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Lundmark Drca A, Westergren Söderberg M, Ek M. Obesity as an independent risk factor for poor long-term outcome after mid-urethral sling surgery. Acta Obstet Gynecol Scand 2024. [PMID: 38863323 DOI: 10.1111/aogs.14883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION High body mass index (BMI) is a risk-factor for stress urinary incontinence (SUI). Mid-urethral sling (MUS) surgery is an effective treatment of SUI. The aim of this study was to investigate if there is an association between BMI at time of MUS-surgery and the long-term outcome at 10 years. MATERIAL AND METHODS Women who went through MUS surgery in Sweden between 2006 and 2010 and had been registered in the Swedish National Quality Register of Gynecological Surgery were invited to participate in the 10-year follow-up. A questionnaire was sent out asking if they were currently suffering from SUI or not and their rated satisfaction, as well as current BMI. SUI at 10 years was correlated to BMI at the time of surgery. SUI at 1 year was assessed by the postoperative questionnaire sent out by the registry. The primary aim of the study was to investigate if there is an association between BMI at surgery and the long-term outcome, subjective SUI at 10 years after MUS surgery. Our secondary aims were to assess whether BMI at surgery is associated with subjective SUI at 1-year follow-up and satisfaction at 10-year follow-up. RESULTS The subjective cure rate after 10 years was reported by 2108 out of 2157 women. Higher BMI at the time of surgery turned out to be a risk factor for SUI at long-term follow-up. Women with BMI <25 reported subjective SUI in 30%, those with BMI 25-<30 in 40%, those with BMI 30-<35 in 47% and those with BMI ≥35 in 59% (p < 0.001). Furthermore, subjective SUI at 1 year was reported higher by women with BMI ≥30, than among women with BMI <30 (33% vs. 20%, p < 0.001). Satisfaction at 10-year follow-up was 82% among women with BMI <30 versus 63% if BMI ≥30 (p < 0.001). CONCLUSIONS We found that higher BMI at the time of MUS surgery is a risk factor for short- and long-term failure compared to normal BMI.
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Affiliation(s)
- Anna Lundmark Drca
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | | | - Marion Ek
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
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Daykan Y, Klein Z, Eliner O, O'Reilly BA, Yagur Y, Belkin S, Ribak R, Arbib N, Schonman R. Can obesity impact mesh exposure rate after mid-urethral sling operation? Medium term follow-up. Eur J Obstet Gynecol Reprod Biol 2023; 280:98-101. [PMID: 36442380 DOI: 10.1016/j.ejogrb.2022.11.014] [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: 09/22/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study mesh exposure rates among obese (BMI ≥ 30 kg/m2) vs non-obese women after mid-urethral sling (MUS) operation. STUDY DESIGN This retrospective cohort study included all patients who underwent MUS surgery for stress urinary incontinence April 2014-April 2021 in a tertiary-level university hospital. Data from obese and non-obese patients were compared. RESULTS A total of 120 (41 %) obese patients and 172 (59 %) non-obese patients who had mid-urethral sling surgery were compared. Of the cohort, 265 (90.7 %) underwent TVT-obturator, 15 (5.1 %) mini-sling TVT, and 12 (4.1 %) retro-pubic TVT. Diabetes mellitus was significantly more prevalent in the obese group (p =.01), without other demographic differences. Mesh post-operative exposure rate was 5.4 % during the study. The obese group had lower incidence of mesh exposure than the non-obese group (1.6 % vs 8.1 % respectively, p =.018). Mean follow-up was 51 months (range 8-87 months) without significant differences between groups (49.9 ± 21.2 vs 51.5 ± 22.3, p =.548). Pelvic organ prolapse, cystocele, and rectocele stages were significantly higher in non-obese patients. Similar numbers of post-menopausal women were in each group. CONCLUSION This follow-up after MUS surgery showed an association between obesity and lower rate of mesh exposure. Further research is needed to evaluate correlations between estrogen and mesh exposure.
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Affiliation(s)
- Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland.
| | - Zvi Klein
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Or Eliner
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barry A O'Reilly
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Yael Yagur
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Belkin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Ribak
- Department of Obstetrics and Gynecology, HaEmek Medical Center, Afula, Israel. Affiliated to Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nissim Arbib
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Schonman
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kender Erturk N, Tasgoz FN, Temur M. Effects of transobturator tape procedure on female sexual function at 2-year follow-up: A prospective cohort study with matched control group. Low Urin Tract Symptoms 2022; 14:358-365. [PMID: 35603770 DOI: 10.1111/luts.12445] [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: 03/03/2022] [Revised: 04/11/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We aimed to compare the effect of elapsed time on sexual function in women who underwent a transobturator tape (TOT) procedure for stress urinary incontinence (SUI) with continent controls. METHODS Urinary and sexual function of 70 females were assessed preoperatively at month 6 and postoperatively at month 24 in the study group. Forty-five patients without urinary incontinence and demographically matched with the study group were assessed for sexual function at first administration and 24 months later in the control group. The Female Sexual Function Index (FSFI) was used. RESULTS The baseline total FSFI score (23.4 ± 3.2 vs 27.0 ± 4.3, P < .001) was significantly lower in patients with SUI. There was a slight increase (24.0 ± 3.0, P = .167) in sexual function at the end of 2 years in the study group, whereas in the control group, the total FSFI score (25.0 ± 4.5, P < .001) decreased significantly within 2 years. The success of the incontinence surgery was associated with higher long-term sexual function scores. CONCLUSIONS Successful TOT surgery can improve sexual function in women with SUI. This improvement decreases less over time compared to healthy controls.
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Affiliation(s)
- Nergis Kender Erturk
- Department of Obstetrics and Gynecology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Fatma Nurgul Tasgoz
- Department of Obstetrics and Gynecology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Muzaffer Temur
- Department of Obstetrics and Gynecology, Yıldırım Doruk Special Hospital, Bursa, Turkey
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Liu HM, Lin HH, Hsiao SM. Predictors of cure and overactive bladder syndrome after a mid-urethral sling procedure in women with stress urinary incontinence. Maturitas 2022; 156:18-24. [PMID: 35033229 DOI: 10.1016/j.maturitas.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/01/2021] [Accepted: 10/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine predictive factors for the cure of stress urinary incontinence (SUI) or persisting or de novo overactive bladder syndrome (OAB) after a mid-urethral sling procedure (MUS) for women with SUI, especially for menopausal women. STUDY DESIGN All women who had consecutively received MUS for SUI between January 2008 and July 2019 in a tertiary referral center were reviewed. MAIN OUTCOME MEASURES Multivariable Cox proportional hazards model or logistic regression analysis was used to assess the predictors of cure and persisting or de novo OAB after MUS. RESULTS A total of 385 women had undergone MUS, of whom 265 (68.8%) were menopausal. The multivariable Cox proportional hazards model revealed that age (hazard ratio = 1.04), and preoperative detrusor overactivity (hazard ratio = 2.26) were independent predictors of persisting/recurrent SUI. Among the 216 women with preoperative OAB, 109 (50.5%) experienced resolution of their OAB after MUS; and among 169 women without preoperative OAB, twenty-five (14.8%) women developed de novo OAB after MUS (p < 0.0001). Preoperative OAB (hazard ratio = 3.97), small voided volume (hazard ratio = 0.83), and preoperative detrusor overactivity (hazard ratio = 1.62) were predictors of postoperative OAB. In addition, six (1.6%) women had mesh extrusion. Parity (odds ratio = 2.08) was the sole predictor of mesh extrusion. Menopause (hazard ratio = 1.69) was a predictor of postoperative OAB in the univariate analysis. However, menopause was not a predictor of cure or OAB in the multivariable analysis. CONCLUSIONS Age and preoperative detrusor overactivity were independent predictors of persisting/recurrent SUI. In addition, preoperative OAB, small voided volume, and preoperative detrusor overactivity were predictors of postoperative OAB. These findings could serve as a guide for preoperative consultation for MUS.
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Affiliation(s)
- Hsin-Mei Liu
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei, Taiwan
| | - Ho-Hsiung Lin
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei, Taiwan; Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei, Taiwan; Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan.
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Even L, Tibi B, Bentellis I, Treacy PJ, Berrogain N, Bosset PO, Campagne-Loiseau S, Cardot V, Charles T, Deffieux X, Donon L, Girard F, Hermieu JF, Hurel S, Klap J, Meyer F, Peyrat L, Thuillier C, Vidart A, Wagner L, Cornu JN. [Complications of mid-urethral sling - A review from the Committee for Female Urology and Pelviperineology for the French Association of Urology]. Prog Urol 2021; 31:1141-1166. [PMID: 34794867 DOI: 10.1016/j.purol.2021.09.007] [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: 07/19/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Placement of a mid-urethral sling is the gold standard in the surgical management of stress urinary incontinence in women in France. The cure rate of this material is no longer to be demonstrated, but the per- and post-operative complications are currently the subject of a growing controversy not only in Europe but also across the Channel and across the Atlantic, having led to the modification of operative indications. In France, recommendations are also evolving with a stricter framework for indications for surgery by multidisciplinary consultation meeting and an obligation for postoperative follow-up in the short and long term. OBJECTIVES In this context, CUROPF realized a review of the literature bringing together the available scientific evidence concerning the occurrence of per- and post-operative complications relating to the installation of mid urethral sling. The bibliographic search was carried out using the Medline database and 123 articles were selected. RESULTS Analysis of the data highlights various complications, depending on the implanted material, the patient and the indication for surgery. The retro-pubic mid urethral sling provides more bladder erosion during surgery (up to 14%), more suprapubic pain (up to 4%) and more acute urinary retention (up to 19,7%) and postoperative dysuria (up to 26%). The trans obturator mid-urethral sling is responsible for more vaginal erosion during the operation (up to 10,9%), more lower limb pain of neurological origin (up to 26,7%). The risk of developing over active bladder is similar in both procedures (up to 33%). But these risks of complications must be balanced by the strong impact of urinary incontinence surgery on the overall quality of life of these women. CONCLUSION Thus, surgical failure and long term complications exist but should not limit the surgical management of stress urinary incontinence with mid urethral tape. Women should be treated with individualized decision-making process and long-term follow -up is necessary.
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Affiliation(s)
- L Even
- Cabinet d'urologie, espace santé 3 83500 La Seyne sur Mer, clinique du Cap d'Or, 83500 La Seyne sur mer, Polyclinique Les Fleurs, 83190 Ollioules, France
| | - B Tibi
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - I Bentellis
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - P J Treacy
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - N Berrogain
- Clinique Ambroise-Paré, 31100 Toulouse, France
| | - P O Bosset
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - S Campagne-Loiseau
- Service de gynécologie-obstétrique, CHU Estaing, Clermont-Ferrand, France
| | - V Cardot
- Clinique de Meudon-Clamart, 3, avenue de Villacoublay, 92360 Meudon, France
| | - T Charles
- Service d'urologie, CHU La Miletrie, 86000 Poitiers, France
| | - X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère (AP-HP), 92140 Clamart, France
| | - L Donon
- Clinique de la Côte Basque, 64100 Bayonne, France
| | - F Girard
- Service d'urologie, clinique Oudinot Fondation Cognac-Jay, 2, rue Rousselet, 75007 Paris, France
| | - J-F Hermieu
- Service d'urologie, hôpital Bichat, AP-HP, Paris, France
| | - S Hurel
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - J Klap
- Service d'urologie, hôpital Privé Claude Galien, 91480 Quincy-sous-Sénart, France
| | - F Meyer
- Service d'urologie, hôpital Saint-Louis, AP-HP, Paris, France
| | - L Peyrat
- Service d'urologie, clinique Turin, 75008 Paris, France
| | - C Thuillier
- Service d'urologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L Wagner
- Service d'urologie, CHU de Nîmes, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| | - J N Cornu
- Service d'urologie, université de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
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Dyrkorn OA, Staff AC, Kulseng-Hanssen S, Svenningsen R. Previous obstetrical history does not impact short-term mid-urethral sling outcomes. Int Urogynecol J 2021; 32:1733-1743. [PMID: 33988787 PMCID: PMC8295164 DOI: 10.1007/s00192-021-04836-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/02/2021] [Indexed: 12/02/2022]
Abstract
Abstract Introduction and hypothesis Pregnancy and delivery are known risk factors for stress and mixed urinary incontinence. The most common surgical treatment is mid-urethral sling (MUS) surgery. This study evaluated the potential impact of the obstetrical history on the short-term subjective and objective failure rates after MUS surgery. Methods A registry-based surgical cohort study using data from the Medical Birth Registry of Norway (MBRN) and the national Norwegian Female Incontinence Registry (NFIR). Data from 14,787 women that underwent MUS surgery from 1998 to 2016 with complete registrations in the MBRN were included. Outcomes were 6–12-month postoperative subjective and objective failure rates. The potential impact of obstetrical and constitutional factors on both outcomes was tested in a multivariate logistic regression model. Results Several obstetrical variables seemed to impact both outcomes in the univariate analyses. However, in the multivariate analyses, none of the obstetrical variables significantly impacted subjective failure, and only being nulliparous before MUS surgery remained a risk factor for objective failure [aOR 1.60, (95% CI 1.07–2.40), p = 0.022]. High body mass index at time of surgery, non-retropubic slings, high preoperative urgency symptom load, and surgical complications were all strong risk factors for poor outcomes in the multivariate analyses. Conclusion Although childbirth is considered a risk factor for developing stress urinary incontinence, childbirth does not appear to affect the result of MUS in parous women. Our results suggest that nulliparous women with SUI may have a different pathophysiology than SUI after childbirth. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-021-04836-5.
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Affiliation(s)
- Ole Aleksander Dyrkorn
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Ullevål, PB 4950, Nydalen, 0424, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Anne Cathrine Staff
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Ullevål, PB 4950, Nydalen, 0424, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Rune Svenningsen
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Ullevål, PB 4950, Nydalen, 0424, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,The Norwegian Female Incontinence Registry, Oslo University Hospital, Oslo, Norway
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Barco-Castillo C, Plata M, Zuluaga L, Serrano A, Gómez A, Santander J, Caicedo JI, Azuero J, Echeverry M, Trujillo CG. Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta-analysis. Neurourol Urodyn 2020; 39:2153-2160. [PMID: 32794648 DOI: 10.1002/nau.24459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/11/2020] [Accepted: 07/08/2020] [Indexed: 11/12/2022]
Abstract
PURPOSE Obesity is one of the main risk factors for stress urinary incontinence (SUI) and has also been associated with worse surgical outcomes. However, the literature is heterogeneous and inconclusive. The goal of this study was to perform a systematic review and meta-analysis to evaluate cure rates and perioperative complications in obese women. MATERIALS AND METHODS A literature search of OVID, MEDNAR, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases was conducted. Randomized controlled trials comparing cure rates and failure of treatment in normal and obese patients, who underwent mid-urethral sling surgery, were identified. A systematic review of subjective and objective cure rates, and complications was performed. Meta-analyses of dichotomous data under the random-effects model were applied using Review Manager 5.3. Nonrandomized comparative studies and gray literature were excluded. RESULTS A total of 219 studies were identified. Four randomized controlled trials were included for evaluation. The risk of bias evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. One study was excluded due to missing data on the outcomes. Patients were stratified according to their body mass index as obese (>30 kg/m2 ) and nonobese (<30 kg/m2 ). Complications could not be meta-analyzed. The meta-analysis of subjective (risk ratio [RR] = 1.69 [95% confidence interval [CI]: 1.32-2.16]) and objective (RR = 1.62 [95% CI: 1.26-2.07]) cure rates disfavored obese women. CONCLUSIONS This meta-analysis shows that obesity is a risk factor for the nonsuccessful treatment of SUI with tension-free mid-urethral sling. Differences in regards to the surgical approach and its association with obesity could not be established with the current evidence.
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Affiliation(s)
- Catalina Barco-Castillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Laura Zuluaga
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Adolfo Serrano
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Andrea Gómez
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Jessica Santander
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Juan I Caicedo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Julián Azuero
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Mariana Echeverry
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Carlos Gustavo Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
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Impact of Midurethral Sling Implantation on Sexual Function in Women with Stress Urinary Incontinence. J Clin Med 2020; 9:jcm9051538. [PMID: 32443682 PMCID: PMC7290326 DOI: 10.3390/jcm9051538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/29/2020] [Accepted: 05/18/2020] [Indexed: 11/16/2022] Open
Abstract
Stress urinary incontinence (SUI) negatively influences sexual functions. However, the available data on sexual activity of patients who underwent midurethral sling (MUS) implantation are inconsistent. Our aim was to evaluate the impact of MUS implantation on sexual functions of women with SUI. We enrolled 171 patients undergoing the MUS procedure. Preoperative examination included the cough test, 1 h pad test and the Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA Revised (PISQ-IR). All patients had the retropubic sling implanted. Follow-up visits were performed 6-12 months after surgery. Objective cure rate was obtained in 90.98% of patients. Coital incontinence was reported by 56% of women before the surgery, and 8.6% afterwards. Among women who gained continence, significant improvement in sexual function was observed in the majority of the domains. In women who were not objectively cured (9.02%), we did not observe improvement in sexual life. All these patients indicated fear of leaking urine during sexual activity as the main cause of avoiding sex, similarly as before operation. To conclude, successful treatment of SUI with MUS significantly improves the quality of sexual life. On the other hand, persistent incontinence appears to be the most probable cause of lack of improvement in the quality of sexual life.
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Does Previous Pelvic Organ Prolapse Surgery Influence the Effectiveness of the Sub-Urethral Sling Procedure? J Clin Med 2020; 9:jcm9030653. [PMID: 32121239 PMCID: PMC7141339 DOI: 10.3390/jcm9030653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 02/24/2020] [Indexed: 02/02/2023] Open
Abstract
Pelvic organ prolapse (POP) often co-occurs with stress urinary incontinence. There is no consensus on whether prolapse repair and anti-incontinence surgery should be performed concomitantly or separately, in a two-step manner. The present study evaluated the effects of the tension-free vaginal tape (TVT) procedure in patients who had previously undergone pelvic floor repair (study group), compared to women who underwent TVT insertion only (control group). The study group comprised 84 patients who underwent the TVT procedure but had previously also undergone surgical POP repair. The control group consisted of 250 women in whom the TVT was inserted. The primary objective was to compare the objective cure rate and the secondary objective was to compare the subjective cure rate in both groups. Negative pad test was achieved in over 91% in both groups. Objective and subjective cure rates were compared, as well as complication rates. Significant improvement was observed in the postoperative 1-h pad test in all patients. In all patients, we observed significant improvement in the quality of life, with no differences between the groups. No differences were found in the occurrence of postoperative urinary retention, urgency and frequency of daytime micturition, or vaginal erosion between the groups. The current results demonstrate that the two-step approach to pelvic reconstruction and anti-incontinence surgery is as safe and effective as primary TVT implantation.
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