Comparative analysis of the efficacy and complications of mid-urethral slings when inserted either in isolation or in conjunction with pelvic organ prolapse surgery.

INTRODUCTION: Stress urinary incontinence (SUI) is a highly prevalent condition that affects between 20 and 50% of the female population. Pelvic organ prolapse (POP) can coexist with SUI and both can be addressed through a vaginal approach. However, it is unclear whether simultaneous surgery for these two conditions can influence the outcome of incontinence treatment. OBJECTIVE: To evaluate the objective and subjective effectiveness of the transobturator suburethral (TO) band by comparing two groups: group A, of patients undergoing surgery for stress urinary incontinence (SUI) by insertion of TO mesh, and group B, formed for patients requiring simultaneous correction of pelvic organ prolapse (POP) in addition to TO mesh insertion. MATERIALS AND METHODS: This is an observational, descriptive and retrospective study in which 91 patients participated: 33 (group A) underwent surgery for SUI and 58 (group B) underwent corrective surgery for pelvic organ prolapse (POP) and TO band simultaneously. Variables included: total urinary continence, objective urinary continence, subjective urinary continence (satisfaction levels and two validated questionnaires (PGI-1 and ICIQ-SF)) and complications. RESULTS: Regarding total continence, from the seventh to the ninth year, statistically significant differences were observed, with total continence being higher in group A. Objective continence decreased in both groups during the follow-up period. No significant differences were found between the two groups regarding subjective urinary continence (ICIQ-SF) and the degree of improvement after surgical treatment (PGI-1). The level of satisfaction after surgery was high in both groups. Regarding complications, there were no statistically significant differences. CONCLUSIONS: Isolated surgery for SUI could be considered more effective in achieving total and objective continence. However, the insertion of the TO band in both cases improves subjective urinary continence and quality of life with great safety and without differences regarding complications.

Comparative Efficacy of TVT-A and TVT-O in the Treatment of Stress Urinary Incontinence in Elderly Women: Single-Centre Retrospective Study.

BACKGROUND: Tension-free vaginal tape-Abbrevo (TVT-A) and tension-free vaginal tape-Obturator (TVT-O) are the main procedures for the treatment of stress urinary incontinence (SUI) in females. This study investigated the clinical efficacy of TVT-A versus TVT-O for the treatment of SUI in elderly women. METHODS: A retrospective analysis was conducted on 126 cases of SUI in elderly female patients admitted to our hospital from January 2022 to January 2023. The patients were divided into TVT-A group (65 cases) and TVT-O group (61 cases) according to the surgical methods. Follow-up was conducted via outpatient examination and telephone. Perioperative conditions, surgical outcomes, postoperative complications and quality of life were analysed and compared between the two groups. RESULTS: No statistically significant difference in surgical time, intraoperative blood loss, indwelling catheter duration, average hospital days, bladder injury, urethral injury, incision infection, dysuria, cured rate and quality of life was found between the two groups (p > 0.05). The incidence of postoperative groin pain in the TVT-A group was significantly lower than that in the TVT-O group (p < 0.05). CONCLUSIONS: The efficacy of TVT-A and TVT-O in treating SUI in older women is about the same. However, TVT-A is more minimally invasive, safer and has fewer complications.

Clinical efficacy of tension-free vaginal tape-ischiopubic ramus versus transobturator tension-free vaginal tape in the management of female stress urinary incontinence.

BACKGROUND: Stress urinary incontinence (SUI), a prevalent condition among middle-aged and elderly women in China, is characterized by the involuntary leakage of urine during instances of increased abdominal pressure [1]. Although SUI is not life-threatening, it substantially impacts patients' physical and psychological well-being, impairs their social interactions, and diminishes their overall quality of life. OBJECTIVE: The aim of this study was to evaluate and compare the clinical efficacy of tension-free vaginal tape-ischiopubic ramus (TVT-IR) and transobturator tension-free vaginal tape (TVT-O) in the treatment of female stress urinary incontinence (SUI). METHODS: A retrospective analysis of clinical data from 83 female SUI patients was conducted, dividing them into a TVT-IR group (n= 41) and a TVT-O group (n= 42) based on the surgical procedures employed. Perioperative indices, surgical efficacy, complications, symptom improvement pre- and post-operation (3 months), urodynamic measurements, and indices related to pelvic floor function and quality of life were compared between the two groups. RESULTS: The TVT-IR group had significantly shorter operative time than the TVT-O group (P< 0.05). Three months after surgery, both groups had significantly lower frequency of incontinence, incontinence score, and number of nocturnal urination, significantly higher Pdet, ALPP, Qmax, and MUCP, significantly higher class I and class II fiber muscle strength and muscle potential, and significantly higher I-QOL scores (P< 0.05). The aforementioned indicators were superior in the TVT-IR group compared to the TVT-O group three months after surgery (P< 0.05). CONCLUSION: Both TVT-IR and TVT-O are effective in treating SUI, with comparable complication rates.

Results of Adjustable Trans-Obturator Male System for Stress Urinary Incontinence after Transurethral Resection or Holmium Laser Enucleation of the Prostate: International Multicenter Study.

Background: Male stress urinary incontinence (SUI) after surgical treatment of benign prostatic enlargement (BPE) is an infrequent but dreadful complication and constitutes a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS®) in these patients is rather unknown, mainly due to the rarity of this condition. We aimed to assess the results of ATOMS to treat SUI after transurethral resection (TURP) or holmium laser enucleation (HoLEP) of the prostate. Methods: Retrospective multicenter study evaluating patients with SUI after TURP or HoLEP for BPE primarily treated with silicone-covered scrotal port (SSP) ATOMS implants in ten different institutions in Europe and Canada between 2018 and 2022. Inclusion criteria were pure SUI for >1 year after endoscopic treatment for BPE and informed consent to receive an ATOMS. The primary endpoint of the study was a dry rate (pad test ≤ 20 mL/day after adjustment). The secondary endpoints were: the total continence rate (no pads and no leakage), complication rate (Clavien-Dindo classification) and self-perceived satisfaction (Patient Global Impression of Improvement (PGI-I) scale 1 to 3). Descriptive analytics, Wilcoxon's rank sum test and Fisher's exact test were performed. Results: A total of 40 consecutive patients fulfilled the inclusion criteria, 23 following TURP and 17 HoLEP. After ATOMS adjustment, 32 (80%) patients were dry (78.3% TURP and 82.4% HoLEP; p = 1) and total continence was achieved in 18 (45%) patients (43.5% TURP and 47% HoLEP; p = 0.82). The median pad test was at a 500 (IQR 300) mL baseline (648 (IQR 650) TURP and 500 (IQR 340) HoLEP; p = 0.62) and 20 (IQR 89) mL (40 (IQR 90) RTUP and 10 (IQR 89) HoLEP; p = 0.56) after adjustment. Satisfaction (PGI-I ≤ 3) was reported in 37 (92.5%) patients (95.6% TURP and 88.2% HoLEP; p = 0.5). There were no significant differences between patients treated with TURP or HoLEP regarding the patient age, radiotherapy and number of adjustments needed. After 32.5 (IQR 30.5) months, median follow-up postoperative complications occurred in seven (17.5%) cases (two grade I and five grade II; three after TURP and four HoLEP) and two devices were removed (5%, both HoLEP). Conclusions: ATOMS is an efficacious and safe alternative to treat SUI due to sphincteric damage produced by endoscopic surgery for BPE, both TURP and HoLEP. Future studies with a larger number of patients may identify predictive factors that would allow better patient selection for ATOMS in this scenario.

The True Impact of Voiding Dysfunctions after Transobturator Sub-Urethral Tape Procedures: A Systematic Review of Literature.

Introduction: Transobturator techniques are frequently used for the surgical treatment of female stress urinary incontinence (SUI), due to their high success rates and few intraoperative complications. However, controversial results have been reported in the literature regarding their incidence. The aim of this study is to analyze the real incidence and trend over time of such complications, especially voiding dysfunctions and overactive bladder (OAB) symptoms. Methods: A comprehensive search using PubMed/MEDLINE, Scopus, and Cochrane databases was performed. The search string used was the following: (female stress urinary incontinence) AND (complication) AND ((midurethral sling) OR (transobturator tape) OR (TVT-O) OR (voiding dysfunctions) OR (de novo OAB) OR (recurrent UTI) OR (vaginal erosion)). We included randomized controlled trials, prospective controlled studies, prospective and retrospective observational studies. All selected articles were screened based on titles and abstracts. Relevant data were extracted and tabulated. Results: A total of 39 studies were included in our analysis. Transobturator tape procedures show a high objective cure rate for SUI, from 76.9% to 100%. Postoperative voiding dysfunctions are shown to be quite common, ranging from 0-22% of cases. Despite that, this percentage decreases to 0-1% after 12 months. De novo OAB incidence ranges from 3% to 14% at 12 months, with variability over time due to multiple factors. Tape-related complications usually occur after 12 months, with a variable incidence up to 7%. Urinary tract infections (UTIs) are quite common in the immediate postoperative period but sometimes can be recurrent, requiring long-term prophylactic antibiotic treatment. Conclusions: Voiding dysfunctions are generally transient complications, while de novo OAB may persist over time. An adequate preoperative counseling, along with accurate written informed consent, could enhance patient tolerance of these issues and contribute to long-term patient satisfaction.

Navigating Treatment Choices for Stress and Urgency Urinary Incontinence Using Graph Theory in Discrete Mathematics.

In this study, we propose a method for navigating the choice of treatment for stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) using graph theory in discrete mathematics. Our previous study accumulated data from 150 patients who underwent tension-free vaginal tape (TVT), transobturator tape (TOT), and vaginal non-ablation Erbium YAG laser (VEL) surgeries between 2014 and 2016. Network diagrams were created using this data. The treatments TVT, TOT, and VEL, along with patient characteristics (1-hour pad test: 1-hrPadTest, Overactive Bladder Symptom Score: OABSS), were represented as nodes and edges in the network diagram. We then employed a heuristic function to select the optimal treatment method for the patients with SUI and UUI. This process enables medical professionals to easily navigate the data for patients with both SUI and UUI concerns by calculating the shortest path connecting the 1-hrPadTest and OABSS. These results, which are consistent with those of previous studies, suggest that VEL is the optimal treatment. Unlike previous studies that employed statistical knowledge that is challenging for patients to understand, our study aids patients in visually comprehending and developing a customized treatment plan. This approach introduces a novel perspective for clinical decision-making in the treatment of urinary incontinence. To the best of our knowledge, this is the first study to apply discrete mathematics to patient decision-making for urinary incontinence treatment.

The effect of the distance between mesh and the urethra on sexual function in patients who underwent transobturator tape

Objective: To evaluate the effect of mesh-urethra distance on sexual function in continent patients who underwent transobturator tape (TOT) surgery due to isolated stress urinary incontinence (SUI). Material and Methods: Continent patients who had undergone TOT surgery for SUI were eligible. Objective treatment for SUI was defined as the absence of urine leakage during a stress test. Translabial perineal ultrasound was performed six months after surgery. The successful surgical group was split into two subgroups based on the distance from the posterior of the urethra at the bladder neck to the nearest proximal edge of the tape: <5 mm and >5 mm. In addition to these, band percentile, the descent of bladder neck and urethra length measured by perineal ultrasound, pubo-urethral distance, urethral thickness, detrusor thickness, cystocele descent, rectal descent, and uterine descent were evaluated. Preoperative and postoperative results of the standardized and internationally valid incontinence questionnaires Incontinence Questionnaire Urinary Incontinence Short Form and Female Sexual Function Index (FSFI) were compared between groups. Results: Eighty-two patients were included. The postoperative FSFI scores for the >5 mm group were significantly lower than those of the <5 mm group, including the postoperative FSFI average, all subscales except lubrication, and average change scores due to the operation (p<0.001). There was no statistically significant relationship between the percentile occupied and postoperative FSFI score (p=0.553), and the FSFI preoperative-postoperative difference was not significant (p=0.905). Conclusion: Sexual functions are more affected in patients with a mesh-urethra distance >5 mm as measured by perineal ultrasound.

Quality of life following transobturator sling surgery for female stress urinary incontinence.

OBJECTIVE: This descriptive study examines quality of life in women undergoing placement of a midurethral sling for stress urinary incontinence. MATERIALS AND METHODS: This was a retrospective cohort study based on data from 51 women consecutively undergoing this procedure at a tertiary hospital in the years 2014 and 2015. The main outcome variable was quality of life assessed through the Sandvick severity test and International Consultation on Incontinence Short Quality of Life Questionnaire (ICIQ-IU-SF) at the time points baseline or presurgery, and 6 months and 5 years postsurgery. Factors associated with treatment failure were determined through binary logistic regression. RESULTS: At 5-year follow up we obtained an absolute reduction of 8.78 points (95% CI 6.43-11.14; p < 0.001) in the ICIQ-IU-SF questionnaire and 4.54 (95% CI 3.25-5.83; p < 0.001) in the Sandvick severity test score, compared to baseline, in the 35 patients that completed follow-up. Out of the 51 patients that were followed, the rate of success in incontinence correction was 86.3% (44/50) with a failure rate of 12% (6/50). Multiparity and previous gynaecological surgery were identified as predisposing factors for treatment failure. Obesity was associated with a worse treatment outcome. CONCLUSION: Sling treatment for incontinence was successful in 86.3% (44/50) of participants and remained effective 5 years after surgery in terms of quality of life.

Autologous versus synthetic midurethral transobturator sling: A systematic review and meta-analysis of outcomes.

INTRODUCTION: There have been concerns around the use of synthetic mesh for stress urinary incontinence (SUI) surgery with a renewed interest in the use of autologous tissues. Recently, an autologous transobturator sling (aTOT) has been described, but the comparative data with synthetic transobturator sling (sTOT) is limited. The objective of this systematic review and meta-analysis was to assess the outcome of aTOT and compare it with sTOT. METHODS: A systematic search of PubMed, Scopus, and Web of Science databases was performed and all articles available up to December 31, 2023 were screened. Studies reporting on the outcomes of aTOT and those comparing aTOT with sTOT were included. This review was performed as per Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS: Eleven studies evaluating 323 patients that met the criteria were included in the final analysis, of which 6 were single arm (155 patients) and 5 were comparative. In single-arm studies, the pooled success rate, defined as negative cough stress test at 12 months follow-up was 96.8%, 3.8% had postoperative urinary retention, 6.1% had graft site-related complications and 7.6% required additional intervention for persistent SUI. The overall complication rate was 20.6% and there were no Clavien III-V complications. aTOT had similar success and complication rates when compared with sTOT but had a significantly longer operative time (weighted mean difference: 22.35 min, p < 0.00001) and superior sexual function outcomes. CONCLUSIONS: aTOT, at short-term follow-up (12 months), has similar efficacy and complication rates when compared to sTOT. However, given that the data is limited and not of very good quality, and the fact that long-term follow-up is not available, further studies are required to better define the role of aTOT in the management of female patients with SUI.

The effect of stress incontinence and pelvic organ prolapse surgery on sexual function and quality of life.

Objective: The objective of this study was to evaluate the sexual function and quality of life in female patients diagnosed with stress urinary incontinence (SUI) and pelvic organ prolapse (POP) after undergoing transobturator tape (TOT) or TOT with POP surgery and perineoplasty. Material and Methods: This prospective study population (n=86) consisted of sexually active women who had been diagnosed with SUI. Forty-six patients diagnosed with SUI with no POP (group 1) underwent TOT procedure only. Forty patients had a diagnosis of stage 2 and higher POP, based on POP quantification system with SUI (group 2). The second group was randomized as TOT-POP surgery (n=20) and TOT-POP surgery with perineoplasty (n=20). Prior to and six months after the surgical procedure, all female participants underwent assessment using the validated Urinary Distress Pre-Operative Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ). Results: Post-operative IIQ-7 and UDI-6 scores were significantly lower for all three groups compared to the preoperative period, while a significant increase was observed in PISQ scores (p<0.01). The dissimilarity in preoperative and postoperative IIQ-7 and UDI-6 scores exhibited comparable results across the groups, whereas the variance in PISQ scores was notably greater in the TOT + POP surgery + perineoplasty group (p=0.03). Conclusion: Women with SUI or SUI with POP have better quality of life and sexual dysfunction after surgery. Perineoplasty may enhance sexual life in patients with perineal defect and vaginal enlargement.

Quality of life outcomes after transobturator tape full removal surgeries: A monocentric experience.

Objective: The objective of this study is to describe a standardised technique of full TOT removal with groin dissection and to report clinical improvement, satisfaction, safety and long-term functional, quality of life (QoL) and sexual QoL outcomes. Materials and methods: A retrospective review enrolling all women who had full TOT removal, in a tertiary referral centre from May 2017 to November 2020. Functional outcomes, satisfaction and QoL were assessed using a bespoke composite questionnaire (UDI-6, EQ-5D-5L and ICIQ-S) with additional questions on sexual QoL. Secondary outcomes were post-operative recurrent stress urinary incontinence (SUI) and complication rate according to the Clavien-Dindo classification. Results: Full TOT removal using a vaginal approach and bilateral groin/para-labial incisions was performed in 67 patients. Chronic pelvic pain was the main indication for mesh removal (51% of cases, n = 34). QoL questionnaires were answered by 43 patients. The satisfaction rate was high 86% (n = 37), and 81% (n = 35) of the patients considered the surgery successful. Seventy per cent (n = 30) of patients returned to having a sexual life after surgery. Recurrent SUI was reported in 32% (n = 14) of cases. The complication rate was 10% (7/67), all of them Clavien-Dindo ≤2. Conclusion: Despite a high rate of postoperative bothersome SUI, full TOT removal with bilateral groin dissection improves pain and QoL. It is associated with a high overall satisfaction rate and an acceptable rate of complications.

Novel technique of laparoscopic mid-urethral autologous rectus fascial sling for stress urinary incontinence.

Serious concerns have been raised over the safety of vaginal mesh tapes for stress urinary incontinence (SUI). Autologous rectus fascial sling and the more recent 'sling on a string' through a laparotomy are gaining popularity as native tissue options for SUI. We describe a novel technique of laparoscopic mid-urethral autologous rectus fascial sling for SUI. Ten patients underwent this new technique safely. At 12 months, all patients reported cure of SUI with normal voiding. The advantages of this technique include the minimal access approach, introduction of the sutures under laparoscopic guidance, and avoidance of over-tightening of the sling.

Current status of the adjustable transobturator male system (ATOMSTM) for male stress urinary incontinence.

Male stress urinary incontinence is a debilitating condition, which can occur after prostate surgery. In persistent cases, surgery is indicated and a number of options are available. This includes one of the male slings, Adjustable transobturator male system (ATOMSTM, A.M.I, Austria). There are now an increasing number of studies published. This review provides an overview of the current status of this implant device including technical considerations, surgical outcomes and potential advantages and disadvantages compared to alternatives such as the artificial urinary sphincter.

The effectiveness of adjustable trans-obturator male system (ATOMS) in radiated patients is reduced: A propensity score-matched analysis.

Objectives: This study aimed to compare the effectiveness and safety of the adjustable trans-obturator male system (ATOMS®) to treat post-prostatectomy incontinence (PPI) in radiated patients compared with non-radiated patients, using propensity score-matching analysis to enhance the validity of the comparison. Patients and methods: Consecutive men with PPI treated with silicone-covered scrotal port ATOMS (A.M.I., Feldkirch, Austria) in nine different institutions between 2016 and 2022 were included. Preoperative assessment evaluated 24-h pad usage, urethroscopy and urodynamics, if indicated. Propensity score-matching analysis was based on age, length of follow-up, previous PPI treatment, previous bladder neck stricture, androgen deprivation and pad usage. The primary endpoint was dry rate, defined as no pads post-operatively with a security pad allowed. The secondary endpoints were complications, device removal and self-perceived satisfaction with the Patient Global Impression of Improvement (PGI-I) scale. Results: Of the 710 included patients, 342 were matched, and the study groups were balanced for the baseline matched variables. The mean baseline 24-h pad was 4.8 in both groups (p = 0.48). The mean follow-up was 27.5 ± 18.6 months, which was also equivalent between groups (p = 0.36). The primary outcome was achieved in 73 (42.7%) radiated patients and in 115 (67.3%) non-radiated patients (p < 0.0001). The mean pad count at the last follow-up was 1.5 and 0.8, respectively (p < 0.0001). There was no significant difference in complications (p = 0.94), but surgical revision and device explant rates were higher (p = 0.03 and p = 0.01, respectively), and the proportion of patients highly satisfied (PGI-I = 1) was lower in the radiated group (p = 0.01). At sensitivity analysis, the study was found to be reasonably robust to hidden bias. Conclusion: ATOMS implantation significantly outperformed in patients without adjuvant radiation over radiated patients.

Synthetic vs nonsynthetic slings for female stress and mixed urinary incontinence: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to systematically review objective and subjective success and surgical outcomes of suburethral sling surgery for female patients with stress or mixed urinary incontinence using synthetic vs nonsynthetic material with corresponding surgical approaches (retropubic or transobturator). DATA SOURCES: We systematically searched Medline, Embase, EBM Reviews, ClinicalTrials.gov, and Web of Science Core Collection using standardized Medical Subject Headings (MeSH) without date restrictions (PROSPERO-registered). We double-screened studies and used backward citation chaining. STUDY ELIGIBILITY CRITERIA: We included peer-reviewed randomized controlled trials and prospective or retrospective comparative studies examining outcomes of retropubic or transobturator synthetic vs nonsynthetic (autologous, allograft, or xenograft) slings for female stress or mixed urinary incontinence, with available English or French full texts. We excluded minislings (single insertion point). We allowed slings for recurrent stress or mixed urinary incontinence, and slings concomitant with prolapse surgery, with at least 6 weeks of postoperative follow-up. We excluded systematic reviews, meta-analyses, review studies, case-control studies, case reports, studies that did not describe surgical approach or material, and studies of combination slings. METHODS: We evaluated study quality using RoB, the Cochrane risk-of-bias tool for randomized controlled trials, and the Newcastle-Ottawa scale for observational studies. We used pooled relative risk with 95% confidence intervals to estimate the effect of sling material type on each outcome through meta-analysis and meta-regression, as appropriate. RESULTS: We screened 4341 abstracts, assessed 104 full texts, and retained 35 articles (30 separate studies). For retropubic synthetic vs nonsynthetic slings, there was no difference in the number of objectively or subjectively continent patients. The rates of reoperation for stress urinary incontinence and overall were higher with nonautologous retropubic slings than with synthetic slings. Compared with autologous slings, retropubic synthetic slings were associated with higher subjective continence in populations with ≥25% recurrent stress urinary incontinence (relative risk, 1.27; 95% confidence interval, 1.12-1.43). There were no differences in continence between transobturator synthetic and nonsynthetic slings. Subjective satisfaction was better in the transobturator synthetic group than in the autologous sling group (relative risk, 1.42; 95% confidence interval, 1.03-1.94). CONCLUSION: Synthetic and nonsynthetic slings have comparable objective and subjective success, with synthetic materials generally showing better operative outcomes and fewer complications.

Outcomes with the Adjustable Transobturator Male System (ATOMS) for the Treatment of Male Stress Urinary Incontinence After Prostate Surgery and the Impact of Previous Radiotherapy.

Background and objective: The adjustable transobturator male system (ATOMS) is an established treatment for patients with urinary incontinence after prostate surgery. Our objective was to evaluate the efficacy and the complication burdens associated with ATOMS with a focus on exploring the potential impact on previous radiotherapy (RT). Methods: We performed a retrospective analysis for consecutive patients who underwent ATMOS implantation procedure at a tertiary center over an 11-yr study period. Outcomes of interest were dryness at 3-mo follow up, postoperative complications (≤30 d), and late treatment failures (>30 d). Key findings and limitations: A total of 118 patients underwent ATOMS surgery performed by five different surgeons. Median follow-up was 67 mo (interquartile range 41-95). The mean 24-h pad count after surgery was 1.1 (range 0-8) and the mean reduction in pad weight was 179 g (range 0-1080). There was no significant difference in the reduction in pad use between groups with and without RT (-1.7 vs -2.4; p = 0.13). Multivariable analysis revealed that RT, degree of incontinence, and age were not risk factors for reoperation. Conclusions and clinical implications: ATOMS implantation is feasible in patients who have undergone prostate RT and patients with severe stress urinary incontinence after prostate surgery. We found that RT was not a risk factor for reoperation and there was no significant difference in pad weight reduction by RT status. This study offers new insight into potential incontinence surgery for male patients with stress urinary incontinence and previous RT. Patient summary: We assessed outcomes for patients who had an ATOMS (adjustable transobturator male system) device implanted to control stress urinary incontinence after prostate surgery. After implantation, 52.5% of the patients reported zero leakage and 39.9% reported only mild incontinence. Our results show that this device can improve continence after prostate surgery and is also suitable in patients who underwent radiotherapy.

Evaluating Patient Preferences and Clinical Outcomes for Modified Laparoscopic Burch Colposuspension and Transobturator Tape Procedures in Stress Urinary Incontinence Treatment.

OBJECTIVE: This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two prominent surgical techniques for treating Stress Urinary Incontinence (SUI): the modified laparoscopic Burch colposuspension and the transobturator tape (TOT) procedure. MATERIAL AND METHODS: A prospective cohort study was conducted on 145 patients who recieved surgical treatment for SUI, of which 71 patients (49%) underwent the modified laparoscopic Burch procedure, while 74 patients (51%) received the TOT procedure. Data on clinical characteristics, treatment success rates, and postoperative outcomes were collected and analyzed to understand patient preferences and real-world clinical effectiveness. RESULTS: This study revealed notable differences in patient demographics and clinical characteristics between the two groups. At the 2-year follow-up, a success rate of 100% was reported in the modified laparoscopic Burch group and 86.48% in the TOT group. A total of 99 patients (68.28%) were considered cured postoperatively, with 47 (66.20%) in the modified laparoscopic Burch group and 52 (70.27%) in the TOT group (p = 0.598). A significant difference was found in the incidence of dyspareunia, with six cases (8.10%) reported in the TOT group, compared to none reported in the modified laparoscopic Burch group (p = 0.028). The median operation time was significantly shorter in the TOT group, namely 15 min, compared to the modified laparoscopic Burch group, which had a median equal to 27 min (p < 0.001). Despite these differences, patient preference for either surgical technique was observed, along with similar success rates and varied postoperative outcomes. CONCLUSIONS: The findings provide a comprehensive overview of patient preferences and factual clinical outcomes for the two surgical techniques in SUI treatment. This study contributes to understanding the factors influencing patient choice and offers valuable insights into the real-world application of these techniques, enhancing patient-centered care in SUI management.

Quality of life and anxiety 12 and 36 months after surgical SUI treatment in postmenopausal women.

BACKGROUND: Stress urinary incontinence (SUI) is a common condition that affects a significant group of postmenopausal women, lowering quality of life, leading to embarrassment, social isolation, and decreased physical activity. SUI can be treated with medication, behavioral changes, pelvic floor muscle exercises, or surgical intervention. This study aimed to assess the changes in quality of life, acceptance of illness, and impact on physical activity, in patients after the transobturator tape (TOT) procedure following long-term assessment. MATERIAL AND METHODS: Forty-five women aged 71.52 ± 4.12 years took part in our follow-up project at 12 and 36 months after surgical intervention. The World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), Acceptance of Illness Scale Questionnaire (AIS), and International Physical Activity Questionnaire (IPAQ) were used in the study. RESULTS: At 36 months after surgery, SUI using TOT showed a significant improvement in health acceptance. Also, there was a number of patients who reported a high level of acceptance according to the AIS. CONCLUSION: Elderly women with SUI, after treatment by TOT, showed a significant improvement in health acceptance 3 years after the procedure.

Exploring the Challenges of Using Minimal Invasive Surgery to Treat Stress Urinary Incontinence: Insights from a Retrospective Case-Control Study.

Stress urinary incontinence (SUI) is a significant global health issue that particularly affects females, leads to notable societal and economic challenges and significantly affects the quality of life. This study focuses on the comparative analysis of two established surgical interventions, tension-free vaginal tape (TVT) and transobturator tape (TOT), at a single center and applied to 455 women suffering from SUI, with a mean follow-up period of 102 ± 30 months for TVT and 80.4 ± 13 months for TOT. Our findings indicate that, in comparison to TVT, the TOT procedure demonstrates fewer early and late post-operative complications in patient outcomes (1.41% vs. 17.64% and; 5.66% vs. 12.74%, both respectively). However, the TVT procedure shows a modestly favorable outcome in the risk of recurrence of SUI, compared to TOT (0% vs. 3.7%); the TOT procedure has also proven to be more effective in alleviating of urgency symptoms, although not at a statistically significant level (p = 0.072). Univariable and multivariable analysis of factors that predict late complications showed that only obesity can predict a worse outcome [OR]: 1.125 CI 95%: 1.105-1.533, p = 0.037), when adjustments are made for symptoms presented before surgery and procedure type. While both methods are safe and effective, the choice between them should be based on the specific characteristics of each case.

Adjustable transobturator male system (ATOMS) for stress urinary incontinence: the evidence is mounting.

OBJECTIVES: To evaluate the New Zealand clinical experience with the adjustable transobturator male system (ATOMS), a novel continence device in the management of all degrees of stress urinary incontinence (SUI), focusing on efficacy and safety outcomes. PATIENTS AND METHODS: A retrospective review of all ATOMS devices placed between May 2015 and November 2020 was conducted. Severity of SUI was assessed (pad usage) before and after surgery. SUI was defined as mild (1-<3 pads/day), moderate (≥3-5 pads/day) or severe (>5 pads/day). The primary outcome measures considered were the overall success rate (improvement in pad use) and the dry rate (with dry defined as either no or 1 safety pad/day). The number of outpatient adjustments and total filling volumes were also documented in each case. Additionally, we documented incidence and severity of device complications and an analysis of treatment failures. RESULTS: A total of 140 patients were reviewed, with the most common indication for ATOMS placement being SUI after radical prostatectomy (82.8%). Of the patients included, 53 (37.9%) had previous radiotherapy, with 26 (18.6%) patients having had a previous continence procedure performed. No intraoperative complications were noted. The median preoperative pad usage was 4 pads/day. After a median follow-up of 11 months, median postoperative pad usage reduced to 1 pad/day. In our cohort, 116 patients (82.9%) reported an improvement in their pad usage and were considered successful with 107 (76.4%) patients reporting themselves to be dry. Complications within the first 90-days after surgery occurred in 20 (14.3%) of patients. CONCLUSION: Treatment of SUI with the ATOMS is safe and effective. The option of long-term, minimally invasive adjustment to respond to patient needs is a significant advantage.