Atuação do enfermeiro estomaterapeuta no manejo da incontinência urinária de esforço / The role of the nurse stomatherapist in the management of stress urinary incontinence / El papel de las enfermeras de terapia estomal en el manejo de la incontinencia urinaria de esfuerzo

Objetivo: Relatar a atuação do enfermeiro estomaterapeuta no manejo da incontinência urinária de esforço. Métodos: Estudo observacional, do tipo relato de caso, seguindo duas fases, onde a primeira foi a coleta de dados e levantamento do histórico clínico do paciente, e segunda fase foi descrever a atuação do enfermeiro estomaterapeuta no manejo da incontinência urinária de esforço. Resultados: Na primeira etapa revelou-se o diagnóstico de incontinência urinária por esforço. Foram aplicados o diário miccional, a terapia comportamental, a cinesioterapia e a eletroestimulação. Conclusão: A atuação do enfermeiro estomaterapeuta no manejo da incontinência urinária de esforço compreende a implementação do tratamento conservador, perpassando pela prevenção, estimulação da mudança comportamental e manejo de tecnologias para fortalecimento da musculatura do assoalho pélvico. (AU)

Objective: To report the role of the nurse stomatherapist in the management of stress urinary incontinence. Methods: Observational study, of the case report type, following two phases, where the first was the collection of data and survey of the patients clinical history, and the second phase was to describe the role of the nurse stomatherapist in the management of stress urinary incontinence. Results: In the first stage the diagnosis of stress urinary incontinence was revealed. Were applied the mictional diary, behavioral therapy, kinesiotherapy and electrostimulation. Conclusion: The role of the nurse stomatherapist in the management of stress urinary incontinence includes the implementation of conservative treatment, through prevention, stimulation of behavioral change and management of technologies for strengthening the pelvic floor muscles. (AU)

Objetivo: Informar sobre el papel de la enfermera estomaterapeuta en el tratamiento de la incontinencia urinaria de esfuerzo. Métodos: Estudio observacional, del tipo case report, siguiendo dos fases, donde la primera fue la recolección de datos y relevamiento de la historia clínica de la paciente, y la segunda fase fue describir la actuación de la enfermera estomaterapeuta en el manejo de la incontinencia urinaria de esfuerzo. Resultados: En la primera etapa se reveló el diagnóstico de incontinencia urinaria de esfuerzo. Se aplicaron el diario miccional, la terapia comportamental, la cinesiterapia y la electroestimulación. Conclusión: La actuación del enfermero estomaterapeuta en el manejo de la incontinência urinaria de esfuerzo comprende la aplicación del tratamiento conservador, pasando por la prevención, la estimación del cambio de comportamiento y el manejo de tecnologías para el fortalecimiento de la musculatura del assoalado pelviano. (AU)

Diagnostic value of pelvic floor ultrasound combined with electromyographic physiological parameters for postpartum SUI of different degrees and pelvic floor function of primipara / 中国医学装备

Objective:To investigate the diagnostic value of pelvic floor ultrasound combined with electromyography physiological parameters for postpartum stress urinary incontinence(SUI)of different degrees and pelvic floor function of primipara.Methods:A total of 160 SUI patients who admitted to Yan'an hospital of Kunming City from January 2019 to January 2022 were selected,and they were divided into abnormal group(110 cases)and normal group(50 cases)according to pelvic floor function(the muscle voltage values of different muscle fibers).The SUI was graded according to the Chinese Guidelines for Diagnosis of Urological Diseases and the International Incontinence Advisory Committee's Incontinence Questionnaire(ICI-Q-SF).The posterior horn(α)of bladder and urethra at rest,the displacements of the bladder neck on y-axis(△y)and x-axis(△x)after the rest to the fatigue action,the proximal urethral rotation angle after the rest to the fatigue action(γ),the posterior horn of bladder and urethra(β)after the fatigue action were observed.The electromyography was used to draw and record the pelvic floor myoelectric activity signals of the patients of two groups at five stages(pre baseline rest period,class II muscle fiber systole period,class II and I muscle fiber systole period,class I muscle fiber systole period and post baseline rest period).And then,the muscle voltage values of different muscle fibers on the surface of pelvic floor were quantified.Results:There was no statistically significant difference in Δ x between patients with postpartum SUI of different degrees.There were significant differences in △y,α,β and γ between patients with postpartum SUI of different degrees(F=7.162,7.655,14.998,2.758,P<0.05).The differences of the means of muscle voltages of pre and post baseline rest period,and class I muscle fiber systole period among patients with postpartum SUI of different degrees were not significant.The differences of the means of muscle voltages of class II,and the class II and I muscle fiber systole period among patients with postpartum SUI of different degrees were significant(F=12.062,24.501,P<0.05),respectively.There was no statistically significant difference in △x between the two groups.The △y,α,β and γ of abnormal group were significantly higher than those of normal group(t=8.991,8.691,9.389,27.552,P<0.05),respectively.There were no statistically significant differences in the means of muscle voltage values of the pre and post baseline rest period,and class I muscle fibers systole period between the two groups.The means of muscle voltage values of class II,and class II and I muscle fibers systole period in the abnormal group was significantly higher than them in the normal group(t=9.613,14.452,P<0.05),respectively.The sensitivities of △y,α,β,γ,the means of class II muscle fibers systole period,and the means of class II and I muscle fibers systole period of pelvic floor ultrasound and electromyography physiological parameters were respectively 71.60%,79.40%,81.40%,91.20%,83.30%and 82.40%,and the specificities of them were respectively 41.40%,37.90%,37.90%,60.30%,41.40%,and 44.80%in diagnosing postpartum SUI of different degrees of primipara.The sensitivity and specificity of the combined diagnosis of them were respectively 92.20%and 82.80%in diagnosing postpartum SUI of different degrees of primipara.The sensitivities of △y,α,β,γ,the means of class II muscle fibers systole period,and the means of class II and I muscle fibers systole period of pelvic floor ultrasound and electromyography physiological parameters were respectively 79.10%,77.30%,88.20%,89.10%,77.30%,87.30%,and the specificities of them were respectively 64.00%,64.00%,52.00%,46.00%,70.00%and 66.00%in diagnosing pelvic floor function of primipara.The sensitivity and specificity of the combined diagnosis were respectively 98.20%and 80.00%in diagnosing pelvic floor function of primipara.Conclusion:Pelvic floor electromyography physiological parameters and pelvic floor ultrasonic parameters have a certain value in diagnosing postpartum SUI of different degrees and pelvic floor function,and the value of the combined diagnosis of them is higher.

Efficacy of intravaginal fractional superpulse CO2 laser in the treatment of mild to moderate female stress urinary incontinence / 现代泌尿外科杂志

【Objective】 To evaluate the efficacy and safety of intravaginal fractional superpulse CO2 laser in the treatment of mild to moderate female stress urinary incontinence (SUI), so as to provide reference for the treatment options for female SUI. 【Methods】 A total of 41 female mild-to-moderate SUI patients confirmed at the Department of Urology, The First Affiliated Hospital, Air Force Medical University, during Aug.2019 and Nov.2020 were involved.All patients received 3 intravaginal fractional superpulse CO2 laser treatments (1/month).The improvement of urinary incontinence symptoms after treatment was evaluated with International Consultation on Incontinent Questionnaire Short Form (ICI-Q-SF).The motion of bladder neck and rotation angle of bladder and urethra were measured with pelvic ultrasound before and after treatment.The therapeutic effects, pain and patients’ satisfaction were evaluated, and adverse reactions such as bleeding, infection and scar were observed. 【Results】 Three months after treatment, urinary incontinence symptoms improved to varying degrees, the ICI-Q-SF score decreased, the motion of bladder neck [ (28.70±3.11) mm vs.(19.10±4.54) mm] and the vesicourethral rotation angle [(52.78°±15.79°) vs.(41.56°±13.24°)] significantly decreased (P<0.05).The total effective rate was 100.0%.No patients complained severe pain during treatment.All patients were satisfied with the treatment.No adverse reactions such as bleeding, infection or scar occurred. 【Conclusion】 Intravaginal fractional superpulse CO2 laser is effective and safe in the treatment of mild to moderate female SUI, but the long-term efficacy still needs further observation.

Progression in the treatment of female stress urinary incontinence with underactive bladder / 现代泌尿外科杂志

Stress urinary incontinence (SUI) and underactive bladder (UAB) are common types of lower urinary tract dysfunction in women.As the treatment mechanisms of the two conditions are contradictory, the treatment of SUI patients complicated with UAB remains a difficult clinical problem.In order to improve the treatment rate of such patients and promote research, this paper reviews the latest domestic and overseas diagnostic criteria of UAB, summarizes the treatment experience of conventional midurethral sling (tension-free vaginal tape or outside-in transobturator tape) and adjustable sling procedures (transobturator adjustable tape or Remeex system) combined with medication or intermittent catheterization, and the application prospects of cutting-edge technologies such as stem cell injection, cytokine therapy and gene therapy, so as to provide reference for clinicians and researchers.

Using an anatomic model to teach female stress incontinence to gynecologic residents‑in‑training: A prospective cohort study / Philippine Journal of Obstetrics and Gynecology

Background@#Stress urinary incontinence (SUI) is a complex condition with a multifactorial etiology that makes its concepts challenging to teach. This study aimed to assess the efficacy of simulation-based training (SBT) with an anatomic teaching model in improving the understanding of SUI among gynecologic residents-in-training. @*Objective@#The primary objective of this study was to evaluate the efficacy of SUI simulation-based teaching in enhancing the learning experience for gynecologic residents-in-training. The secondary objective was to gather feedback from participants with the intent to further enhance existing teaching methodologies.@*Materials and Methods@#This was a descriptive prospective study within a single institution, involving gynecologic residents-in-training. Participants were given an anatomic teaching tool to construct, followed by an SUI lecture. Pre- and posttest Multiple Choice Questions were administered to assess the efficacy of the teaching tool in improving the participants’ understanding of SUI. Frequency and percentages were used to describe the categorical variables, whereas continuous variables were described using mean and standard deviation. Paired t-test was used to compare the pre- and posttest scores. ANOVA was used to compare the pre- and posttest scores of participants by year level. A P < 0.05 is statistically significant. A separate Likert-scale questionnaire, to evaluate changes in participant’s self-assessment on learning, response to teaching content and resources, and overall feedback of the SBT was used.@*Results@#There were 50 gynecologic residents-in-training that were included in the study. The mean posttest score is significantly higher (6.4 vs. 3.48) than the pretest score, with a mean difference of 3.48. The mean posttest score is significantly different between the year levels with a P < 0.05, with senior residents-in-training performing best. Although participants with only gynecologic conferences as SUI reference performed best, the mean pre- and posttest scores were not statistically different with respect to SUI education exposure. With the use of an anatomic SUI model, the number of correct answers for questions pertaining to anatomy, physiology, and pathophysiology was consistently higher in the posttest scores as compared to the pretest scores but did not reach statistical significance. The majority of participants strongly agree to recommend the course to a colleague.@*Conclusion@#This study supports the use of simple, low-fidelity physical teaching tools in improving the understanding of SUI in gynecologic residents-in-training. Considering the ease of production, improved test scores, and participants’ enthusiasm, the incorporation of the anatomic teaching tool for its use in SUI education should be encouraged.

Agentes de abultamiento en incontinencia de orina de esfuerzo femenina: una alternativa a las mallas suburetrales / Bulking agents in female stress urinary incontinence: an alternative to suburethral mesh

OBJETIVO: Presentar una serie de casos de agentes de abultamiento (AA) de nuestro centro. MATERIAL Y MÉTODOS: Estudio retrospectivo. Se evaluaron todos los casos operados con AA entre 2017 y 2022. La inyección de AA se realizó en quirófano, bajo sedación con anestesia local periuretral o raquídea. La inyección se realizó con uretroscopia, 0,5 cc en 4 puntos periuretrales (horas 2, 5, 7 y 10). Se analizaron datos demográficos, quirúrgicos y de seguimiento. RESULTADOS: 15 casos. 13/15 presentaron incontinencia urinaria mixta. Solo dos casos tenían incontinencia de orina de esfuerzo pura. El procedimiento fue ambulatorio. La mediana del tiempo operatorio fue 15 minutos (15-20). La mediana de seguimiento fue 5 meses (1-9). El índice de severidad preoperatorio promedio fue 10,6 y en el seguimiento fue 2,79. La Escala de Mejoría Global mostró mejoría en 12/15, y 12/15 estaban satisfechas con la cirugía con mejoría en la calidad de vida. CONCLUSIÓN: Los AA son una opción quirúrgica efectiva, con una tasa de éxito del 80% en otros reportes, siendo similar con nuestra casuística. Ofrecer esta opción es posible a la hora de hablar de terapias alternativas.

OBJECTIVE: To present a case series of bulking agents (BA) from our center. MATERIAL AND METHODS: Retrospective study. All cases operated with BA between 2017 and 2022 were evaluated. A BA injection was performed in the operating room, under periurethral local anesthesia sedation or spinal anesthesia. The injection was performed with urethroscopy, 0.5 cc in 4 periurethral points (hours 2, 5, 7 and 10). Demographic, surgical, and follow-up data were analyzed. RESULTS: 15 cases were reported. 13/15 patients presented with mixed urinary incontinence. Only 2 cases had pure stress urinary incontinence. The procedure was ambulatory. Median operative time was 15 minutes (15-20). Median follow-up was 5 months (1-9). The average preoperative Sandvik Severity Index was 10.6 and in follow-up was 2.79. The PGI showed improvement in 12/15, and 12/15 were satisfied with the surgery with quality-of-life improvement. CONCLUSION: BA are an effective surgical option, with a success rate of 80%, according to other reports, being similar with our casuistry. Offer this option is possible at the moment of discussing alternative therapies.

Application of intelligent pelvic floor ultrasound combined with multi-planar imaging in the assessment of postpartum SUI and POP / 中国医学装备

Objective:To explore the application of intelligent pelvic floor ultrasound combined with multi-planar imaging in the assessment of postpartum stress urinary incontinence(SUI)and pelvic organ prolapse(POP).Methods:A total of 516 delivery women who delivered in hospital and underwent voluntarily pelvic floor ultrasound were retrospectively selected.They were divided into SUI group(55 cases),POP group(187 cases)and normal group(274 cases)according to the results of clinical diagnosis.The resting state and a series of ultrasound parameters included bladder neck symphyseal distance(BSD),posterior urethrovesical angle(PUVA),urethral tilt angle(UTA)and bladder neck descent(BND)under the maximum Valsalva action among three groups were observed and compared.In addition,the accuracy of intelligent pelvic floor ultrasound combined with multi-planar imaging in assessing SUI and POP among three groups also were observed and compared.Results:Under the resting state,the BSD and PUVA of the SUI group were respectively lower than those of the normal group,and UTA of SUI group was higher than that of the normal group,and the differences were statistical significance(t=2.008,t=2.012,t=2.392,P<0.05).Under the maximum Valsalva action,the BSD and PUVA of the SUI group were respectively lower than those of the normal group,and UTA of the SUI group was higher than that of the normal group,and the differences were statistical significance(t=2.265,t=9.144,t=3.728,P<0.05),and the BND of the SUI group was significantly higher than that of the normal group(t=11.861,P<0.05).Under the resting state,the BSD and PUVA of the POP group were respectively lower than those of the normal group,and UTA of the POP group was significantly higher than that of the normal group(t=2.139,t=3.179,t=2.817,P<0.05),and the differences were statistical significance.Under the maximum Valsalva action,the BSD and PUVA of the POP group were respectively lower than those of the normal group,and the UTA of the POP group was significantly higher than that of the normal group,and the differences were statistical significance(t=3.748,t=12.293,t=4.396,P<0.05),and the BND of POP group was significantly higher than that of the normal group(t=20.855,P<0.05).The accuracy,sensitivity and specificity of intelligent pelvic floor ultrasound combined with multi-planar imaging were respectively 97.87%,94.44%and 98.55%in assessing SUI,and they were respectively 97.61%,97.31%and 97.82%in assessing POP.The result of Kappa consistency test indicated the consistency between the intelligent pelvic floor ultrasound combined with multi-planar imaging and the clinically diagnostic results was strong in assessing SUI and POP(Kappa=0.923,Kappa=0.950,P<0.05).Conclusion:The intelligent pelvic floor ultrasound combines with multi-planar imaging can effectively diagnose the SUI and POP of postpartum by intelligent assessing the changes of pelvic floor structure and function of delivery woman,which has favorably clinical application value.

Application of stem cells therapy in the treatment of stress urinary incontinence / 中华内分泌外科杂志

Stress urinary incontinence (SUI) is a kind of involuntary urinary incontinence caused by various etiologies. It has a high incidence in middle-aged women and seriously affects the physical and mental health of patients. The treatment methods for SUI include lifestyle therapy, drug therapy and surgery. Stem cell therapy has been widely studied in the treatment of SUI in recent years due to its potential to regenerate damaged tissues. This article discusses the main types, treatment methods, clinical trials and other research progress of stem cell therapy for SUI. In recent years, adipose-derived stem cells, muscle-derived stem cells, bone marrow-derived stem cells and human amniotic fluid-derived stem cells have been applied to the treatment of SUI, and a variety of treatment techniques have been applied. Preclinical and clinical trials have shown the therapeutic effects of stem cells.

Discussion on Acupuncture in the Treatment of Female Stress Urinary Incontinence Based on the Theory of Channel Sinew / 中医杂志

Female stress urinary incontinence （SUI） caused by support structure damage or relaxation of the urethra and bladder belongs to the category of “channel sinew disease” in traditional Chinese medicine （TCM）. The pathogenesis of this disease is “loss of nourishment in the channel sinews， and failure to contract because of relaxation”， which can be divided into two situations： deficiency syndrome mainly refers to qi deficiency， closely related to the three zang （脏） organs including lung， spleen， and kidney； and the excess syndrome mainly refers to heat pathogen and blood stasis. Therefore， the treatment principle of “nourishing the channel sinews， regulating sinews and controlling fluid” is proposed. The acupoints in the lower abdomen， lumbosacral region， and lower limbs are mainly selected in the treatment of SUI with channel sinew needling， such as Qihai （RN 6）， Guanyuan （RN 4）， and Baliao. The selection of acupoints also emphasizes the pain area. Channel sinew needling includes floating needling， round-sharp needling， penetrating needling， and prickly needling， which reflects the integrity of channel sinew system， and emphasizes the local therapeutic effects highlighting arrival of needling effects at the location of disease. The theory of channel sinew opens up new ideas for treating SUI with acupuncture and moxibustion.

Establishment of a nomogram model for predicting the risk of postpartum stress urinary incontinence based on pelvic floor ultrasound and clinical data / 现代泌尿外科杂志

【Objective】 To analyze the risk factors of postpartum stress urinary incontinence (SUI) and to establish a nomogram model. 【Methods】 A total of 278 puerpera who gave birth at our hospital during Dec.2018 and Aug.2020 were selected as the modeling group, and 132 puerpera who gave birth during Sep.2020 and Sep.2021 were involved in the verification group. Factors affecting postpartum SUI were identified with univariate and multivariate logistic regression, and a nomogram prediction model was constructed with R software. The predictive effectiveness and discrimination of the model were assessed, and the decision curve analysis (DCA) was drawn to evaluate the clinical application value of the model. 【Results】 A total of 84 cases (30.22%) in the modeling group developed SUI 2 months after delivery. Fetal weight, delivery method, maternal age, mobility (Δhy) and rotation Angle (Δβ) were factors affecting postpartum SUI (P<0.05). Multivariate logistic regression analysis showed that increased fetal weight, normal delivery, increased Δhy, and increased Δβ were independent risk factors of postpartum SUI (P<0.05). The constructed nomogram fitted well. The H-L fit curve of the modeling group and verification group were (χ2=7.514, P=0.312) and (χ2=6.157, P=0.267), respectively. The area under the receiver operating characteristic curve of the modeling group and verification group were 0.815 and 0.760, respectively, indicating high specificity and consistency. DCA indicated that when the high-risk threshold probability of the model was between 0.06-0.80, the nomogram model had a high clinical value. 【Conclusion】 Increased fetal weight, normal delivery, increased Δhy and elevated Δβ are independent risk factors that affect postpartum SUI. The nomogram model constructed has good predictive effectiveness and discrimination, and high clinical application value.

Long-term follow-up outcomes of modified transobturator bulbourethral sling suspension for post-prostatectomy incontinence / 现代泌尿外科杂志

【Objective】 To evaluate the safety and efficacy of transobturator bulbourethral suspension with modified four-armed pelvic sling for post-prostatectomy incontinence (PPI). 【Methods】 The clinical data of 78 male PPI patients treated during Jan.2012 and Dec.2017 in our hospital were collected. The incontinence quality of life (I-QOL) score, daily use of urine pad, 1-hour urine pad test, residual urine volume (RUV), and maximum flow rate (Qmax) were assessed before and after surgery. 【Results】 The total success rate was 79.5%, of which the cure rate was 56.4% and the improvement rate was 23.1%. The preoperative I-QOL score was (54.6±3.9), daily use of urinary pad was (3.6±0.7), and increase in weight of the 1-hour urine pad test was (33.6±5.0) g. Three years after surgery, the I-QOL score was (80.4±5.7), daily use of a urinary pad was (1.9±0.4), and increase in weight of the 1-hour urine pad test was (7.4±1.3) g. Compared to preoperative status, the I-QOL score, daily use of urine pad, and increase in weight of the 1-hour urine pad test 3 years after surgery improved significantly (P<0.05). During the mean follow-up of (61.4±20.5) months, no significant changes in the I-QOL score, daily use of a urinary pad, 1-hour urinary pad test, RUV or Qmax were observed, and no complications occurred. 【Conclusion】 Transobturator bulbourethral suspension with modified four-armed pelvic sling is an effective and safe procedure to treat post-prostatectomy incontinence. The long-term efficacy is satisfactory.

Efficacy of pelvic floor magnetic and electrical stimulation combined with Kegel exercise training in the treatment of stress urinary incontinence after minimally invasive surgery for benign prostatic hyperplasia / 现代泌尿外科杂志

【Objective】 To explore the clinical efficacy and safety of pelvic floor magnetic and electrical stimulation combined with Kegel exercise training in the treatment of stress urinary incontinence (SUI) after minimally invasive surgery for benign prostatic hyperplasia (BPH). 【Methods】 A total of 52 patients with SUI after minimally invasive surgery for BPH treated during Jan.2016 and Feb.2022 were randomly divided into test group (n=26) and control group (n=26). The test group received pelvic floor magnetic and electrical stimulation and Kegel exercise training, while the control group received Kegel exercise training only. The treatment lasted for 3 months. The scores of International Consultation on Incontinence Modular Questionnaire Short Form (ICIQ-SF), 1 h pad test, International Prostate Symptom Score (IPSS) and Incontinence Quality of Life Questionnaire (I-QoL) were recorded and compared between the two groups before and after treatment. The adverse reactions were observed. 【Results】 The scores of ICIQ-SF, IPSS and I-QoL and 1 h pad test significantly decreased in both groups after treatment (P0.05), but after treatment, the scores of ICIQ-SF,IPSS,I-QoL and 1 h pad test were significantly lower in the test group than in the control group (P<0.05). No severe adverse reactions were observed. 【Conclusion】 Pelvic floor magnetic stimulation combined with Kegel exercise training is safe and effective for SUI after minimally invasive surgery for BPH.

Efficacy of modified TOT surgery on patients with failed previous anti-incontinence procedures / 现代泌尿外科杂志

【Objective】 To analyze the causes of the failure of previous operations in female patients with stress urinary incontinence (SUI), and to evaluate the efficacy and safety of modified transobturator outside-in tape (TOT). 【Methods】 A total of 42 female SUI patients who had failed in previous anti-incontinence surgery during Aug.2016 and Jul.2022 were enrolled. The causes of failure were analyzed. All patients were treated with modified TOT, and the operation time, estimated blood loss, duration of catheterization, symptom improvement and complications were observed. The outcomes were evaluated with the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF), pad test and urodynamic study. 【Results】 All operations were technically successful. The average operation time was (32.4±18.6) min, and estimated blood loss was (54.2±34.5) mL. There were no obvious complications. After operation, the ICI-Q-SF score significantly decreased (P0.05). The overall effective rate was 88.1%. 【Conclusion】 Modified TOT can be used for the treatment of patients with failed anti-SUI surgery, which is simple and easy to perform, with a low complication rate and satisfactory postoperative results.

Clinical observation on electroacupuncture at "four points of sacral region" on moderate to severe stress urinary incontinence after radical prostatectomy / 中国针灸

OBJECTIVE@#To compare the clinical therapeutic effect between electroacupuncture at "four points of sacral region" and transurethral Erbium laser in treatment of moderate to severe stress urinary incontinence after radical prostatectomy.@*METHODS@#A total of 68 patients of moderate to severe stress urinary incontinence after radical prostatectomy were divided into an electroacupuncture group (34 cases) and an Erbium laser group (34 cases, 3 cases dropped off) according to the settings. In the electroacupuncture group, electroacupuncture was applied at "four points of sacral region", i.e. points of 0.5 cun beside bilateral sacrococcygeal joints and bilateral Huiyang (BL 35), with continuous wave, 2 Hz in frequency, 60 min each time, once every other day, 3 times a week, 12 times as one course of treatment. In the Erbium laser group, transurethral Erbium laser technology was given, once every 4 weeks as one course of treatment. Both groups were treated for 5 courses. The scores of the International Consultation on Incontinence questionnaire-short form (ICI-Q-SF) and the incontinence quality of life questionnaire (I-QOL) were observed before treatment, after each course of treatment and in follow-up after 1 and 2 months of treatment completion, respectively, and the clinical efficacy was evaluated after treatment in the two groups.@*RESULTS@#Compared with those before treatment, the ICI-Q-SF scores were decreased while the I-QOL scores were increased after 5 courses of treatment and in follow-up after 1, 2 months of treatment completion in the two groups (P<0.01). The ICI-Q-SF score in follow-up after 2 months of treatment completion were higher than that after 5 courses of treatment in the Erbium laser group (P<0.05). After 3, 4, 5 courses of treatment and in follow-up after 1 and 2 months of treatment completion, the ICI-Q-SF scores in the electroacupuncture group were lower than those in the Erbium laser group (P<0.05, P<0.01); after 2, 3, 4, 5 courses of treatment and in follow-up after 1 and 2 months of treatment completion, the I-QOL scores in the electroacupuncture group were higher than those in the Erbium laser group (P<0.01). The change ranges of ICI-Q-SF score and I-QOL score between before treatment and after each course of treatment in the electroacupuncture group were lager than those in the Erbium laser group (P<0.01, P<0.05). The total effective rate was 61.8% (21/34) in the electroacupuncture group, which was superior to 19.4 (6/31) in the Erbium laser group (P<0.01).@*CONCLUSION@#Both electroacupuncture at "four points of sacral region" and transurethral Erbium laser can improve the clinical symptoms and the quality of life in patients of moderate to severe stress urinary incontinence after radical prostatectomy. The short-term efficacy and long-term efficacy of electroacupuncture are superior to the Erbium laser technology.

Técnica de reconstrucción de ligamentos pélvicos según la Teoría Integral / Pelvic Ligament Reconstruction Technique According to Integral Theory

La patología de piso pélvico es una entidad multifactorial con un conjunto de síntomas ginecológicos, urinarios, fecales y de sensibilidad pelviperineal. La Teoría Integral de la Continencia propone un tratamiento holístico con la reconstrucción de los ligamentos del piso pélvico. La presente técnica propuesta constituye una alternativa quirúrgica que permite dar respuesta de forma global a los síntomas que refieren las pacientes. Método: Reconstrucción de los ligamentos pubouretrales, cardinales y úterosacros con acortamiento de su longitud y colocación de cinta de malla de polipropileno que permita la formación de colágeno y mejore los resultados a largo plazo. Resultados: Se incluyeron 15 pacientes con prolapso de órganos pélvicos, incontinencia urinaria, vulvodinia, nocturia, alteración del vaciamiento vesical y nocturia. Se realizó seguimiento al 1, 3 y 6 años. Se obtuvo diferencia estadísticamente significativa al año en la incontinencia urinaria de esfuerzo, dolor pélvico, alteración del vaciamiento y nocturia y prolapso ( p = 0,33, 0,033, 0,002 y 0,001 respectivamente). En el seguimiento a 6 años se evaluó el 20 % de la muestra inicial, 2 pacientes con recidiva de la alteración del vaciamiento y la incontinencia urinaria, ninguna con recidiva de prolapso. Vulvodinia: Se incluyeron 2 pacientes las cuales no tuvieron el síntoma a los 3 años de seguimiento. Conclusiones: La técnica propuesta es una alternativa para el tratamiento de la patología del piso pélvico y requiere aumentar el tamaño de la muestra para aumentar el aprendizaje de la técnica y tener mayor evidencia estadística de sus resultados a corto y largo plazo(AU)

Pelvic floor pathology is a multifactorial entity with a set of gynecological, urinary, fecal and pelviperineal sensitivity symptoms. The Integral Theory of Continence proposes a holistic treatment with the reconstruction of the ligaments of the pelvic floor. This proposed technique constitutes a surgical alternative that allows a global response to the symptoms reported by the patients. Method: Reconstruction of the pubourethral, cardinal and uterosacral ligaments with shortening of their length and placement of polypropylene mesh tape that allows collagen formation and improves long-term results. Results: 15 patients with pelvic organ prolapse, urinary incontinence, vulvodynia, nocturia, impaired bladder emptying and nocturia were included. Follow-up was performed at 1, 3 and 6 years. A statistically significant difference was obtained at one year in stress urinary incontinence, pelvic pain, impaired voiding, and nocturia and prolapse (p = 0.33, 0.033, 0.002, and 0.001, respectively). At 6-year follow-up, 20% of the initial sample was evaluated, 2 patients with recurrence of impaired voiding and urinary incontinence, none with recurrence of prolapse. Vulvodynia: 2 patients were included who did not have the symptom at 3 years of follow-up. Conclusions: The proposed technique is an alternative for the treatment of pelvic floor pathology. A larger sample is necessary to improve the learning curve of this technique and achieve greater statistical evidence of its outcomes at short and long term(AU)

Experiencia de cuatro años con la cinta reajustable para incontinencia urinaria de esfuerzo / 4-year experience with the use of readjustable tape for stress urinary incontinence

Resumen OBJETIVO: Describir la experiencia con el cabestrillo reajustable Remeex® en pacientes con incontinencia urinaria de esfuerzo recurrente, como una alternativa de tratamiento. MATERIALES Y MÉTODOS: Estudio retrospectivo, observacional, de serie de casos llevado a cabo en un solo centro de la ciudad de Medellín, Colombia, en pacientes atendidas en la Unidad de Uroginecología de la Clínica Universitaria Bolivariana. Criterios de inclusión: mujeres mayores de 18 años, con diagnóstico de incontinencia urinaria recidivante después de una o más cirugías fallidas para corregir la incontinencia urinaria o con diagnóstico de deficiencia intrínseca del esfínter a las que se les practicó el procedimiento de cabestrillo reajustable (Remeex Female Neomedic) entre el 2016 y el 2019. RESULTADOS: Se evaluaron 19 pacientes con media de edad de 62 años (DE ± 9). La mediana de seguimiento fue de 19.4 meses (RIQ 10-26.5). Todas las pacientes tenían urodinamia prequirúrgica que confirmó el diagnóstico de incontinencia urinaria de esfuerzo. Las 19 pacientes tuvieron diagnóstico de incontinencia urinaria moderada-severa-recurrente, 4 con hipoactividad del detrusor y 1 con deficiencia intrínseca del esfínter. De las 19 pacientes, a 10 se les intervino para corrección de prolapso de órganos pélvicos concomitante, que se distribuyeron en: 6 pacientes con colporrafia anterior o posterior, 3 colpocleisis y 1 sacrocolpopexia por laparotomía. CONCLUSIONES: El cabestrillo reajustable es una buena opción para mujeres con intervenciones previas antiincontinencia con recidiva en quienes se demostró la mejoría en el grado de incontinencia en relación con el inicial, beneficio que se reflejó en mejor calidad de vida.

Abstract OBJECTIVE: To describe the experience with the readjustable sling Remeex® in patients with recurrent stress urinary incontinence as a treatment alternative. MATERIALS AND METHODS: Retrospective, observational, case series study carried out in a single center in the city of Medellin, Colombia, in patients attended at the Urogynaecology Unit of the Bolivarian University Clinic. Inclusion criteria: women over 18 years of age, with a diagnosis of recurrent urinary incontinence after one or more failed surgeries to correct urinary incontinence or with a diagnosis of intrinsic sphincter deficiency who underwent the readjustable sling procedure (Remeex Female Neomedic) between 2016 and 2019. RESULTS: Nineteen patients were evaluated with mean age 62 years (SD ± 9). The median follow-up was 19.4 months (RIQ 10-26.5). All patients had preoperative urodynamics that confirmed the diagnosis of stress urinary incontinence. All 19 patients had a diagnosis of moderate-severe-recurrent urinary incontinence, 4 with detrusor hypoactivity and 1 with intrinsic sphincter deficiency. Of the 19 patients, 10 underwent surgery for correction of concomitant pelvic organ prolapse, which were distributed as follows: 6 patients with anterior or posterior colporrhaphy, 3 colpocleisis and 1 sacrocolpopexy by laparotomy. CONCLUSIONS: The readjustable sling is a good option for women with previous anti-incontinence interventions with recurrence in whom improvement in the degree of incontinence in relation to the initial one was demonstrated, a benefit that was reflected in better quality of life.

Burch Procedure: A Historical Perspective / Procedimento de Burch: Uma perspectiva histórica

Abstract Introduction The Burch procedure (1961) was considered the gold standard treatment for stress urinary incontinence (SUI) before the midurethral slings (MUSs) were introduced, in 2001. Objective This historical perspective of the Burch's timeline can encourage urogynecological surgeons to master the Burch technique as one of the options for surgical treatment of SUI. Search Strategy and Selection Criteria A bibliographic search was performed in the PubMed and National Library of Medicine (NIH) databases with the terms Burch colposuspension AND history AND stress urinary incontinence in the last 20 years. The original article by Burch (1961) was included. The references were read by three authors. The exclusion criterion was studies in non-English languages. Biomedical Library Special Collections were included as historical relevant search. Data Collection, Analysis and Main Results Some modifications of the technique have been made since the Burch procedure was first described. The interest in this technique has been increasing due to the negative publicity associated with vaginal synthetic mesh products. Twenty-nine relevant articles were included in the present review article, and numerous trials have compared Burch colposuspension with MUS. Conclusion This historical perspective enables the scientific community to review a standardized technique for SUI. Burch colposuspension should be considered an appropriate surgical treatment for women with SUI, and an option in urogynecological training programs worldwide.

Resumo Introdução O procedimento de Burch (1961) foi considerado o tratamento padrão ouro para a incontinência urinária de esforço (IUE) antes da introdução dos slings de uretra média (SUMs), em 2001. Objetivo Esta perspectiva histórica da linha do tempo do procedimento de Burch pode encorajar os cirurgiões uroginecológicos a dominar a técnica deste procedimento como uma das opções para o tratamento cirúrgico da IUE. Estratégia de busca e critérios de seleção A busca bibliográfica foi realizada nas bases de dados PubMed e National Library of Medicine (NIH) com os termos Burch colposuspension AND history AND stress urinary incontinence nos últimos 20 anos. O artigo original de Burch (1961) foi incluído. As referências foram analisadas por três autores com exclusão de estudos em idiomas diferentes do inglês. Coleções de bibliotecas biomédicas foram incluídas por ordem de relevância histórica. Coleta de dados, análise e principais resultados Algumas modificações de técnica foram realizadas desde que o procedimento de Burch foi inicialmente descrito. O interesse por essa técnica vem aumentando devido à publicidade negativa associada aos produtos de tela sintética vaginal. Vinte e nove artigos relevantes foramincluídos, e vários estudos compararam a colposuspensão de Burch com SUMs. Conclusão Essa perspectiva histórica possibilita à comunidade científica revisar uma técnica padronizada para a IUE. A colposuspensão de Burch pode ser considerada um tratamento cirúrgico adequado paramulheres com IUE, e uma opção emprogramas de treinamento uroginecológico em todo o mundo.

Ejercicio y educación mejoran equilibrio y la calidad de vida en mujeres con incontinencia urinaria de esfuerzo / Exercise and education improve balance and quality of life in women with stress urinary incontinence

Introducción: La incontinencia urinaria por esfuerzo (IUE) tiene una alta prevalencia en mujeres adultas, afectando variables psicológicas, sociales y funcionales como la disminución de capacidad de equilibrio, debido a una escasa contribución en los movimientos del tronco hacia una corrección postural. Objetivo: Determinar los efectos de un programa basado en ejercicio muscular de piso pélvico y educación sobre el equilibrio estático y la calidad de vida en mujeres con IUE. Materiales y métodos: Participaron 18 mujeres con IUE durante 12 semanas en 10 sesiones de ejercicio muscular de piso pélvico y educación (hábitos de higiene, micción, ingesta de líquidos). Pre y post-intervención se evaluó equilibrio estático mediante oscilografía postural y calidad de vida mediante el International Consultation on Incontinence Questionnaire Short-Form (ICQ-SF). Los datos fueron analizados con la prueba no paramétrica de Wilcoxon. Resultados: Se encontró una disminución significativa en el área de desplazamiento del centro de presión en el subtest ojos abiertos (p=0,027) y en el Subtest ojos cerrados (p=0,006). Disminuyó la sintomatología asociada a IUE (p=0,0001). Conclusiones: Pos-intervención mejora equilibrio estático y calidad de vida, confirmando los efectos positivos de este programa que pueden servir de orientación a profesionales de la salud que trabajan con mujeres con IUE.

Introduction: Stress urinary incontinence (SUI) has high prevalence in adult women, affecting psychological, social and functional variables, including decreased balance capacity, due to a lack of trunk movements that contribute to postural correction. Objective: To determine how a program based on pelvic floor muscle exercises and education affects static balance and quality of life of women with SUI. Materials and methods: 18 SUI female patients participated in a 12 week/10 sessions program that included pelvic floor muscle exercises and education (hygiene habits, urination, fluid intake). Static balance and quality of life were assessed before and after the intervention using postural oscillography and the International Consultation on Incontinence Questionnaire Short Form(ICQ-SF), respectively. Data were analyzed with the non-parametric Wilcoxon test. Results: The displacement area of the center of pressure in the open (p=0.027) and closed (p=0.006) subtests showed a significant reduction. Likewise, the amount of symptoms associated with SUI decreased (p=0.0001). Conclusions: Intervention improves static balance and quality of life, confirming the positive effects of this program, which can serve as a guide for health professionals who work with women with SUI.

Factors affecting postpartum stress urinary incontinence among lying-in women at ages of 35 years and older / 预防医学

Objective@#To investigate the factors affecting postpartum stress urinary incontinence (PSUI) among lying-in women at ages of 35 years and older, so as to provide insights into PSUI prevention. @*Methods@#Lying-in women at ages of 35 years and older receiving postpartum examinations were sampled using a convenient sampling method from Hangzhou Obstetrics and Gynecology Hospital during the period from January 2021 to April 2022. Participants' demographic data, type of delivery, birth weight, diastasis recti abdominis, pelvic floor muscle strength injury, pelvic floor muscle training were collected, and the development of PSUI was evaluated using the International Consultation on Incontinence modular questionnaire. The factors affecting the development of PSUI were identified among lying-in women at ages of 35 years and older using a multivariable logistic regression model. @*Results@#A total of 230 questionnaires were allocated, and 226 valid questionnaires were recovered, with an effective recovery rate of 98.26%. The lying-in women had a mean age of (37.30±2.11) years, and 75.66% had a pre-pregnancy body mass index (BMI) of 18.5 to 24.0 kg/m2. There were 29 women with postpartum BMI of 24.0 kg/m2 and greater (12.83%), 201 women with gestational weeks of 37 weeks and greater at delivery (88.94%), 105 women with vaginal delivery (46.46%), 20 women with neonatal birth weights of 4 000 g and higher (8.85%), 149 women with diastasis recti abdominis (65.93%), 154 women with pelvic floor muscle strength injury (68.14%). The prevalence of PSUI was 25.22% among the study subjects. Multivariable logistic regression analysis showed that vaginal delivery (OR=4.061, 95%CI: 2.124-7.763), postpartum BMI of 24 kg/m2 and higher (OR=1.903, 95%CI: 1.275-3.288), neonatal birth weight of 4 000 g and higher (OR=2.108, 95%CI: 1.420-4.135), diastasis recti abdominis (OR=1.487, 95%CI: 1.110-2.169) and pelvic floor muscle strength injury (OR=2.924, 95%CI: 1.726-4.803) were risk factors for PSUI among lying-in women at ages of 35 years and older, and pelvic floor muscle training was a protective factor for PSUI among lying-in women at ages of 35 years and older (OR=0.410, 95%CI: 0.216-0.780).@*Conclusions@#The development of PSUI correlates with the type of delivery, postpartum BMI, neonatal birth weight, diastasis recti abdominis and pelvic floor muscle strength injury among lying-in women. Reasonable weight control and active pelvic floor muscle training may facilitate the prevention of PSUI.

A comparative analysis of clinical efficacy of thulium laser enucleation of the prostate-pre-transection urethral mucosa at the apex of prostate and traditional three lobe enucleation of the prostate for the treatment of benign prostatic hyperplasia / 中华泌尿外科杂志

Objective:To investigate the efficacy and safety of thulium laser enucleation of the prostate-pre-transection urethral mucosa at the apex of prostate and traditional three lobe enucleation of the prostate for the treatment of benign prostatic hyperplasia patients.Methods:The data of 270 patients with benign prostatic hyperplasia who were underwent ThuLEP-PAM or ThuLEP in our hospital from May 2020 to September 2021 were analyzed retrospectively. According to the operation methods, the patients were divided into two groups: ThuLEP-PAM group (120 cases) and ThuLEP group (150 cases). There was no significant difference comparing the age [(69.8±7.7) years vs. (71.4±8.0) years], prostate volume [55.5(41.0, 71.0)ml vs. 58.5(45.0, 80.3)ml], the serum PSA [3.0(1.8, 4.6) ng/ml vs. 3.3(2.1, 5.5)ng/ml], international prostate symptom scores (IPSS) [22(17, 28) vs. 22(17, 27)], the quality of life score (QOL)[5(4, 6) vs. 5(4, 6)], the maximum urinary flow rate (Q max)[5.6(3.5, 7.3)ml/s vs. 5.5(4.0, 7.1)ml/s], the residual urine volume [ 31(0, 81)ml vs. 31(0, 102)ml] between the ThuLEP-PAM group and the ThuLEP group. No significant difference was found between the two groups( P>0.05). In the ThuLEP-PAM group, the external sphincter ring was located firstly, and urethral mucosa at the apex of prostate was circumferentially incised at 5 mm proximal of the sphincter ring by laser. Then the urethral mucosa was incised at the left sulcus beside the verumontanum and the prostate surgical capsule gap was exposed. After the middle lobe was removed, the left and right lobes were removed along the urethral mucosa pre-incision line at the prostatic apex. The ThuLEP group was enucleated by traditional three lobes enucleation. Perioperative indicators and postoperative complications during short-term follow-up were compared between the two groups. Results:All patients successfully completed the operation and the symptoms of the lower urinary tract were significantly improved. Comparison the perioperative factors between ThuLEP-PAM group and ThuLEP group included the following: operative time 90(70, 103)min vs. 83(61, 102)min; enucleated tissue weight 27.0(19.3, 36.5)g vs. 27.0(19.0, 39.0)g; decrease of the hemoglobin 9.9(7.4, 12.4)g/L vs. 9.5(7.1, 12.7)g/L; catheterization time 3.5(3.0, 4.0)d vs. 3.5(3.0, 5.0)d; hospital stay 6.0(5.0, 6.0)d vs. 5.0(4.0, 6.0)d. NO significant difference in these parameters was found between the two groups( P>0.05). There also was no significant difference in PSA[1.1(0.8, 1.5) ng/ml vs. 1.0(0.8, 1.6) ng/ml], IPSS score [5(4, 6) min vs. 5(4, 6)min], QOL score [2(1, 3) vs. 2(1, 3)], Q max [20.9(17.5, 22.5) ml/s vs. 20.4(17.8, 22.7) ml/s] and PVR [0 ml vs. 0(0, 6)ml] between the two groups ( P>0.05) after more than 3 months of follow-up. The incidence of incontinence for ThuLEP-PAM(2 cases)were lower than that for ThuLEP(11 cases)( P=0.031), but there was no significant between the two groups in other complications such as blood transfusion, haematuria, post-voidalurinary retention and urethral stricture. Conclusions:ThuLEP-PAM and ThuLEP have similar effect on the improvement of lower urinary tract symptoms in patients with benign prostatic hyperplasia, both of which have good efficacy and high safety. The biggest advantage of ThuLEP-PAM over ThuLEP is that it reduces the incidence of early postoperative stress urinary incontinence.