The surgical management of stress urinary incontinence with or without combined prolapse treatment continues to evolve. New technologies have emerged which have impacted surgical treatment algorithms. Cystoscopy has been added as a standard component of the procedure during surgical implantation of slings.

Non-surgical, transurethral RF micro-remodeling is a safe treatment for women with SUI. In women with moderate to severe SUI, this novel therapy resulted in statistically significant improvement in quality of life of a magnitude associated with patient satisfaction with the treatment. Women who underwent RF micro-remodeling demonstrated a statistically significant elevation in mean LPP at 12 months.

Aims: The aim of this study is to report the functional results, patient satisfaction, and morbidity of the Transobturator tape procedure (TOT) in the treatment of stress incontinence (SUI). Methods: One hundred and thirty patients were prospectively evaluated with history, physical examination, quality of life questionnaire including Incontinence Impact Questionnaire (IIQ), urogenital distress inventory (UDI), and analog global satisfaction scale (GSS), and urodynamic studies. Results: One hundred and seventeen patients (90%) had history of SUI, and 78 (60%) had urge incontinence. Pads/day (PPD) used was 2.48 AE 2.42, and the score of IIQ 16.13 AE 7.86, UDI 10.95 AE 3.4, and GSS 1.41 AE 1.67. All patients underwent TOT using the ObTape TM . Hospital stay was 0.84 AE 0.76 days and catheter duration was 1.42 AE 2.08 days. At a follow-up of 16.85 AE 4.68 months, 13 patients (10%) have recurrent SUI, 21 (16.15%) persistent urge incontinence, and 1 (1.92%) de novo urge incontinence. The mean PPD is 0.15 AE 0.56, IIQ 1.47 AE 5.14, UDI 3.28 AE 3.09, and GSS 8.29 AE 1.64. Two patients (1.52%) developed urethral obstruction, ¢ve (3.84%) had vaginal extrusion of the tape, and two (1.52%) had intra-operative bladder perforation.Conclusions: These results demonstrate the safety and e⁄cacy of the TOT. The short hospitalization and catheterization, low incidence of de novo urge incontinence and obstructive voiding o¡ers a distinct advantage over existing techniques. No signi¢cant di¡erence in outcome between patients with VLPP 60 cm H 2 O, and patients with VLPP >60 cm H 2 O was observed. Neurourol.

Magnetic stimulation using an external surface coil induces an electrodynamic field that penetrates various tissues and stimulates peripheral nerves in a similar fashion to conventional electrical stimulation. An 83 mm magnetic surface coil was used to stimulate 11 spinal cord injury (SCI) patients, during which time detrusor activity and evoked potentials of the striated urinary sphincter motor pathways were evaluated. All patients had urodynamic studies and conventional sacral evoked potentials prior to magnetic stimulation. The mean bladder capacity was 337 ml (range 109-590), mean leak point pressure was 50 cm H2O (range 10-80), and mean sacral reflex (afferent-efferent) latency was 37.9 ms (range 25.1-49.3). Eight patients had detrusor-sphincter dyssynergia. Magnetic stimulation over the sacral spine at different bladder volumes was performed. Detrusor and striated sphincter responses were recorded during stimulation. In all patients the technique was easy and the results were reproducible. The mean sacral motor pathway (efferent) latency was 27.9 ms (range 18.7-39.6). Using maximal stimulation, no detrusor response was recorded at bladder volumes < 200 ml. However, a detrusor response was recorded in 7 patients (> 10 cm H2O in 2, < 10 cm H2O in 5) when the bladder volume was > 200 ml. No complications were seen. Sacral evoked potential measurements assess the function and integrity of the sacral arc but it does not distinguish between afferent and efferent pathways. Magnetic stimulation is a safe and effective method to assess the integrity and function of the detrusor and striated sphincter motor (efferent) pathways. When combined with sacral evoked potential studies, the sensory (afferent) pathways can be evaluated indirectly.(ABSTRACT TRUNCATED AT 250 WORDS)

Transurethral sphincterotomy is a commonly performed operation in spinal cord injury patients. Sixty-three patients who have had transurethral sphincterotomy were evaluated at our spinal cord injury unit for the risk and possible predictors of long-term outcome associated with this procedure. In addition to history and physical examination, all patients had urine culture, blood urea and creatinine, intravenous pyelogram and/or KUB with renal ultrasound, 4 channel videourodynamics, voiding cystourethrogram, and cystocopy when indicated. Their mean age was 53 years, and their level of injury was cervical 32, thoracic 25, and lumbar 6. The mean time since injury was 27 years (3-50), and the mean follow-up since their last sphincterotomy was 11 years (2-30). The mean number of sphincterotomies was 1.74 (1-4). Urine culture revealed bacteruria (asymptomatic) in 48 and sterile urine in 15 patients. Renal function was normal in 61 patients and abnormal in 2 patients. Videourodynamics revealed detrusor hyperreflexia in 60, detrusor areflexia in 3, abnormal detrusor compliance in 9, and detrusor sphincter dyssynergia in 34 patients. The mean Leak point pressure was 36.4 cm H2O (5-100), and the mean maximum detrusor pressure was 54.7 cm H2O (12-100). Nineteen (30%) patients had significant upper tract complications including; renal calculi, atrophic kidney, vesicoureteral reflux, and renal scarring with impaired renal function. Fifty percent of upper tract complications developed more than 2 years after sphincterotomy. Thirty patients had lower tract complications including; recurrent symptomatic urinary tract infection, bladder stones, urethral diverticulum, urethral stricture, bladder neck stenosis, and recurrent epididymitis.(ABSTRACT TRUNCATED AT 250 WORDS)