Slings

Dmochowski, Roger R.; Padmanabhan, Priya; Scarpero, Harriette M.

doi:10.1016/b978-1-4160-6911-9.00073-6

Cited by 12 publications

(12 citation statements)

References 393 publications

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“…The pubourethral ligaments appear to restrict movement of the midurethral anterior wall during increases in intra-abdominal pressure. During such increases in intra-abdominal pressure, the midurethra is compressed shut against this hammock-like, firm, ligamentous support 1, 2. Therefore, stress incontinence could be associated with a deficiency or weakness in the pubourethral ligaments that can occur over time, initiated by such factors as childbirth, mechanical compression, and tissue breakdown with aging 1 .…”

Section: Introductionmentioning

confidence: 99%

“…During such increases in intra-abdominal pressure, the midurethra is compressed shut against this hammock-like, firm, ligamentous support 1, 2. Therefore, stress incontinence could be associated with a deficiency or weakness in the pubourethral ligaments that can occur over time, initiated by such factors as childbirth, mechanical compression, and tissue breakdown with aging 1 . Using various surgical reconstructive procedures, most of which are termed midurethral slings, also referred to as transobturator tapes (TOTs) or transvaginal tapes (TVTs), mechanical reinforcement that mimics effective ligamentous support in the midurethral region can be achieved 3 .…”

Section: Introductionmentioning

confidence: 99%

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A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence

Szell

Komisaruk

Goldstein³

et al. 2017

Sexual Medicine

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IntroductionMore than 200,000 midurethral slings are placed yearly for stress urinary incontinence. Approximately 14% to 20% of women experience worsening sexual function overall after these procedures. We postulated that sling placement injures neural pathways regulating “female prostate” tissue within the anterior vaginal wall.AimTo perform a meta-analysis for overall sexual function and orgasm using validated questionnaires for transvaginal tape, transobturator tape, and their variants.MethodsEffect sizes of preoperative and postoperative questionnaire scores for overall sexual function and orgasm were calculated. Random-effects models were selected for meta-analyses. Statistical analysis involved determination of the ratio of total heterogeneity to total variability.Main Outcome MeasuresDifferences of overall sexual and orgasm functions were calculated by subtracting postoperative sling scores from preoperative sling scores. Forest plots of effect sizes were performed.ResultsSixty-seven percent of midurethral sling procedures analyzed showed no change or improvement in overall sexual function postoperatively, whereas 33% of studies analyzed for orgasm function showed improvement after the procedure. For transvaginal tape, mean total sexual function and orgasm postoperative scores were significantly higher than preoperative scores. For transobturator tape, mean total postoperative score was significantly higher than the preoperative score; however, the mean orgasm postoperative score was not significantly higher than the preoperative score, possibly because of variability in transobturator tape data.ConclusionThere is a discrepancy between postoperative sexual satisfaction and orgasmic function after midurethral sling surgery. Although overall sexual function remained the same or improved for most women, orgasmic function in only one third of cases improved overall, with most women experiencing no change or deterioration in orgasmic function. Dissection for, and placement of, the midurethral sling can compromise the neural integrity of the anterior vaginal wall, thereby detrimentally affecting the periurethral prostate tissue that is essential to the orgasmic response. We propose that this surgical procedure can compromise orgasmic function in some women.Szell N, Komisaruk B, Goldstein SW, et al. A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence. Sex Med 2017;5:e84–e93.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence

Szell

Komisaruk

Goldstein³

et al. 2017

Sexual Medicine

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“…Urethral slings and suspensions aim to correct SUI by correcting hypermobility and augmenting intrinsic sphincter deficiency by allowing urethral compression during periods of increased intra-abdominal pressure without causing obstruction during voiding. At 48 months postoperatively, current surgical techniques for SUI have success rates of 30% for collagen injection, 73% for urethral suspensions, and 82-96% for urethral slings [Nygaard and Heit, 2004;Appell et al 2009;Dmochowski et al 2011]. A number of complications can result from sling implantation, including erosion rates in up to 23% of cases, permanent retention in up to 5% of cases, as well as wound complications, bladder perforation, and persistent groin/ suprapubic pain and dyspareunia in up to 15% of cases [Kuhn et al 2009;Dmochowski et al 2011].…”

Section: The Clinical Problemsmentioning

confidence: 99%

“…At 48 months postoperatively, current surgical techniques for SUI have success rates of 30% for collagen injection, 73% for urethral suspensions, and 82-96% for urethral slings [Nygaard and Heit, 2004;Appell et al 2009;Dmochowski et al 2011]. A number of complications can result from sling implantation, including erosion rates in up to 23% of cases, permanent retention in up to 5% of cases, as well as wound complications, bladder perforation, and persistent groin/ suprapubic pain and dyspareunia in up to 15% of cases [Kuhn et al 2009;Dmochowski et al 2011]. Although SUI is the culmination of diverse injuries to a host of pelvic structures, the current gold standard therapy only indirectly addresses one such aspect of injury by providing mechanical support to a weakened pelvic floor.…”

Section: The Clinical Problemsmentioning

confidence: 99%

“…Patients with SUI can benefit from initial conservative measures including pelvic floor physiotherapy, biofeedback, electrical stimulation, and, in some countries, pharmacotherapy; however, surgical options remain the mainstay for cases nonresponsive to conservative measures [Nygaard and Heit, 2004;Dmochowski et al 2011]. Urethral slings and suspensions aim to correct SUI by correcting hypermobility and augmenting intrinsic sphincter deficiency by allowing urethral compression during periods of increased intra-abdominal pressure without causing obstruction during voiding.…”

Section: The Clinical Problemsmentioning

confidence: 99%

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The potential role of stem cells in the treatment of urinary incontinence

Tran

Damaser

2014

Therapeutic Advances in Urology

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Voiding dysfunction encompasses a wide range of urologic disorders including stress urinary incontinence and overactive bladder that have a detrimental impact on the quality of life of millions of men and women worldwide. In recent years, we have greatly expanded our understanding of the pathophysiology of these clinical conditions. However, current gold standard therapies often provide symptomatic relief without targeting the underlying etiology of disease development. Recently, the use of stem cells to halt disease progression and reverse underlying pathology has emerged as a promising method to restore normal voiding function. Stem cells are classically thought to aid in tissue repair via their ability for multilineage differentiation and self-renewal. They may also exert a therapeutic effect via the secretion of bioactive factors that direct other stem and progenitor cells to the area of injury, and that also possess antiapoptotic, antiscarring, neovascularization, and immunomodulatory properties. Local injections of mesenchymal, muscle-derived, and adipose-derived stem cells have all yielded successful outcomes in animal models of mechanical, nerve, or external urethral sphincter injury in stress urinary incontinence. Similarly, direct injection of mesenchymal and adipose-derived stem cells into the bladder in animal models of bladder overactivity have demonstrated efficacy. Early clinical trials using stem cells for the treatment of stress urinary incontinence in both male and female patients have also achieved promising functional results with minimal adverse effects. Although many challenges remain to be addressed prior to the clinical implementation of this technology, novel stem-cell-based therapies are an exciting potential therapy for voiding dysfunction.

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