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Hoque SS, Ahern S, O'Connell HE, Romero L, Ruseckaite R. Comparing Patient-Reported Outcome Measures for Pain in Women With Pelvic Floor Disorders: A Scoping Review. THE JOURNAL OF PAIN 2024; 25:104454. [PMID: 38142984 DOI: 10.1016/j.jpain.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 12/26/2023]
Abstract
Women with pelvic floor disorders (PFDs) typically undergo surgery involving transvaginal mesh implants; however, transvaginal mesh surgery is associated with many adverse events including post-surgical pain. Assessment of pain as a symptom is necessary using patient-reported outcome measures (PROMs). This scoping review aimed to describe and compare existing PROMs previously used to measure pain in women with PFDs. A scoping search of Ovid MEDLINE, EMBASE, CINAHL Plus, Ovid PsycInfo, and grey literature was conducted. Studies published in English describing the development, implementation, and application of PFD-associated pain PROMs among adult women before and after pelvic floor surgery were included. From each article, a descriptive summary organised by study first author, publication year, country, setting, aim, study characteristics, and results were extracted. From 2,604 articles identified, 54 studies were included, describing 44 PROMs. Most studies described at least 2 to 3 instruments. The Pelvic Floor Distress Inventory-20 was most commonly described by 12 studies followed by the Patient Global Impression of Improvement scale. Of the 44 PROMs, 27 were condition-specific, of which 9 included items on pain; 17 generic PROMs, 4 of which contained items on pain; and 6 pain-specific PROMs. PROMs identified in our review measured pain not related to PFDs or pelvic floor surgery and quantified the pain experienced. These PROMs did not measure all areas of pain including region, sensation, impact, and triggers. The findings of this review will assist with developing a new pain-specific PROM in this population. PERSPECTIVE: Women with pelvic floor disorders often undergo surgery involving transvaginal mesh, from which they experience debilitating pain. Pain is a major issue impacting women's lives. Patient-reported outcome measures can be used to assess the pain; however, it is unclear whether existing instruments are relevant.
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Affiliation(s)
- Sheymonti S Hoque
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helen E O'Connell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Lorena Romero
- The Ian Potter Library, Alfred Hospital, Melbourne, Victoria, Australia
| | - Rasa Ruseckaite
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Kusin SB, Carroll TF, Alhalabi F, Christie AL, Zimmern PE. Long-term Outcomes With Macroplastique in Women With Stress Urinary Incontinence Secondary to Intrinsic Sphincter Deficiency. Urology 2024; 185:36-43. [PMID: 38199277 DOI: 10.1016/j.urology.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To evaluate the long-term outcomes of polydimethylsiloxane (Macroplastique (MPQ)) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD) using validated questionnaires. METHODS Following IRB approval, charts of non-neurogenic women with SUI secondary to ISD who underwent MPQ injection were reviewed from a prospectively maintained database. ISD was defined as positive stress test with a well-supported urethra and low Valsalva leak point pressure when available. Excluded were women with follow-up <5years. Baseline data included validated questionnaire scores (UDI-6 question 3 (0-3), VAS Quality of Life, Incontinence Impact Questionnaire (IIQ-7)) and urodynamic study findings. Patients were followed with same questionnaires and three-dimensional ultrasound evaluating volume/configuration of MPQ. All three-dimensional ultrasound measurements were performed by the same imaging team blinded to clinical outcomes. Outcomes were evaluated in four groups based on prior SUI treatment. Success was defined as UDI-6 question 3 score of 0-1 and not requiring additional anti-incontinence therapy at the last visit after the last MPQ injection. RESULTS From April 2011-December 2016, 106 patients (median age 67) met study criteria. Median follow-up time was 7.4years. Median MPQ injected was 5 mL. Overall success was 43%, with 54% successful after one injection and 46% requiring ≥2 injections. Across all groups, patients had improvement in Quality of Life and IIQ-7 Question 7 (frustration). Among the failure group, 17% opted for a secondary autologous sling procedure. CONCLUSION MPQ demonstrated long-term favorable outcomes in a subset of women with SUI secondary to ISD.
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Affiliation(s)
- Samuel B Kusin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Timothy F Carroll
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Feras Alhalabi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alana L Christie
- Simmons Comprehensive Cancer Center Biostatistics, University of Texas, Southwestern Medical Center, Dallas, TX
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
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Salo H, Sova H, Laru J, Talvensaari-Mattila A, Nyyssönen V, Santala M, Piltonen T, Koivurova S, Rossi HR. Long-term results of a prospective randomized trial comparing tension-free vaginal tape versus transobturator tape in stress urinary incontinence. Int Urogynecol J 2023; 34:2249-2256. [PMID: 37074367 PMCID: PMC10506929 DOI: 10.1007/s00192-023-05527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/10/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study was aimed at investigating the long-term effectiveness of minimally invasive mid-urethral sling (MUS) surgery and at comparing the outcomes between retropubic (tension-free vaginal tape, TVT) and transobturator tape (TOT) methods in the treatment of stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) with a predominant stress component in a long-term follow-up of a randomized controlled trial. METHODS This work is a long-term follow-up study of a previous prospective randomized trial conducted in the Department of Obstetrics and Gynecology at Oulu University Hospital between January 2004 and November 2006. The original 100 patients were randomized into the TVT (n=50) or TOT (n=50) group. The median follow-up time was 16 years, and the subjective outcomes were evaluated using internationally standardized and validated questionnaires. RESULTS Long-term follow-up data were obtained from 34 TVT patients and 38 TOT patients. At 16 years after MUS surgery, the UISS significantly decreased from a preoperative score in the TVT (11.88 vs 5.00, p<0.001) and TOT (11.05 vs 4.95, p<0.001) groups, showing a good long-term success of the MUS surgery in both groups. In comparing the TVT and TOT procedures, the subjective cure rates did not differ significantly between the study groups in long-term follow-up according to validated questionnaires. CONCLUSION Midurethral sling surgery had good long-term outcomes in the treatment of SUI and MUI with a predominant stress component. The subjective outcomes of the TVT and TOT procedures were similar after a 16-year follow-up.
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Affiliation(s)
- Heini Salo
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Henri Sova
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Johanna Laru
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Anne Talvensaari-Mattila
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Virva Nyyssönen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Markku Santala
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Terhi Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Sari Koivurova
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland
| | - Henna-Riikka Rossi
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, Box 5000, 90014, Oulu, Finland.
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Warro A, Ojala J, Ala-Nissilä S, Laurikainen E. Nine years follow-up after TVT-O; the mesh still available for women suffering from urinary incontinence. J Gynecol Obstet Hum Reprod 2023; 52:102534. [PMID: 36642377 DOI: 10.1016/j.jogoh.2023.102534] [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: 04/22/2022] [Revised: 08/30/2022] [Accepted: 01/11/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The efficacy of TVT-O is well established in patients with stress urinary incontinence (SUI). The objective of this study was to evaluate the efficacy, safety and patient satisfaction of TVT-O in patients suffering from primary or recurrent SUI or mixed urinary incontinence (MUI). METHODS A single-center follow-up study was conducted. All consecutive women treated by TVT-O between August 2004 and October 2011 were included. Objective treatment success was a negative stress test. Patient satisfaction was assessed by questionnaires. RESULTS The mean time from the surgery to the last follow-up visit was 9 years. One hundred and six patients were included in the final evaluation. Nineteen patients (18%) were previously operated on for urinary incontinence (UI). Ninety patients (85%) were objectively cured; 68 (89%) of the SUI and 22 (73%) of the MUI patients (p = 0.067). Fourteen (74%) of the previously operated patients and 76 (87%) of the patients who underwent first-time TVT-O were objectively cured (p = 0.158). Eighty-six patients (81%) achieved subjective success; 70 (92%) of the SUI and sixteen (53%) of the MUI patients (p<0.001). Eleven women (58%) who had repeat surgery and 75 women (86%) who had primary operation were subjectively cured (p = 0.008). CONCLUSIONS TVT-O is effective in women who suffer from SUI having 90% objective and subjective cure rate 9 years after surgery. There were no major complications, but 16% of the women suffered from groin pain and 37% had urgency symptoms. The results of TVT-O were still good, and it is a therapeutic alternative for different subgroups of UI including recurrent cases.
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Affiliation(s)
- Aino Warro
- Department of gynecology, Turku University Central hospital, Savitehtaankatu 5, 20520 Turku, Finland.
| | - Johanna Ojala
- Department of gynecology, Turku University Central hospital, Savitehtaankatu 5, 20520 Turku, Finland.
| | - Seija Ala-Nissilä
- Department of gynecology, Turku University Central hospital, Savitehtaankatu 5, 20520 Turku, Finland.
| | - Eija Laurikainen
- Department of gynecology, Turku University Central hospital, Savitehtaankatu 5, 20520 Turku, Finland.
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Moossdorff-Steinhauser HFA, Berghmans BCM, Spaanderman MEA, Bols EMJ. Prevalence, incidence and bothersomeness of urinary incontinence in pregnancy: a systematic review and meta-analysis. Int Urogynecol J 2021; 32:1633-1652. [PMID: 33439277 PMCID: PMC8295103 DOI: 10.1007/s00192-020-04636-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI) is a common and embarrassing complaint for pregnant women. Reported prevalence and incidence figures show a large range, due to varying case definitions, recruited population and study methodology. Precise prevalence and incidence figures on (bothersome) UI are of relevance for health care providers, policy makers and researchers. Therefore, we conducted a systematic review and meta-analysis to investigate the prevalence and incidence of UI in pregnancy in the general population for relevant subgroups and assessed experienced bother. METHODS All observational studies published between January 1998 and October 2018 reporting on prevalence and/or incidence of UI during pregnancy were included. All women, regardless of weeks of gestation and type of UI presented in all settings, were of interest. A random-effects model was used. Subgroup analyses were conducted by parity, trimester and subtype of UI. RESULTS The mean (weighted) prevalence based on 44 included studies, containing a total of 88.305 women, was 41.0% (range of 9-75%). Stress urinary incontinence (63%) is the most prevalent type of UI; 26% of the women reported daily loss, whereas 40% reported loss on a monthly basis. Bother was experienced as mild to moderate. CONCLUSIONS UI is very prevalent and rising with the weeks of gestation in pregnancy. SUI is the most common type and in most cases it was a small amount. Bother for UI is heterogeneously assessed and experienced as mild to moderate by pregnant women.
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Affiliation(s)
| | - Bary C M Berghmans
- Pelvic care Unit Maastricht, CAPHRI, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | | | - Esther M J Bols
- Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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Moossdorff-Steinhauser HFA, Berghmans BCM, Spaanderman MEA, Bols EMJ. Prevalence, incidence and bothersomeness of urinary incontinence between 6 weeks and 1 year post-partum: a systematic review and meta-analysis. Int Urogynecol J 2021; 32:1675-1693. [PMID: 34142179 PMCID: PMC8295150 DOI: 10.1007/s00192-021-04877-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
Introduction and hypothesis Urinary incontinence (UI) is a common complaint for post-partum women. Reported prevalence and incidence figures show a large range due to varying study methodology. The crude prevalence of post-partum UI may differ when accounting for bother. Precise prevalence and incidence figures on (bothersome) UI are of relevance for health care providers, research planning, and policy makers. Therefore, we conducted a systematic review and meta-analysis to investigate the prevalence and incidence of UI in post-partum women in the Western world for relevant subgroups and assessed experienced bother in relation to UI. Methods Observational studies, published between January 1998 and March 2020 and reporting on prevalence and incidence between 6 weeks and 1 year post-partum, were included, regardless of type of UI or setting. We used a random effects model with subgroup analyses for post-partum period, parity and subtype of UI. Results The mean (weighted) prevalence based on 24 included studies, containing a total of 35.064 women, was 31.0%. After an initial drop in prevalence at 3 months post-partum, prevalence rises up to nearly the same level as in the third trimester of pregnancy at 1 year post-partum (32%). Stress UI (54%) is the most prevalent type. UI prevalence is equal among primi- and multiparous women. Experienced bother of UI is heterogeneously assessed and reported to be mild to moderate. Conclusions Post-partum UI is highly prevalent in women in the Western world. After an initial drop it rises again at 1 year post-partum. Experienced bother is mild to moderate. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-021-04877-w.
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Affiliation(s)
- Heidi F A Moossdorff-Steinhauser
- Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Bary C M Berghmans
- Pelvic care Center Maastricht, CAPHRI, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | | | - Esther M J Bols
- Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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Wuytack F, Moran P, Daly D, Panda S, Hannon K, Cusack C, O'Donovan M. A systematic review of utility-based and disease-specific quality of life measurement instruments for women with urinary incontinence. Neurourol Urodyn 2021; 40:1275-1303. [PMID: 34082483 DOI: 10.1002/nau.24678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/16/2021] [Accepted: 04/05/2021] [Indexed: 11/09/2022]
Abstract
AIM This systematic review aims to identify disease-specific and generic quality of life (QoL) outcome measurement instruments used in populations of women with urinary incontinence (UI) and to determine the most psychometrically robust and appropriate disease-specific and generic tools for measuring the quality of life in this population. METHODS A systematic search was conducted of PubMed, Embase, SCIELO, and CINAHL databases for studies evaluating measurement properties of QoL instruments in women with UI. The methodological quality of studies and the quality of measurement properties were evaluated using the COnsensus-based Standards for the selection of health status Measurement INtruments (COSMIN) checklist and quality criteria. Overall, evidence for measurement properties was graded using the modified grading of recommendations, assessment, development & evaluation approach. RESULTS A total of 73 studies were included, and 27 specific and 6 generic instruments were identified. The Incontinence QoL questionnaire (IQoL) had the highest overall psychometric quality for English-speaking populations and was the most widely translated tool. Evidence for generic QoL tools in this population is limited. Few studies evaluated measurement error or cross-cultural validity. CONCLUSION The IQoL is the most psychometrically robust disease-specific tool for use in this population. More research is needed to determine the most psychometrically robust generic tool. Future studies should also evaluate measurement error and cross-cultural validity as evidence for these properties is particularly lacking.
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Affiliation(s)
- Francesca Wuytack
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Patrick Moran
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Hannon
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Maggie O'Donovan
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Okoro RN, Adibe MO, Okonta MJ, Ummate I, Ohieku JD, Yakubu SI. Assessment of health-related quality of life and its determinants in the pre-dialysis patients with chronic kidney disease. Int Urol Nephrol 2021; 54:165-172. [PMID: 33772421 DOI: 10.1007/s11255-021-02846-2] [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: 08/19/2020] [Accepted: 03/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Health-related quality of life (HRQoL) is increasingly being considered as a critical parameter to measure how the disease affects patients' health status, especially for long-term ailments like chronic kidney disease (CKD). This study aimed to assess the HRQoL and its determinants in pre-dialysis patients with CKD. METHODS This cross-sectional study recruited patients with CKD stages one to four. Data were collected using the HRQoL Questionnaire (15D). Descriptive statistics were used to summarize patients' characteristics. Chi-square test or Fisher's exact test was used to explore the association between independent variables and the HRQoL. Multivariate logistic regression analyses were employed to investigate the determinants of HRQoL. A P value of less than 0.05 was considered statistically significant. RESULTS Two hundred and twenty patients were enrolled in the study (average age 52.7 ± 12.4 years, 61.8% females, and 69.1% with CKD stage 4). The average multidimensional utility score of the study population was 0.82 ± 0.13, while the single-attribute utility scores ranged from 0.73 to 0.89. The speech, and discomfort and symptoms dimensions had the highest (0.89) and lowest (0.73) single-attribute utility scores, respectively. The patients who were uneducated [Adjusted Odds Ratio (AOR) 0.34, 95% CI (0.12-0.97)] were significantly less likely to have poor HRQoL compared to those with tertiary education level. Additionally, unemployed [AOR 4.69, 95% CI (1.69-13.02)], and self-employed patients [AOR 4.25, 95% CI (1.26-14.38)] were significantly more likely to have poor HRQoL compared to the retirees CONCLUSIONS: This study shows that the overall HRQoL of the participants was high, though a considerable proportion of them had poor HRQoL, while the discomfort and symptoms dimension was the most impacted. Being educated, unemployed, and self-employed were significantly and independently associated with poor overall HRQoL.
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Affiliation(s)
- Roland Nnaemeka Okoro
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Maiduguri, Maiduguri, Nigeria.
| | - Maxwell Ogochukwu Adibe
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Nigeria
| | - Mathew Jegbefume Okonta
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Nigeria
| | - Ibrahim Ummate
- Department of Medicine, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
- Department of Medicine, Nephrology Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - John David Ohieku
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Maiduguri, Maiduguri, Nigeria
| | - Sani Ibn Yakubu
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Maiduguri, Maiduguri, Nigeria
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Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, Hay-Smith EJC. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2020; 5:CD007471. [PMID: 32378735 PMCID: PMC7203602 DOI: 10.1002/14651858.cd007471.pub4] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND About one-third of women have urinary incontinence (UI) and up to one-tenth have faecal incontinence (FI) after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both preventing and treating incontinence. This is an update of a Cochrane Review previously published in 2017. OBJECTIVES To assess the effects of PFMT for preventing or treating urinary and faecal incontinence in pregnant or postnatal women, and summarise the principal findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearched journals and conference proceedings (searched 7 August 2019), and the reference lists of retrieved studies. SELECTION CRITERIA We included randomised or quasi-randomised trials in which one arm included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Populations included women who, at randomisation, were continent (PFMT for prevention) or incontinent (PFMT for treatment), and a mixed population of women who were one or the other (PFMT for prevention or treatment). DATA COLLECTION AND ANALYSIS We independently assessed trials for inclusion and risk of bias. We extracted data and assessed the quality of evidence using GRADE. MAIN RESULTS We included 46 trials involving 10,832 women from 21 countries. Overall, trials were small to moderately-sized. The PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Two participants in a study of 43 pregnant women performing PFMT for prevention of incontinence withdrew due to pelvic floor pain. No other trials reported any adverse effects of PFMT. Prevention of UI: compared with usual care, continent pregnant women performing antenatal PFMT probably have a lower risk of reporting UI in late pregnancy (62% less; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; moderate-quality evidence). Antenatal PFMT slightly decreased the risk of UI in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; high-quality evidence). There was insufficient information available for the late postnatal period (more than six to 12 months) to determine effects at this time point (RR 1.20, 95% CI 0.65 to 2.21; 1 trial, 44 women; low-quality evidence). Treatment of UI: compared with usual care, there is no evidence that antenatal PFMT in incontinent women decreases incontinence in late pregnancy (very low-quality evidence), or in the mid-(RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; low-quality evidence), or late postnatal periods (very low-quality evidence). Similarly, in postnatal women with persistent UI, there is no evidence that PFMT results in a difference in UI at more than six to 12 months postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; low-quality evidence). Mixed prevention and treatment approach to UI: antenatal PFMT in women with or without UI probably decreases UI risk in late pregnancy (22% less; RR 0.78, 95% CI 0.64 to 0.94; 11 trials, 3307 women; moderate-quality evidence), and may reduce the risk slightly in the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; low-quality evidence). There was no evidence that antenatal PFMT reduces the risk of UI at late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; moderate-quality evidence). For PFMT started after delivery, there was uncertainty about the effect on UI risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; moderate-quality evidence). Faecal incontinence: eight trials reported FI outcomes. In postnatal women with persistent FI, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (very low-quality evidence). In women with or without FI, there was no evidence that antenatal PFMT led to a difference in the prevalence of FI in late pregnancy (RR 0.64, 95% CI 0.36 to 1.14; 3 trials, 910 women; moderate-quality evidence). Similarly, for postnatal PFMT in a mixed population, there was no evidence that PFMT reduces the risk of FI in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, low-quality evidence). There was little evidence about effects on UI or FI beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it. AUTHORS' CONCLUSIONS This review provides evidence that early, structured PFMT in early pregnancy for continent women may prevent the onset of UI in late pregnancy and postpartum. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on UI, although the reasons for this are unclear. A population-based approach for delivering postnatal PFMT is not likely to reduce UI. Uncertainty surrounds the effects of PFMT as a treatment for UI in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches, and in certain groups of women. Hypothetically, for instance, women with a high body mass index (BMI) are at risk of UI. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups, and how much PFMT women in both groups do, to increase understanding of what works and for whom. Few data exist on FI and it is important that this is included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence. In addition to further clinical studies, economic evaluations assessing the cost-effectiveness of different management strategies for FI and UI are needed.
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Affiliation(s)
| | - Peter Lawrenson
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Rhianon Boyle
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - June D Cody
- c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Siv Mørkved
- Clinical Service, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
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Tantawy SA, Elgohary HM, Abdelbasset WK, Kamel DM. Effect of 4 weeks of whole-body vibration training in treating stress urinary incontinence after prostate cancer surgery: a randomised controlled trial. Physiotherapy 2019; 105:338-345. [DOI: 10.1016/j.physio.2018.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/25/2018] [Indexed: 01/09/2023]
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11
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Eloranta S, Rantanen V, Kauppila M, Hautaniemi S, Vahlberg T, Laasik M, Joronen K, Sintonen H, Ala-Nissilä S. Pelvic floor disorders and health-related quality of life in older women: Results from the Women's Gynaecological Health study in Lieto, Finland. Arch Gerontol Geriatr 2019; 82:226-231. [PMID: 30875524 DOI: 10.1016/j.archger.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this study was to analyse the prevalence of pelvic floor disorders and to describe health-related quality of life (HRQoL) among older women. We also compared participants' HRQoL with the age-matched general female population and analysed factors associated with HRQoL. STUDY DESIGN This is a population-based study of a cohort of women born in 1948 and in 1950 (n = 143) which is also part of the Women's Gynaecological Health study in Lieto, Finland. METHODS The data were collected by questionnaires which pertained to socio-demographics, health-related variables, pelvic floor disorders and HRQoL (15D). Linear model was conducted to estimate a model of factors that associated with HRQoL. RESULTS The prevalence of urinary incontinence, faecal incontinence and pelvic organ prolapse was 50%, 13% and 12%, respectively. The overall HRQoL score of the study cohort is broadly similar to that of the agematched general Finnish female population (mean±SD15D scores 0.905±0.084 vs 0.912±0.077). Higher number of medications was the most important explanatory factor for lower HRQoL. CONCLUSION Urinary incontinence was common; however, the impact on HRQoL was minor. The overall HRQoL score of the study cohort was broadly similar to that of age-matched general female population. Women who used a higher number of medications had lower HRQoL compared to women who used fewer medications.
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Affiliation(s)
- Sini Eloranta
- University of Turku, Faculty of Medicine, Department of Nursing Science, FI-20014, Finland; Turku University of Applied Science, Health and Well-being, Finland.
| | - Virpi Rantanen
- Hospital District of Southwest Finland Turku, 20520, Turku, Finland; University of Turku, Faculty of Medicine, Department of Obstetrics and Gynaecology, FI-20014, Finland
| | - Marjo Kauppila
- Hospital District of Southwest Finland Turku, 20520, Turku, Finland
| | - Soili Hautaniemi
- Hospital District of Southwest Finland Turku, 20520, Turku, Finland
| | - Tero Vahlberg
- University of Turku, Faculty of Medicine, Department of Clinical Medicine, Biostatistics, FI-20014, Finland
| | - Maren Laasik
- Hospital District of Southwest Finland Turku, 20520, Turku, Finland; University of Turku, Faculty of Medicine, Department of Obstetrics and Gynaecology, FI-20014, Finland
| | - Kirsi Joronen
- Hospital District of Southwest Finland Turku, 20520, Turku, Finland; University of Turku, Faculty of Medicine, Department of Obstetrics and Gynaecology, FI-20014, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Finland
| | - Seija Ala-Nissilä
- Hospital District of Southwest Finland Turku, 20520, Turku, Finland; University of Turku, Faculty of Medicine, Department of Obstetrics and Gynaecology, FI-20014, Finland
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König I, Kuhn M, Radlinger L, Koehler B. Development and validation of the ICF-Incontinence Assessment Form (ICF-IAF) to identify problems and resources for planning and evaluation of interventions using the Classification of Functioning, Disability and Health of the World Health Organization: Preliminary study. Neurourol Urodyn 2019; 38:1053-1066. [PMID: 30803015 DOI: 10.1002/nau.23938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/30/2018] [Accepted: 01/07/2019] [Indexed: 11/07/2022]
Abstract
AIMS Current level-A recommended questionnaires that provide a valid assessment of urinary incontinence (UI) and/or faecal incontinence (FI), but do not cover all aspects of the burden of the disease in the sense of the bio-psycho-social model of the World Health Organization's International Classification of Functioning, Disability and Health (ICF). Therefore, an ICF oriented questionnaire for patients with UI and/or FI to assess treatment barriers (problems) as well as positive influencing factors (resources), the "ICF-Incontinence Assessment Form" will be developed. The aim of this preliminary study was (a) to identify problems and resources of UI and/or FI in current level-A recommended questionnaires and (b) to evaluate problems and resources of patients with UI and/or FI from the perspective of experienced physiotherapists. METHODS (a) Current level-A recommended questionnaires for UI and/or FI were analyzed. Questions were linked to the ICF categories. (b) A 3-round Delphi technique survey among 262 physiotherapists from five German-speaking countries was used to evaluate patients' problems and resources relevant to physiotherapy. RESULTS (a) A total of 27 identified questionnaires were linked to 110 ICF categories. No positive influencing factors could be identified. (b) After Delphi-round 3, 110 categories of problems and 71 resources were identified. CONCLUSION Since there is a lack of resource items in the present validated questionnaires, there is a need for a short, practical questionnaire to assess and monitor both, problems and resources of patients with UI and/or FI.
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Affiliation(s)
- Irene König
- Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Manuel Kuhn
- Department of Health, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Physiotherapy, Stadtspital Triemli, Zurich, Switzerland
| | - Lorenz Radlinger
- Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Barbara Koehler
- Department of Health, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Physiotherapy, Stadtspital Triemli, Zurich, Switzerland
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Efficacy of Transdermal Oxybutynin in the Treatment of Overactive Bladder Syndrome: Does It Make Sense Using It in 2017? Adv Urol 2018; 2018:6782736. [PMID: 30151004 PMCID: PMC6087608 DOI: 10.1155/2018/6782736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/05/2018] [Indexed: 11/27/2022] Open
Abstract
Objectives Evaluation of changes in symptoms among patients with overactive bladder syndrome treated with transdermal oxybutynin and tolerability after 12 months of follow-up. Methods This was a multicenter, retrospective, single-cohort, observational study. Changes in symptoms were evaluated primarily with a 3-day voiding diary. Results were compared to baseline. Subgroup analyses were performed in patients previously treated for OAB or not and aged < 65 years versus ≥65 years. Results Clinical records of 105 patients were examined; 92.4% were women. At 12 months, 58 patients continued to receive transdermal oxybutynin. Changes in symptoms according to the voiding diary were evaluated in 47 patients. Significant improvements from baseline were observed in urinary frequency (−2.6 voids/24 hours (95% CI: −3.5; −1.8), p < 0.001); daily number of urgent episodes (−4.7 episodes/day (95% CI: −6.1; −3.6), p < 0.001); and urge incontinence (−1.9 episodes/day (95% CI: −2.9; −1.3), p < 0.001). No statistically significant differences were found in subgroup analyses. In total, 38.1% of patients had adverse events, primarily in the application site (27.6%). No severe systemic adverse events occurred. Only 6 patients (5.7%) reported dry mouth. Conclusions Improved symptoms and good tolerability observed after 1 year of treatment with transdermal oxybutynin shows that it currently has a place in the treatment of OAB patients.
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Translation and Linguistic Validation of the Korean Version of the Treatment Satisfaction Visual Analogue Scale and the Overactive Bladder Satisfaction With Treatment Questionnaire. Int Neurourol J 2018; 21:309-319. [PMID: 29298470 PMCID: PMC5756819 DOI: 10.5213/inj.1734992.496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/01/2017] [Indexed: 01/01/2023] Open
Abstract
Purpose This study reports the development of the Korean Version of the Treatment Satisfaction Visual Analogue Scale (TS-VAS) and the Overactive Bladder Satisfaction with Treatment Questionnaire (OAB-SAT-q) based on the original versions, with subsequent linguistic validation by Korean patients with overactive bladder receiving active treatment from a physician. Methods Translation and linguistic validation were performed in 2016. The validation process included permission for translation, forward translation, reconciliation, backward translation, cognitive debriefing, and proofreading. The original versions of the TS-VAS and OAB-SAT-q were independently translated into Korean by 2 bilingual translators and were then reconciled into a single version. The third bilingual translator performed a backward translation of the reconciled version into English. A trained interviewer and 5 Korean-speaking patients with OAB carried out the cognitive debriefing. Results During the forward translation process, the terms used in the 2 questionnaires were adjusted to use more appropriate expressions in the Korean language than were used in the original versions. During the backward translation process, no changes were made in terms of semantic equivalence. In the cognitive debriefing session, 5 patients were asked to fill in the answers within 8 minutes; most of them reported that the translated questions were clear and easy to understand. Conclusions The present study presents successful linguistic validation of the Korean version of the TS-VAS and OAB-SAT-q, which could be useful tools for evaluating treatment satisfaction in patients.
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Relationship of Anatomy and Function: External Anal Sphincter on Transperineal Ultrasound and Anal Incontinence. Female Pelvic Med Reconstr Surg 2017; 23:238-243. [DOI: 10.1097/spv.0000000000000350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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16
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Kobashi KC, Albo ME, Dmochowski RR, Ginsberg DA, Goldman HB, Gomelsky A, Kraus SR, Sandhu JS, Shepler T, Treadwell JR, Vasavada S, Lemack GE. Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline. J Urol 2017. [PMID: 28625508 DOI: 10.1016/j.juro.2017.06.061] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Stress urinary incontinence is a common problem experienced by many women that can have a significant negative impact on the quality of life of those who suffer from the condition and potentially those friends and family members whose lives and activities may also be limited. MATERIALS AND METHODS A comprehensive search of the literature was performed by ECRI Institute. This search included articles published between January 2005 and December 2015 with an updated abstract search conducted through September 2016. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS The AUA (American Urological Association) and SUFU (Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction) have formulated an evidence-based guideline focused on the surgical treatment of female stress urinary incontinence in both index and non-index patients. CONCLUSIONS The surgical options for the treatment of stress urinary incontinence continue to evolve; as such, this guideline and the associated algorithm aim to outline the currently available treatment techniques as well as the data associated with each treatment. Indeed, the Panel recognizes that this guideline will require continued literature review and updating as further knowledge regarding current and future options continues to grow.
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Affiliation(s)
- Kathleen C Kobashi
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Michael E Albo
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Roger R Dmochowski
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - David A Ginsberg
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Howard B Goldman
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Alexander Gomelsky
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Stephen R Kraus
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Jaspreet S Sandhu
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Tracy Shepler
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Jonathan R Treadwell
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Sandip Vasavada
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Gary E Lemack
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
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Ala-Nissilä S, Haarala M, Järvenpää T, Mäkinen J. Long-term follow-up of the outcome of supracervical versus total abdominal hysterectomy. Int Urogynecol J 2016; 28:299-306. [PMID: 27640066 DOI: 10.1007/s00192-016-3143-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/28/2016] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Hysterectomy for benign indications can be performed either as a supracervical or a total procedure. It is controversial whether removing the cervix is beneficial or not. This study aimed at comparing long-term outcomes after supracervical (n = 107) and total (n = 105) abdominal hysterectomy. METHODS Two prospective questionnaire-based studies were conducted among the original 212 patients operated on between February 1978 and May 1979 at Turku University Hospital, Finland. In the first study in 1997, a nonvalidated questionnaire was mailed to 193 patients to inquire about any postoperative symptoms. In the second study in 2011, a validated questionnaire and an invitation to a follow-up visit were sent to 153 women. During the visit, pelvic support was assessed using the Pelvic Organ Prolapse Quantification system. Additionally, hospital records were reviewed to identify any gynecological operations at both evaluation times. RESULTS In the first evaluation, the response rate was 94 %, and in the second, the rate was 62 %. Objective evaluation was possible in 75 women in 2011, 37 in the supracervical group and 38 in the total hysterectomy group. There were no significant differences in the rates of subjective urinary and sexual symptoms or subsequent operations for urinary incontinence and genital prolapse between women in the supracervical group and women in the total hysterectomy group. Four patients in the supracervical group required a re-operation: three for a prolapsed cervical stump and one for a cervical abscess. CONCLUSIONS Supracervical and total hysterectomies resulted in similar postoperative outcomes regarding subjective symptoms and subsequent gynecological operations during a follow-up of 33 years. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov ( www.clinicaltrials.gov ): NCT02166749.
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Affiliation(s)
- Seija Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital, FI-20520, Turku, Finland.
| | - Mervi Haarala
- Department of Obstetrics and Gynecology, Turku University Hospital, Vakka-Suomi Hospital, Uusikaupunki, Finland
| | - Tuija Järvenpää
- Department of Obstetrics and Gynecology, Turku University Hospital, Vakka-Suomi Hospital, Uusikaupunki, Finland
| | - Juha Mäkinen
- Department of Obstetrics and Gynecology, Turku University Hospital, FI-20520, Turku, Finland
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Giannantoni A, Carbone A, Carone R, Cervigni M, Del Popolo G, Agrò EF, Giocoli Nacci G, Palleschi G, Salvatore S, Spinelli M, Tubaro A. Real-life clinical practice of onabotulinum toxin A intravesical injections for overactive bladder wet: an Italian consensus statement. World J Urol 2016; 35:299-306. [PMID: 27229889 DOI: 10.1007/s00345-016-1847-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/07/2016] [Indexed: 01/21/2023] Open
Affiliation(s)
| | | | - Roberto Carone
- Azienda Ospedaliero-Universitaria Citta' della Salute e della Scienza, Torino, Italy
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Long-term outcome after transvaginal mesh repair of pelvic organ prolapse. Int Urogynecol J 2016; 27:1069-74. [PMID: 26837782 DOI: 10.1007/s00192-015-2939-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 12/18/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to report long-term subjective and objective outcomes after the transvaginal mesh (TVM) procedure in long-term. Possible late-onset complications were of particular interest. METHODS This was a retrospective analysis of TVM performed using Prolift™ transvaginal mesh measuring subjective outcome using validated questionnaires. Objective outcome was assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system using two definitions: POP-Q stage ≤ 1, and vaginal wall prolapse at or above the hymen or vaginal apex not descending below the upper third of the vagina. Complications were reported with the Prosthesis/Graft Complication Classification Code designed by the International Continence Society/International Urogynecological Association (ICS/IUGA). RESULTS Of 195 patients, 161 (82.6 %) participated this study after a median of 7 years. The scores in questionnaires evaluating urinary (UI) or anal incontinence and constipation or pelvic floor symptoms were low, indicating favorable surgical outcomes. Altogether, 80.1 % of patients were satisfied with the procedure. Anatomical cure was 56.4 % and 69.3 % depending on the definition used. Reoperation due to POP in any compartment was performed in 16.2 % of patients. Mesh exposure rate was 23 %, most of these being asymptomatic and of late onset. CONCLUSIONS Outcome of the TVM procedure was satisfactory. Anatomical cure was inferior to subjective cure. Mesh exposure rate was high; most exposures observed in the long-term were of late onset and were asymptomatic.
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Paka C, Atan IK, Dietz HP. The bother of anal incontinence and St. Mark's Incontinence Score. Tech Coloproctol 2015; 20:123-8. [PMID: 26573810 DOI: 10.1007/s10151-015-1397-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/30/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patient self-report is important in the assessment of the impact of anal incontinence (AI) on quality of life. This study aimed to (1) determine the correlation between total St. Mark's Incontinence Score (SMIS) and a single-item visual analogue scale (VAS) for bother from AI, and (2) determine the correlation between individual components of SMIS and VAS. METHODS This is a retrospective study conducted on a cohort of 516 women seen for symptoms of lower urinary tract and pelvic floor dysfunction between January 2013 and August 2014. If a woman responded "yes" to the question "Do you experience any leakage from the back passage/anus?" they were considered to have AI, and the SMIS was administered. They were also asked "How much are you bothered by these symptoms?" to assess bother from AI by VAS. Statistical analyses were performed using Spearman's correlation and Mann-Whitney U test. RESULTS Eighty-four (16.3 %) women reported AI with a mean SMIS of 11 (SD ± 5.11, range 2-24) and median bother of 5 (VAS 1-10). There was a fair correlation between VAS for the bother from AI and SMIS (Spearman's r = 0.523, p < 0.001). Fecal urgency, impact on lifestyle, and use of pad/plug were significantly associated with VAS (p = 0.05, p = 0.002 and p < 0.001, respectively). CONCLUSIONS There is a fair, positive correlation between VAS for bother from AI and SMIS. Patients' bother from AI is strongly associated with its impact on lifestyle as quantified by individual SMIS components.
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Affiliation(s)
- C Paka
- Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia.,Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - I K Atan
- Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia.,Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - H P Dietz
- Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia.
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Pai A, Al-Singary W. Durability, safety and efficacy of polyacrylamide hydrogel (Bulkamid(®)) in the management of stress and mixed urinary incontinence: three year follow up outcomes. Cent European J Urol 2015; 68:428-33. [PMID: 26855795 PMCID: PMC4742441 DOI: 10.5173/ceju.2015.647] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/14/2015] [Accepted: 09/07/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction There are a myriad of treatment options available for patients suffering with the increasingly prevalent condition of stress urinary incontinence (SUI). The minimally invasive nature of periurethral bulking agents makes them an attractive proposition in the correctly selected patient. There is, however, limited data available on the medium to long term safety and efficacy of this procedure. The aim of our study is to evaluate the outcomes of Polyacrylamide Hydrogel (PAHG) (Bulkamid®) as a periurethral bulking agent at our institution. Material and methods From 2006 to 2011, two hundred and fifty six women underwent periurethral bulking with PAHG in the management of SUI or mixed urinary incontinence (MUI). Women were assessed with at least yearly quality of life and ICIQ questionnaires. Results The majority of patients had the procedure under a local anaesthetic, with a median operative time of 9 minutes. Median follow up was 38 months. 82% of patients reported cure/significant improvement at 3 months. Importantly, this high satisfaction rate was maintained at final follow up and was reflected in both VAS and ICIQ scores. There were no reported adverse reactions and no significant safety concerns. Conclusions We conclude that Bulkamid® injection is an efficacious, minimally invasive, and safe procedure for a selected group of patients with stress incontinence. In our study, PAHG has been shown to be durable and safe.
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Affiliation(s)
- Aakash Pai
- Worthing Hospital, Department of Urology, Worthing, United Kingdom
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Lavelle RS, Christie AL, Alhalabi F, Zimmern PE. Risk of Prolapse Recurrence after Native Tissue Anterior Vaginal Suspension Procedure with Intermediate to Long-Term Followup. J Urol 2015; 195:1014-20. [PMID: 26523882 DOI: 10.1016/j.juro.2015.10.138] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE We report our experience with recurrence of pelvic organ prolapse after native tissue repair for stage 2 anterior prolapse. MATERIALS AND METHODS We reviewed a prospectively maintained, institutional review board approved database of women with symptomatic stage 2 anterior prolapse who underwent vaginal repair with anterior vaginal wall suspension between 1996 and 2014. Women with concurrent pelvic organ prolapse repair or hysterectomy or without 1 year followup were excluded from analysis. Failure was defined as stage 2 or greater prolapse recurrence on examination or reoperation for symptomatic pelvic organ prolapse. Outcome measures included validated questionnaires (Urogenital Distress Inventory-short form, quality of life), physical examination, standing voiding cystourethrogram at 6 months postoperatively, further surgery for pelvic organ prolapse in other compartments or for secondary stress urinary incontinence or fecal incontinence, and complications. RESULTS A total of 121 women met the study inclusion criteria with a mean followup of 5.8 ± 3.7 years. Prolapse recurrence rates were isolated anterior 7.4%, isolated apical 10.7%, isolated posterior 8.3% and multiple compartments 19%. Surgery for recurrent prolapse included anterior compartment 3.3% at 1.4 ± 1.0 years, apical 9.9% at 2.8 ± 3.0 years, posterior compartment 5.8% at 2.0 ± 1.0 years and multiple compartments 17.4% at 3.2 ± 3.3 years. There was a 1.6% rate of intraoperative complications and a 5.7% rate of 30-day complications (all Clavien I). CONCLUSIONS Anterior vaginal wall suspension for symptomatic stage 2 anterior prolapse offers a native tissue vaginal repair with minimal morbidity and a low anterior recurrence rate at intermediate to long-term followup. However, 33% of patients required secondary prolapse compartment procedures from 0.6 to 13 years later, highlighting the importance of long-term followup.
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Yonguc T, Degirmenci T, Bozkurt IH, Aydogdu O, Gunlusoy B, Sen V, Polat S. Effectiveness of Transobturator Tape Procedure in Obese and Severely Obese Women: 3-Year Follow-up. Urology 2015. [PMID: 26199159 DOI: 10.1016/j.urology.2015.03.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of transobturator tape (TOT) for the treatment of stress urinary incontinence in severely obese and obese women. METHODS We retrospectively reviewed the women who underwent a TOT procedure at 2 institutions between March 2005 and March 2013. The patients were divided into 3 groups according to the World Health Organization body mass index (BMI) values: normal weight group (BMI <25 kg/m(2); group 1), obese group (BMI = 30-34 kg/m(2); group 2), and severely obese group (BMI ≥35 kg/m(2); group 3). Overweight women (BMI = 25-29 kg/m(2)) were omitted. Patients filled in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) preoperatively and at the postoperative follow-up visits. The severity of urinary incontinence was classified by ICIQ-SF: slight (1-5), moderate (6-12), severe (13-18), and very severe (19-21). Patient satisfaction was assessed using a visual analog scale. Subjective improvement was defined as an ICIQ-SF score ≤12 and satisfaction with surgery (visual analog scale score ≥80). RESULTS A total 470 women met the requirements for inclusion. There were 153 women in group 1, 72 women in group 2, and 32 women in group 3. Mean follow-up period was at least 12 months in all the groups. The difference between the groups according to mean operative time was significant (P <.001). The objective cure, subjective success (cured and improved), patient satisfaction rates, and complications were similar between the groups. CONCLUSION Obesity and severe obesity do not seem to be risk factors for the failure of TOT procedure. However, postoperative urgency urinary incontinence rate was higher in severely obese women, and more women showed improvement instead of cure among severely obese women.
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Affiliation(s)
- Tarik Yonguc
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
| | - Tansu Degirmenci
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | | | - Ozgu Aydogdu
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Bulent Gunlusoy
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Volkan Sen
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Salih Polat
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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OnabotulinumtoxinA intravesical treatment in patients affected by overactive bladder syndrome: best practice in real-life management. Urologia 2015; 82:179-83. [PMID: 26044994 DOI: 10.5301/uro.5000120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE We evaluated intradetrusorial OnabotulinumtoxinA (Onabot/A) treatment protocols in patients with idiopathic overactive bladder (OAB), in order to assess the care of patients before, during and after treatment. METHODS In 64 OAB patients injected with Onabot/A, we reviewed the length of the hospital stay, frequency of catheterization, frequency of intraoperative and postoperative complications, and patients' satisfaction to the proposed treatment protocol (as assessed by VAS). We also compared the results of the 3-day voiding diary, uroflowmetry with postvoid residual urine (PVR) and VAS to score the bother of urinary symptoms on quality of life (QoL) before and after treatment. RESULTS Twenty-one patients were firstly treated in an 'inpatient' setting. The mean ± SD duration of hospitalization and catheterization was 39.4 ±12.6 and 37.8 ± 10.6 h, respectively. The mean ± SD VAS values of treatment satisfaction and of bother of urinary symptoms on QoL were 6.3 ± 1.1 and 8.2 ± 1.3, respectively. The mean ± SD PVR value was 74.3 ± 15.2 ml. Frequency of UTIs was 2.4 ± 1.6. Forty-three patients were treated on an outpatient basis; the mean ± SD duration of catheterization, the 'outpatient' stay and the mean ± SD frequency of UTIs were lower than those of patients treated in an inpatient setting. The mean ± SD VAS value to score QoL was high. CONCLUSIONS Intradetrusorial Onabot/A injection is a simple and fast procedure that can be easily carried on in an outpatient setting under local anesthesia, with low rates of intraoperative and postoperative complications.
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Coskun B, Lavelle RS, Alhalabi F, Christie AL, Zimmern PE. Anterior Vaginal Wall Suspension Procedure for Moderate Bladder and Uterine Prolapse as a Method of Uterine Preservation. J Urol 2014; 192:1461-7. [DOI: 10.1016/j.juro.2014.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Burhan Coskun
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | | | - Feras Alhalabi
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Alana L. Christie
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
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Yonguc T, Bozkurt IH, Arslan B, Kozacioglu Z, Gulden I, Gunlusoy B, Degirmenci T. Outcomes of two different incision techniques for surgical treatment of stress urinary incontinence with concomitant anterior vaginal wall prolapse. World J Urol 2014; 33:1045-9. [PMID: 25173749 DOI: 10.1007/s00345-014-1388-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/20/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess the outcomes of two different incision techniques used in the surgical treatment of stress urinary incontinence (SUI) with concomitant anterior vaginal wall prolapse and to identify possible associated risk factors with a medium-term follow-up in patients who underwent TOT procedure. METHODS We conducted a retrospective cohort study of 233 women who underwent transobturator tape procedure with cystocele repair. The women were divided into two groups according to two different incision techniques. The outcomes were analyzed considering five postoperative parameters: objective cure, subjective cure, patient satisfaction, resolution of urgency urinary incontinence and complications. The mean follow-up period was 43.6 months (range 12-85). RESULTS A total of 226 women were documented in this study: 79 women in single-incision technique (group 1) and 147 women in double-incision technique (group 2). The objective and subjective cure and patient satisfaction (visual analog scale score ≥80) rates were 89.8, 73.4, 84.8 % and 90.4, 74.1, 86.4 % in group 1 and group 2, respectively. Complications reported according to the Clavien-Dindo classification were grade I 5.2 %, grade II 42.1 %, grade IIIa 47.3 %, and grade IIIb 5.2 %, and grade I 22.2 %, grade II 77.7 %, grade IIIa 0 % and grade IIIb 0 % in group 1 and group 2, respectively. The mean operative time was significantly shorter in group 1 compared to group 2 (p = 0.001). CONCLUSIONS Both incision techniques have satisfactory outcomes in the surgical treatment of SUI with cystocele; nevertheless, the postoperative complications favor the double-incision technique.
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Affiliation(s)
- Tarik Yonguc
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Saim Cikrikci Str. No: 59 Bozyaka, 35110, Izmir, Turkey,
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TVT versus laparoscopic mesh colposuspension: 5-year follow-up results of a randomized clinical trial. Int Urogynecol J 2014; 26:57-63. [DOI: 10.1007/s00192-014-2454-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/14/2014] [Indexed: 11/25/2022]
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Five-year Results of a Randomized Trial Comparing Retropubic and Transobturator Midurethral Slings for Stress Incontinence. Eur Urol 2014; 65:1109-14. [DOI: 10.1016/j.eururo.2014.01.031] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/21/2014] [Indexed: 11/22/2022]
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Yonguc T, Gunlusoy B, Arslan B, Bozkurt IH, Kozacioglu Z, Degirmenci T, Koras O. Does concomitant vaginal prolapse repair affect the outcomes of the transobturator tape procedure in the long term? Int Urogynecol J 2014; 25:1419-23. [DOI: 10.1007/s00192-014-2392-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 04/07/2014] [Indexed: 11/27/2022]
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The “bother” of urinary incontinence. Int Urogynecol J 2014; 25:947-51. [DOI: 10.1007/s00192-014-2337-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 01/20/2014] [Indexed: 11/25/2022]
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Elliott V, de Bruin ED, Dumoulin C. Virtual reality rehabilitation as a treatment approach for older women with mixed urinary incontinence: a feasibility study. Neurourol Urodyn 2014; 34:236-43. [DOI: 10.1002/nau.22553] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/05/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Valérie Elliott
- Centre de Recherche; Institut Universitaire de Gériatrie de Montréal (CRIUGM); Montréal, Québec Canada
- School of Rehabilitation; Faculty of Medicine of Université de Montréal; Montréal, Québec Canada
| | - Eling D. de Bruin
- Department Health Sciences and Technology; Institute of Human Movement Sciences and Sport; Zurich Switzerland
| | - Chantale Dumoulin
- Centre de Recherche; Institut Universitaire de Gériatrie de Montréal (CRIUGM); Montréal, Québec Canada
- School of Rehabilitation; Faculty of Medicine of Université de Montréal; Montréal, Québec Canada
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Hewison A, McCaughan D, Watt I. An evaluative review of questionnaires recommended for the assessment of quality of life and symptom severity in women with urinary incontinence. J Clin Nurs 2013; 23:2998-3011. [PMID: 24372609 DOI: 10.1111/jocn.12503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2013] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To provide an up-to-date assessment of the quality of commonly recommended questionnaires for measuring symptom severity and quality of life in women with urinary incontinence and also to consider their application to practice. BACKGROUND Urinary incontinence is a common problem for women. In addition to various physical symptoms, there is a known effect on quality of life. Psychometrically robust questionnaires are reported to be the best way to measure an individual's perceptions of symptom severity and quality of life, and a number of different ones are recommended for use in international and national guidance, which can be confusing for clinicians. Moreover, there are concerns over the applicability of some of these instruments in clinical practice. DESIGN An evaluative review was carried out examining selected questionnaires measuring symptom severity and/or quality of life. METHODS Selection of questionnaires for inclusion in the review was based on the recommendations of evidence-based guidance, followed by systematic scrutiny of the characteristics of the individual recommended questionnaires. RESULTS Thirteen questionnaires were included in the review, of which three appeared to 'outperform' the remainder in terms of their psychometric properties and other characteristics. CONCLUSIONS This review provides the most up-to-date and comprehensive analysis of the quality and applicability of the included questionnaires and offers the practitioner advice on which to select for use in practice. RELEVANCE TO CLINICAL PRACTICE This review aims to help the practitioner choose a questionnaire based on a sound evaluation of the quality of the questionnaire and its applicability to the clinical setting.
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Affiliation(s)
- Ann Hewison
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
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Nyyssönen V, Talvensaari-Mattila A, Santala M. A prospective randomized trial comparing tension-free vaginal tape versus transobturator tape in patients with stress or mixed urinary incontinence: subjective cure rate and satisfaction in median follow-up of 46 months. Scand J Urol 2013; 48:309-15. [DOI: 10.3109/21681805.2013.863802] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pyykönen A, Aronen P, Räsänen P, Roine RP, Sjöberg J, Tapper AM. The effectiveness of urinary incontinence treatments measured using the 15D Health-Related Quality of Life instrument. Int Urogynecol J 2013; 25:359-67. [PMID: 24008366 DOI: 10.1007/s00192-013-2206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 08/03/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The health-related quality of life (HRQoL) is significantly impaired among urinary incontinent women and the effectiveness of urinary incontinence (UI) treatment should be measured using an HRQoL instrument. METHODS A prospective, observational study evaluating the HRQoL of 178 non-selected UI patients referred for routine treatment at the Helsinki University Central Hospital between the years 2004 and 2010. HRQoL was assessed using the generic 15D questionnaire on four occasions: before treatment, 6 and 18 months after treatment, and after a median follow-up of 5 years. The HRQoL of the patients was compared with that of an age-standardized Finnish female population. RESULTS Compared with the general population, the baseline total HRQoL score of the patients was significantly impaired (p < 0.001). It was worse among the urge or mixed (UUI (±SUI)) incontinence patients than among the stress incontinence (SUI) patients (p = 0.035). During follow-up, HRQoL improved and the improvement was more substantial among the operatively than among the conservatively treated patients (p = 0.027). Statistically significant improvement was only seen in the SUI group (Δ + 0.021, 95 % CI 0.005-0.036), but clinically relevant improvement was also found in the operatively treated UUI (±SUI) group. The maximum benefit of treatment was reached between at 2 and 3 years. CONCLUSIONS 15D is a sensitive tool for monitoring the change in HRQoL and could be implemented into clinical practice. Operative treatment of UI is effective when measured by improved HRQoL. Not only SUI patients, but also selected patients with an urgency component may benefit from surgery.
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Affiliation(s)
- Aura Pyykönen
- Department of Gynecology and Pediatrics, Helsinki University Central Hospital HUCH, P.O. Box 140, 00029, Helsinki, Finland,
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Nilsson CG, Palva K, Aarnio R, Morcos E, Falconer C. Seventeen years' follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence. Int Urogynecol J 2013; 24:1265-9. [PMID: 23563892 DOI: 10.1007/s00192-013-2090-2] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The minimally invasive tension-free vaginal tape (TVT) operation has become the "gold standard" of incontinence surgery. The aim of the present study was to evaluate the long-term effect of the tape material and to assess the continence status 17 years after surgery METHODS A cohort of 90 women operated upon with the TVT procedure at three Nordic centers has been prospectively followed for 17 years. All of the women alive according to national registries were contacted and invited to visit the clinics for evaluation. Pelvic examination was performed to reveal any adverse effects of the tape material. Objective and subjective continence status were assessed by a cough stress test and the patients' global impression of improvement as well as by condition-specific quality of life questionnaires. RESULTS Seventy-eight percent of the potentially assessable women were evaluated either by a clinic visit or by a telephone interview. One case of a minimal, symptom-free tape extrusion was seen. No other tape complications occurred. Over 90 % of the women were objectively continent. Eighty-seven per cent were subjectively cured or significantly improved. CONCLUSION The TVT operation is durable for 17 years, with a high satisfaction rate and no serious long-term tape-induced adverse effects.
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Affiliation(s)
- C G Nilsson
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, POB 140, 00029 HUS, Helsinki, Finland.
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Dumoulin C, Martin C, Elliott V, Bourbonnais D, Morin M, Lemieux MC, Gauthier R. Randomized controlled trial of physiotherapy for postpartum stress incontinence: 7-year follow-up. Neurourol Urodyn 2013; 32:449-54. [DOI: 10.1002/nau.22330] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 09/12/2012] [Indexed: 11/11/2022]
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Objective Cure Rates and Patient Satisfaction After the Transobturator Tape Procedure During 6.5-Year Follow-Up. J Minim Invasive Gynecol 2013; 20:73-8. [DOI: 10.1016/j.jmig.2012.09.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 09/12/2012] [Accepted: 09/22/2012] [Indexed: 11/18/2022]
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Toozs-Hobson P, Al-Singary W, Fynes M, Tegerstedt G, Lose G. Two-year follow-up of an open-label multicenter study of polyacrylamide hydrogel (Bulkamid®) for female stress and stress-predominant mixed incontinence. Int Urogynecol J 2012; 23:1373-8. [PMID: 22531952 PMCID: PMC3448051 DOI: 10.1007/s00192-012-1761-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 03/18/2012] [Indexed: 12/04/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Polyacrylamide hydrogel (PAHG, Bulkamid®) is a promising urethral bulking agent. This article presents the 2-year follow-up results of a multicenter study of PAHG injections for treating stress and stress-predominant mixed urinary incontinence. METHODS Submucosal injection of PAHG was performed in 135 women with urinary incontinence, with subjective and objective assessment of the efficacy and safety 24 months postinjection. RESULTS At 24 months, the subjective responder rate was 64 % (a statistically non-significant reduction from 67 % at 12 months). The decreased number of incontinence episodes and urine leakage were maintained compared with the result from the 12-month evaluations, as were objective result rates and quality of life data. No safety issues occurred. CONCLUSIONS PAHG is an effective and safe treatment option for women with stress-predominant mixed urinary incontinence, with maintained medium-term responder rates.
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Affiliation(s)
- Philip Toozs-Hobson
- Department of Urogynaecology, Birmingham Women’s Hospital, Methchley Lane, Edgbaston, Birmingham B15 2TG UK
| | - Waleed Al-Singary
- Worthing Hospital, Department of Urology, Lyndhurst Road, Worthing, West Sussex BN11 2DH UK
| | - Michelle Fynes
- Department of Gynaecology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Gunilla Tegerstedt
- Department of Obstetrics & Gynaecology, Karolinska University Hospital Huddinge, Hälsovägen, Flemmingsberg, 14186 Stockholm, Sweden
| | - Gunnar Lose
- Department of Obstetrics and Gynaecology, Herlev County Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
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Naumann G, Hagemeier H, Albrich S, Skala C, Koelbl H, Laterza R. Patient goals after incontinence procedures: does the single-incision sling satisfy them? Eur J Obstet Gynecol Reprod Biol 2012; 163:234-7. [DOI: 10.1016/j.ejogrb.2012.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 04/25/2012] [Indexed: 11/28/2022]
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Heinonen P, Ala-Nissilä S, Kiilholma P, Laurikainen E. Tension-free vaginal tape procedure without preoperative urodynamic examination: Long-term outcome. Int J Urol 2012; 19:1003-9. [DOI: 10.1111/j.1442-2042.2012.03078.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Palva K, Nilsson CG. Prevalence of urinary urgency symptoms decreases by mid-urethral sling procedures for treatment of stress incontinence. Int Urogynecol J 2011; 22:1241-7. [PMID: 21850510 DOI: 10.1007/s00192-011-1511-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 07/11/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Conflicting opinions on the effect of incontinence surgery on the prevalence of postoperative urgency symptoms exists. Our aim was to evaluate the prevalence of urgency symptoms preoperatively and during 3-year of follow-up in women undergoing mid-urethral sling procedures for stress incontinence. METHODS Two hundred and sixty-seven women were randomly assigned to a retropubic or a transobturator operation. Detrusor instability score (DIS) and Urogenital Distress Inventory-6 (UDI-6) questionnaires were used to assess prevalence of urgency symptoms. The Incontinence Impact Questionnaire-7, visual analog scale, urinary incontinence severity score, and the EuroQol-5D assessed overall quality of life changes. RESULTS A significant decrease in the DIS and UDI-6 score was seen postoperatively. Signs of de novo urgency symptoms were low. CONCLUSIONS Mid-urethral sling procedures can be recommended in cases of mixed incontinence, and the procedures seems to decrease prevalence of urgency symptoms.
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Affiliation(s)
- Kirsi Palva
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, POB 140, Haartmaninkatu 2, 00029, Helsinki, Finland
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Validated Instruments in the Evaluation and Treatment Outcomes of Stress Urinary Incontinence in Women. Curr Urol Rep 2011; 12:381-6. [DOI: 10.1007/s11934-011-0203-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Franco MDM, Souza FDO, Vasconcelos ECLMD, Freitas MMSD, Ferreira CHJ. Avaliação da qualidade de vida e da perda urinária de mulheres com bexiga hiperativa tratadas com eletroestimulação transvaginal ou do nervo tibial. FISIOTERAPIA E PESQUISA 2011. [DOI: 10.1590/s1809-29502011000200008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Trata-se de um ensaio clínico prospectivo comparativo que objetivou comparar os efeitos do tratamento com eletroestimulação transvaginal (ET) e do nervo tibial (ENT) sobre a qualidade de vida (QV) e queixas de perda urinária em mulheres com bexiga hiperativa. Participaram 42 pacientes com bexiga hiperativa ou incontinência urinária (IU) mista e foram divididas para tratamento com ET ou ENT. A QV foi avaliada pelo questionário de QV genérico, o Medical Outcomes Study Short Form 36 (SF-36) e um questionário específico para IU, o Incontinence Quality of Life Instrument (I-QOL). Os relatos de perdas urinárias e incômodos ocasionados foram avaliados, respectivamente, por meio do diário miccional de 24 horas e Escala Visual Analógica (EVA). O tratamento foi realizado uma vez por semana, totalizando doze semanas. O grupo da ENT teve melhora significativa em três domínios do I-QOL, na EVA, que avaliou o grau de incômodo causado pela IU e em quatro aspectos do diário miccional. No grupo de ET houve melhora significativa de dois domínios do SF-36, três domínios do I-QOL, na EVA e em quatro aspectos do diário. Houve melhora da QV em ambos os grupos, assim como uma diminuição das queixas de perda urinária, entretanto, o grupo que recebeu ET obteve melhora nos escores em dois domínios do questionário de QV genérico após o tratamento, que teve limitação por aspectos físicos e limitação por aspectos emocionais. O que não ocorreu com o grupo de ENT.
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RINNE KIRSI, KAINULAINEN SAKARI, AUKEE SINIKKA, HEINONEN SEPPO, NILSSON CARLG. Dynamic MRI confirms support of the mid-urethra by TVT and TVT-O surgery for stress incontinence. Acta Obstet Gynecol Scand 2011; 90:629-35. [DOI: 10.1111/j.1600-0412.2011.01122.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sherburn M, Bird M, Carey M, Bø K, Galea MP. Incontinence improves in older women after intensive pelvic floor muscle training: an assessor-blinded randomized controlled trial. Neurourol Urodyn 2011; 30:317-24. [PMID: 21284022 DOI: 10.1002/nau.20968] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 05/26/2010] [Indexed: 11/09/2022]
Abstract
AIMS To test the hypotheses that high intensity pelvic floor muscle training (PFMT) is effective in relief of stress urinary incontinence in community dwelling older women, and that intense PFMT improves stress urinary incontinence more than bladder training (BT) in this population. METHODS A two-center, assessor-blinded randomized controlled trial of 20 weeks duration with two active intervention arms: PFMT and BT. Assessments and interventions were undertaken at two metropolitan tertiary hospitals. Participants were community dwelling women over 65 years of age with urodynamic stress incontinence. Primary outcome measure was urinary leakage during a cough stress test. Secondary outcome measures included symptoms and bother (ICIQ-UI SF), participant global perception of change, leakage episodes (7-day accident diary), degree of "bother" (VAS) and health related quality of life (AQoL). RESULTS Eighty-three Caucasian women, 71.8 (SD 5.3) years participated in the study. Both groups improved over the intervention period; however, the PFMT group reported significantly lower amounts of leakage on the stress test [PFMT median 0.0 g, 95% CI: 0.2-0.9; BT median 0.3 g, 95% CI: 0.2-1.7, P=0.006], improved symptoms and bother [PFMT mean 5.9, 95% CI: 4.8-7.1; BT group mean 8.5, 95% CI: 7.1-9.9 and greater perception of change [PFMT 28 (73.6%); BT 12 (36.4%) (P=0.002)] after 5 months than the BT group. CONCLUSIONS High intensity PFMT is effective in managing stress urinary incontinence and is more effective than BT in healthy older women.
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Affiliation(s)
- Margaret Sherburn
- Rehabilitation Sciences Research Centre, Melbourne Physiotherapy School, The University of Melbourne, Parkville, Victoria, Australia.
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ALA‐NISSILÄ SEIJA, HAARALA MERVI, MÄKINEN JUHA. Tension‐free vaginal tape – a suitable procedure for patients with recurrent stress urinary incontinence. Acta Obstet Gynecol Scand 2010; 89:210-6. [DOI: 10.3109/00016340903508635] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- SEIJA ALA‐NISSILÄ
- Department of Obstetrics and Gynecology, University of Turku, Turku, Finland
| | - MERVI HAARALA
- Department of Obstetrics and Gynecology, University of Turku, Turku, Finland
| | - JUHA MÄKINEN
- Department of Obstetrics and Gynecology, University of Turku, Turku, Finland
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The use of extracorporeal magnetic innervation for the treatment of stress urinary incontinence in older women: a pilot study. Arch Gynecol Obstet 2010; 284:1163-8. [PMID: 21184090 DOI: 10.1007/s00404-010-1814-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Stress urinary incontinence (SUI) is a major health problem that has substantial and important effects on health-related quality of life. In recent years, extracorporeal magnetic innervation (ExMI) has become a preferred method of treatment in urinary incontinence. This study presents the effects of ExMI treatment on pelvic floor muscle strength, urinary symptoms, incontinence conditions and quality of life of older women with SUI. METHODS A total of 13 patients between the ages of 61 and 69 (mean 65.23 ± 2.8 years) were treated for SUI with ExMI. The following parameters were investigated: urinary symptoms, pelvic floor electromyographic (EMG) activity, 1-h pad test, incontinence conditions utilizing visual analog scale (VAS) and quality of life using Turkish version of the Urogenital Distress Inventory (UDI-6) and the Incontinence Quality of Life Instrument (I-QoL). All assessments were conducted at baseline and at the end of the study. Treatment lasted for 20 min, twice a week and for a total of 6 weeks. RESULTS The urinary symptoms and incontinence conditions decreased after the ExMI treatment sessions. The pad test results indicated a reduction in urine loss (p = 0.016). EMG values were improved (p = 0.005). Scores of I-QoL, UDI-6 and VAS were reduced after the treatment, respectively (p = 0.002), (p = 0.002) and (p = 0.006). CONCLUSION Extracorporeal magnetic innervation can be considered as it is an alternative, non-invasive and painless treatment method with good compliance for treatment of SUI in older patients.
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Patil SP, Nagrale AV, Ganvir SD. Additive effect of interferential therapy over pelvic floor exercises. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2010. [DOI: 10.12968/ijtr.2010.17.11.79540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Shyam D Ganvir
- Ravi Nair Physiotherapy College, Sawangi (Meghe) Wardha, India
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Lose G, Sørensen HC, Axelsen SM, Falconer C, Lobodasch K, Safwat T. An open multicenter study of polyacrylamide hydrogel (Bulkamid®) for female stress and mixed urinary incontinence. Int Urogynecol J 2010; 21:1471-7. [PMID: 20645077 PMCID: PMC2977052 DOI: 10.1007/s00192-010-1214-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 06/22/2010] [Indexed: 11/24/2022]
Abstract
Introduction Polyacrylamide hydrogel (PAHG, Bulkamid®) is a promising urethral bulking agent. This multicenter study was carried out to evaluate safety and efficacy of Bulkamid® for female stress and mixed urinary incontinence. Methods Submucosal injection of Bulkamid® was performed in 135 women with urinary incontinence (stress, 67; mixed, 68) followed for 12 months. Forty-seven had a reinjection (35%). Results At 12 months, the subjective response rate was 66%. Incontinence episodes/24 h and urine leakage g/24 h decreased significantly (from 3.0 to 0.7 and 29 g to 4 g, respectively). Additionally, the median International Consultation on Incontinence Questionnaire score was reduced to approximately 50%, and the overall quality of life visual analogue scale score was decreased significantly (from 72 to 20). Efficacy was very similar between patients with stress and mixed incontinence. Thirty treatment-related adverse events were registered. The most frequent was urinary tract infection (n = 10). No polyacrylamide hydrogel-specific adverse events were seen. Conclusions Bulkamid® is an effective and safe bulking agent in women with stress or mixed incontinence.
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Affiliation(s)
- Gunnar Lose
- Department of Obstetrics and Gynaecology, Herlev County Hospital, University of Copenhagen, Herlev, Denmark.
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Palva K, Rinne K, Aukee P, Kivelä A, Laurikainen E, Takala T, Valpas A, Nilsson CG. A randomized trial comparing tension-free vaginal tape with tension-free vaginal tape-obturator: 36-month results. Int Urogynecol J 2010; 21:1049-55. [PMID: 20440474 DOI: 10.1007/s00192-010-1160-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 03/26/2010] [Indexed: 11/27/2022]
Affiliation(s)
- Kirsi Palva
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, POB 140 Haartmaninkatu 2, 00029, Helsinki, Finland
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