Transvaginal mesh surgery for pelvic organ prolapse does not affect sexual function at long term follow up.

OBJECTIVE: Pelvic Organ Prolapse (POP) may impair sexual health. Though sexual dysfunction in women with POP is associated with reduced sexual arousal and dyspareunia, sexual outcomes have not been fully investigated. Transvaginal mesh repair (TVMR) is a POP therapeutic option, but is debated as a possible cause of worsening in sexual function. Aim of this study is to evaluate pre- and post-operative sexual outcomes in women undergone to TVMR. STUDY DESIGN: Data coming from sexually active women submitted to TVMR for POP with commercial mesh kits (device whose production has been suspended) were prospectively collected from 2012 to 2016 in a tertiary referral center. POP was measured according to the POP-Q classification. Patients' characteristics, operative and post-operative data were collected. Follow-up was carried out at month 1, 6, 12 and then yearly. Sexual function was measured through FSFI (Female Sexual Function Index) questionnaire. Minimum follow up was 12 months. FSFI score was assessed in these women before and after TVMR. A sub-analysis according to mesh kit used was made. RESULTS: From 2012 to 2016, 155 women underwent TVMR active for stage III or higher POP and 56 (36.6%) were sexually active, while 52 (92.9%) had adequate follow-up. Median age was 62 years (IQR 56-66), median BMI was 24,7 kg/m2 (IQR 22,3-28,9) and median parity was 2 (IQR 1-2). All patients presented anterior compartment POP and 14 (269%) had previous POP surgery. Urodynamic SUI was present in 13 (250%) patients. Commercial mesh kits used were Prolift© in 19 patients (36.5%) and Elevate© in 33 (63.5%). Median follow up was 42 months (IQR 22-59). Globally, FSFI was unaltered from TVMR at 12 months and at last follow up (p = 0.856). In detail, even if dyspareunia was reported in 1 patient, pain sub score was stable at long term follow up after TVMR (p = 0.124). Globally, there were 8 (15.4%) perioperative complications, none exceeding Clavien 2. At late follow up here was 1 (1.9%) mesh vaginal erosion occurred and there were 4 (7.7%) de novo stress urinary incontinence. Preoperative characteristics, surgical complications and outcomes were similar between mesh kits (p > 0.05). CONCLUSION: In our experience, global sexual function doesn't seem to be affected by TVMR when performed by expert surgeons. Despite being a confounding factor, lost at follow up rate was low, thus affecting only in a mild way surgical outcomes. Also ageing might be a confounding factor during follow up to establish real mesh impact on sexual function. Dyspareunia was a rare complication in patients during follow-up and pain was not a major complaint.

Use of sigmoid colon in orthotopic neobladder reconstruction: Long-term results.

OBJECTIVES: To present our experience with a sigmoid orthotopic neobladder. METHODS: We retrospectively evaluated the functional and oncological outcomes of 160 patients who underwent orthotopic neobladder reconstruction using a detubularized 20-25-cm sigmoid segment at our institution. Each patient was evaluated every 3 months the first year, every 6 months for the next 4 years and annually thereafter. Urodynamic studies of all consenting patients were carried out after 6 months, and 2, 5 and 10 years. We carried out the log-rank test, and used Cox regression models and Kaplan-Meier survival analysis. The anova test was used to compare urodynamic findings over time. RESULTS: Mean follow up was 6.8 years (range 0.65-21.7 years). Overall survival was 58.1% at 5 years, and 47.1% at 10 years. Early complications occurred in 36 patients (22.6%); late complications in 40 (25%). Stage V chronic kidney disease developed in two patients (1.3%). Complete (daytime and night-time) continence, defined as no need for pads or condom devices, was achieved by 45% of patients at 5 years, daytime continence was achieved by just 36% of patients; both were unchanged at 10 years. A significant difference emerged in maximal neobladder capacity and post-void residual values between 6 months and 2 years, and between 2 and 5 years (P < 0.01 and P = 0.03, respectively). CONCLUSIONS: Sigmoid neobladder continence and capacity significantly improve over the first 5 years, and they remain stable over the long term. Upper urinary tract function is not affected by endoluminal pressure, and the rate of metabolic imbalance is negligible.

Urinary incontinence after ischemic stroke: clinical and urodynamic studies.

AIMS: To investigate the frequency, the prognostic effect on functional status and the urodynamic patterns of post-stroke urinary incontinence (UI) in a sample of in-patients affected by ischemic stroke. METHODS: One hundred six patients with recent ischemic stroke admitted to a neurorehabilitation unit were enrolled. Stroke localization was made according to the Oxfordshire Community Stroke Project (OCSP) stroke subtypes and assessment of stroke severity using the National Institute of Health Stroke Scale (NIHSS). The presence of UI was associated with functional status, measured with Barthel Index and Functional Independence Measure (FIM). At admission, urodynamic studies were performed on all the patients and repeated in 63 patients after 30 days. RESULTS: Eighty-four patients (79%) were incontinent. Incontinence was associated with age (P<0.05) and functional disability (P=0.01), but not with sex, side of stroke, or time from stroke to entry in the study. Urodynamic studies, performed on all 106 patients at admission, showed normal studies in 15%, detrusor overactivity (DO) in 56%, detrusor overactivity with impaired contractility (DOIC) in 14%, and detrusor underactivity (DU) in 15%. After 1 month urodynamic studies, repeated on 63 patients, showed normal studies in 30%, DO in 48%, DOIC in 6%, and DU in 16%. CONCLUSIONS: Incontinent patients showed a worse functional outcome compared to continent patients. Post-stroke incontinence may be associated with different urodynamic patterns, each of which may necessitate different treatment strategies. Urodynamic findings in patients with ischemic stroke vary depending upon timing of the study.

Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence.

PURPOSE: Urinary incontinence after radical prostatectomy is a significant clinical problem. In this prospective study we investigate the effectiveness of early pelvic floor muscle training (PFMT) on a large population, that had undergone radical retropubic prostatectomy (RRP) at our department. METHODS: 300 consecutive patients who had undergone RRP for clinically confined prostate cancer were randomized in two groups after catheter removal. One group of 150 patients took part in a structured PFMT program. This began before discharge and consisted of Kegel exercises. The remaining 150 patients constituted the control group, they were not formally instructed in PFMT. Incontinence was assessed objectively using the 1 hour and 24 hour pad test, as well as with the ICS-Male questionnaire. All patients who were incontinent after 6 months underwent urodynamic evaluation. RESULTS: In the treated group, 19% (29 patients) achieved continence after 1 month, and 94.6% (146 patients) after 6 months. In the control group 8% (12 patients) achieved continence after 1 month, and 65% (97 patients) after 6 months (p<0.001). Patient age did not correlate with continence in the control group (p>0.05), although a significant correlation was revealed within the treated group (p<0.01). Overall, 93.3% of the total population achieved continence after one year. CONCLUSIONS: After RRP an early supportive rehabilitation program like PFMT significantly reduces continence recovery time.