The surgical management of recurrent stress urinary incontinence: a systematic review

Nikolopoulos, Kostis I.; Betschart, Cornelia; Doumouchtsis, Stergios K.

doi:10.1111/aogs.12625

Cited by 21 publications

(12 citation statements)

References 80 publications

(154 reference statements)

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“…The authors concluded that there was no difference between the retropubic or transobturator approaches to the MUS as the two most studied procedures, while one trial showed no difference between retropubic MUS and colposuspension. A systematic review that allowed pooling of data for small studies, some with as few as five subjects, showed objective cure rates for recurrent SUI treated with colposuspension, MUS, and PVS of 76%, 66%, and 79%, respectively . The success rate for retropubic MUS was higher than for the transobturator approach.…”

Section: Variables Confounding Outcomes Of Surgery For Uimentioning

confidence: 99%

Surgery for urinary incontinence in women: Report from the 6th international consultation on incontinence

Gomelsky

Athanasiou

Choo

et al. 2018

Neurourology and Urodynamics

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Urinary incontinence is a prevalent condition worldwide and causes a tremendous impact on a woman's quality of life. While conservative and non‐surgical therapies are options for treatment, surgery for stress urinary incontinence (SUI) is common. Options include colposuspension, slings (pubovaginal and midurethral), and periurethral bulking. While evidence supports each of these options in the treatment of SUI, each is associated with various rates of success and unique adverse event profiles. Urgency urinary incontinence (UUI) is initially treated with behavioral modification and pharmacologic means, with surgery reserved for those with refractory symptoms or significant complications from medication use. At present, intravesical onabotulinumtoxinA injections, percutaneous tibial nerve stimulation, and sacral neurostimulation are all viable options for refractory UUI/overactive bladder. As with surgical interventions for SUI, each of these is, likewise, associated with unique outcomes and adverse event profiles. Herein, we summarize the findings and conclusions from the 6th International Consultation on Incontinence (ICI) regarding surgical treatment of urinary incontinence in women.

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Section: Variables Confounding Outcomes Of Surgery For Uimentioning

confidence: 99%

Surgery for urinary incontinence in women: Report from the 6th international consultation on incontinence

Gomelsky

Athanasiou

Choo

et al. 2018

Neurourology and Urodynamics

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“…In a recent review, Nikolopoulos et al [9] suggested that cure rates for recurrent SUI were 68.5% with MUS procedure, 61% with MUS fixation, 76% with Burch colposuspension, 53.8% with adjustable continence therapy and adjustable slings, 38% with bulking agents and 79.3% with pubovaginal slings. Also in this review, success rates of repeat MUS procedures using the transobturator approach appeared lower than in the retropubic procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Although all surgical treatment options for primary SUI are theoretically suitable for women with failed MUS, the surgeries most commonly performed are Burch colposuspension, laparoscopic 2-team sling procedure, pubovaginal sling, MUS fixation, repeat MUS, injection of urethral bulking agents, adjustable continence therapy and adjustable slings, salvage spiral sling and artificial urinary sphincter [9]. …”

Section: Introductionmentioning

confidence: 99%

A Valuable Option in the Management of Female Recurrent Stress Urinary Incontinence: Re-Adjustable Sling (Remeex Sling System)

Yaşa

Uğurlucan²,

Dural³

et al. 2016

Urol Int

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Introduction: This study was conducted to evaluate the effectiveness and safety of adjustable slings in the treatment of recurrent stress urinary incontinence (SUI) after mid-urethral sling (MUS) failure. Materials and Methods: A prospective study was performed among women with recurrent SUI at the Urogynecology Division of Istanbul School of Medicine between February 2010 and March 2015. All women were preoperatively evaluated with detailed urogynecologic evaluations, which included pelvic examination, Q-tip test, pad test, urodynamic studies and a compilation of the Kings Health Questionnaire (KHQ). Postoperative follow-up was performed at 1, 6 and 12 months and annually thereafter. Our primary outcome was objective cure and patient's satisfaction with treatment. Secondary outcomes included perioperative complications and adverse events. Results: Nineteen women were included in the study. The patients' mean age was 55.3 ± 6.9 years (range 43-66 years). The median follow-up time was 20.7 ± 14.0 months (range 6-55 months). The overall cure and improvement rates were 84.2 and 10.5%, respectively. In the satisfaction questionnaire, 15 (79%) patients responded that they were very satisfied and 3 (15.7%) were moderately satisfied. Sling tension re-adjustment was needed during follow-up in 1 patient (5.3%), 13 months after the initial surgery. The preoperative mean KHQ score was 545.9 ± 243.0 and changed to 237.0 ± 217.5 (p < 0.05). Postoperative complications were slight and easily manageable. Conclusions: Recurrent SUI is a challenging condition in urogynecology. The Regulation Mechanical External (Remeex) system has been found to be effective in the treatment of recurrent SUI after MUS failure with acceptable adverse effects. The Remeex system has the advantage of re-adjustment as a valuable option in the long-term management of patients.

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“…Uygulanan ikincil cerrahilerin başarı oranı ilk cerrahiden daha düşük seviyededir (15). İngiltere'de ürojinekologların nüks SÜİ'ye yaklaşımlarını araştıran bir çalışmada en sık seçilen cerrahinin %54'lük bir oranla ikinci MUS olduğu ve bunu %14'lük bir oranla mesane boynu enjeksiyonlarının takip ettiği bildirilmiştir (16).…”

Section: Cerrahi Tedaviunclassified

Nuks Stres Uriner Inkontinansin Yonetimi

Yurdakul¹,

Çoşkun²

2016

Kontinans ve Nöroüroloji Bülteni

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ÖzetGünümüzde stres üriner inkontinans tedavisindeki başarılı sonuçlara rağmen %20'ye kadar varan oranlarda rekürrens gelişebilmektedir. Rekürrens tedavisinde atın standart yöntem konusunda fikir birliği yoktur. Rekürrens dışı komplikasyonlar değerlendirildikten sonra tedavi inkontinansın şiddeti, hastanın tercihi ve cerrahın deneyimine göre şekillendirilmelidir. Anahtar Kelimeler: Stres üriner inkontinans, rekürrens GirişStres üriner inkontinans (SÜİ), öksürme hapşırma gibi karın içi basıncını artıran durumlarda istemsiz idrar kaçırma olarak tanımlanmaktadır (1). Kadınlarda yaygın bir semptom olan SÜİ'nin prevalansı çeşitli çalışmalarda %4-35 arasında bildirilmiştir (2). Günümüzde mid üretral slingler (MUS), SÜİ cerrahi tedavisinde altın standart yöntem-lerdir (3). MUS'un uzun dönem başarı oranları literatürde %80-95 arasında değişmektedir (4,5). Kolay uygulanan ve öğrenilen bir metod olarak oldukça popüler hale gelmelerine rağmen Amerikan Üroloji Derneği'nin 2009 yılında yayınladığı kılavuzda ilk operasyondan 12-23 ay sonra %16; 24-47 ay sonra ise %19 oranında etki kaybı yaşanabileceği belirtilmiştir (6).Stres üriner inkontinans cerrahisi sonrası başarı tanımının standart bir değerlendirilmesi mevcut değildir. Objektif olarak muayene bulguları veya ped testi kullanılan araştır-maların yanında hasta memnuniyetine ait sorgulamaları temel edinen ya da bunların her ikisini birden kullanan ça-lışmalar mevcuttur. Standardı olmayan bu ölçütler içinde değerlendirme yapmak her ne kadar kolay olmasa da cerrahi sonrası 'başarısızlık': persistans ya da rekürrens başlık-ları altında incelenebilir. Bazı olgular, cerrahiden hiç fayda görmemiş ya da minimum fayda görmüş olup bu durumda persistanstan söz edilebilir. Belirli bir dönem semptomların giderilmesine rağmen tekrar ortaya çıkması ise rekür-rens olarak değerlendirilir. Persistan ve rekürrens arasında-ki süre tam net olmamakla birlikte bazı yayınlarda 6 hafta olduğu kabul edilmektedir (7).Genetik ya da tıbbi bir nedenden dolayı pelvik taban güç-süzlüğü SÜİ tekrarlanmasına sebep olmaktadır. Bu nedenlere eşlik eden durumlar (kronik obstrüktif akciğer hastalığı (KOAH) obezite, kronik konstipasyon) da rekürrensi tetikleyen etmenlerdendir. Ayrıca ürogenital yaşlanma ve östrojen yetersizliği sonucunda da rekürren SÜİ görülmektedir (8).Stres üriner inkontinans başarısızlığının nedenlerini araştı-ran bir çalışmada vücut kitle indeksinin 25 kg/m 2 'den fazla olması, intrensek sfinfkter yetmezliği (ISD), geçirilmiş cerrahi ve diabetes mellitus bağımsız risk faktörleri olarak bulunmuştur (8). Bunların yanında cerrahi tecrübe, ileri evre sistosel ve eş zamanlı sistosel onarımı diğer çalışmalarda ortaya koyulan risk faktörleridir (9,10). DeğerlendirmeStres üriner inkontinans cerrahisi sonrası inkontinans tarif eden bir hastada persistans veya rekürrensin dışında, de novo sıkışma inkontinansı ve fistül gibi cerrahi komplikasyonların mutlaka araştırılması gerekmektedir. Bu nedenle hastanın ayrıntılı değerlendirilmesi son derece önemlidir. Anamnez ile depolama ve boşaltma semptomları i...

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The surgical management of recurrent stress urinary incontinence: a systematic review

Abstract: There is a wide spectrum of surgical interventions reported for secondary or tertiary treatment of SUI. A common characteristic for all recurrent procedures is a lower success rate compared with those reported following primary procedures.

Cited by 21 publications

References 80 publications

Surgery for urinary incontinence in women: Report from the 6th international consultation on incontinence

Surgery for urinary incontinence in women: Report from the 6th international consultation on incontinence

A Valuable Option in the Management of Female Recurrent Stress Urinary Incontinence: Re-Adjustable Sling (Remeex Sling System)

Nuks Stres Uriner Inkontinansin Yonetimi

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