery, Medical University of Warsaw, 00-001 Warsaw, Poland;
| | - Wojciech Majkusiak
- Department of Obstetrics and Gynecology, Multidisciplinary Hospital Warsaw-Miedzylesie, 04-749 Warsaw, Poland; (E.H.); (A.P.); (A.Z.); (W.M.); (P.T.); (B.R.); (J.S.); (M.S.); (D.B.)
| | - Paweł Tomasik
- Department of Obstetrics and Gynecology, Multidisciplinary Hospital Warsaw-Miedzylesie, 04-749 Warsaw, Poland; (E.H.); (A.P.); (A.Z.); (W.M.); (P.T.); (B.R.); (J.S.); (M.S.); (D.B.)
| | - Beata Rutkowska
- Department of Obstetrics and Gynecology, Multidisciplinary Hospital Warsaw-Miedzylesie, 04-749 Warsaw, Poland; (E.H.); (A.P.); (A.Z.); (W.M.); (P.T.); (B.R.); (J.S.); (M.S.); (D.B.)
| | - Joana Skalska
- Department of Obstetrics and Gynecology, Multidisciplinary Hospital Warsaw-Miedzylesie, 04-749 Warsaw, Poland; (E.H.); (A.P.); (A.Z.); (W.M.); (P.T.); (B.R.); (J.S.); (M.S.); (D.B.)
| | - Małgorzata Siemion
- Department of Obstetrics and Gynecology, Multidisciplinary Hospital Warsaw-Miedzylesie, 04-749 Warsaw, Poland; (E.H.); (A.P.); (A.Z.); (W.M.); (P.T.); (B.R.); (J.S.); (M.S.); (D.B.)
| | - Dominika Banasiuk
- Department of Obstetrics and Gynecology, Multidisciplinary Hospital Warsaw-Miedzylesie, 04-749 Warsaw, Poland; (E.H.); (A.P.); (A.Z.); (W.M.); (P.T.); (B.R.); (J.S.); (M.S.); (D.B.)
| | - Ewa Barcz
- Department of Obstetrics and Gynecology, Multidisciplinary Hospital Warsaw-Miedzylesie, 04-749 Warsaw, Poland; (E.H.); (A.P.); (A.Z.); (W.M.); (P.T.); (B.R.); (J.S.); (M.S.); (D.B.)
- Correspondence: ; Tel.: +48-22-473-5335
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Dueñas-Garcia OF, Matta-Gonzalez MDP, Fuller K, Fang W, Shapiro RE. The Effect of Toileting Position in Uroflow Curves in Young Healthy Nulliparous Women. SCIENTIFICA 2019; 2019:5273083. [PMID: 31781474 PMCID: PMC6875003 DOI: 10.1155/2019/5273083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
The objective of our study was to determine the effect of voiding positions on uroflow parameters in young, healthy nulliparous women with no pelvic floor disorders. Material and Methods. From December 2017 to February 2018, we performed a single-institution cross-sectional study with 30 healthy volunteers comparing uroflow curves in sitting and hovering positions. 49 participants were initially prescreened with a validated tool questionnaire for pelvic floor disorders and 30 participants who had absent symptoms were included for the final analysis. From the selected participants, demographics were collected and comparisons between the sitting and hovering position groups regarding the maximum flow rate (Qmax), average flow rate (Qave), voided volume (VV), and time to peak flow (TQmax) were conducted using either the paired t-test or the Wilcoxon rank sum test. In addition, linear regression analysis was performed to determine whether height, BMI, and age have significant impact on the log-transformed average of the pre- and postvalues of either Qmax, Qave, VV, or TQmax, as the average of these values are not normally distributed. Results. There were no statistical differences between the hovering and sitting position groups on the maximum flow rate (p=0.93), average flow rate (p=0.82), voided volume (p=0.53), and time to peak flow (p=0.82). BMI had borderline significant impact on Qave with p value = 0.0531. Conclusion. Different voiding toileting habits do not affect the most commonly used uroflow parameters in young healthy nulliparous patients. Results need to be corroborated by a larger scale study considering the small sample size of our study.
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Affiliation(s)
| | | | - Kylie Fuller
- Obstetrics and Gynecology Department, West Virginia University, Morgantown, West Virginia, USA
| | - Wei Fang
- Obstetrics and Gynecology Department, West Virginia University, Morgantown, West Virginia, USA
| | - Robert Edward Shapiro
- Obstetrics and Gynecology Department, West Virginia University, Morgantown, West Virginia, USA
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Blanco C, Chen IA. Phage therapy administered noninvasively could be effective in thin tubes subject to episodic flow despite washout: a simulation study. Phys Biol 2019; 16:054001. [PMID: 31266001 PMCID: PMC6771420 DOI: 10.1088/1478-3975/ab2ea0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bacteriophages (phages) have been proposed as candidates for the treatment of bacterial infections in light of emerging antibiotic-resistant microorganisms. Bacterial growth within thin tubes is a particular concern, such as in urinary tract infections and colonization of catheters. However, it is not clear whether phage administration to the urinary tract or in catheters could be effective in the context of flow to the outside (i.e. voiding or saline flush). Here, we adapt a previous model of phage infection to a thin tube geometry mimicking the spatial organization of the urinary tract, including bacterial motility and episodic flow during which phages are washed out of the system. We show that density-dependent dynamics permit propagation of the phage infection and that washout has little effect on the timing of bacterial clearance. In addition, instillation of phage at the bottom ~0.1 mm of the tract is effective in our computational model, suggesting that therapeutic phage introduced non-invasively could be efficacious in such situations.
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Affiliation(s)
- Celia Blanco
- Department of Chemistry and Biochemistry 9510, University of California, Santa Barbara, CA 93106, United States of America
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Dropkin BM, Kowalik CG, Jaunarena JH, Delpe SD, Reynolds WS, Dmochowski RR, Kaufman MR. Proximal location of explanted midurethral slings is associated with urinary storage symptoms. Neurourol Urodyn 2019; 38:1611-1615. [PMID: 31059638 DOI: 10.1002/nau.24022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 03/07/2019] [Accepted: 04/16/2019] [Indexed: 11/07/2022]
Abstract
AIM To examine the location of midurethral slings (MUS) at the time of excision to determine associations between presenting symptoms and sling location at explant. METHODS We performed an IRB approved, retrospective review of MUS explants between January 2011 and March 2016. Symptoms and physical examination findings were compared between women with slings explanted from the mid-urethra (MU) and women with slings explanted from the proximal urethra/bladder neck (PU/BN). RESULTS We included 95 consecutive women who underwent MUS explant in the analysis. Presenting symptoms included pain in 69 women (72.6%), urinary urgency in 66 (66.5%), voiding dysfunction in 55 (57.9%), urge urinary incontinence (UUI) in 41 (43.2%), stress urinary incontinence in 34 (35.8%), and recurrent urinary tract infections in 22 (23.2%). At sling explant, 2 (2.1%) slings were found at the distal urethra, 33 (34.7%) at the MU and 60 (63.2%) at the PU/BN. Women with slings explanted from the PU/BN were more likely to present with urgency (78.3% vs 54.5%; P = 0.017) and UUI (53.3% vs 27.3%; P = 0.015) and less likely to present with pain on examination (48.3% vs 75.8%; P = 0.01). CONCLUSIONS The majority of MUS requiring explant in this cohort were found at the PU/BN. The most common presenting symptom before MUS explant was pain, followed by urgency and voiding dysfunction. PU/BN location of MUS is likely a factor in the development of urgency and UUI in women who ultimately undergo explant.
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Affiliation(s)
- Benjamin M Dropkin
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Casey G Kowalik
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jorge H Jaunarena
- Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sophia D Delpe
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William S Reynolds
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Natale F, Illiano E, Marchesi A, La Penna C, Costantini E. Transobturator Tape: Over 10 Years Follow-up. Urology 2019; 129:48-53. [PMID: 30890420 DOI: 10.1016/j.urology.2019.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/03/2019] [Accepted: 03/04/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess subjective and objective outcomes in incontinent patients following "out-in" TOT, at >10-year follow-up; to evaluate effect on quality of life and other urinary symptoms, late adverse events and predictive factors for failure. METHODS This single-centre prospective study evaluated women with "complicated" or "uncomplicated" stress urinary incontinence (SUI) following "out-i"' TOT between 2003 and 2007. The pre-op work-up comprised: history; pelvic examination; cough stress test; urodynamic study; UDI-6; and King's Health questionnaires. Work-up was the same as pre-op plus the Patient Global Impression of Improvement scale with final follow-up in 2017. RESULTS One hundred thirty six consecutive patients underwent TOT; at final follow-up (mean 145 months) we evaluated 123. Cure rates: objective: 78.9%; subjective: 62.6%; no significant deterioration in SUI cure rates over time. Urgency and urgency urinary incontinence (UUI) significantly reduced. Voiding dysfunction increased without urodynamic obstruction. De novo urgency appeared in 7.3% and de novo UUI in 4.1%. In the 31 uncomplicated SUI patients, the objective cure rate was 87.1% and the subjective cure rate was 72.2%. De novo urgency appeared in 9.7% and de novo UUI in 3.2%. Nine King's Health questionnaires domains saw statistically significant improvements. In univariate analysis, pre-op wet OAB was associated with subjective recurrent SUI (P < .038) and parity >2 was associated with objective recurrent SUI (P = .023). We had 5 cases of partial mesh exposure. CONCLUSION Cure rates are satisfactory, 10 years after TOT surgery, with good quality of life and few major complications. However, some postoperative symptoms may be caused by long-term treatment failure or by advancing age or another pathology.
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Affiliation(s)
- Franca Natale
- Urogynecology Unit, San Carlo di Nancy Hospital, Rome, Italy
| | - Ester Illiano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy.
| | - Alessandro Marchesi
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy
| | - Chiara La Penna
- Section of Gynecology and Obstetrics, Department of Surgery, "Tor Vergata" University, Rome, Italy
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy
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Alt CD, Katzenberger SM, Hallscheidt P, Sohn C, Kauczor HU, Eickhoff SB, Brocker KA. Urethral length and bladder neck behavior: can dynamic magnetic resonance imaging give the same results as introital ultrasound? Arch Gynecol Obstet 2019; 299:809-816. [PMID: 30706182 DOI: 10.1007/s00404-019-05060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/21/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare dynamic magnetic resonance imaging (dMRI) and introital ultrasound results with regard to urethral length measurements and the evaluation of bladder neck changes. METHODS Retrospective analyses of urethral length measurements and detection of bladder neck changes (rotated/vertical bladder neck descent, urethral funneling) were conducted in women-scheduled for surgical treatment with alloplastic material-who had undergone introital ultrasound and dMRI presurgery and 3 months postsurgery. Measurement differences between both imaging modalities were evaluated by assessing the confidence interval for the difference in means between the datasets using bootstrap analysis. RESULTS Based on data from 40 patients (320 image series), the urethra could be clearly measured on every pre- and postsurgical dMRI dataset but not on preoperative ultrasound images in nine women during Valsalva maneuver due to a large cystocele. The estimation of the mean difference distribution based on 500,000 bootstrap resamples indicated that the urethral length was measured shorter by dMRI pre- and postsurgery at rest and postsurgery during Valsalva maneuver (median 1.6-3.1 mm) but longer by dMRI (median 0.2 mm) during Valsalva maneuver presurgery. Rotated/vertical bladder neck descent and urethral funneling diagnoses showed concordance of 67-74% in the direct comparison of patients; the estimation of the concordance indicated poorer outcomes with 50-72%. CONCLUSIONS Metric information on urethral length from dMRI is comparable to that from introital ultrasound. dMRI is more advantageous in cases with an extended organ prolapse. At present, dMRI does not give the same diagnosis on bladder neck changes as introital ultrasound does.
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Affiliation(s)
- C D Alt
- Department of Diagnostic and Interventional Radiology, University Duesseldorf, Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - S M Katzenberger
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.,Hannover Medical School, Clinic of Orthodontics, OE 7730, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - P Hallscheidt
- Department of Diagnostic and Interventional Radiology, University Heidelberg, Medical Faculty, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Radiological Department Darmstadt, Academic Teaching Practice, University of Heidelberg Medical Center, Dieburger Str. 29-31, 64287, Darmstadt, Germany
| | - C Sohn
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - H U Kauczor
- Department of Diagnostic and Interventional Radiology, University Heidelberg, Medical Faculty, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - S B Eickhoff
- Institute of Neuroscience and Medicine (INM-7), Juelich Research Centre, 52428, Juelich, Germany.,Institute of Systems Neuroscience, Heinrich Heine University, 40225, Dusseldorf, Germany
| | - K A Brocker
- Department of Obstetrics and Gynecology, Medical School, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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Majkusiak W, Pomian A, Horosz E, Zwierzchowska A, Tomasik P, Lisik W, Barcz E. Demographic risk factors for mid-urethral sling failure. Do they really matter? PLoS One 2018; 13:e0207185. [PMID: 30418999 PMCID: PMC6231652 DOI: 10.1371/journal.pone.0207185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 10/26/2018] [Indexed: 11/18/2022] Open
Abstract
Age, obesity and vaginal deliveries (VD) are recognized risk factors for stress urinary incontinence (SUI). According to many authors, the abovementioned risk factors for incontinence also increase the risk of mid-urethral sling (MUS) failure. Our aim was to evaluate the objective and subjective effectiveness of retropubic MUS in 12 months observation, relative to the three potential risk factors of failure: obesity, age and VDs. A prospective observational study including 238 women who underwent retropubic MUS implantation was performed. Patients were divided into subgroups: obese vs non-obese, <65 vs ≥65 years old and no history of VD vs ≥1 VD. Follow-up took place between 6 and 12 months post-surgery. Cough test, 1-hour pad test, pelvic floor ultrasound examination, and Incontinence Impact Questionnaire 7 (IIQ-7) results were assessed pre- and post-operatively. Of the 238 patients, 208 (86.3%) completed a minimum follow-up period of 12 months. Significant improvement in the pad test was observed in all patients (83.2 ± 78.6 g vs 0.7 ± 3.3 g). Negative cough test results were obtained in over 94% of patients. Significant improvement in the IIQ7 results was observed in all patients (74.2 ± 17.7 vs 5.5 ± 13.4). No significant differences in all the analyzed parameters with regard to BMI, age and parity were observed. No combination of risk factors influenced the objective and subjective cure rates. Our study demonstrated that older age, obesity and history of VDs have no impact on objective and subjective sling effectiveness in a short term observation. There is no influence of combined demographic features on the failure risk.
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Affiliation(s)
- Wojciech Majkusiak
- Multidisciplinary Hospital Warsaw-Miedzylesie, Department of Obstetrics and Gynecology, Warsaw, Poland
| | - Andrzej Pomian
- Multidisciplinary Hospital Warsaw-Miedzylesie, Department of Obstetrics and Gynecology, Warsaw, Poland
| | - Edyta Horosz
- Multidisciplinary Hospital Warsaw-Miedzylesie, Department of Obstetrics and Gynecology, Warsaw, Poland
| | - Aneta Zwierzchowska
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Tomasik
- Multidisciplinary Hospital Warsaw-Miedzylesie, Department of Obstetrics and Gynecology, Warsaw, Poland
| | - Wojciech Lisik
- Department of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Barcz
- Multidisciplinary Hospital Warsaw-Miedzylesie, Department of Obstetrics and Gynecology, Warsaw, Poland
- * E-mail:
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Fontaine F, Tu LM, Carroll MS, Morin M. Agreement between simple catheter method and 3D transperineal ultrasound for assessing urethral length measurement before stress urinary incontinence treatment. Neurourol Urodyn 2018; 37:2875-2880. [PMID: 30178605 DOI: 10.1002/nau.23805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/01/2018] [Indexed: 12/14/2022]
Abstract
AIMS Optimal placement of periurethral material has an important role in treatment efficacy with stress urinary incontinence (SUI). The validity of methods for determining urethral length and the precise location of the mid-urethral complex for SUI treatment have been sparsely studied. The aim of this study was to investigate the agreement between urethral lengths measured with a catheter and by transperineal ultrasound. METHODS Fifty-seven women with SUI or mixed urinary incontinence (MUI) with predominant stress symptoms were recruited. The urethral length was assessed with 3D transperineal ultrasound and measurements were taken offline from the postero-inferior margin of the pubic symphysis to the bladder neck. Then, it was measured with a foley catheter by another evaluator, blinded to the ultrasound data. The distance between the inflated balloon and the urethral meatus was considered. RESULTS Thirty-three women (58%) had SUI and 24 (42%) had MUI. The mean urethral length evaluated with ultrasound and the catheter were 3.03 ± 0.34 cm and 3.02 ± 0.41 cm (P = 0.857), respectively. Agreement between the two methods as assessed by the intra-class correlation coefficient was 0.90 (CI0.82-0.94, P ≤ 0.001). Limits of agreement (Bland-Altman) were +0.46 to -0.45 cm, with a mean difference of -0.01 ± 0.23 cm. CONCLUSIONS Findings of this study, reveal an excellent agreement between a simple catheter technique and ultrasound assessment for measuring urethral length, with a small mean bias and clinically acceptable limits of agreement. This provides relevant information in clinical practice for determining optimal placement of periurethral material or mid-urethral tape for SUI treatment.
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Affiliation(s)
- Félix Fontaine
- Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center of the Centre Hospitalier Sherbrooke, Québec, Canada
| | - Le Mai Tu
- Faculty of Medicine and Health Sciences, Division of Urology, Department of Surgery, Université de Sherbrooke and Research Center of the Centre Hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marie-Soleil Carroll
- Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Mélanie Morin
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke and Research Center of the Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada
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