Long-term postoperative follow-up results of transobturator autologous rectus fascial sling versus transobturator tension-free vaginal tapes for female stress urinary incontinence: Randomized controlled clinical trial.

AIMS: To evaluate the outcomes of a new surgical technique for the treatment of stress urinary incontinence (SUI). METHODS: This randomized study included 132 index patients from January 2017 to May 2021, 60 applied with autologous facia and 60 with transobturator tension-free vaginal tape (TVT-O). The primary endpoint was dryness (negative stress test and 0 pad use per day) and this was assessed at 3, 6, 12, and 24 months. The secondary endpoints were the International Consultation on Incontinence Questionnaire short form (ICIQ-SF) and the urinary incontinence quality of life (QoL) at 3, 6, 12, and 24 months. RESULTS: The dryness rate at 24 months was 92.4% (49/53) for patients with transobturator autologous rectus fascial sling (TO-AFS) and 94.6% (53/56) for those with TVT-O (p = 0.47). No difference was determined between the TO-AFS and TVT-O groups in respect of the ICIQ-SF and QoL scores at 2 years postoperatively (p = 0.87). There were five postoperative complications in the TO-AFS group (one urinary retention, one hematoma at suprapubic incision line, and three intermittent groin pains) and four in the TVT-O group (four persistent groin pain) (p = 0.98). CONCLUSIONS: The objective cure rates of the 24-month outcomes of TO-AFS indicate that this novel surgical technique seems to be a highly effective, safe, and feasible procedure for the treatment of SUI, but further studies including long-term follow-up are mandatory to confirm these preliminary data.

Using a checklist to increase the effectiveness of behavioral therapy for overactive bladder: A prospective randomized controlled trial.

AIM: To evaluate the benefits of a newly established checklist form of behavioral therapy for overactive bladder (OAB). METHODS: Of a total of 180 patients suffering eight or more micturitions, two or more nocturia, seven or more urgency, or four more urinary urgency incontinence (UUI) episodes per day according to a 3-day bladder diary, 155 were randomly divided into four groups. Group I (n = 29) patients were instructed to apply only behavioral therapy as a written guideline and group II (n = 27) patients were instructed to apply behavioral therapy with a written checklist. Group III (n = 26) patients received medical treatment plus behavioral therapy without a checklist. Group IV (n = 28) patients received medical treatment with a written checklist over a 6-month period. RESULTS: A total of 110 participants completed the study period. The demographic data and baseline voiding parameters such as frequency, urgency, nocturia, and UUI of the participants in all four groups were similar (P > 0.05 for all). At the end of the study period, the highest rates of treatment response (64.3%) and adherence (85.7%) were determined for the patients with antimuscarinic drugs plus checklist. The persistence rate of patients using antimuscarinics with the checklist was higher than that of those using antimuscarinics plus a written guideline of behavioral therapy (75.4% vs 60.2%). CONCLUSION: The effectiveness of behavioral therapy for OAB can be improved with this newly designed checklist. In addition, the adherence and persistence rate of medical treatment may also improve with the checklist used.

Preoperative Risk Factors Predicting Complication Rates of Augmentation Cystoplasty Using the Modified Clavien Classification System in Pediatric Population.

OBJECTIVE: To evaluate preoperative predictive factors for postoperative complications of augmentation cystoplasty in children by using the modified Clavien classification system (MCCS). PATIENTS AND METHODS: A retrospective review of medical records between 1994 and 2014 identified 117 children (64 males and 53 females) who underwent augmentation cystoplasty. Complications were evaluated according to the MCCS. Univariate and multivariate analyses were used to determine predictive factors affecting complication rates. RESULTS: The mean (SD) age was 9.3 (1.9) years and the mean (SD) hospitalization time was 9.7 (3.6) days. Patients with an adverse or unexpected event within 30 days of surgery were identified. Complications occurred in 29 (24.7%) children; 13 (11.1%) were MCCS grade I, 8 (5.1%) were grade II, 5 (4.2%) were grade III, and 3 (2.5%) were grade IV. Antireflux surgery, outlet resistance increasing procedures, Society of Fetal Urology (SFU) grades 3-4 hydronephrosis, posterior urethral valves, scoliosis, and serum creatinine greater than 1.0 mg/dL were statistically significant predictors of complications on univariate analysis. In the multivariate analysis, SFU grades 3-4 hydronephrosis, bladder neck reconstruction, and serum creatinine greater than 1.0 mg/dL were statistically significant independent predictors of complications. CONCLUSION: Augmentation cystoplasty remains a valid method of treating severe bladder dysfunction in children. SFU grades 3-4 hydronephrosis, outlet resistance increasing procedures, and serum creatinine greater than 1.0 mg/dL were the main predictive factors for postoperative complications. Use of a standardized complication grading system, such as the MCCS, should be encouraged to allow the valid comparison of complication rates between series.