Predicting failed access in unstented ureteroscopy.

The risk of failed access (FA) in unstented ureteroscopy ranges from 7.7 to 16%, with young females and those with prior ipsilateral stone surgery, narrow ureteral anatomy, and proximal ureteral stone location carrying higher risk. We aim to determine the rate of failed access at our institution and analyze demographic, clinical, and operative variables associated with FA. We conducted a review of all unstented ureteroscopy procedures at our institution between January 2018 and June 2022. Ureteroscopy for stone, stricture, and neoplasm were included. The primary endpoint was rate of FA, when the unstented ureter failed to accommodate the ureteroscope distal to the target lesion. Demographic, clinical, and operative variables were analyzed to determine if there was an association with FA. Of the 562 ureteroscopies cases reviewed, 221 unstented ureteroscopies fit our inclusion criteria. FA occurred in 34 (15.4%). Previous stone passage (p = 0.039) and distal ureteral location (p = 0.042) were associated with successful access (SA). Proximal ureteral location was associated with FA (p = 0.008). These variables remained statistically significant when analyzed with multivariable logistic regression. There was no association with other demographic, clinical and operative variables. FA occurred at a rate of 15.4% at our institution. Previous stone passage and distal ureteral location were associated with SA, while proximal ureteral location was associated with FA. Prospective studies are needed to better determine predictors of FA.

Does trocar puncture of the bladder during midurethral sling impact postoperative urinary storage and voiding symptoms?

INTRODUCTION AND HYPOTHESIS: The incidence of trocar bladder puncture during midurethral sling (MUS) surgery varies widely. We aim to further characterize risk factors for bladder puncture and examine its long-term impact on storage and emptying. METHODS: This is an Institutional Review Board-approved, retrospective chart review of women who underwent MUS surgery at our institution from 2004 to 2018 with ≥12 months of follow-up. Unless prolonged catheterization was necessary, a voiding trial was performed prior to discharge, or the next morning in outpatients, regardless of puncture. Preoperative and postoperative details were obtained from office charts and operative records. RESULTS: Of 1,500 women, 1,063 (71%) had retropubic (RP) and 437 (29%) had transobturator MUS surgery. Mean follow-up was 34 months. Thirty-five women (2.3%) sustained a bladder puncture. RP approach and lower BMI were significantly associated with puncture. No statistical association was found between bladder puncture and age, previous pelvic surgery, or concomitant surgery. Mean day of discharge and day of successful voiding trial were not statistically different between the puncture and nonpuncture groups. There was no statistically significant difference in de novo storage and emptying symptoms between the two groups. Fifteen women in the puncture group had cystoscopy during follow-up and none had bladder exposure. Level of the resident performing trocar passage was not associated with bladder puncture. CONCLUSIONS: Lower BMI and RP approach are associated with bladder puncture during MUS surgery. Bladder puncture is not associated with additional perioperative complications, long-term urinary storage/voiding sequelae, or delayed bladder sling exposure. Standardized training minimizes bladder punctures in trainees of all levels.

The Effect of Core Stabilization Training on Improving Gait and Self-Perceived Function in Patients with Knee Osteoarthritis: A Single-Arm Clinical Trial.

The treatment of patients with knee osteoarthritis is typically focused on the involved lower extremity. There is a gap in the literature concerning the effectiveness of core stabilization training on the treatment of patients with knee osteoarthritis. This investigation aimed to determine whether core stabilization improved the gait and functional ability of patients with knee osteoarthritis. Eighteen participants with knee osteoarthritis completed the six-week core stabilization intervention. Participants completed the gait motion analysis and the Knee Injury and Osteoarthritis Outcome Score to assess self-perceived function, pre- and post-intervention. Gait speed improved (p = 0.006, d = 0.59), while the external knee adduction moment decreased (p = 0.034, d = −0.90). Moreover, self-reported function improved (p < 0.001, d = 1.26). The gait speed and external knee adduction moment changes met minimal detectable change thresholds, while gait speed also met the minimal clinically important difference. A six-week core stabilization program can thus improve gait speed and reduce the external knee adduction moment, which is tied to disease progression. Increased functional scores post-intervention indicate an important clinical improvement. Core stabilization training is a safe and potentially effective treatment option for this population.

Impact of preoperative pelvic floor muscle training (pretraining) on urinary storage and emptying symptoms in women undergoing sling surgery.

INTRODUCTION AND HYPOTHESIS: Although pelvic floor muscle training (PFMT) is an option for female mixed incontinence (MUI), the role of PFMT prior to midurethral sling (MUS) surgery is not well defined. We hypothesize that preoperative PFMT (pretraining) positively impacts urinary storage and voiding symptoms prior to retropubic MUS. METHODS: We carried out an institutional review board-approved, retrospective chart review of women with stress-predominant MUI undergoing a retropubic MUS. Seventy-two women elected for initial PFMT before MUS (group 1). These were age-matched with 72 women who underwent MUS only (group 2). The primary outcome was the change in urinary voiding and storage symptoms (Emptying [E] and Inhibition [I; UUI] subsets of the SEAPI classification). Additional outcomes were stress urinary incontinence (SUI) resolution and change in quality of life (QoL) indices. RESULTS: Mean age and follow-up were 49 ± 12 years and 33 ± 12 months respectively. After MUS, SUI resolved in 79.2% and 69.4% in groups 1 and 2 respectively (p > 0.05). In group 1, 18% and 20.8% had improvement/resolution in the E and I subsets prior to MUS. Postoperatively, similar rates of improvement/resolution in the E (25% for both) and I (68% vs 63.9%) subsets were observed in groups 1 and 2 respectively. Postoperative QoL indices were statistically improved in both groups, with no significant difference between groups. CONCLUSIONS: Pretraining with PFMT before MUS was associated with preoperative improvement in emptying symptoms and UUI. Although not statistically significant, pretraining was associated with a higher chance of SUI resolution in the long term. If pretraining is beneficial before MUS, the effect appears to be small.

Abdominal versus robotic sacral colpopexy: A detailed analysis of outcomes.

AIMS: Although abdominal sacrocolpopexy (ASC) is considered the gold standard for surgical repair of vaginal vault prolapse, the open surgical approach has significant morbidity. We aim to compare anatomic and functional outcomes in women receiving either robotic-assisted sacral colpopexy (RSC) or ASC for post-hysterectomy prolapse. METHODS: We present a retrospective chart review of all women who underwent ASC and RSC at our institution and had 12-month follow-up (FU). Pelvic organ prolapse quantification (POP-Q) staging was assessed both preoperatively and postoperatively. Perioperative and demographic details were collected from the medical records. RESULTS: One hundred twenty four women underwent RSC (mean age 63, median FU 16 months). Those in the ASC group (n = 144) were statistically younger (mean age 60) and had longer FU (median 60 months). Both median day of successful voiding trial and discharge day significantly favored RSC. There were no Clavien Grade IV/V complications for either procedure and three RSC procedures were converted to ASC. Both approaches were associated with a significant improvement in POP-Q stage at FU, with few women requiring additional surgery. Overall, 76% of women in each group were dry from stress urinary incontinence. Improvement in storage and emptying indices, dyspareunia, and quality of life measures was observed after both approaches. CONCLUSION: RSC demonstrates good support of significant vaginal vault prolapse at medium term FU, with shorter hospital stays and low complication rates. Close FU after RSC over a longer period will be needed to fully assess durability of both functional and anatomic outcomes.

Transversus abdominis activation does not alter gait impairments in patients with and without knee osteoarthritis.

BACKGROUND: Knee osteoarthritis accounts for more years of disability than all other forms of osteoarthritis combined. Gait kinetic and kinematic changes, in addition to reduced gait speed, are commonly observed. This study investigates whether core activation, which modifies lower extremity movement in young, active populations, can alter the gait and baseline core activation of those with knee osteoarthritis as compared to controls, and alter osteoarthritic knee pain. METHODS: Forty-four participants (22 controls and 22 with knee osteoarthritis) underwent biomechanical gait assessment, examining kinetic and kinematic variables, in addition to gait speed, with and without volitional transversus abdominis activation. Surface electromyography was used to measure baseline transversus abdominis activation under both conditions. Knee pain ratings were examined for those with knee osteoarthritis. FINDINGS: No significant biomechanical differences were observed within groups, or in the time/group interaction. Between-groups kinetic (time to first peak ground reaction force and amplitude of second peak ground reaction force) and gait speed differences were observed under both conditions. There were no differences in baseline electromyography activation between or within-groups, or within-group for self-reported pain for the osteoarthritic group. INTERPRETATION: Although previous studies have shown the benefit of core activation in correcting lower extremity movement patterns and kinetic loading in young, athletic populations, this study is the first to show this is not the case for persons with knee osteoarthritis. Future studies should examine the value of a progressive core stabilization program, of sufficient dose and mode, in correcting the observed gait differences in those with knee osteoarthritis. CLINICAL TRIAL REGISTRATION NUMBER: NCT03776981.

Long-term outcomes of transobturator midurethral slings: A critical evaluation of a real-world population.

AIMS: The American Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction stress urinary incontinence (SUI) guidelines strongly recommend the midurethral sling (MUS) for the index female patient with SUI. While numerous studies report long-term outcomes and complications for the retropubic MUS, these are largely absent for the transobturator MUS and are assessed in this study. METHODS: This is an Institutional Review Board approved retrospective chart review of all women who underwent a transobturator MUS at a single institution from 2004 to 2010. Pre- and postoperative assessment included a cough-stress test, SEAPI assessment, and validated quality-of-life (QoL) questionnaires. SUI resolution was defined as no subjective or objective SUI, and no additional surgery to achieve stress continence. RESULTS: Of 437 women, 305 (70%) had a minimum follow-up of 48 months (mean 88; median 92). SUI was resolved in 69% of the entire cohort and 58% of the 78 women who had MUS only. The median time to SUI recurrence was 38 months in the entire cohort and 18 months in the MUS only group. Perioperative complications were infrequent and typically associated with concomitant surgery. A statistically significant improvement was observed in SEAPI scores and all QoL indices postoperatively. CONCLUSIONS: Long-term resolution of SUI after the transobturator MUS is achieved by 69%, which is commensurate with success rates reported in the literature. Overall, women experience a significant improvement in their QoL after transobturator MUS; however, late recurrences and delayed sequelae may occur. Thus, long-term follow-up is warranted in this population.

Focal epilepsy caused by single cerebral cavernous malformation (CCM) is associated with regional and global resting state functional connectivity (FC) disruption.

Epilepsy, including the type with focal onset, is increasingly viewed as a disorder of the brain network. Here we employed the functional connectivity (FC) metrics estimated from the resting state functional MRI (rsfMRI) to investigate the changes of brain network associated with focal epilepsy caused by single cerebral cavernous malformation (CCM). Eight CCM subjects and 21 age and gender matched controls were enrolled in the study. Seven of 8 CCM subjects underwent surgical resection of the CCM and became seizure free and 4 of the surgical subjects underwent a repeat rsfMRI study. We showed that there was both regional and global disruption of the FC values among the CCM subjects including decreased in homotopic FC (HFC) and global FC (GFC) in the regions of interest (ROIs) where the CCMs were located. There was also the disruption of the default mode network (DMN) especially the FC between the middle prefrontal cortex (MPFC) and the right lateral parietal cortex (LPR) among these individuals. We observed the trend of alleviation of these disruptions after the individual has become seizure free from the surgical resection of the CCM. Using a voxel-based approach, we found the disruption of the HFC and GFC in the brain tissue immediately adjacent to the CCM and the severity of the disruption appeared inversely proportional to the distance of the brain tissue to the lesion. Our findings confirm the disruption of normal brain networks from focal epilepsy, a process that may be reversible with successful surgical treatments rendering patients seizure free. Some voxel-based metrics may help identify the epileptogenic zone and guide the surgical resection.

Correction to: Ultrasound localization of lacerated flexor tendon ends in the hand: a cadaveric study.

In the results section of the abstract, it states "99.0% (n = 05/96 tendons)" when it should state "99.0% (n = 95/96 tendons)".

Ultrasound localization of lacerated flexor tendon ends in the hand: a cadaveric study.

OBJECTIVE: Flexor tendon repair currently requires extensive exposure to locate and repair tendons. Ultrasound (US) has been used to identify lacerated tendon ends with little information on accuracy. This study was designed to measure the accuracy of US to localize tendon ends in zone II flexor tendon lacerations in a cadaveric model. MATERIALS AND METHODS: US was used to locate tendon ends in zone II lacerations of fingers of six cadaveric hands (96 tendon ends) by a musculoskeletal radiologist. The distance of each tendon end relative to the laceration was recorded. Specimens were dissected and tendon position was compared to US position. RESULTS: The radiologist correctly identified full-thickness lacerations of both superficial and deep tendons 99.0% (n = 05/96 tendons) of the time. The average difference between mean US predicted retraction and anatomic confirmed retraction for all digits all tendons was 3.5 mm of underestimation. US correctly identified the position of all tendon stumps to within 10 mm 92.7% (n = 89/96 tendons) of the time and 69.8% (n = 67/96 tendons) of the time to within 5 mm. Error tended to underestimate (61.5%; 59/96 tendons) rather than overestimate retraction (29.2%; 28/96 tendons). CONCLUSIONS: This fresh cadaveric study has demonstrated that with an experienced radiologist, there was 99.0% accuracy identifying a completed tendon tear and locating the tendon ends with US to within 1 cm was 92.7% accurate.

An original method for staging sleep based on dynamical analysis of a single EEG signal.

BACKGROUND: The dynamical complexity of brain electrical activity manifested in the EEG is quantifiable using recurrence analysis (RA). Employing RA, we described and validated an originative method for automatically classifying epochs of sleep that is conceptually and instrumentally distinct from the existing method. NEW METHOD: Complexity in single overnight EEGs was characterized second-by-second using four RA variables that were each averaged over consecutive 30-sec epochs to form four-component vectors. The vectors were staged using four-component cluster analysis. Method validity and utility were established by showing: (1) inter- and intra-subject consistency of staging results (method insusceptible to nonstationarity of the EEG); (2) use of method to eliminate costly and arduous visual staging in a binary classifications task for detecting a neurogenic disorder; (3) ability of method to provide new physiological insights into brain activity during sleep. RESULTS: RA of sleep-acquired EEGs yielded four continuous measures of complexity and its change-rate that allowed automatic classification of epochs into four statistically distinct clusters ("stages"). Matched subjects with and without mental distress were accurately classified using biomarkers based on stage designations. COMPARISON WITH EXISTING METHODS: For binary-classification purposes, the method was cheaper, faster, and at least as accurate as the existing staging method. Epoch-by-epoch comparison of new versus existing methods revealed that the latter assigned epochs having widely different dynamical complexities into the same stage (dynamical incoherence). CONCLUSIONS: Sleep can be automatically staged using an originative method that is fundamentally different from the existing method.

Outcomes of three sling procedures at the time of abdominal sacral colpopexy.

INTRODUCTION: A sling at time of sacral colpopexy (SCP) for apical pelvic organ prolapse (POP) is valuable in the treatment of overt, urodynamic, and occult stress urinary incontinence (SUI). As there is no current agreement regarding the optimal choice of sling in these women, we compare the outcomes of three sling procedures in this population: autologous rectus fascia bladder neck sling (ARF), retropubic midurethral sling (RPM), and transobturator midurethral sling (TOM). METHODS: We performed a retrospective single institution, single-surgeon review of data identifying women with minimum follow-up of 12 months who underwent a concomitant sling and SCP following urodynamics with and without POP reduction. Preoperative and postoperative evaluation included objective and subjective assessment. Cure required absence of subjective and objective SUI. RESULTS: Out of 187 women, 152 (81%) met inclusion criteria (49 ARF, 58 RPM, and 45 TOM). There were no significant differences among sling groups regarding demographics. SUI cure rates were not significantly different between sling groups, or within each group after stratification by overt and occult SUI. QoL indices improved significantly after surgery for the entire cohort. CONCLUSIONS: All three sling types appear to produce similar cure rates of SUI when done concomitantly with SCP. There did not appear to be any significant differences when stratified by occult or overt SUI. No sling type was associated with more postoperative complications. Larger studies are necessary to confirm the findings of this single-institution, retrospective study. Neurourol. Urodynam. 36:482-485, 2017. © 2016 Wiley Periodicals, Inc.

The impact of obesity on outcomes and complications after top-down retropubic midurethral sling.

AIMS: Obese women (BMI ≥ 30 kg/m2 ) have been considered at higher risk for postoperative complications and failure in efficacy after SUI surgery. We compare the outcomes in this population with non-obese women (BMI < 30 kg/m2 ) undergoing top-down retropubic polypropylene midurethral sling (RPM). METHODS: We retrospectively identified 328 non-obese women and 294 obese women who underwent RPM. Evaluation included SEAPI (stress incontinence, emptying, anatomy, protection, inhibition) assessment and validated QoL questionnaires. Cure was defined as absence of subjective and objective SUI and no additional procedures to correct SUI. Perioperative details were abstracted from the hospital and clinic charts. Groups and outcomes were statistically compared. RESULTS: All women had a minimum follow up of 12 months. Preoperative demographic variables, SEAPI scores, and QoL indices were similar between BMI groups. SUI cure rates were significantly higher for non-obese women (82.9% vs. 74.5%; P < 0.01). When controlling for concomitant pelvic surgery, cure rates were not statistically different (76.9% vs. 73.7%; P = 0.65). Statistically significant improvement in SEAPI scores and QoL indices was achieved in both groups. Overall, obese women had no increase in complications compared with the non-obese. The chance of passing an initial postoperative voiding trial was statistically higher in the obese group. CONCLUSIONS: Obese women have similar success rates and significant improvement in QoL as non-obese women after RPM. Obesity alone does not appear to be a risk factor for additional complications during sling surgery and obese women may have earlier return to normal voiding after surgery.

The Fingerprint of Rapid Eye Movement: Its Algorithmic Detection in the Sleep Electroencephalogram Using a Single Derivation.

The strong associations of rapid eye movement (REM) sleep with dreaming and memory consolidation imply the existence of REM-specific brain electrical activity, notwithstanding the visual similarity of the electroencephalograms (EEGs) in REM and wake states. Our goal was to detect REM sleep by means of algorithmic analysis of the EEG. We postulated that novel depth and fragmentation variables, defined in relation to temporal changes in the signal (recurrences), could be statistically combined to allow disambiguation of REM epochs. The cohorts studied were consecutive patients with obstructive sleep apnea (OSA) recruited from a sleep medicine clinic, and clinically normal participants selected randomly from a national database (N = 20 in each cohort). Individual discriminant analyses were performed, for each subject based on 4 recurrence biomarkers, and used to classify every 30-second epoch in the subject's overnight polysomnogram as REM or NotREM (wake or any non-REM sleep stage), using standard clinical staging as ground truth. The primary outcome variable was the accuracy of algorithmic REM classification. Average accuracies of 90% and 87% (initial and cross-validation analyses) were achieved in the OSA cohort; corresponding results in the normal cohort were 87% and 85%. Analysis of brain recurrence allowed identification of REM sleep, disambiguated from wake and all other stages, using only a single EEG lead, in subjects with or without OSA.

A retrospective study of the effects of clostridial collagenase ointment and negative pressure wound therapy for the treatment of chronic pressure ulcers.

UNLABELLED: Nonhealing, chronic pressure ulcers present a continuous challenge in the global health care venue, with decreased mobility and the effects of aging on skin placing the elderly at particular risk. Debridement is an important process to decrease risk of infection and promote healing. Enzymatic debridement with, for example, clostridial collagenase ointment (CCO) has been shown to assist with the achievement and maintenance of a clean wound bed in preparation for closure. Negative pressure wound therapy (NPWT) has also been used successfully for the treatment of wounds. Although conclusive research has demonstrated positive independent effects of both CCO and NPWT as treatments for chronic pressure ulcers, there are no known published studies that have investigated the 2 as a conjunctive treatment. MATERIALS AND METHODS: A retrospective analysis of 114 adult patients was conducted to assess wound healing of chronic pressure ulcers in a setting with medically complex patients. Two groups were established comparing those who received NPWT alone to those who received NPWT plus CCO. The study sample included 67 patients treated with NPWT + CCO and 47 patients who received only NPWT. RESULTS: Results were similar for both treatment groups with mean values indicating the cohorts were closely aligned with respect to wound size, complexity, length of long-term acute care hospital stay, and duration of NPWT. The patients who received NPWT + CCO demonstrated statistically significant changes in several key areas including initial Bates-Jensen Wound Assessment Tool (BWAT) score, changes in the overall BWAT score and in the necrotic tissue domain. CONCLUSION: Data analysis from this retrospective study indicates patients who received both therapies (NPWT + CCO) demonstrated improved outcomes in speed of debridement and rate of wound closure compared to those who received NPWT alone.

Recurrence analysis of the EEG during sleep accurately identifies subjects with mental health symptoms.

Analysis of brain recurrence (ABR) is a novel computational method that uses two variables for sleep depth and two for sleep fragmentation to quantify temporal changes in non-random brain electrical activity. We postulated that ABR of the sleep-staged EEG could identify an EEG signature specific for the presence of mental health symptoms. Using the Mental Health Inventory Questionnaire (MHI-5) as ground truth, psychological distress was assessed in a study cohort obtained from the Sleep Heart Health Study. Subjects with MHI-5 <50 (N=34) were matched for sex, BMI, age, and race with 34 subjects who had MHI-5 scores >50. Sixteen ABR markers derived from the EEG were analyzed using linear discriminant analysis to identify marker combinations that reliably classified individual subjects. A biomarker function computed from 12 of the markers accurately classified the subjects based on their MHI-5 scores (AUROC=82%). Use of additional markers did not improve classification accuracy. Subgroup analysis (20 highest and 20 lowest MHI-5 scores) improved classification accuracy (AUROC=89%). Biomarker values for individual subjects were significantly correlated with MHI-5 score (r=0.36, 0.54 for N=68, 40, respectively). ABR of EEGs obtained during sleep successfully classified subjects with regard to the severity of mental health symptoms, indicating that mood systems were reflected in brain electrical activity.

Two-group classification of patients with obstructive sleep apnea based on analysis of brain recurrence.

OBJECTIVE: To demonstrate that the severity of obstructive sleep apnea (OSA) could be predicted algorithmically by means of recurrence analysis of the sleep-staged electroencephalogram (EEG). METHODS: A randomly selected cohort of 20 sleep-staged patients with OSA (apnea-hypopnea index (AHI) 5-30) was divided into mild and moderate sub-cohorts (AHI 5-15, 16-30, respectively), and the sleep EEG (C3) was analyzed using analysis of brain recurrence (ABR) (LSU cohort). Twenty distinct but related markers for sleep depth and fragmentation were computed from four ABR variables, and a marker function capable of classifying each patient into one of the two sub-cohorts was determined by linear discriminant analysis. Classification accuracy of individual patients was evaluated using area under the receiver operator characteristics curve (AUROC). As a control procedure, 20 additional sleep-staged patients with OSA whose polysomnographic data was obtained from an independent database were also evaluated (SHHS cohort). RESULTS: On average, markers for sleep depth were reduced and those for sleep fragmentation were increased in the patients with moderate OSA, as expected. All patients in both cohorts were correctly classified using as few as 5-6 markers. SIGNIFICANCE: The degree of severity of OSA was reflected in objective changes in the sleep EEG. Recurrence analysis of the EEG potentially has uses beyond identification of the degree of OSA.

EEG recurrence markers and sleep quality.

OBJECTIVES: To show that EEG markers formed using the variable percent recurrence reliably quantified two related aspects of sleep quality, sleep depth and sleep fragmentation. As hypotheses, the depth marker would increase and the fragmentation marker decrease in patients where improved sleep quality occurred when assessed by polysomnography. METHODS: The patients (N=20) had been diagnosed with obstructive sleep apnea during diagnostic polysomnography (dPSG), and had exhibited increased REM sleep (clinical indication of improved sleep quality) during subsequent polysomnography to titrate the pressure of a treatment device (cPSG). Percent recurrence was computed second-by-second from the EEG; sleep-depth and sleep-stability markers were obtained algorithmically. By assumption, the markers contained temporal information regarding the extent of deterministic (non-random) brain activity. Marker means were compared between the dPSG and the cPSG for NREM and REM sleep. RESULTS: Sleep depth was greater and sleep fragmentation was less during cPSG, as hypothesized (P<0.05). The effects occurred during NREM and REM sleep, but were greater during NREM sleep (P<0.05). At least one of the predicted changes occurred in 95% of the patients. CONCLUSIONS: The factors generally regarded as responsible for subjective sleep quality were objectively quantified on the basis of dynamical changes in the EEG.

Long-term follow-up of porcine dermis pubovaginal slings.

INTRODUCTION AND HYPOTHESIS: Outcomes of xenografts in incontinence surgery are uncommon. Our objective was to report long-term outcomes of women after porcine dermis (PD) bladder neck sling. METHODS: Seventy women completed a mean follow-up of 62.1 months. "Global cure" equaled SEAPI subjective composite = 0 and visual analog score ≥8. "Stress urinary incontinence (SUI) cure" equaled SEAPI-subjective (S) subset = 0 and negative cough stress test. RESULTS: The SUI cure rate was 42.9 % and global cure rate was 11.4 %. Perioperative complications were seen in <10 % of women. The mean time to SUI recurrence was 10.4 months, with 30 of 40 women redeveloping SUI <12 months after sling. Twenty women (28.6 %) have since undergone additional anti-incontinence procedures. There was a significant postoperative improvement in SEAPI scores, daily pad use, and quality of life (QOL) indices. CONCLUSIONS: At long-term follow-up, PD is not a durable material in sling surgery. Although QOL generally improves after surgery, most SUI recurrences occurred soon after surgery.