Current trends in urogynecological surgeries in Poland.

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) treatment has become more common in the world's health care systems, and the demand for pelvic floor disorder rehabilitation has been projected to increase by 35% between 2010 and 2030. Restitution procedures vary, but after the US Food and Drug Administration (FDA) notifications, the global use of mesh in vaginal surgeries has significantly decreased. The aim of this study is to show trends in urogynecological surgeries in Poland. METHODS: Retrospective analysis was performed of data obtained between 2009 and 2017 from the National Health Fund Information Centre website. Vaginal hysterectomies (VH), POP and urinary incontinence (UI) surgeries were considered. RESULTS: In the study, 327,294 hospitalizations between 2009 and 2017 were considered: 29,821 VH, 265,147 POP and 53,328 UI procedures. Between 2009 and 2015, a rapid increase in the number of POP procedures was observed (r2 = 0.94, b = 1711, p < 0.001). The following years, however, were characterized by a marked decline in the number of POP surgeries. In addition, the number of vaginal suspensions with mesh dropped by 24.7%, posterior and anterior repair by 8.5%, and posterior repair by 7.5%, but the number of anterior repair procedures increased slightly by 1.5%. Moreover, between 2015 and 2017, the number of vaginal hysterectomies decreased by 9%. The number of UI surgeries had increased between 2011 and 2015 and then remained at a relatively stable level. A similar trend was observed for tape procedures, whereas the popularity of colposuspension has declined noticeably. CONCLUSIONS: The impact of FDA notifications has been observed in Poland as a decrease in TVM surgeries.

Transobturator midurethral sling: What should patients expect after surgery?

INTRODUCTION AND HYPOTHESIS: Midurethral sling (MUS) surgeries are minimally invasive procedures; however, they are not free of postoperative complications. The aim of the study was to assess the occurrence of lower urinary tract symptoms (LUTS) (urgency, nocturia, frequency, splitting/spraying, hesitancy, terminal dribbling, and subjective feeling of postvoid residual) in patients suffering from stress (SUI) or mixed (MUI) urinary incontinence with a predominant SUI component before and after transobturator MUS placement. METHODS: The study group consisted of 88 women with SUI and 18 with MUI who underwent transobturator MUS. All participants were questioned with a self-developed questionnaire before and after surgery regarding the presence of LUTS. RESULTS: Seven days after surgery, 62 patients (58.5%) noted voiding and postmicturition symptoms, whereas 67 (63.2%) reported problems in storage. The more commonly reported LUTS at week 1 after surgery were urgency (52.8%), splitting/spraying (41.5%), and feeling of incomplete bladder emptying (34.0%). Patients perceived that splitting/spraying was the most bothersome. After 6 months, the most common LUTS reported were hesitancy (14.1%), terminal dribbling (10.4%), and splitting/spraying (9.4%). We noticed a decrease in the number of urgency episodes >2.7 times (p < 0.001) compared with baseline. After 6 months, 97 (91.5%) patients reported the lack of incontinence episodes. CONCLUSIONS: A vast majority of patients after MUS suffer from LUTS in the early postoperative period; however, the majority of undesired symptoms resolve spontaneously within the first 6 months postsurgery.

Use of uroflow parameters in diagnosing an overactive bladder-Back to the drawing board.

AIMS: The aim of our study was to analyze whether uroflowmetry parameters are helpful in diagnosing overactive bladder (OAB). The working hypothesis was that the flow curves of patients with OAB symptoms would appear as a sharp peak flow rate with a short duration and high amplitude, lasting only for a short period during urgency sensation, followed by reduced urine flow. We introduced a new parameter called flow index (FI) defined as an average divided by maximal urine flow rates as a potential marker for diagnosing OAB. METHODS: We conducted a retrospective study analyzing 757 urodynamic studies performed in women with lower urinary tract symptoms between 2007-2014. Based on subjective clinical symptoms patients were divided into four groups (pure OAB, mixed urinary incontinence with predominant OAB [MUI-OAB], mixed urinary incontinence with predominant SUI [MUI-SUI], and pure SUI patients). RESULTS: When comparing FI between pure OAB and pure SUI patients, a strong statistically significant difference was found (mean 0.45 ± 0.08 vs. 0.53 ± 0.09, respectively; P < 0.001). Similar results were found when comparing the patients with pure OAB and MUI-OAB versus patients with pure SUI and MUI-SUI (mean 0.47 ± 0.11 vs. 0.53 ± 0.09, respectively; P < 0.001). On the other hand, we did not find a statistically significant difference in the FI value between mixed urinary incontinence where SUI is the predominant factor and pure SUI groups (median 0.51 ± 0.09 vs. 0.53 ± 0.09, respectively; P > 0.5). CONCLUSIONS: FI may be used as an additional marker for OAB diagnosis. Neurourol. Urodynam. 36:198-202, 2017. © 2015 Wiley Periodicals, Inc.

Can botox improve night-time overactive bladder symptoms in women?

AIMS: Despite the efficacy of intravesical onabotulinumtoxinA (Botox) therapy for urgency, urgency incontinence, and daytime frequency, its value in treatment of nocturia remains unclear. The aim of the prospective observational study was to assess the effect of onabotulinumtoxinA on night-time symptoms in women with overactive bladder (OAB), including nocturia, night-time urgency incontinence, and nocturnal voided volume as end-points. METHODS: Women with idiopathic OAB (with at least one episode of urgency urinary incontinence (UUI) per day, ≥8 micturitions per 24 hr, and ≥2 nocturia episodes per night) were enrolled. Patients with nocturnal polyuria were excluded. Botox (100 U) was administered in 20 intra-detrusor injections. Post-void residual volumes (PVR) were checked at 2, 4, and 12 weeks. Participants completed a 3-day bladder diary and the King's Health Questionnaire (KHQ) before and 12 weeks after treatment, and reported the efficacy of the treatment on visual analog scale (VAS) at the final follow-up visit. RESULTS: Seventy-six women completed the study. Botox injections were effective in the reduction of nocturia episodes (mean -0.98; P < 0.001) and night-time UUI episodes (-0.37; P < 0.001) compared to the baseline. The increase of mean voided volume of the night-time micturitions was 92.6 ml (P < 0.001). Patients reported a mean 58 points of improvement on the VAS. Urinary retention, which required self-catheterization, was observed in three patients. CONCLUSIONS: Intravesical Botox injection provides significant benefit for night-time symptoms in OAB patients. Our results are applicable for women without nocturnal polyuria, and should prove useful when counseling patients about the risks and benefits of Botox. Neurourol. Urodynam. 36:648-652, 2017. © 2016 Wiley Periodicals, Inc.

Impact of intravesical onabotulinumtoxinA on sexual function in women with OAB.

AIMS: Urgency urinary incontinence (UUI), and the symptoms of overactive bladder (OAB) have a negative impact on female sexual function. The aim of this study was to investigate the effect of intravesical onabotulinumtoxinA (Botox) injection on sexual function in women with OAB, using the multi domain Female Sexual Function Index (FSFI) questionnaire. METHODS: Sixty-eight sexually active women with idiopathic OAB with at least one episode of UUI and ≥8 micturitions per 24 h were recruited. Patients completed the FSFI questionnaire before and 12 weeks after treatment with intravesical onabotulinumtoxinA injections. Baseline scores were compared with a control group of age-matched healthy women. RESULTS: Fifty-six women completed the study. At baseline OAB patients reported decreased quality of sexual function in all domains measured with FSFI, in comparison to healthy women (median 21.8 vs. 26.3, P < 0.001). Over 90% of participants reported clinically relevant improvements in sexual function, with statistically significant changes in mean scores in all six domains. CONCLUSIONS: Intravesical Botox injections provide improvement in sexual function in women with OAB. Neurourol. Urodynam. 9999:XX-XX, 2016. © 2016 Wiley Periodicals, Inc.

Urinary retention in female OAB after intravesical Botox injection: who is really at risk?

INTRODUCTION AND HYPOTHESIS: Intravesical onabotulinumtoxinA (Botox) injections are effective for the treatment of idiopathic overactive bladder (OAB) symptoms. The aim of our study was to assess the predisposing factors for urinary retention in women with OAB after intravesical Botox injection. METHODS: All participants were women of European descent with idiopathic OAB. OnabotulinumtoxinA (100 U) was administered in 20 intra-detrusor injections. Analysis was performed based on the results of safety assessments made during follow-up (FU) visits on weeks 2, 4 and 12, in 208 women who were treated with Botox injections for refractory OAB and who completed all FU visits. RESULTS: Women who required clean intermittent self-catheterisation (CISC) and those with post-void residual (PVR) greater than 200 ml were older in comparison with patients with PVR between 50 and 200 ml. Patients who required CISC were also characterised by higher parity and particularly by a higher number of vaginal deliveries. Other factors such as body mass index or comorbidities did not significantly influence PVR and the risk of CISC. CONCLUSIONS: Elderly and/or multiparous women are at increased risk of urinary retention after intravesical 100-U Botox injections. The risk of new onset urine retention in our study has completely disappeared 2 weeks after Botox injections. Based on our results of the way in which the PVRs have changed over time, we can conclude that OAB patients should be optimally assessed during the first 2 weeks after Botox injections.

Effectiveness of botulinum toxin injection in the treatment of de novo OAB symptoms following midurethral sling surgery.

INTRODUCTION AND HYPOTHESIS: Intravesical onabotulinumtoxinA (Botox®) is effective for idiopathic overactive bladder (OAB) symptoms. Our primary objective was to compare the efficacy of onabotulinumtoxinA for women with de novo OAB after midurethral sling (MUS) surgery and women with idiopathic OAB. METHODS: Women enrolled in this prospective study had idiopathic (n = 53) or de novo (n = 49) OAB symptoms after MUS, with at least one episode of urgency urine incontinence per day. OnabotulinumtoxinA (100 U) was administered in 20 intradetrusor injections. Postvoid residual volumes were checked at 2, 4 and 12 weeks. Participants completed a 3-day bladder diary and the King's Health Questionnaire (KHQ) before and 12 weeks after treatment. RESULTS: After 12 weeks, 22 patients (41.5 %) in the idiopathic OAB and 19 patients (38.8 %) in the de novo OAB groups were completely dry. OnabotulinumtoxinA injections had a significant benefit within both groups (p <0.001) to decrease both the daily numbers of voids (-2.39 and -2.0) and incontinence episodes (-1.38 and -1.44), with no significant difference between groups. We observed an increase of mean voided volume of >90 ml in both groups. Urinary retention was observed in four patients. CONCLUSIONS: We observed similar improvement in OAB symptoms after intravesical onabotulinumtoxinA injections within both groups. The rates of retention and requirement for catheterization even for women with a prior MUS were acceptable. These observational data provide evidence that onabotulinumtoxinA can effectively treat patients with OAB following stress urinary incontinence surgery.

Opportunistic salpingectomy for prevention of sporadic ovarian cancer - a jump from basic science to clinical practice?

Ovarian cancer is the most malignant and aggressive gynecological cancer. Due to nonspecific symptoms in the early stage and a lack of effective screening methods, it is typically diagnosed at an advanced stage. The high-grade serous cancer (HGSC) represents 75% of all ovarian cancers and accounts for the majority of deaths. Contemporary thought suggests that precursor lesions of HGSC originate in the fallopian tube. The presumed precursor tubal lesion, localized at the fimbrial end of the fallopian tubes, is termed the serous tubal intraepithelial carcinoma (STIC). Thus, removal of the fallopian tubes at the time of pelvic or abdominal surgery for a benign condition (i.e. opportunistic salpingectomy) appears as an attractive option for primary prevention of HGSC. This paper presents the scientific background of opportunistic salpingectomy and discusses controversies regarding the benefits and safety of the procedure.

Ultrasound imaging in urogynecology - state of the art 2016.

The role of ultrasound imaging in urogynecology is not clearly defined. Despite significant developments in visualization techniques and interpretation of images, pelvic ultrasound is still more a tool for research than for clinical practice. Structures of the lower genitourinary tract and pelvic floor can be visualized from different approaches: transperineal, introital, transvaginal, abdominal or endoanal. According to contemporary guidelines and recommendations, the role of ultrasound in urogynecology is limited to the measurement of post-void residue. However, in many instances, including planning and audit of surgical procedures, management of recurrences or complications, ultrasound may be proposed as the initial examination of choice. Ultrasound may be used for assessment of bladder neck mobility before anti-incontinence procedures. On rare occasions it is helpful in recognition of pathologies mimicking vaginal prolapse such as vaginal cyst, urethral diverticula or rectal intussusception. In patients subjected to suburethral slings, causes of surgery failure or postsurgical voiding dysfunctions can be revealed by imaging. Many reports link the location of a tape close to the bladder neck to unfavorable outcomes of sling surgery. Some postoperative complications, such as urinary retention, mesh malposition, hematoma, or urinary tract injury, can be diagnosed by ultrasound. On the other hand, the clinical value of some applications of ultrasound in urogynecology, for example measurement of the bladder wall thickness as a marker of detrusor overactivity, has not been proved.

Both the middle and distal sections of the urethra may be regarded as optimal targets for 'outside-in' transobturator tape placement.

PURPOSE: To investigate whether the position of the tape under the urethra may influence 'outside-in' transobturator sling (TOT) outcome. METHODS: The study comprised 141 women who underwent TOT for clinically and urodynamically proved stress urinary incontinence. The postoperative ultrasound examination with an endovaginal biplane probe was performed before discharging the patients from hospital. The measurements obtained described the position of the tape relative to the urethra and pubic symphysis, as well as anatomical relationships in the anterior compartment. RESULTS: Ninety-six (68.1 %) patients were cured, 27 (19.1 %) significantly improved, and in 18 cases (12.7 %), the surgery failed. The tape position under the midurethra (40-70th percentile of the urethral length) or distal urethra (>70th percentile) coincided with better results (cure rate 67.1 and 82.4 %, respectively) than the location in the proximity of the bladder neck (<40th percentile) (21.4 % cured, p = 0.0015 and p < 0.001, respectively). However, the risk of failure was the lowest when the tape was located under the distal urethra. Other ultrasonographic findings were not related to treatment results. CONCLUSIONS: The highest failure rate for 'outside-in' TOT is associated with the location of the tape under the proximal third of the urethra. Both the middle and distal sections of the urethra may be regarded as targets for transobturator tape placement.

Leiomyomatosis peritonealis disseminata with formation of endometrial cysts within tumors arising after supracervical laparoscopic hysterectomy.

BACKGROUND: Use of morcellation during laparoscopic hysterectomy may result in seeding of uterine tissue throughout the abdominal cavity and development of 'iatrogenic' leiomyomatosis peritonealis disseminata. CASE: Two years after a supracervical laparoscopic hysterectomy a 42-year-old parous women presented with abdominal pain and bloating. CT scans and subsequent surgical exploration reveled multiple solid tumors containing cysts filled with altered blood. Histologically the tumors had characteristic features of a benign leiomyoma with smooth muscle cells infiltrated by endometrial glands. CONCLUSION: Pieces of smooth muscle cell and endometrial uterine tissue lost in the abdominal cavity during morcellation may progress to leiomyomatosis peritonealis disseminata with unusual appearance.

Most of the patients with suburethral sling failure have tapes located outside the high-pressure zone of the urethra.

OBJECTIVES: The high-pressure zone of the urethra (HPZ), which is crucial for the continence mechanism, extends between the point of the maximum urethral closure pressure and the urethral knee, and has been calculated to lie between 53% and 72% of the functional urethral length. According to recent studies the best results of suburethral slings are achieved when tapes are positioned under this zone. The aim of the study was to determine the location of tapes relative to the urethral length in patients seeking help due to recurrent stress urinary incontinence (SUI) following sling procedures. MATERIAL AND METHODS: The study group comprised 61 patients suffering from recurrent SUI following suburethral slings performed from 6 months to 5 years earlier Forty-nine (80.3%) women were initially treated with a transobturator sling and 12 (19.7%) with a retropubic procedure. Twenty patients had the original sling performed at our department whereas, the other 41 in other institutions. The position of the tapes was determined at the sagittal plane by 3-D transvaginal ultrasound using a linear transducer The length of the urethra was measured from the bladder neck to the external urethral meatus following the urethral lumen, taking into account its curve. The position of the tapes relative to the percentage of the urethral length was calculated assuming the bladder neck as the proximal end of the urethra. The reference point was set at the midpoint on the tape. RESULTS: Only 13 (21.3%) patients had tapes positioned at 50%-75% of the urethral length. In 45 (73.8%) of women examined the tapes were found under proximal half of the urethra and in 3 (4.9%) distally to the 75% of the urethral length. CONCLUSIONS: In most patients in whom slings procedures proved unsuccessful the tapes are located under the proximal half of the urethra, that is outside the HPZ The position of a.tape outside the HPZ may be considered as a cause of suburethral sling failure.

Outcome of transobturator sling for treatment of female stress urinary incontinence applied as a single procedure or concomitantly with pelvic organ prolapse surgery.

INTRODUCTION AND OBJECTIVE: The aim of the study was to check the safety and efficacy of transobturator tape (TOT) combined with various prolapse procedures. The results were compared with outcomes of sling performed as an alone surgery. Risk factors for TOT failure were also identified. MATERIAL AND METHODS: The study comprised 219 patients with sling alone (Group SUI) and 221 after TOT combined with concomitant prolapse surgery (Group POP/SUI). Medical records were carefully reviewed to obtain demographic and clinical data, details of surgery, including intra-and postoperative complications. RESULTS: Subjective cure rate was slightly, but statistically significantly, higher in POP/SUI group (89.6% vs 82.6%; ch2 = 4.44; p = 0.035). There was no significant difference in sling efficacy dependant of type of POP surgery. Post-operative urine retention was more frequent in POP/SUI group compared to SUI group (18.6% vs 3.2%; ch2 = 34.36; p < 0.001). Logistic regression showed that age, BMI and prolonged pos-operative urine retention are independent factors affecting TOT outcome. Age ≥65years and BMI ≥30kg,m2 more than doubled the risk of failure: OR 2.348, CI 95% (1.330-4.147); p = 0.003 and 2.030, (95% CI 1.148-3.587); p = 0.015; respectively. Interestingly, post-operative urine retention appeared to be a positive prognostic factor OR 0.145, (95% CI 0.019-1.097); p < 0.05. CONCLUSIONS: Subjective efficacy of TOT used concomitantly with POP procedures is slightly higher than TOT alone. Better sling outcomes can be expected both for POP procedures involving both the anterior and posterior compartments. Age and obesity are independent factors of TOT failure, whereas prolonged post-operative urine retention is a positive predictive factor of TOT success.

Urine Nerve Growth Factor May Not Be Useful as a Biomarker of Overactive Bladder in Patients with Pelvic Organ Prolapse.

(1) Background: Overactive bladder (OAB) symptoms are frequently present in women with pelvic organ prolapse (POP). Although urinary nerve growth factor (NGF) is a promising biomarker of OAB, little is known about its role in patients with OAB secondary to POP. The aim of the study was to evaluate urinary NGF levels in patients with POP involving the anterior vaginal wall and check if it may serve as a predicting factor for postoperative resolution of OAB symptoms. (2) Methods: Eighty-three Caucasian women included in the study were divided into three groups: pure OAB, one associated with POP (POP&OAB) and a control group composed of healthy volunteers. The urine NGF and creatinine were assessed with ELISA tests to calculate the NGF/creatinine ratio. (3) Results: The NGF/creatinine ratio was significantly higher in patients with pure OAB in comparison with other groups; however, it did not differ between the control group and the POP&OAB group. There was no correlation between NGF/creatinine ratio and age, menopausal status, BMI, parity or urodynamic findings. The NGF/creatinine ratio was not a prognostic factor for OAB symptoms' resolution after surgical treatment of POP. (4) Conclusions: Urinary NGF excretion is not increased in women with OAB secondary to POP; thus, it may not serve as an OAB biomarker in these patients.

Tape fixation: an important surgical step to improve success rate of anti-incontinence surgery.

PURPOSE: Mid urethral slings are effective surgical treatment for stress urinary incontinence. However, 5% to 20% of patients still experience surgical failure with clinically significant recurrent or persistent stress urinary incontinence. Since a subset of these failures may be caused by improper tape position, we elucidated whether additional paraurethral fixation of a tape to prevent displacement during tensioning could improve the transobturator sling outcome. MATERIALS AND METHODS: The study was done in 463 patients with stress urinary incontinence who were randomly allocated to treatment with a standard transobturator intravaginal monofilament sling procedure (232) or to an intravaginal transobturator monofilament sling with additional 2-point tape fixation (231). Another 2 absorbable sutures parallel to the urethra were added to fix the tape and prevent displacement during tape tensioning. Outcome was assessed by a cough test and a 1-hour pad test at 12 months. RESULTS: Clinical efficacy of the procedure with fixation was significantly higher with 195 women (95.12%) cured or improved compared to the 199 (88.73%) cured or improved with the standard sling (chi-square 5.71, p = 0.0169). There was no increase in intraoperative or postoperative complications. Also, among patients with intrinsic sphincter deficiency we noted a significantly better outcome in the fixation group than in the control group, that is 39 of 41 patients (95.1%) cured or improved vs 31 of 42 (73.8%) (chi-square 10.65, p = 0.0011). CONCLUSIONS: Tape fixation significantly increases the clinical efficacy of the transobturator sling, especially in patients with intrinsic sphincter deficiency.

Quantitative assessment of urethral vascularity in nulliparous females using high-frequency endovaginal ultrasonography.

PURPOSE: To assess the vascular parameters in the urethra of nulliparous females and to compare the vascularity among various parts of the urethra, using high-frequency endovaginal ultrasonography (EVUS). METHODS: Twenty-two nulliparous women, mean age 27 years, underwent EVUS using a biplane transducer at 12 MHz frequency. Color Doppler examinations of the urethra were recorded and further evaluated off-line using special software (Pixel Flux) for quantitative assessment of the vascularity. The urethra was divided into four regions of interest (ROIs) in the midsagittal plane and three ROIs in the axial plane. The following parameters were measured: velocity (V), perfused area (A), perfusion intensity (I), pulsatility index (PI), and resistance index (RI). Interobserver and intraobserver reproducibility analysis was also performed. RESULTS: In midsagittal plane, the midurethra presented the highest value of V and lowest value of A. The intramural part showed the lowest value of I and the highest values of RI and PI. In the distal urethra, the highest value of I and the lowest value of RI was seen. In the axial plane, the values of V, A, and I were statistically significantly higher in the external part of the midurethra compared with the internal part. Excellent interobserver and intraobserver reproducibility was shown in the majority of parameters for the entire urethra. CONCLUSIONS: Vascularity differs in different parts of the urethra. Pixel Flux is a valuable tool for providing reproducible quantitative analysis of vascular parameters for the entire urethra.

Anatomical variation of bony pelvis from the viewpoint of transobturator sling placement for stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to investigate the variability of bony pelvis architecture from the viewpoint of transobturator sling placement. METHODS: The pelvimetry was performed on 122 women who underwent pelvic computed tomography. Measurements included: the distance between the interobturator foramina line and inferior pubic symphysis (IF-PS distance) as well as pubic arch angle, pubic ramus width, and pubic symphysis length. RESULTS: The length of the IF-PS distance varied between 7.4 and 26.9 mm (mean 15.2 ± 4.3 mm, median 14.2 mm). The distribution of measurements was asymmetrical with a tilt of the values towards shorter distances. In 11.5% of women, the IF-PS distance was longer than 20 mm. The IF-PS distance correlated with the pubic ramus width (r = 0.37, p < 0.0001) and pubic arch angle (r = -0.22, p = 0.017). CONCLUSION: The IF-PS distance varies considerably in the general population of women.

Impact of Hysterectomy on Quality of Life, Urinary Incontinence, Sexual Functions and Urethral Length.

The aim of the study was to evaluate the influence of different types of hysterectomy on UI symptoms, quality of life and sexual functions using dedicated questionnaires. We investigated a correlation between the urethral length (UL), UI symptoms and the length of the cervix (left after LSH and SH) with sexual functions. The study enrolled 500 consecutive women referred for hysterectomy: 121 underwent VH, 171 underwent LSH, 96 underwent SH, 68 underwent TAH, and 44 underwent TLH. The patients filled in the UI-specific questionnaires and FSFI before and 12 months after hysterectomy. The UL was measured by introital ultrasound before and 12 months after hysterectomy. Before surgery, 137 out of 399 (34.3%) patients had UI symptoms; afterwards, 139 (34.8%) indicated the same (p > 0.05). There was no statistically significant difference in the UL in the patients before and after the procedure, and the cervix length did not differ between patients after LSH and SH. When the entire investigated population was analyzed, a significant improvement of the QoL was found on the IIQ-7. Hysterectomy performed due to benign diseases has effects on UI regardless of the surgical technique used. The UI symptoms improved only in the patients after LSH. The UL measured 12 months after hysterectomy did not change.

Body mass index does not influence the outcome of anti-incontinence surgery among women whereas menopausal status and ageing do: a randomised trial.

INTRODUCTION AND HYPOTHESIS: A few series comparing the clinical efficacy of midurethral slings in obese and postmenopausal patients are available. The aim of the study was to assess clinical efficacy of suburethral tape operations for the surgical treatment of female stress urinary incontinence (SUI) stratified by obesity, menopause and ageing. METHODS: Five hundred thirty-seven patients underwent either retropubic or transobturator sling procedure. Patients were randomly allocated into two study groups in a ratio of 1:1. After 18 months, 398 women were available for a follow-up efficacy evaluation. RESULTS: The clinical effectiveness of surgical SUI treatment did not depend on patients' body mass index (BMI) and type of midurethral sling, but menopausal status and ageing significantly influenced the outcome of the surgery. CONCLUSIONS: We found that BMI does not influence the clinical effectiveness of SUI treatment, whereas both menopause and ageing had a detrimental influence on the final outcome of the surgery.