Female stress urinary incontinence and the mid-urethral sling: Is obstruction necessary to achieve dryness?

Dobberfuhl, Amy D.; De, Elise

doi:10.1007/s00345-015-1600-x

Cited by 13 publications

(10 citation statements)

References 66 publications

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“…Isovolumetric strength has been shown to improve selection of men considering anti-incontinence surgery [ 28 ]. Given the low pressures at which women void [ 29 ], the application of the Marshall-Marchetti test to simulate outlet resistance at time of urodynamics could represent a future research opportunity.…”

Section: Discussionmentioning

confidence: 99%

The evolution of incontinence into resolved, refractory and de novo urgency urinary incontinence following sling placement at time of prolapse repair in a large urodynamic cohort

2021

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Purpose To improve counseling in women at risk of refractory and/or de novo urgency urinary incontinence (UUI) following sling placement at time of prolapse repair, we created an outcome model to characterize changes in storage dysfunction. Materials and Methods We identified 139 women who underwent urodynamics followed by sling or no sling placement at the time of prolapse repair over a 6-year period. Our primary outcome was the presence of UUI following sling placement. Data were analyzed in SAS using chi-square, Fisher's exact, Student's t-test, and Kaplan-Meier methods. Results At baseline, the sling group had significantly higher subjective (62/81 [76.5%] vs. 18/58 [31.0%]; p<0.001), objective (62/81 [76.5%] vs. 6/58 [10.3%]; p<0.001), and occult (41/81 [50.6%] vs. 6/58 [10.3%]; p<0.001) stress urinary incontinence (SUI); and rates of subjective and objective UUI were similar to the no sling group prior to surgery. After surgery (mean follow-up 859 days) there was no difference with or without sling, in the rate of SUI (subjective, objective) and further SUI treatments (bulking agent, repeat sling). Higher rates of de novo (13/81 [16.0%] vs. 6/58 [10.3%]; p=0.454) and refractory (31/81 [38.3%] vs. 14/58 [24.1%]; p=0.048) UUI were noted in the sling group following surgery. On Kaplan-Meier analysis, a greater proportion of women in the no sling group did not report UUI at longest follow-up (hazard ratio 0.63; 95% confidence interval 0.37–1.06; p=0.081). Conclusions Women should be counseled on the risk of de novo and refractory UUI following sling placement at time of prolapse repair.

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Section: Discussionmentioning

confidence: 99%

The evolution of incontinence into resolved, refractory and de novo urgency urinary incontinence following sling placement at time of prolapse repair in a large urodynamic cohort

2021

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“…SUI has attracted the attention of gynaecologists at home and abroad, and has led to the rise and development of related disciplines such as gynaecology urology and female pelvic floor reconstruction surgery. At present, pelvic sling suspension is recommended as a first‐line treatment of SUI, especially the middle urethral suspension 27,28 . It has been reported that the operation has the advantages of minimally invasive incision, shorter operation time and quicker recovery time after surgery 29 .…”

Section: Discussionmentioning

confidence: 99%

TVT‐O vs TVT‐S for female stress urinary incontinence: A systematic review and meta‐analysis

Song

Shen

et al. 2020

Int J Clin Pract

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Background Tension‐free vaginal tape obturator (TVT‐O) and tension‐free vaginal tape secur (TVT‐S) are common surgeries for the treatment of stress urinary incontinence (SUI), several randomised controlled trials (RCTs) have compared the effects of TVT‐O and TVT‐S, yet the results remained inconsistent. Therefore, we attempted to conduct this systematic review and meta‐analysis to analyse the role of TVT‐O and TVT‐S in patients with SUI. Methods We searched PubMed databases from inception date to Jan 15, 2020 for RCTs that compared TVT‐O and TVT‐S in SUI patients. Two authors independently screened and extracted data from the published articles. Summary odd ratios (OR) or mean differences (MD) with 95% confidence intervals (95% CI) were calculated for each outcome by fixed‐ or random‐effects model. Results Seven RCTs with a total of 755 patients were identified, with 373 patients for TVT‐O and 382 patients for TVT‐S. TVT‐O preceded TVT‐S in the objective cure at 12 months (OR = 1.72, 95% CI 1.21‐2.45), subjective cure (OR = 1.98, 95% CI 1.08‐3.62); but TVT‐S have more advantage in the incidence of postoperative thigh pain (OR = 18.94, 95% CI 7.01‐51.15); no significant differences on the duration of operative procedure (OR = −1.09, 95% CI −2.37‐0.18), urinary retention (OR = 0.77, 95% CI 0.36‐1.62) and urinary infection (OR = 1.80, 95% CI 0.63‐5.13) were found. Conclusions TVT‐O should be preferred for patients with SUI even though with higher risks of postoperative thigh pain when compared with TVT‐S, more related studies are needed to identify the role of TVT‐O and TVT‐S for the treatment of SUI.

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“…Several experts claim that it is paramount to continue to pursue various mechanisms by which to address SUI, so as not to become complacent with the negative factors associated with this procedure. This is propelled by recent data, which illustrates the adverse events associated with MUS [7,8]. Although of relatively low incidence, it is imperative to recognize these complications and understand how to remedy undesirable events potentially resulting from this treatment method.…”

Section: Introductionmentioning

confidence: 89%

Bladder Outlet Obstruction After Incontinence Surgery

Brucker

Malacarne

2016

Curr Bladder Dysfunct Rep

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Stress urinary incontinence (SUI) is said to effect up to 80 % of all women who complain of some type of urinary leakage. As education about the diagnosis and treatment of SUI becomes more widespread, there is a need for understanding the efficacy and potential complications of the therapies used to treat this condition. It is widely accepted that the gold standard for treatment of SUI is mid-urethral sling (MUS). One significant complication of the MUS procedure is subsequent bladder outlet obstruction (BOO). We review the incidence and etiology of BOO following MUS and hope this document can be used as a guide for identifying patients who may be affected by postsurgical BOO. Additionally, we discuss modalities for achieving a timely and accurate diagnosis and highlight recent evidence regarding the various applications of urodynamic studies, when concerned for BOO. Lastly, various managements of this complication are discussed. This chapter serves as a comprehensive overview of BOO after incontinence procedures, highlighting the recent research contributions, which have enhanced our understanding of this potential complication when treating SUI.

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Female stress urinary incontinence and the mid-urethral sling: Is obstruction necessary to achieve dryness?

Abstract: As a discipline, we need to conceptualize stress incontinence due to urethral hypermobility or intrinsic sphincter deficiency as separate entities and design our procedures to restore the underlying suspected pathology.

Cited by 13 publications

References 66 publications

The evolution of incontinence into resolved, refractory and de novo urgency urinary incontinence following sling placement at time of prolapse repair in a large urodynamic cohort

The evolution of incontinence into resolved, refractory and de novo urgency urinary incontinence following sling placement at time of prolapse repair in a large urodynamic cohort

TVT‐O vs TVT‐S for female stress urinary incontinence: A systematic review and meta‐analysis

Bladder Outlet Obstruction After Incontinence Surgery

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