Editor's comment: refractory neuropathic mixed incontinence

Abstract

The January -February 2008 issue of the International Braz J Urol presents interesting contributions from different countries, and as usual, the editor's comment highlights some papers.Doctor Patki and co-workers, from Royal National Orthopaedic Hospital, United Kingdom, examined on page 63 efficacy of a combination of day case intradetrusor (ID) botulinum toxin (BTX-A) bladder injections and transobturator (TOT) or tension free vaginal tape (TVT). Eleven women who are pharmacotherapy intolerant or who have drug refractory neurogenic mixed incontinence were treated. Two opted for open surgery and the remaining 9 received 1000 units of Dysport diluted in 30 mL saline cystoscopically at 30 ID sites followed by TOT in 6 or TVT in 3 as a day case combination treatment. The mean age was 56.7 years (range 41 to 78) with a mean follow-up of 19.1 months (range 7 to 33). All women were continent at 3 and 12 months. Anticholinergics were discontinued in 7 with global high satisfaction with the treatment. BTX-A injections were repeated in 4 (mean 13.5 months). The authors concluded that anticholinergic refractory women with neurogenic mixed incontinence could be effectively treated as a day case with combination of ID BTX-A injections and TVT or TOT. Dr. Kathleen C. Kobashi, from Virginia Mason Medical Center, Seattle, Washington, USA, provided editorial comment on this paper. Doctor Constantini and colleagues, from the University of Perugia, Italy, tested on page 73 the hypothesis that preoperative Valsalva leak point pressure (VLPP) predicts long-term outcome of mid-urethra slings for female stress urinary incontinence (SUI). One hundred and forty-five patients with SUI were prospectively randomized to tension free vaginal tape (TVT) or transobturator tape (TOT). The patients were followed-up at 3, 6 and 12 months post-operatively and then annually for outcome variables. Preoperative VLPP was correlated with primary and secondary outcome variables. Mean follow-up was around 32 months for both TVT and TOT. The overall objective cure rates were 75.8% for patients with VLPP > 60 cm H 2 O and 72% for those with VLPP ≤ 60 cm H 2 O (p < 0.619). No significant differences in objective cure rates emerged when patients were stratified for pre-operative VLPP and matched for TOT or TVT procedures.