Bladder neck incompetence could be an etiology of overactive bladder syndrome in women with stress urinary incontinence after anti-incontinence surgery: insights from transrectal sonography

Combination of skin sympathetic nerve activity and urine biomarkers in improving diagnostic accuracy for urge urinary incontinence

Urge urinary incontinence (UUI) poses diagnostic challenges due to subjective assessments and limited biomarkers. This study aims to enhance accuracy by integrating skin sympathetic nerve activity (SKNA) with urine biomarkers. A prospective analysis included 36 UUI and 36 non-UUI participants. All participants underwent measurements of SKNA and evaluations of nine urine biomarkers, both with and without urinary creatinine correction. Logistic regression and support vector machine with L1 penalty were applied to SKNA and urine biomarker measurements. Six-fold stratified cross-validation ensuring equitable distribution of UUI positive and negative samples was adopted. Nonzero model weights were extracted to identify most relevant biomarkers. Elevated SKNA and calibrated urine biomarkers were observed in UUI participants. Calibrated urinary biomarkers alone achieves better accuracy than using raw biomarkers. Integration of SKNA and calibrated biomarkers demonstrated superior diagnostic performance for UUI (AUC = 0.80 ± 0.07; sensitivity = 0.72, specificity = 0.83) compared to using SKNA alone, raw or calibrated urine biomarkers alone, and alternative combinations. Baseline SKNA, calibrated MCP-1, MIP-1β, and IP-10 emerged as promising biomarkers. In conclusion, combining SKNA and urinary creatinine-normalized biomarkers yielded the highest diagnostic accuracy for UUI. This study proposes an innovative diagnostic algorithm, advancing UUI diagnostics by integrating autonomic function parameters and urine biomarker analysis.

Effect of lower urinary tract conditions on surgical outcomes of different suburethral sling procedures for female stress urinary incontinence

PURPOSE

The suburethral sling procedure has been widely used as the first-line treatment for female stress urinary incontinence (SUI). This study retrospectively compared the long-term surgical outcomes and complications between retropubic and transobturator suburethral sling procedures.

METHODS

From 2010 to 2022, a total of 533 women with SUI underwent retropubic pubovaginal sling (PVS) or transobturator tape (TOT) procedures using a synthetic polypropylene mesh with or without concomitant anterior colporrhaphy. All patients underwent preoperative videourodynamic studies, Valsalva leak point pressure (VLPP), and voiding efficiency (VE). The success rate, postoperative complications, overactive bladder symptoms, transvaginal urethrolysis, and repeat procedures were compared among different surgical procedures.

RESULTS

Among the patients, PVS was performed in 251 (47.1%) patients and with colporrhaphy in 58 (10.9%), TOT in 174 (32.6%) and with colporrhaphy in 50 (9.4%). The success rate was 87.4% in the PVS group and 75.4% in the TOT group, with or without colporrhaphy (p = 0.001). Urethrolysis was performed in 4.7% of the patients, and repeat suburethral sling procedures were performed in 8.3%. The overall success rate was significantly lower in TOT group, either with high or low VLPP, or with high or low VE. The rate of persistent OAB was significantly higher in TOT group regardless of VLPP or VE, whereas patients with VE < 90% at baseline had a significantly higher rate of postoperative dysuria.

CONCLUSION

TOT procedures had an inferior long-term success rate than PVS procedures for female SUI. Additionally, no differences in the success rate were observed between patients with different bladder functions, high or low VLPP, and high or low VE.