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1.
Urologiia ; (5): 44-47, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808631

RESUMO

AIM: to improve treatment results of patients with stress urinary incontinence and severe cystocele by optimizing surgical tactics and rehabilitation methods. MATERIALS AND METHODS: a total of 56 women aged 54 to 68 years with stages III-IV of the anterior vaginal wall prolapse (according to the POP-Q classification) and urethral sphincter insufficiency were evaluated. All patients underwent a transvaginal extraperitoneal anterior mesh repair without concomitant sling procedure. The severity of prolapse, a presence or absence of stress urinary incontinence, and ultrasound signs of sphincter insufficiency were re-evaluated two months after procedure. RESULTS: in all cases, the anterior wall prolapse was eliminated or reduced to subclinical stage. Two months after procedure, 48 patients (85,7%) noted the onset of stress urinary incontinence (moderate and severe) with progressive deterioration. In the remaining cases (14,3%), patients did not have any urinary incontinence. All patients underwent active rehabilitation for 6 months. In 6 cases (12,5%), there was a decrease in the severity of urinary incontinence to the level that had virtually didnt affect the quality of life; in remaining cases, conservative treatment was considered ineffective and sling procedure was recommended. DISCUSSION: A diagnosis of latent urinary incontinence remains to be controversial. To detect this form, a cough test with a prolapse reduction is usually performed. In addition, preoperative urodynamic testing can be used, since it has good sensitivity in identifying latent urinary incontinence, but it is an expensive procedure for the routine practice. A determination of the urethral sphincter insufficiency makes it possible to predict the development of the stress urinary incontinence with a high accuracy, but this method also has a number of limitations. CONCLUSION: patients with stages III-IV of the anterior vaginal wall prolapse and ultrasound signs of sphincter insufficiency have a risk of developing stress urinary incontinence after surgical treatment. In this group of patients, a simultaneous surgery can be recommended in order to correct prolapse and to prevent subsequent urinary incontinence.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Qualidade de Vida , Uretra/diagnóstico por imagem , Incontinência Urinária por Estresse/reabilitação , Prolapso Uterino/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Telas Cirúrgicas , Uretra/fisiopatologia , Incontinência Urinária por Estresse/complicações , Urodinâmica
2.
Curr Med Sci ; 39(4): 615-621, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31346999

RESUMO

The prevalence of, and related factors to, stress urinary incontinence (SUI) among perimenopausal Chinese women and its impact on daily life among those women with sexual desire problem in Hubei province were investigated. In this study, 1519 perimenopausal women aged 40 to 65 years were selected from three urban communities in the Wuhan area, and two impoverished, mountainous communities in Hubei province, and followed from April to October 2014. Detailed information about demographic characteristics, menstruation, pregnancy, sexual life and chronic diseases was collected. A cross-sectional survey was carried out following information collection by Chi-square test and multiple logistic regression analysis. Univariate and multivariate logistic regression analysis demonstrated that the potential factors associated with developing SUI were old age (OR=3.4, 95% CI: 1.92-6.04), vaginal delivery (OR=0.623, 95% CI: 0.45-0.87), low income (OR=0.063, 95% CI: 0.40-0.92), atrophic vaginitis (OR=1.4, 95% CI: 1.03-1.80), pelvic organ prolapse (OR=2.81, 95% CI: 1.36-5.80), chronic pelvic pain (OR=2.17, 95% CI: 1.90-4.03), constipation (OR=1.44, 95% CI: 1.07-1.93) and incontinence of feces (OR=3.32, 95% CI: 2.03-5.43). Moreover, the ratio of SUI (33.2%) was higher than the ratio of urgency urinary incontinence (24.1%) or the ratio of mixed urinary incontinence (17.4%), and SUI had a greater impact on daily life among women with decreased sexual desire. In conclusion, SUI is a common disorder affecting over one third of the women surveyed, and has a severe impact on the daily life of perimenopausal women with declined sexual desire. Age, mode of delivery, and monthly income are major risk factors involved in the development of SUI.


Assuntos
Prolapso de Órgão Pélvico/epidemiologia , Comportamento Sexual/fisiologia , Incontinência Urinária por Estresse/epidemiologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/patologia , Perimenopausa/fisiologia , Gravidez , Prevalência , Fatores de Risco , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/patologia
3.
Urology ; 129: 210-216, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31005655

RESUMO

OBJECTIVE: To determine whether frailty is associated with increased odds of 30-day surgical complications among men undergoing both artificial urinary sphincter (AUS) placement and removal procedures and to determine whether frailty was associated with increased odds of having an AUS removal procedure. METHODS: This is a retrospective cohort study of men undergoing AUS placement and removal procedures using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2006 to 2013. Frailty was quantified using the NSQIP-FI (frailty index) and was applied to logistic regression models predicting 30-day complications (overall, major, and minor) and the odds of having an AUS removal procedure (over an AUS placement procedure). RESULTS: We identified a total of 624 and 147 men undergoing AUS placement and removal procedures, respectively. NSQIP-FI of ≥0.27, but not age, was associated with major complications (aOR 3.5, 95% confidence interval 1.2-9.9), while age ≥85 years, but not NSQIP-FI, was associated with minor complications (aOR 7.9, 95% confidence interval 1.4-45.6). Men undergoing AUS removal procedures tended to be more frail compared to men undergoing AUS placement procedures (12.9% vs 6.1% had NSQIP-FI of ≥0.27, P<.01). CONCLUSION: Men undergoing AUS removal procedures are, on average, more frail compared to men undergoing AUS placement procedures. Frailty is associated with increased odds of major complications and with having an AUS removal procedure. These findings highlight the importance of incorporating measures of frailty, instead of age alone, into the perioperative decision-making process for adults considering these types of procedures.


Assuntos
Remoção de Dispositivo/métodos , Fragilidade/complicações , Complicações Pós-Operatórias/epidemiologia , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial/efeitos adversos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Incontinência Urinária por Estresse/complicações
4.
Geriatr Gerontol Int ; 19(4): 299-304, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30811813

RESUMO

AIM: The aim of the present study was to investigate the effect of female pelvic floor dysfunction on sexual function and quality of life among different age groups. METHODS: An observational study was carried out on 648 patients with pelvic organ prolapse (POP) or/and stress urinary incontinence. We assessed female sexual function and quality of life through the Prolapse/Urinary Incontinence Sexual Questionnaire Short Form and Incontinence Quality of Life Scale before surgeries, respectively. Patients were assigned into different age groups. RESULTS: The mean age of all patients was 62.04 ± 9.39 years. A total of 436 patients had POP, 120 patients had stress urinary incontinence and the remaining patients had both. Although sexual frequency decreased with increasing age, 517 patients still remained sexually active. A total of 10.83% of the patients aged ≥70 years were still sexually active, and 8.51% of them had sex less than one time per month. The Prolapse/Urinary Incontinence Sexual Questionnaire Short Form score and sexual frequency decreased with increasing age. However, the Incontinence Quality of Life Scale score increased with increasing age. Patients with only POP and aged ≥70 years showed a higher Incontinence Quality of Life Scale score (P < 0.001). CONCLUSIONS: The present study showed that POP and stress urinary incontinence are common among older Chinese women, and re associated with decreased sexual satisfaction and quality of life in China. It suggests that the existing sexual requirement of these patients should also be reconsidered before surgical assessment. Doctors should take sexual satisfaction into consideration when choosing a personalized type of surgery to improve the patients' quality of life physiologically and psychologically. Geriatr Gerontol Int 2019; 19: 299-304.


Assuntos
Diafragma da Pelve/fisiopatologia , Prolapso de Órgão Pélvico , Qualidade de Vida , Disfunções Sexuais Fisiológicas , Incontinência Urinária por Estresse , Idoso , China/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Orgasmo , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/diagnóstico , Prolapso de Órgão Pélvico/epidemiologia , Pesquisa Qualitativa , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/epidemiologia
5.
Eur J Obstet Gynecol Reprod Biol ; 233: 141-145, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30597338

RESUMO

OBJECTIVE: Overactive bladder (OAB) symptoms are frequently associated with pelvic organ prolapse (POP) and both postoperative improvement and de novo onset of OAB symptoms have been described. The aim of the study is to identify risk factors for persistent, de novo and overall postoperative OAB after POP repair. STUDY DESIGN: This was a retrospective study including patients who underwent primary POP surgery. Medical interview, urogenital examination and urodynamics were performed preoperatively; patients were examined one and six months after surgery and then yearly. RESULTS: 518 patients were included. 36.1% of women preoperatively complained of OAB symptoms while detrusor overactivity was found in 20.5%. The rate of persistent and de novo OAB after surgery were respectively 14.1% and 13.5%. Multivariate analysis found age, BMI, preoperative OAB, sling placement and postoperative SUI as independent risk factors for overall OAB after surgery. Moreover, preoperative OAB and postoperative constipations were associated with OAB persistence after surgery. Finally, age, sling placement, postoperative SUI and voiding symptoms were independently associated with de novo OAB. CONCLUSION: Preoperative OAB symptoms are associated with OAB persistence after POP surgery, while age and sling placement correlate with de novo OAB. Finally, increased BMI is related to postoperative OAB.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/etiologia , Slings Suburetrais/efeitos adversos , Bexiga Urinária Hiperativa/etiologia , Incontinência Urinária por Estresse/complicações , Fatores Etários , Idoso , Índice de Massa Corporal , Feminino , Humanos , Histerectomia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/epidemiologia , Incontinência Urinária por Estresse/epidemiologia
6.
Low Urin Tract Symptoms ; 11(2): O168-O173, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30484955

RESUMO

OBJECTIVE: This study investigated the long-term success rate of retropubic suburethral sling in the treatment of women with stress urinary incontinence (SUI) and different bladder function. METHODS: Surgical outcomes of women with SUI undergoing a retropubic suburethral sling procedure between October 1989 and November 2014 were analyzed retrospectively. Bladder function was evaluated in every patient preoperatively using videourodynamic studies. Patients were classified as having stable bladder, detrusor overactivity (DO), or detrusor underactivity (DU). Baseline urodynamic parameters were analyzed and long-term therapeutic outcomes were compared among these three groups. RESULTS: In all, 403 patients underwent sling procedure for SUI. Of these, 291 (72.2%) had a stable bladder, 78 (19.4%) had DO, and 34 (8.4%) had DU. Mean (± SD) patient age was 60.2 ± 11.8 years, and the median follow-up was 97 months (interquartile range 24-325 months). Postoperatively, the overall continence rate was 83.4% (336/403). After surgery, 71 patients (17.6%) complained of dysuria, 14 (3.5%) complained of urgency incontinence, 25 (6.2%) had recurrent SUI requiring a secondary sling procedure, and urethrolysis was performed in 13 (3.2%). In the stable bladder, DO, and DU groups, the 5-year continence rates were 88.6%, 84.1%, and 79.4%, respectively (P = 0.59), whereas the 10-year continence rates were 83.8%, 72.9%, and 79.4%, respectively. Kaplan-Meier survival analysis indicated that the long-term success rate was similar among the three groups (P = 0.39). CONCLUSIONS: The overall continence rate was 83.4% and the 10-year continence rate was satisfactory in all bladder function subgroups. Treatment outcomes were the same for women with SUI but different bladder function.


Assuntos
Slings Suburetrais , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária/fisiopatologia , Incontinência Urinária por Estresse/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Implantação de Prótese , Estudos Retrospectivos , Resultado do Tratamento , Bexiga Urinária/fisiologia , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária por Estresse/complicações , Urodinâmica
7.
World J Urol ; 37(5): 885-889, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30116962

RESUMO

PURPOSE: Stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) lead to poor quality of life. In Japan, urinary incontinence is treated with tension-free vaginal tape (TVT) or transobturator tape (TOT) sling procedures, which involves inserting a synthetic material; however, problems arise with artificial mesh in some instances, requiring new treatment methods. Hence, laser therapy, whereby an erbium-doped yttrium aluminum garnet laser is directed into the vagina and urethra, may be useful. The study aimed to compare the effects of these three treatments. METHODS: Subjects included patients who received TVT, TOT, or laser therapy (n = 50 each). The 1-h pad test, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and overactive bladder symptom score were used to assess the patients before and 12 months after treatment. For laser therapy, a probe was inserted into the vagina after applying a local anesthetic to the vaginal wall, and irradiation was performed for 20 min at a wavelength of 2940 nm. This treatment was performed three times every alternate month. RESULTS: As per the 1-h pad test and ICIQ-SF, the TVT, TOT, and laser therapy groups showed comparable improvements in SUI. For patients with MUI, some in the TVT and TOT groups showed exacerbation; however, all patients in the laser therapy group tended to improve. CONCLUSIONS: The efficacy of laser therapy for urinary incontinence was confirmed. This is the first study to report on the effect of laser therapy on urinary incontinence in Japanese women.


Assuntos
Terapia a Laser/métodos , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária de Urgência/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Feminino , Humanos , Lasers de Estado Sólido , Pessoa de Meia-Idade , Incontinência Urinária por Estresse/complicações , Incontinência Urinária de Urgência/complicações
8.
Gynecol Endocrinol ; 35(2): 155-159, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30324854

RESUMO

The aim of this study was to assess the effectiveness and safety of Ospemifene in the improvement of urgency component in women affected by mixed urinary incontinence (MUI) who underwent surgery with mid-urethral sling (MUS). Eighty-one patients with MUI underwent surgical intervention with MUS were enrolled. After surgical intervention 38 patients received Ospemifene 60 mg one tablet daily per os for 12 weeks. Physical examination, 3-day voiding diary, urodynamic testing were performed at the start and the follow-up after 12 weeks in the Trans-Obturator-Tape (TOT)-Alone group and TOT-Ospemifene. Patients completed the Overactive Bladder Symptom and Health-Related Quality of Life Short-Form (OAB-Q SF), International Consultation on Incontinence Questionnaire (ICIQ-UI-SF), and King' s Health Questionnaire (KHQ). A significant difference between the two groups was observed in peak flow (ml/s), in first voiding desire (ml), in maximum cystometric capacity (ml), and in detrusor pressure at peak flow (cmH2O) at urodynamic evaluation. A significative difference between the two groups at voiding diary was observed in the mean number of voids, urgent micturition episodes/24 h, urge urinary incontinence, and in nocturia events. The OAB-Q symptoms and OAB-Q (HRQL) scores after 12 weeks showed a significative difference between the two groups. Ospemifene is an effective potential therapy after MUSs in women with MUI improving urgency symptoms and quality of life.


Assuntos
Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Slings Suburetrais , Tamoxifeno/análogos & derivados , Incontinência Urinária por Estresse/terapia , Incontinência Urinária de Urgência/terapia , Procedimentos Cirúrgicos Urológicos , Idoso , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Tamoxifeno/uso terapêutico , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária de Urgência/complicações , Incontinência Urinária de Urgência/fisiopatologia , Urodinâmica
9.
J Sex Med ; 15(11): 1515-1517, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30327263

RESUMO

INTRODUCTION: Vaginal laxity is increasingly recognized as an important condition, although little is known regarding its prevalence and associated symptoms. AIM: To report the prevalence of self-reported vaginal laxity in women attending a urogynecology clinic and investigate its association with pelvic floor symptoms and female sexual dysfunction. METHOD: Data were analyzed from 2,621 women who completed the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF). MAIN OUTCOME MEASURE: Response data from ePAQ-PF questionairre. RESULTS: Vaginal laxity was self-reported by 38% of women and significantly associated with parity, symptoms of prolapse, stress urinary incontinence, overactive bladder, reduced vaginal sensation during intercourse, and worse general sex life (P < .0005). CLINICAL IMPLICATIONS: Clinicians should be aware that vaginal laxity is prevalent and has an associated influence and impact on sexual function. STRENGTH & LIMITATIONS: The main strength of this study is the analysis of prospectively collected data from a large cohort of women using a validated questionnaire. The main limitation is lack of objective data to measure pelvic organ prolapse. CONCLUSION: Vaginal laxity is a highly prevalent condition that impacts significantly on a woman's sexual health and quality of life. Campbell P, Krychman M, Gray T, et al. Self-reported vaginal laxity-Prevalence, impact, and associated symptoms in women attending a urogynecology clinic. J Sex Med 2018;15:1515-1517.


Assuntos
Diafragma da Pelve/fisiopatologia , Autorrelato , Doenças Vaginais/epidemiologia , Adulto , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Reino Unido/epidemiologia , Incontinência Urinária por Estresse/complicações , Doenças Vaginais/complicações , Doenças Vaginais/fisiopatologia , Saúde da Mulher
10.
Int J Gynaecol Obstet ; 143(3): 339-343, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30238448

RESUMO

OBJECTIVE: To assess the long-term outcomes of tension-free vaginal tape obturator (inside-out) (TVTO) with or without anterior colporrhaphy. METHODS: The present prospective follow-up observational study included patients attending the 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Greece, between April 3 and December 20, 2017, for follow-up care after treatment for urodynamic stress urinary incontinence (USUI) with or without cystocele. Patients without cystocele had been treated with TVTO only; those with cystocele underwent TVTO with anterior colporrhaphy. The primary outcome was the objective cure rate assessed by the cough stress test during filling cystometry. RESULTS: Follow-up data were available for 70 patients who underwent TVTO only and 38 who underwent TVTO and anterior colporrhaphy. The mean follow-up period was 13 years. Objective cure was achieved for 57 (81%) patients in the TVTO-only group and 32 (84%) patients in the TVTO and anterior colporrhaphy group. Regarding cystocele management, objective cure was recorded for 35 (92%) patients. CONCLUSION: At 13-year follow-up, anterior colporrhaphy demonstrated a cure rate of 92% in the management of cystocele, and 84% in the management of cystocele and USUI when combined with TVTO. TVTO alone for the management of USUI had an objective cure rate of 81%.


Assuntos
Cistocele/cirurgia , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Idoso , Idoso de 80 Anos ou mais , Colpotomia , Cistocele/complicações , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária por Estresse/complicações
11.
Cochrane Database Syst Rev ; 8: CD013108, 2018 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-30121956

RESUMO

BACKGROUND: Pelvic organ prolapse (POP) is common in women and is frequently associated with stress urinary incontinence (SUI). In many cases however, SUI is present only with the prolapse reduced (occult SUI) or may develop after surgical treatment for prolapse (de novo SUI). OBJECTIVES: To determine the impact on postoperative bladder function of surgery for symptomatic pelvic organ prolapse with or without concomitant or delayed two-stage continence procedures to treat or prevent stress urinary incontinence. SEARCH METHODS: We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE-In-Process, ClinicalTrials.gov, WHO ICTRP, handsearching journals and conference proceedings (searched 11 November 2017) and reference lists of relevant articles. We also contacted researchers in the field. SELECTION CRITERIA: Randomised controlled trials (RCTs) including surgical operations for POP with or without continence procedures in continent or incontinent women. Our primary outcome was subjective postoperative SUI. Secondary outcomes included recurrent POP on examination, overactive bladder (OAB) symptoms, and voiding dysfunction. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by Cochrane. MAIN RESULTS: We included 19 RCTs (2717 women). The quality of the evidence ranged from low to moderate. The main limitations were risk of bias (especially blinding of outcome assessors), indirectness and imprecision associated with low event rates and small samples.POP surgery in women with SUIVaginal repair with vs without concomitant mid-urethral sling (MUS)A concomitant MUS probably improves postoperative rates of subjective SUI, as the evaluated clinical effect appears large (risk ratio (RR) 0.30, 95% confidence interval (CI) 0.19 to 0.48; 319 participants, two studies; I² = 28%; moderate-quality evidence), and probably decreases the need for further continence surgery (RR 0.04, 95% CI 0.00 to 0.74; 134 participants, one study; moderate-quality evidence). This suggests that if the risk of SUI with POP surgery alone is 39%, the risk with an MUS is between 8% and 19%.Rates of recurrent POP on examination, OAB, and voiding dysfunction were not reported.Vaginal repair with concomitant vs delayed MUSEvidence suggested little or no difference between groups in reporting postoperative SUI (RR 0.41, 95% CI 0.12 to 1.37; 140 participants, one study; moderate-quality evidence).Rates of recurrent POP on examination, OAB, and voiding dysfunction and the need for further surgery were not reported.Abdominal sacrocolpopexy with vs without Burch colposuspensionAn additional Burch colposuspension probably has little or no effect on postoperative SUI at one year (RR 1.38, 95% CI 0.74 to 2.60; 47 participants, one study; moderate-quality evidence), OAB symptoms (RR 0.85, 95% CI 0.61 to 1.18; 33 participants, one study; moderate-quality evidence), or voiding dysfunction (RR 0.96, 95% CI 0.06 to 14.43; 47 participants, one study; moderate-quality evidence). Rates of recurrent POP and the need for further surgery were not reported.POP surgery in women with occult SUIVaginal repair with vs without concomitant MUSMUS probably improves rates of subjective postoperative SUI (RR 0.38, 95% CI 0.26 to 0.55; 369 participants, five studies; I² = 44%; moderate-quality evidence). This suggests that if the risk with surgery alone is 34%, the risk with a concomitant MUS is between 10% and 22%. Evidence suggests little or no difference between groups in rates of recurrent POP (RR 0.86, 95% CI 0.34 to 2.19; 50 participants, one study; moderate-quality evidence), OAB symptoms (RR 0.75, 95% CI 0.52 to 1.07; 43 participants, one study; low-quality evidence), or voiding dysfunction (RR 1.00, 95% CI 0.15 to 6.55; 50 participants, one study; low-quality evidence). The need for further surgery was not reported.POP surgery in continent women Vaginal repair with vs without concomitant MUSResearchers provided no conclusive evidence of a difference between groups in rates of subjective postoperative SUI (RR 0.69, 95% CI 0.47 to 1.00; 220 participants, one study; moderate-quality evidence). This suggests that if the risk with surgery alone is 40%, the risk with a concomitant MUS is between 19% and 40%. Rates of recurrent POP, OAB, and voiding dysfunction and the need for further surgery were not reported.Abdominal sacrocolpopexy with vs without Burch colposuspensionWe are uncertain whether there is a difference between groups in rates of subjective postoperative SUI (RR 1.31, 95% CI 0.19 to 9.01; 379 participants, two studies; I² = 90%; low-quality evidence), as RCTs produced results in different directions with a very wide confidence interval. We are also uncertain whether there is a difference between groups in rates of voiding dysfunction (RR 8.49, 95% CI 0.48 to 151.59; 66 participants, one study; low-quality evidence) or recurrent POP (RR 0.98, 95% CI 0.74 to 1.30; 250 participants, one study; moderate-quality evidence. No study reported OAB symptoms and need for further surgery.Vaginal repair with armed anterior vaginal mesh repair vs anterior native tissue Anterior armed mesh repair may slightly increase postoperative de novo SUI (RR 1.58, 95% CI 1.05 to 2.37; 905 participants, seven studies; I² = 0%; low-quality evidence) but may decrease recurrent POP (RR 0.29, 95% CI 0.22 to 0.38; 848 participants, five studies; I² = 0%; low-quality evidence). There may be little or no difference in rates of voiding dysfunction (RR 1.65, 95% CI 0.22 to 12.10; 125 participants, two studies; I² = 0%; low-quality evidence). Rates of OAB and the need for further surgery were not reported.Adverse events were infrequently reported in all studies; cost was not studied in any trial. AUTHORS' CONCLUSIONS: In women with POP and SUI (symptomatic or occult), a concurrent MUS probably reduces postoperative SUI and should be discussed in counselling. It might be feasible to postpone the MUS and perform a delayed (two-stage) continence procedure, if required.Although an abdominal continence procedure (Burch colposuspension) during abdominal POP surgery in continent women reduced de novo SUI rates in one underpowered trial, another RCT reported conflicting results. Adding an MUS during vaginal POP repair might reduce postoperative development of SUI.An anterior native tissue repair might be better than use of transobturator mesh for preventing postoperative SUI; however, prolapse recurrence is more common with native tissue repair.


Assuntos
Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais , Incontinência Urinária por Estresse/complicações , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Telas Cirúrgicas
12.
Arch. esp. urol. (Ed. impr.) ; 71(6): 531-536, jul.-ago. 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-178722

RESUMO

Introducción: Diversos autores han argumentado que el componente de urgencia miccional en incontinencia urinaria mixta (IOM) es diferente a la incontinencia de urgencia pura (IOU). En este caso ha sugerido que la incontinencia en IOM puede ser sobrediagnosticada en pacientes con IOE que malinterpretan su pérdida como IOU. Objetivos: Evaluar las características clínicas y urodinámicas de pacientes con IOM e IOU pura. Métodos: Realizamos un estudio retrospectivo de nuestra base de datos de urodinamia evaluando 450 mujeres con IOM e IOU. Se excluyeron pacientes con vejiga neurogénica, fístulas, divertículo uretral, cirugía uroginecológica previa, obstrucción infravesical conocida, radioterapia pélvica previa, infección del tracto urinario e ingesta de psicofármacos. A todos se les realizó historia clínica completa, examen físico, uroflujometría, cistometría de llenado y estudio presión flujo. Resultados: No existen diferencias en relación a edad, menopausia y número de partos. La presencia de nicturia fue mayor en el grupo de IOU (66,4% vs. 46,1%, p 0,0004) al igual que el aumento de la frecuencia miccional (53,6% vs. 34,6%, p 0,0006). Al examen físico la presencia de hipermovilidad uretral e IOE fue mayor en el grupo de IOM, mientras que la presencia de trofismo vaginal reducido fue mayor en IOU. No encontramos diferencias en la sensibilidad y capacidad vesical. La presencia de detrusor hiperactivo fue de 56,4% en IOU pura vs. 33,2% de IOM (p<0,0001). No encontramos diferencias en estudio presión flujo. Conclusiones: Existen diferencias significativas en los parámetros clínicos y urodinámicos entre pacientes con IOM e IOU pura. La urgencia en pacientes con IOU pura estaría más relacionada con detrusor hiperactivo. Es probable que muchos pacientes con IOM solo tengan IOE pura, lo que llevaría a efectos positivos en los resultados de cirugía antiincontinencia


Introduction: Various authors argued that the voiding urgency component in mixed urinary incontinence (MUI) is different than urge urinary incontinence (UUI). In this last case they suggest that incontinence in MUI could be overdiagnosed in patients with SUI, misunderstanding the leak as UUI. Objetives: To evaluate clinical and urodynamic characteristics of patients with MUI and pure UUI. METHODS: A retrospective study of our urodynamics database was performed evaluating 450 women with MUI and UUI. Patients with neurogenic bladder, fistulae, urethral diverticula, previous urogynecologic surgery, known infravesical obstruction, previous pelvic radiotherapy, urinary tract infection or psychiatric drugs intake. A full clinical history, physical exam, uroflowmetry, filling cystometry and pressure flow study were performed. Results: There is no difference relative to age, menopause and number of births. The presence of nocturia was bigger in the UUI group (66.4% vs. 46.1%, p 0.0004) the same as increased voiding frequency (53.6% vs. 34.6%, p 0.0006). The presence of urethral hypermobility and SUI in the physical exam was greater than MUI, meanwhile the presence of reduced vaginal trophism was bigger in the UUI group. Differences in sensibility or specificity were not found. The presence of overactive detrusor was 56.4% in pure UUI vs. 33.2% in MUI (p<0.0001). No differences in pressure flow study were found. Conclusions: There is a significant difference in the clinical and urodynamic parameters between patients with MUI and pure UUI. The urgency in patients with pure UUI could be related to overactive detrusor. It is probable that many patients with MUI just have pure SUI which could lead to positive effects in the outcomes of anti-incontinence surgery


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/diagnóstico , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária Hiperativa/diagnóstico , Incontinência Urinária de Urgência/complicações , Incontinência Urinária de Urgência/diagnóstico , Estudos Retrospectivos , Incontinência Urinária por Estresse/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Urodinâmica
13.
Arch Esp Urol ; 71(6): 531-536, 2018 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-29991661

RESUMO

INTRODUCTION: Various authors argued that the voiding urgency component in mixed urinary incontinence (MUI) is different than urge urinary incontinence (UUI). In this last case they suggest that incontinence in MUI could be overdiagnosed in patients with SUI, misunderstanding the leak as UUI. OBJETIVES: To evaluate clinical and urodynamic characteristics of patients with MUI and pure UUI. METHODS: A retrospective study of our urodynamics database was performed evaluating 450 women with MUI and UUI. Patients with neurogenic bladder, fistulae, urethral diverticula, previous urogynecologic surgery, known infravesical obstruction, previous pelvic radiotherapy, urinary tract infection or psychiatric drugs intake. A full clinical history, physical exam, uroflowmetry, filling cystometry and pressure flow study were performed. RESULTS: There is no difference relative to age, menopause and number of births. The presence of nocturia was bigger in the UUI group (66.4% vs. 46.1%, p 0.0004) the same as increased voiding frequency (53.6% vs. 34.6%, p 0.0006). The presence of urethral hypermobility and SUI in the physical exam was greater than MUI, meanwhile the presence of reduced vaginal trophism was bigger in the UUI group. Differences in sensibility or specificity were not found. The presence of overactive detrusor was 56.4% in pure UUI vs. 33.2% in MUI (p<0.0001). No differences in pressure flow study were found. CONCLUSIONS: There is a significant difference in the clinical and urodynamic parameters between patients with MUI and pure UUI. The urgency in patients with pure UUI could be related to overactive detrusor. It is probable that many patients with MUI just have pure SUI which could lead to positive effects in the outcomes of anti-incontinence surgery.


Assuntos
Bexiga Urinária Hiperativa/complicações , Bexiga Urinária Hiperativa/diagnóstico , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária de Urgência/complicações , Incontinência Urinária de Urgência/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Urodinâmica
14.
J Urol ; 200(4): 848-855, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29730202

RESUMO

PURPOSE: We examined how mental health measures, sleep and physical function are associated with the presence and type of urinary incontinence and severity in women seeking treatment for lower urinary tract symptoms. MATERIALS AND METHODS: This baseline cross-sectional analysis was performed in treatment seeking women with lower urinary tract symptoms. All participants completed the LUTS (Lower Urinary Tract Symptoms) Tool (Pfizer, New York, New York), which was used to classify women based on urinary incontinence symptoms and measure severity. The PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaire for depression, anxiety, sleep disturbance and physical function, the PSS (Perceived Stress Scale) and the IPAQ-SF (International Physical Activity Questionnaire Short Form) were administered. Multivariable regression modeling was done to assess associations with urinary symptom presence, type and severity. RESULTS: We studied 510 women with a mean ± SD age of 56 ± 14 years. Of the women 82% were Caucasian, 47% were obese and 14% reported diabetes. Urinary incontinence was reported by 420 women (82.4%), including stress urinary incontinence in 70, urgency urinary incontinence in 85, mixed urinary incontinence in 240 and other urinary incontinence in 25. On adjusted analyses there was no difference in any mental health, sleep or physical function measure based on the presence vs the absence of urinary incontinence. Among women with urinary incontinence PROMIS anxiety and sleep disturbance scores were higher in those with mixed urinary incontinence than stress urinary incontinence. Increasing urinary incontinence severity was associated with higher PROMIS depression and anxiety scores, and higher PSS scores. However, higher urinary incontinence severity was not associated with a difference in sleep or physical function. CONCLUSIONS: Among treatment seeking women with lower urinary tract symptoms, increasing urinary incontinence severity rather than the presence or type of urinary incontinence was associated with increased depression, anxiety and stress.


Assuntos
Ansiedade/etiologia , Depressão/etiologia , Qualidade de Vida , Transtornos do Sono-Vigília/epidemiologia , Incontinência Urinária por Estresse/psicologia , Incontinência Urinária por Estresse/terapia , Fatores Etários , Idoso , Ansiedade/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Incidência , Sintomas do Trato Urinário Inferior/complicações , Sintomas do Trato Urinário Inferior/psicologia , Sintomas do Trato Urinário Inferior/terapia , Saúde Mental , Pessoa de Meia-Idade , Análise Multivariada , Medidas de Resultados Relatados pelo Paciente , Aptidão Física/fisiologia , Análise de Regressão , Medição de Risco , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários , Incontinência Urinária por Estresse/complicações
15.
Urol Int ; 100(4): 428-433, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29649817

RESUMO

INTRODUCTION: Transobturator tape (TOT) surgery has been associated with increased overactive bladder (OAB) although much controversy exists. METHODS: In a cross-sectional study, women who underwent TOT surgery for pure stress incontinence (MonarcTM) answered the 6 questions of the symptom bother (SB) subscale of the OAB questionnaire - short form (OABq-SF) and an additional question regarding whether symptoms began after surgery. Women with SB score over the 4th quartile (≥30/100) were reassessed after a longer follow-up. Patients from primary care were recruited as controls. RESULTS: We recruited 213 patients (135 in the TOT group and 78 age-adjusted controls). The mean age of operated patients was 58.7 ± 10.1 years with a mean follow-up of 25.9 ± 13.2 months. OABq-SF SB scores did not differ between the TOT group and controls (respectively, 18.5 ± 30 and 15.5 ± 6.7, p = 0.202). A total of 48% patients reported no relationship between symptoms and surgery. Highly symptomatic operated patients were reassessed after a longer follow-up (46.3 ± 10.6 months). The mean score in the second follow-up (n = 25) was not statistically different from the first assessment (46.4 ± 22.7 and 58.1 ± 19.8, p = 0.059). CONCLUSIONS: Women who underwent TOT surgery did not show increased OAB SB scores when compared to controls. Our study suggests that OAB symptoms may thus be present but overlooked during initial clinical assessment.


Assuntos
Slings Suburetrais/efeitos adversos , Bexiga Urinária Hiperativa/prevenção & controle , Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Estudos Transversais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Resultado do Tratamento , Bexiga Urinária Hiperativa/diagnóstico , Incontinência Urinária por Estresse/complicações , Urodinâmica
16.
Neurourol Urodyn ; 37(5): 1751-1756, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29427320

RESUMO

AIMS: To determine cohort urethral length, identify epidemiological factors influencing the parameter and to establish the percentage of cases with clinically relevant outsized urethras. METHODS: Prospective cohort study conducted in two tertiary clinical centers between 2013 and 2017. Nine hundred and twenty seven consecutive adult, Caucasian females attending outpatients' clinics were included. The urethral length has been measured in pelvic floor ultrasound examination. The exclusion criteria were inadequate bladder filling (<200 mL; >400 mL), previous history of pelvic floor surgery, and no consent. RESULTS: Urethral length varied from 19 to 45 mm. The distribution of the examined parameter was normal. Obese patients had significantly longer urethras as compared to non-obese subjects. Number of vaginal deliveries was connected with shorter urethral length. The limitations of the study are: analysis only of Caucasian patients and subjects without previous pelvic floor surgeries. CONCLUSIONS: Differences in urethral length in the female population were demonstrated. Thirty percent of patients have atypical urethras that may be a risk factor for sling surgery failure. We therefore postulate introduction of urethral measurement before the procedure.


Assuntos
Diafragma da Pelve/diagnóstico por imagem , Ultrassonografia , Uretra/diagnóstico por imagem , Incontinência Urinária por Estresse/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico por imagem , Diafragma da Pelve/cirurgia , Estudos Prospectivos , Fatores de Risco , Slings Suburetrais , Uretra/cirurgia , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos
17.
Curr Urol Rep ; 19(1): 10, 2018 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-29468457

RESUMO

PURPOSE OF REVIEW: Obesity is highly prevalent and is associated with stress urinary incontinence (SUI). The purposes of this review are to assess the pathophysiology of SUI in the obese female and review the outcomes of weight loss and anti-incontinence surgery in this population. RECENT FINDINGS: While increased intra-abdominal pressure appears to be the common pathophysiologic link between obesity and SUI, neurogenic and metabolic pathways have been proposed. Both surgical and non-surgical weight loss continue to have beneficial effects on SUI; however, long-term outcomes are largely absent. Midurethral sling (MUS) surgery is largely effective in the obese population, with a complication profile similar to that in non-obese women. Obesity has been shown to be a risk factor for failure of MUS. While weight loss should be the primary modality to improve SUI in the obese woman, MUS remains an effective and safe option in those women undertaking surgery.


Assuntos
Obesidade/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária por Estresse/cirurgia , Feminino , Humanos , Obesidade/complicações , Implantação de Prótese , Fatores de Risco , Slings Suburetrais , Incontinência Urinária por Estresse/complicações , Perda de Peso/fisiologia
18.
Arch Gynecol Obstet ; 297(3): 725-730, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29335782

RESUMO

OBJECTIVE: To examine the relationship between endogenous sex steroids and various condition-specific quality of life domains in postmenopausal women with pelvic floor disorders. We hypothesized that woman with lowest androgen and estradiol concentrations would report worse scores of quality of life domains. METHODS: Forty-six women with pelvic organ prolapse (POP) and 47 cases with stress urinary incontinence (SUI) answered the validated pelvic floor questionnaire and underwent serum sex steroid measurement. A multivariate logistic regression model was used to determine the association between subjective outcome parameters and serum hormonal levels after adjusting for confounders. RESULTS: Univariate analysis revealed a strong inverse correlation between serum estradiol level (E2) and prolapse domain score (correlation coefficient = 0.005) as well as a significant positive correlation between SHBG level and prolapse domain score (correlation coefficient = 0.019) in cases with POP. Furthermore, the sex domain score showed a significant negative correlation with the androstendion (correlation coefficient = 0.020), DHEAS (correlation coefficient = 0.046) and testosterone level (correlation coefficient = 0.032) in the POP group. In the multivariate model, high serum SHBG (CI: 0.007-0.046) remained independently associated with worse scores in the prolapse domain and low serum DHEAS (CI: - 0.989 to 1.320) persisted as a significant predictor for a worse score in the sex domain. Regarding SUI cases, no association was noted between serum hormonal levels and quality of life related pelvic floor domains (correlation coefficient > 0.05). CONCLUSION: Our results suggest that pelvic floor related quality of life might also be affected by endogenous sex steroids in POP, but not in SUI cases.


Assuntos
Hormônios Esteroides Gonadais/sangue , Distúrbios do Assoalho Pélvico/complicações , Prolapso de Órgão Pélvico/sangue , Pós-Menopausa/sangue , Qualidade de Vida , Incontinência Urinária por Estresse/sangue , Idoso , Sulfato de Desidroepiandrosterona/sangue , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Nível de Saúde , Humanos , Pessoa de Meia-Idade , Distúrbios do Assoalho Pélvico/psicologia , Prolapso de Órgão Pélvico/complicações , Pós-Menopausa/psicologia , Estudos Retrospectivos , Globulina de Ligação a Hormônio Sexual/metabolismo , Inquéritos e Questionários , Incontinência Urinária por Estresse/complicações
19.
Urology ; 112: 38-45, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29107131

RESUMO

OBJECTIVE: To assess the impact of stress urinary incontinence (SUI) on individual components of quality of life (QoL) using both condition-specific and generic questionnaires, and to compare the results of the 2 instruments with a control group. METHODS: Women with or without SUI aged ≥21 years old were recruited. Subjects completed the International Consultation of Incontinence-Urinary Incontinence Short Form (ICIQ-UI-SF), International Consultation of Incontinence-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol), and EQ-5D questionnaires. RESULTS: A total of 120 women with SUI and 145 controls participated. The ICIQ-LUTSqol total score (mean ± standard deviation) was significantly higher in the SUI group (38.96 ± 10.28) compared with the control group (20.78 ± 2.73) (P <.001). When adjusted for significant confounders, the SUI group continued to have significantly poorer QoL compared with the control group (P <.001). The negative effect of SUI on "physical activities" and "jobs" were the 2 most frequently reported and burdensome components of the ICIQ-LUTSqol, with approximately 50% of women with SUI affected "moderately" or "a lot." When measured using the EQ-5D questionnaire, there were significantly higher percentages of patients with SUI who had problems with usual activities, pain or discomfort, and anxiety or depression (P <.05). CONCLUSION: Women suffering from SUI have significantly poorer QoL compared with continent women when measured using both condition-specific and generic QoL measures. Clinicians should pay closer attention to the impact of SUI on individual components of QoL, particularly limitations on physical activities and jobs, which were the 2 most impairing and frequently reported components of QoL.


Assuntos
Qualidade de Vida , Incontinência Urinária por Estresse , Autoavaliação Diagnóstica , Feminino , Humanos , Malásia , Pessoa de Meia-Idade , Incontinência Urinária por Estresse/complicações
20.
Eur J Obstet Gynecol Reprod Biol ; 221: 64-69, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29248808

RESUMO

OBJECTIVES: It is hypothesized that urethral dysfunction is central in mixed urinary incontinence (MUI) in women, since urine entering the proximal urethra under increased intra-abdominal pressure provokes a urethro-detrusorial reflex and involuntary detrusor contraction. Mid-urethral slings have been proposed as a solution. Our primary objective was to evaluate the long-term subjective and objective outcomes on continence and other urinary symptoms of a trans-obturator mid-urethral sling (TOT) procedure. Our secondary objectives were to determine its impact on quality of life (QoL), and to investigate which factors influence outcomes. STUDY DESIGN: This is a single-centre prospective study on a consecutive series of 86 women who underwent TOT for MUI as defined by ICS/IUGA. Since the definition of MUI that we used is symptom-based, we included patients both with and without associated detrusor overactivity. All patients underwent placement of Monarc® Subfascial Hammocks. STATISTICAL ANALYSIS: We used the McNemar chi-square test, the paired t-test and Fisher's exact test. A logistic regression model and odds ratios were used to assess age, parity, body mass index, menopausal status, preoperative detrusor over-activity, and detrusor pressure at maximum flow as possible factors for treatment failure. Only those that were statistically significant in the univariate analysis were included in the multivariate analysis. RESULTS: With a mean follow-up of 59 months, SUI was cured objectively in 83.7% of patients and subjectively in 87.2%. Three patients underwent further anti-incontinence surgery. The continence rates were 74.4% for urgency urinary incontinence (UUI) and 66.3% for SUI-UUI. The patient-reported success rate was 87.2% ('much better' or 'very much better' on Patient Global Impression of Improvement scale). There were statistically significant improvements in all domains except general health. The univariate analysis found no significant risk factor for persistence of SUI. Median age >60 years and menopause were predictive for persistence of UUI. Median and mean age >60 years were predictive of persistence of overall incontinence. In the multivariate model, all variables lost their statistical significance. CONCLUSION: Our study demonstrates TOT surgery can be performed for patients with MUI following unsuccessful conservative therapy. We also demonstrate that menopause and age >60 are risk factors for failure. This should be considered when counselling preoperatively.


Assuntos
Slings Suburetrais , Bexiga Urinária Hiperativa/cirurgia , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária de Urgência/cirurgia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Fatores de Risco , Resultado do Tratamento , Bexiga Urinária , Bexiga Urinária Hiperativa/complicações , Incontinência Urinária por Estresse/complicações , Incontinência Urinária de Urgência/complicações
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