Single-incision Midurethral Sling by the Dynamic Intraoperative Standing Sling Technique as an Office-based Procedure: A Pilot Study.

OBJECTIVES: To assess the safety, feasibility, and short-term success of placing Solyx (Boston Scientific, Marlborough, MA) single-incision midurethral sling (SIMUS) using the Dynamic Intraoperative Standing Sling Technique (DISST) in an office setting under local anesthesia. METHODS: The safety and efficacy of the in-office Solyx DISST procedure for treatment of stress urinary incontinence was assessed 6 months from the procedure. Improvement in stress urinary incontinence was measured using validated questionnaires (Medical, Epidemiologic, and Social Aspects of Aging, MESA; Incontinence Impact Questionnaire-7, IIQ-7; Pelvic Organ Prolapse/Urinary Incontinence Sexual Function, PISQ-12) and by a negative standing provocative stress test. Postoperative complications were documented along with subjective pain diaries, return to work/activities, and overall satisfaction. RESULTS: From July 2019 through February 2020, 20 subjects underwent in-office Solyx procedure by the DISST technique. Six of the 20 (30%) subjects required intraoperative sling adjustments. There were no complications as related to the office-based procedure. Participants reported a favorable intraoperative experience. Subjects had excellent postoperative pain control and early return to work and normal activities. At 6 months, all 20 subjects had negative standing provocative stress tests, showed statistically significant improvements on MESA, IIQ-7, and PISQ-12, and reported high satisfaction and acceptance for the procedure and outcomes. There were no late (>6 weeks) complications associated with the Solyx procedure. CONCLUSIONS: It appears safe and feasible to perform Solyx SIMUS by the DISST method in the office. Subjects remained dry and reported excellent improvement in symptoms and quality of life 6 months from surgery.

The Role of Yoga in the Management of Bladder Pain Syndrome: A Single-Arm Pilot Study.

BACKGROUND: Bladder pain syndrome (BPS) is a devastating urologic condition characterized by irritative bladder symptoms, pelvic pain, and dyspareunia. First-line treatment includes dietary, self-care and behavioral modifications. The ancient practice of yoga is well suited to treat BPS, but evidence is lacking on its use. AIMS: To investigate the feasibility and efficacy of an integrated yoga module on BPS outcomes as measured by self-reported questionnaires from baseline to 3 months after therapy. METHODS AND MATERIALS: This was a prospective single-arm study of 8 patients who underwent 3 months of integrated yoga therapy. The treatment module was performed 3 to 4 times weekly at home with 1 session performed weekly in-office during the first month to ensure proper performance of postures. Patients completed questionnaires (Pelvic Pain and Urgency/Frequency Patient Symptom Scale [PUF], Pelvic Floor Impact Questionnaire - short form 7 [PFIQ-7], Short Form 36 questionnaire [SF-36], Pittsburgh Sleep Quality Index [PSQI]) at baseline and 3 months, including Patient Global Impression of Improvement (PGI-I) at the 3-month follow-up visit. Voiding diaries were also requested at baseline and at the 3-month assessment. RESULTS: There was a trend toward improvement regarding patients' responses to all questionnaires 3 months after yoga therapy, with the only statistically significant improvements noted in social function and pain components of the SF-36. There were no significant changes noted on the voiding diaries except a non-statistically significant trend toward increased voided volumes. Patients rated their experiences with yoga therapy positively. CONCLUSIONS: Yoga therapy for BPS showed evidence of benefit for improving bothersome bladder symptoms, pain and voiding. A randomized controlled trial will follow to investigate the efficacy of this yoga module against a control group.