Predictors for persistent urodynamic stress incontinence following extensive pelvic reconstructive surgery with and without midurethral sling

Lo, Tsia‐Shu; Nawawi, Enie Akhtar; Wu, Pei‐Ying; Karim, Nazura bt; Al-Kharabsheh, Ahlam Mahmoud

doi:10.1007/s00192-015-2837-z

Cited by 16 publications

(9 citation statements)

References 28 publications

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“…It has been reported that patients of old age (>66 years), MUCP <60 mmH 2 O, and functional urethral length < 2 cm were at greater risk of developing de novo SUI after transvaginal pelvic reconstructive surgery. 8,13 Similarly, our study also showed that de novo SUI was more prevalent in elderly patients (≥70 years). Not only after transvaginal surgery but also after LSC, the prevalence of de novo SUI is significantly higher in patients with low MUCP (<40 cmH 2 O).…”

Section: Resultssupporting

confidence: 78%

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Predictive urodynamic factors for de novo stress urinary incontinence after laparoscopic sacrocolpopexy for pelvic organ prolapse

Yoshio

Hayashi

Tokiwa

et al. 2021

LUTS

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Objectives: Laparoscopic sacrocolpopexy is often performed to treat pelvic organ prolapse. Preoperative stress urinary incontinence (SUI) can improve after laparoscopic sacrocolpopexy. In contrast, some patients without incontinence preoperatively develop SUI after pelvic organ prolapse repair (ie, de novo SUI). This study aimed to identify the preoperative predictive factors of de novo SUI after laparoscopic sacrocolpopexy.Methods: A total of 858 patients underwent laparoscopic sacrocolpopexy between January 2013 and November 2017 at Kameda Medical Center. Urodynamic studies were performed pre-and postoperatively on 75 patients. This retrospective study included 43 of 75 patients who did not have SUI preoperatively. We assessed urethral function according to functional profile length and maximum urethral closure pressure. We evaluated voiding function in terms of maximum flow rate, detrusor pressure at maximum flow rate, and postvoid residual volume. Furthermore, each factor was compared between de novo SUI-positive and SUI-negative groups.Results: After laparoscopic sacrocolpopexy, 30 (69.8%) patients presented with SUI.The preoperative maximum urethral closure pressure was significantly lower in the de novo SUI-positive group (36.0 cmH 2 O) than in the de novo SUI-negative group (50.5 cmH 2 O, P = .020). More patients with maximum urethral closure pressure <40 cmH 2 O had de novo SUI than patients with maximum urethral closure pressure ≥40 cmH 2 O (P = .004). There were no significant differences between preoperative maximum urethral closure pressure and postoperative maximum urethral closure pressure in either group.Conclusions: Low preoperative maximum urethral closure pressure, particularly maximum urethral closure pressure <40 cmH 2 O, is a predictor of de novo SUI after laparoscopic sacrocolpopexy.

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Section: Resultssupporting

confidence: 78%

“…12 Some studies have examined preoperative bladder functions using urodynamic studies (UDS) as predictors of de novo SUI after POP surgery. 3,8,13,14 However, urodynamic parameters to predict risk of de novo SUI have been controversial. We have already reported the changes in UDS parameters before and after LSC.…”

Section: Introductionmentioning

confidence: 99%

Predictive urodynamic factors for de novo stress urinary incontinence after laparoscopic sacrocolpopexy for pelvic organ prolapse

Yoshio

Hayashi

Tokiwa

et al. 2021

LUTS

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“…Previous studies have highlighted the risk factors for mesh extrusion, including DM, hypertension, smoking, previous pelvic surgeries, concomitant hysterectomy, greater intraoperative blood loss, and surgery performed by a junior surgeon, with the protective factors being uterine preservation, with no mesh over the apex [16−19]. Although our concomitant hysterectomy rate was high at 63.9%, studies carried out by the same first author using various mesh kits with similarly high hysterectomy rates (67%−92%) have demonstrated that preoperative optimization of medical comorbidities, patient selection, reduction of mesh material, surgeon experience, and surgical technique-rather than concomitant hysterectomy-are the major factors for mesh exposure [16,20,21]. These measures, including tight requirements on preoperative glycated hemoglobin, exclusion of patients with previous radical pelvic surgeries, removal of the 2 middle arms with no mesh placed over the apex or posterior compartment, all surgeries performed by the same senior author (TSL) with a meticulous surgical technique, and minimizing intraoperative blood loss, were similarly employed in our current study.…”

Section: Discussionmentioning

confidence: 91%

Anterior-Apical Transvaginal Mesh (Surelift) for Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year

Huang

et al. 2021

Journal of Minimally Invasive Gynecology

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To determine the objective and subjective outcomes of pelvic organ prolapse (POP) surgery using a modified Surelift system (Neomedic International, Barcelona, Spain) and to evaluate surgical complications and postoperative impact on quality of life (QOL) and lower urinary tract symptoms. Design: Retrospective cohort study. Setting: Tertiary-care university hospital. Patients: Patients with symptomatic anterior or apical POP stage III and above. Interventions: All patients underwent pelvic reconstructive surgery with a modified Surelift transvaginal mesh kit. Measurements and Main Results: Eighty-three women who underwent pelvic reconstructive surgery with a modified Surelift for symptomatic anterior or apical prolapse stage III and above from April 2018 to January 2019 were reviewed retrospectively. All completed a 72-hour voiding diary, urodynamic study, and multiple validated QOL questionnaires at baseline and at between 6 and 12 months postoperatively. Descriptive statistics were used for demographics and perioperative data. Paired-samples t test and the McNemar test were applied for comparison of pre-and postoperative continuous and categoric data, respectively. The primary outcomes were the objective cure of POP, defined as anterior and apical prolapse Pelvic Organ Prolapse Quantification System ≤ stage I, and subjective cure on the basis of negative answers to Pelvic Organ Prolapse Distress Inventory 6. The objective and subjective cure rates at 1 year were 97.6% and 92.8%, respectively. There were significant improvements in QOL scores postoperatively. Although bladder outlet obstruction improved, de novo urodynamic stress incontinence and stress urinary incontinence were increased at 18.9% and 21.6%, respectively, at 1-year follow-up. The mesh extrusion rate was 4.8%. Conclusion:A modified Surelift has good objective and subjective cure rates at 1 year postoperatively with 4.8% mesh extrusion rate. There was significant improvement in lower urinary tract symptoms and QOL. De novo urodynamic stress incontinence at 6 months to 12 months was increased, but it was not sufficiently bothersome to warrant surgery. (2021) 28, 107−116.

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“…Borstad's similarly show 27% of women cured of SUI after surgical repair of POP 32 . The persistence of SUI in 40% (27/68) of the patients without MUS is likely due to having MUCP < 60 cm H 2 O and FUL < 2 cm together with overt SUI and advanced POP 33 .…”

Section: Discussionmentioning

confidence: 99%

Urodynamics mixed type urinary incontinence with advanced pelvic organ prolapse, management and outcomes

Uy-Patrimonio²,

Kao

et al. 2020

Sci Rep

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patients with pelvic organ prolapse (pop) often have accompanying lower urinary tract symptoms. Symptoms such as stress urinary incontinence(SUi-UD) and detrusor overactivty(Do) would co-exist in a number of patients. Management entails relieving the obstructive element. to determine the clinical outcome of patients with urodynamics mixed type urinary incontinence(MUi-U) after vaginal pelvic reconstructive surgery(PRS), a retrospective study was conducted. MUI-U was defined as having urodynamic findings of both of DO/DOI (derusor overactivity incontinence) and SUI-UD. Main outcome measures: Objective cure-absence of involuntary detrusor contraction on filling cystometry and no demonstrable leakage of urine during increased abdominal pressure; Subjective cure-assessment index score of <1 on UDI-6 question #2 and #3. Of the 82 patients evaluated, 14 underwent vaginal PRS with concomitant mid-urethral sling(MUS) insertion while 68 had vaginal PRS alone. Pre-operatively, 49(60%) patients had stage III and 33(40%) had stage IV prolapse. Post-operatively, 1-year data shows an objective cure of 56% (46/82) and subjective cure of 54% (44/82). MUI-U was significantly improved. improvement of SUi UD and results of the 1-hour pad test were more pronounced in patients with concomitant MUS insertion. ergo, vaginal pRS cures symptoms of MUi-U in >50% of patients and concomitant MUS can be offered to SUI predominant MUI. Mixed urinary incontinence (MUI) alone has been the leading cause of urinary incontinence in women above 65 years old. The ten-year cumulative incidence of urinary incontinence rates MUI as the first reported symptom in 37.2% of elderly patients 1. The International Urogynecological Association (IUGA) and International Continence Society (ICS) define MUI as the complaint of involuntary leakage of urine associated with exertion, sneezing, or coughing, as well as leakage associated with urgency 2. The cause of which is due to striated muscle atrophy, estrogen deficiency, abnormalities in histomorphology, and microstructural changes 3. Diagnosis of MUI through urodynamic studies pose a great challenge, since results fail to correlate with patient's symptoms, which lead to under diagnosis. Management of these group patients has generally been based on the predominant symptom that the patients report as the most bothersome 4. On the other hand, patients with pelvic organ prolapse (POP) often have lower urinary tract symptoms (LUTS). The use of urodynamic study for pre-operative evaluation of patients with POP becomes mandatory per recommendation by International Consultation on Incontinence 5. Urodynamic studies unmask occult stress urinary incontinence (SUI-UD) and identify women with concomitant detrusor overactivity (DO) and overt SUI-UD. Women with DO and SUI-UD are considered to have mixed type urinary incontinence (MUI-U). The incidence of MUI in patients with POP is 34.3% 6. Relieving the obstructive element becomes the main focus of management

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Predictors for persistent urodynamic stress incontinence following extensive pelvic reconstructive surgery with and without midurethral sling

Abstract: Overt USI with advanced POP together with low MUCP and FUL values have a higher risk of developing P-USI. Therefore, counseling these women is worthwhile while considering the type of mesh used.

Cited by 16 publications

References 28 publications

Predictive urodynamic factors for de novo stress urinary incontinence after laparoscopic sacrocolpopexy for pelvic organ prolapse

Predictive urodynamic factors for de novo stress urinary incontinence after laparoscopic sacrocolpopexy for pelvic organ prolapse

Anterior-Apical Transvaginal Mesh (Surelift) for Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year

Urodynamics mixed type urinary incontinence with advanced pelvic organ prolapse, management and outcomes

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