Malla suburetral retropúbica (TVT): experiencia clínica y análisis de datos en el Hospital El Carmen de Maipú / Retropubic suburethral mesh (TVT): clinical experience and data analysis at the Hospital El Carmen de Maipú

La incontinencia urinaria de esfuerzo es la pérdida involuntaria de orina durante una maniobra de esfuerzo físico, ejercicio, estornudo o tos. Afecta aproximadamente al 15% de las mujeres de 30-60 años y su prevalencia es del 30-41%. Aunque existen terapias conservadoras para su manejo, muchas pacientes terminarán necesitando cirugía para su resolución. Las mallas suburetrales son alternativas para el manejo quirúrgico, existiendo dos vías de instalación, la transobturadora (TOT o TVT-O) y la retropúbica (del inglés tension-free vaginal tape o TVT), siendo esta última la que presenta mejores resultados y menos complicaciones posoperatorias. Objetivo: evaluar la tasa de efectividad y las complicaciones de la TVT en la Unidad de Piso Pélvico Femenino del Hospital El Carmen de Maipú entre los años 2015 y 2020. Materiales y Métodos: Se obtuvieron 715 registros de pacientes que fueron sometidas a TVT y se logró contactar telefónicamente con el 60,69% de ellas. Resultados: Los resultados muestran una tasa de efectividad del 94,8% y una tasa de complicaciones del 2,3%. Conclusión: Este estudio aporta evidencia local de los resultados posoperatorios en la IOE en pacientes que requirieron la instalación de una malla suburetal retropúbica, demostrando ser una cirugía altamente efectiva y segura.

Stress urinary incontinence is the involuntary loss of urine during physical exertion, exercise, sneezing, or coughing. It affects approximately 15% of women aged 30-60, with a prevalence of 30-41%. Although there are conservative therapies for its management, many patients will eventually require surgery for resolution. Suburethral sling are considered for surgical management, and there are two installation alternatives, transobturator (TOT or TVT-O) and retropubic (tension-free vaginal tape or TVT), with the latter presenting better results and fewer postoperative complications. Objetive: to evaluate effectiveness rate and complications of the TVT in the Female Pelvic Floor Unit of Hospital El Carmen de Maipú between 2015 and 2020. Materials and Methods: A total of 715 patient records were obtained for those who underwent TVT, and 60.69% of them were successfully contacted by telephone. Results: The results show an effectiveness rate of 94.8% and a complication rate of 2.3%. Conclusion: This study provides local evidence for the results of stress urinary incontinence that required the placement of a retropubic suburethral sling, proving to be a highly effective and safe surgery.

Stress urinary incontinence post-holmium laser enucleation of the prostate: a single-surgeon experience

ABSTRACT Purpose To identify incidence and predictors of stress urinary incontinence (SUI) following Holmium laser enucleation of the prostate (HoLEP). Materials and Methods We performed a retrospective review of 589 HoLEP patients from 2012-2018. Patients were assessed at pre-operative and post-operative visits. Univariate and multivariate regression analyses were performed to identify predictors of SUI. Results 52/589 patients (8.8%) developed transient SUI, while 9/589 (1.5%) developed long-term SUI. tSUI resolved for 46 patients (88.5%) within the first six weeks and in 6 patients (11.5%) between 6 weeks to 3 months. Long-term SUI patients required intervention, achieving continence at 16.4 months on average, 44 men (70.9%) with incontinence were catheter dependent preoperatively. Mean prostatic volume was 148.7mL in tSUI patients, 111.6mL in long-term SUI, and 87.9mL in others (p <0.0001). On univariate analysis, laser energy used (p <0.0001), laser "on" time (p=0.0204), resected prostate weight (p <0.0001), overall International Prostate Symptom Score (IPSS) (p=0.0005), and IPSS QOL (p=0.02) were associated with SUI. On multivariate analysis, resected prostate weight was predictive of any SUI and tSUI, with no risk factors identified for long-term SUI. Conclusion Post-HoLEP SUI occurs in ~10% of patients, with 1.5% continuing beyond six months. Most patients with tSUI recover within the first six weeks. Prostate size >100g and catheter dependency are associated with increased risk tSUI. Larger prostate volume is an independent predictor of any SUI, and tSUI.

The impact of perioperative complications on favorable outcomes after artificial urinary sphincter implantation for post-prostatectomy incontinence

ABSTRACT Objective To investigate the effect of perioperative complications involving artificial urinary sphincter (AUS) implantation on rates of explantation and continence as well as health-related quality of life (HRQOL). Materials and methods Inclusion criteria encompassed non-neurogenic, moderate-to-severe stress urinary incontinence (SUI) post radical prostatectomy and primary implantation of an AUS performed by a high-volume surgeon (>100 previous implantations). Reporting complications followed the validated Clavien-Dindo scale and Martin criteria. HRQOL was assessed by the validated IQOL score, continence by the validated ICIQ-SF score. Statistical analysis included Chi (2) test, Mann-Whitney-U test, and multivariate regression models (p <0.05). Results 105 patients from 5 centers met the inclusion criteria. After a median follow-up of 38 months, explantation rates were 27.6% with a continence rate of 48.4%. In the age-adjusted multivariate analysis, perioperative urinary tract infection was confirmed as an independent predictor of postoperative explantation rates [OR 24.28, 95% CI 2.81-209.77, p=0.004). Salvage implantation (OR 0.114, 95% CI 0.02-0.67, p=0.016) and non-prostatectomy related incontinence (OR 0.104, 95% CI 0.02-0.74, p=0.023) were independent predictors for worse continence outcomes. Low visual analogue scale scores (OR 9.999, 95% CI 1,42-70.25, p=0.021) and ICIQ-SF scores, respectively (OR 0.674, 95% CI 0.51-0.88, p=0.004) were independent predictors for increased HRQOL outcomes. Perioperative complications did not significantly impact on continence and HRQOL outcomes. Conclusion Findings show postoperative infections adversely affect device survival after AUS implantation. However, if explantation can be avoided, the comparative long-term functional results and HRQOL outcomes are similar between patients with or without perioperative complications.

Effects of the transobturator tape procedure on overactive bladder symptoms and quality of life: a prospective study

ABSTRACT Introduction: This study aimed to evaluate the effects of transobturator tape (TOT) on overactive bladder (OAB) symptoms and quality of life. Materials and Methods: Patients with stress-predominant mixed urinary incontinence (MUI) who had undergone TOT procedures were considered candidates for this research. Preoperative assessment included anamnesis, pelvic examination, cough stress test (CST), and validated symptom severity and quality of life (QoL) questionnaires. The primary outcome, improvement and cure rates of OAB symptoms were determined based on the patient's baseline scores in symptom-related questions in OAB-V8. Secondary outcomes included the success rates of SUI, changes in the QoL score and patient satisfaction rates. Results: A total of 104 patients were included in the study. Sixty-two patients underwent TOT placement alone, and 42 patients underwent TOT placement along with prolapse surgery. The mean follow-up period of the patients was 30.47 months range: 13-52 months. At the first-year follow-up, 52 patients (50.0%) and 59 patients (56.7%) reported cure in preoperative urgency and urgency incontinence, respectively. The objective and subjective cure rates were 96.2% and 56.7%, respectively. A total of 80.7% of the cases had a 15-point improvement in QoL scores. Conclusions: MUS is not only a gold standard treatment in SUI but also presents as a promising treatment modality in stress-dominant MUI. Although the improvement rates of OAB symptoms significantly decrease over time, QoL and patient satisfaction rates remain higher than any other treatment in this patient group at the third-year follow-up.

Macroplastique for women with stress urinary incontinence secondary to intrinsic sphincter deficiency

ABSTRACT Objective To evaluate the subjective and objective outcomes of Macroplastique® (MPQ) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD). Materials and Methods Following Institutional Review Board (IRB) approval, charts of non-neurogenic women with SUI secondary to ISD who underwent MPQ injection and had 6 months minimum follow-up were reviewed from a prospectively maintained database. Patients were divided into 3 groups: Naïve (Group I), Prior Anti-Incontinence Surgery (Group II), and combined Prior Bulking Agent and Anti-Incontinence Surgery (Group III). Data collected included SUI self-report, Urogenital Distress Inventory (UDI-6) Question 3, and VAS Quality of Life (QoL) Questionnaire scores at baseline and in follow-up. Three-dimensional ultrasound (3DUS) evaluated volume/configuration of MPQ. Success was defined after the last MPQ injection as a UDI-6 Question 3 score of 0 (dry) or 1, and no reoperation for SUI. Results From 2011-2017, 106 of 142 women met study criteria. At a median follow-up of 20 months (mean=26 months; range: 6-71), success rate was 41% for Group I, 40% for Group II, and 65% for Group III (p = 0.22). QoL scores were significantly improved over baseline in all groups. There was no significant difference in clinical outcome between the asymmetrical and symmetrical group on 3DUS. The completely dry rate was highest in Group III at 29%, compared to 4% for Group I and 15% for Group II (p = 0.05). Conclusion Macroplastique® improved subjective and objective outcome measures for SUI secondary to ISD as both a primary and secondary treatment option in women.

Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: results of a single centre

ABSTRACT Purpose: The aim of our study is to evaluate the efficacy and safety of ATOMS® system for the treatment of postoperative male stress urinary incontinence (SUI). Materials and methods: We retrospectively evaluated all patients treated at our institution for postoperative male SUI with ATOMS® implant. We excluded patients with low bladder compliance (< 20 mL / cmH2O), uncontrolled detrusor overactivity, detrusor underactivity (BCI < 100), urethral or bladder neck stricture and low cystometric capacity (< 200 mL). Results: From October 2014 to July 2017 we treated 52 patients, mean age 73.6 years. Most of them (92.3%) had undergone radical prostatectomy, 3.85% simple open prostatectomy, 3.85% TURP; 28.8% of patients had undergone urethral surgery, 11.5% adjuvant radiotherapy; 57.7% had already undergone surgical treatment for urinary incontinence. The average24 hours pad test was 411.6 g (180 - 1100). The mean follow-up was 20.1 months (8.1 - 41.5) 30.8% of patients were dry, 59.6% improved ≥ 50%, 7.7% improved < 50% and 1.9% unchanged. In total 73.1% reached social continence. There was a significant reduction of the 24 hours pad test and ICIQ - UI SF scores (p < 0.01). In the postoperative follow-up we detected complications in 8 patients (19%): 5 cases of displacement of the scrotal port, in 2 cases catheterization difficulties, one case of epididimitis and concomitant superficial wound infection; no prosthesis infection, nor explants. Radiotherapy, previous urethral surgery,previous incontinence surgery were not statistically related to social continence rates (p 0.65;p 0.11;p 0.11). Conclusions: The ATOMS® system is an effective and safe surgical treatment of mild and moderate male postoperative SUI with durable results in the short term.

Five-year follow-up of transobturator sling: 152 cases with the same surgeon / Cinco anos de seguimento do sling transobturatório: 152 casos com o mesmo cirurgião

Abstract Objective To evaluate the long-term subjective cure rate of the transobturator sling, including an analysis of the risk factors and of the impact of increased surgical experience on the results. Methods A retrospective cohort study of women who underwent transobturator sling surgery from 2005 to 2011 was conducted. Patients were evaluated by a telephone survey using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and by subjective questions regarding satisfaction. An ICIQ-SF score of 0 was considered a cure. The crude and adjusted odds ratios and 95% confidence intervals were estimated in univariate and multivariate logistic regression models to identify risk factors for surgical failure. Differences with p < 0.05 were considered significant. Results In total, 152 (70.6%) patients answered the questionnaire. The median follow-up period was 87 months. The urodynamic diagnosis was stress urinary incontinence in 144 patients (94.7%), and mixed urinary incontinence in 8 (5.3%) patients. Complications occurred in 25 (16%) patients. The ICQ-SF results indicated that 99 (65.10%) patients could be considered cured (ICIQ-SF score = 0). Regarding the degree of satisfaction, 101 (66%) considered themselves cured, 43 (28%) considered themselves improved, 7 (4.6%) considered themselves unchanged, and one reported worsening of the incontinence. After the univariate and multivariate analyses, the primary risk factor for surgical failure was the presence of urgency (p < 0.001). Conclusion The transobturator sling is effective, with a low rate of complications and a high long-term satisfaction rate. The risk factors for failure were the presence of urgency and patient age. The increased experience of the surgeon was not a factor that influenced the rate of complications.

Resumo Objetivo Avaliar a taxa de cura subjetiva do sling transobturatório no longo prazo, incluindo a análise dos fatores de risco e o impacto da experiência do cirurgião nos resultados. Métodos Foi realizado um estudo de coorte retrospectivo emmulheres submetidas à cirurgia do sling transobturatório entre 2005 e 2011. As pacientes foram avaliadas por meio de uma entrevista aplicada por telefone utilizando o International Consultation on Incontinence Questionnaire-Short Form ("Questionário Internacional de Consulta sobre Incontinência - Forma Abreviada", ICIQ-SF, na sigla em inglês) acrescido de questões sobre a satisfação das pacientes coma cirurgia. O critério de cura utilizado foi o ICIQ-SF = 0. A razão de chances bruta e ajustada e intervalos de confiança de 95% foram estimados pormeio demodelos de regressão logística univariada e multivariada para identificar fatores de risco para falha cirúrgica. Diferenças com p < 0,05 foram consideradas significativas. Resultados No total, 152 (70,6%) pacientes responderam. A média do período de acompanhamento foi de 87 meses. O diagnóstico urodinâmico foi incontinência urinária de esforço em 144 pacientes (94,7%) e incontinência urinária mista em 8 (5,3%). Complicações ocorreram em 25 (16%) pacientes. Os resultados do ICQ-SF indicaram que 99 (65,10%) pacientes estavam curadas (pontuação no ICIQ-SF = 0). Quanto ao grau de satisfação, 101 (66%) consideraram-se curadas, 43 (28%) melhoraram, em 7 (4,6%) não houve melhora, e uma relatou piora da incontinência. Após análise univariada e multivariada, o principal fator de risco para falha cirúrgica foi a presença de urgência (p < 0,001). Conclusão O sling transobturatório é eficaz, tem baixo índice de complicações, e alto índice de satisfação no longo prazo. Os fatores de risco para falha foram a presença de urgência e a idade da paciente. O aumento da experiência do cirurgião não foi um fator que influenciou na taxa de complicações.

Comparison of the Kelly's plication and TOT simultaneously with vaginal hysterectomy, on the incontinence, and sexual functions

ABSTRACT Purpose: To compare the effect of vaginal hysterectomy-anterior/posterior colporrhaphy with Kelly's plication(VH-KP), versus vaginal hysterectomy-anterior/posterior colporrhaphy-transobturator tape(VH-TOT) surgeries on incontinence, quality of life, and sexual functions in patients with pelvic organ prolapse(POP), and concurrent obvious stress urinary incontinence(SUI). Materials and Methods: Between 2013 and 2017, fifty patients treated with VH-KP(n = 25), and VH-TOT(n = 25) due to POP and SUI, were evaluated prospective consecutively. Age, parity, duration of urinary incontinence, and the daily pad use were recorded. Patients were filled "rinary Distress Inventory-6(UDI-6)", "Incontinence Impact Questionnaire 7(IIQ-7)" and "Index of Female Sexual Function(IFSI)" questionnaire forms at preoperatively, and postoperative 6th month. No usage of pads was accepted as subjective cure rate. Intraoperative, and postoperative complications were noted. Results: There was no statistically significant difference between two groups, for the mean age of the patients, parity, duration of SUI, and the daily pad use, preoperatively (p > 0.05). Decreased UDI-6 scores, IIQ-7 scores and daily pad usage, and increased IFSF scores were found statistical significantly in each group, at the postoperative 6 th month (p < 0.05). However, VH-TOT group had higher improvement rates, on UDI-6 scores (69.5% vs 63.0%, p = 0.04). In addition, it was notable that the the rates of the patients had IFSF scores ≥ 25 was higher in VH-KP group (p = 0.05). Four (16%) patients had recurrent SUI in the VH-KP group (p = 0.039) and vaginal extrusion occurred in 2 (8%) patients in the VH-TOT group (p = 0.153), postoperatively. Conclusions: Although the effects of VH-TOT surgery are superior to conventional methods for incontinence and quality of life; negative effects on sexual functions are notable. In addition, although recurrence rates of TOT are low, complications such as vaginal extrusion are accompanied by drawbacks of mesh usage.

Functional outcomes and quality of life after transobturatory slings: hand - made vs. commercial slings

ABSTRACT Surgical correction is the most efficient treatment for stress urinary incontinence (SUI), and transobturator sling (TO) has optimal results. The high cost of commercially available sling kits makes it difficult the access in most Brazilian public health services. Hand-made polypropylene slings, on the other hand, have been previously reported. The aim of the present study was to compare the effectiveness and safety of commercial vs. hand-made polypropylene mesh slings. Data from 57 women who underwent consecutive TO sling surgery to treat SUI were pros- pectively collected between 2012 and 2014, and divided in two groups for further compa- rison. In Group-1, 31 women underwent surgery with commercial slings. In Group-2, 26 women underwent hand-made polypropylene slings. Women were compared according to epidemiological data, perioperative evaluation, quality of life, urodynamic study, cure and complication rates. Results were objectively (stress test with Valsalva maneuver, with at least 200mL vesical repletion) and subjectively evaluated by the Patient Global Impression of Improvement(PGI-I), Visual Analog Scale (VAS) and ICIQ-SF. Success was defined as PGI-I, VAS and negative stress test. Group-1 (n=31) and Group-2 (n=26) had a mean age of 60 vs. 58years (p=0.386). All de- mographic data were similar. The mean VLPP was 75.6cmH2O vs. 76.6cmH2O (p=0.88). The mean follow-up was 24.3 vs. 21.5months (p=0.96). Success rates were 74.2% vs. 80.2% (p=0.556), with ICIQ-SF variation of 12.6 vs.15.5 (p=0.139) and PGI-I of 71% vs. 80% (p=0.225). There was only one major complication (urethrovaginal fistula in Group-1). In conclusion, handmade and commercial slings have similar effectiveness and safety. The manufacture technique has important key-points stated in the present manuscript.

Costs analysis of surgical treatment of stress urinary incontinence in a brazilian public hospital, comparing Burch and synthetic sling techniques

ABSTRACT Introduction Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. Objective To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Materials and Methods Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Results Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (p<0.001)). Cost was significantly lower in patients submitted to sling in all items, except for time spent in recovery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (p<0.001). Conclusion Burch surgery was more expensive than ambulatory synthetic transobturator sling surgery, even when the cost of the synthetic sling was considered.

Artificial urinary sphincter revision for urethral atrophy: comparing single cuff downsizing and tandem cuff placement

ABSTRACT Objective To compare outcomes for single urethral cuff downsizing versus tandem cuff placement during artificial urinary sphincter (AUS) revision for urethral atrophy. Materials and Methods We identified 1778 AUS surgeries performed at our institution from 1990-2014. Of these, 406 were first AUS revisions, including 69 revisions for urethral atrophy. Multiple clinical and surgical variables were evaluated for potential association with device outcomes following revision, including surgical revision strategy (downsizing a single urethral cuff versus placing tandem urethral cuffs). Results Of the 69 revision surgeries for urethral atrophy at our institution, 56 (82%) were tandem cuff placements, 12 (18%) were single cuff downsizings and one was relocation of a single cuff. When comparing tandem cuff placements and single cuff downsizings, the cohorts were similar with regard to age (p=0.98), body-mass index (p=0.95), prior pelvic radiation exposure (p=0.73) and length of follow-up (p=0.12). Notably, there was no difference in 3-year overall device survival compared between single cuff and tandem cuff revisions (60% versus 76%, p=0.94). Likewise, no significant difference was identified for tandem cuff placement (ref. single cuff) when evaluating the risk of any tertiary surgery (HR 0.95, 95% CI 0.32-4.12, p=0.94) or urethral erosion/device infection following revision (HR 0.79, 95% CI 0.20-5.22, p=0.77). Conclusions There was no significant difference in overall device survival in patients undergoing single cuff downsizing or tandem cuff placement during AUS revision for urethral atrophy.

Female sexual function following a novel transobturator sling procedure without paraurethral dissection (modified-TOT)

ABSTRACT Purpose To determine whether there is a difference in sexual function after modified and classical TOT procedures. Materials and Methods Of the 80 sexually active women with SUI, 36 underwent an original outside-in TOT as described by Delorme, and 44 underwent modified TOT procedure, between 2011 and 2015. The severity of incontinence and sexual function were evaluated using International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Female Sexual Function Index (FSFI) questionnaires preoperatively and 3 months after surgery. Results The postoperative ICIQ-SF score was significantly lower than the preoperative ICIQ-SF score in both groups (p=0.004 for modified TOT and p=0.002 for classical TOT). There was no significant difference in the ICIQ-SF score reduction between the two groups (14.1±2.1 vs. 14.4±1.9; p=0.892). Complication rates according to the Clavien-Dindo classification were also similar in both groups. In both groups, difference between preoperative and postoperative FSFI scores revealed a statistically significant improvement in all domains. Comparison of postoperative 3-month FSFI scores of modified and classical TOT groups showed statistically significant differences in arousal, lubrication and orgasm domains. Desire, satisfaction, pain and total FSFI scores did not differ significantly between two groups. Conclusion The modified TOT technique is a simple, reliable and minimal invasive procedure. The cure rate of incontinence and complication rates are the same as those of the classical TOT technique. However, due to the positive effects of minimal tissue damage on sexual arousal and orgasmic function, modified TOT has an advantage over the classical TOT.

Medium-term results of mini-arc for urinary stress incontinence in ambulatory patients under local anesthesia

Abstract Objective To evaluate the medium-term outcome and patient's satisfaction after Single-incision mini-sling (SIMS) procedure done under local anesthesia in ambulatory set up for patients with stress urinary incontinence (SUI). Materials and Methods This is a retrospective cohort study, including all patients submitted to SIMS procedure for SUI with MiniArc (AMS, U.S.A) without concomitant surgery between January 2011 and March 2013. Patients were followed up during 12 months after surgery and once a year subsequently. Telephone interviews were conducted to evaluate patient satisfaction. Outcome masseurs included: SUI cure rate, urinary urge incontinence (UUI) cure rate in patients with mixed urinary incontinence (MUI), intra and post-operative complications and patient satisfaction. Results Ninety-three patients were included with mean follow-up of 23 months. Fifty percent had MUI with predominant SUI. The cure rates of SUI (objective and subjective) were 89%. UUI was cured in 40% of patients. No major complications occur, neither voiding obstruction or groin pain. Telephone interviews conducted after 26 months on average revealed high satisfaction rate from the procedure (8.8 out of 10) and from the local anesthesia. Visual analog scale (VAS) rating was low during and after the procedure (2.38 and 2.69 respectively). Conclusions The SIMS procedure is safe and highly effective for SUI and it can be performed successfully under local anesthesia in an ambulatory setup.

Transcorporal artificial urinary sphincter in radiated and non - radiated compromised urethra. Assessment with a minimum 2 year follow-up

ABSTRACT Purpose to assess the efficacy of transcorporal artificial urinary sphincter (AUS) implantation on continence for male stress urinary incontinence in cases of prior surgical treatment or/and radiation failure, and as a first option in radiation patients. Materials and Methods From March 2007 to August 2012, 37 male patients were treated with transcorporal AUS AMS™ 800. Twelve patients had primary placement of transcorporal cuff, a surgical option due to a previous history of radiation and 25 patients had secondary procedure after failure of AUS or urinary incontinence surgery. Functional urinary outcomes were assessed by daily pad use, 24-hour Pad-test and ICIQ-SF questionnaire. Quality of life and satisfaction were assessed based on I-QoL and PGI-I questionnaires. Results After a median of 32 months, the continence rate (0 to 1 pad) was 69.7%. Median pad test was 17.5g (0-159), mean ICIQ-SF score was 7.3/21 (±5.4) and mean I-QoL score was 93.9/110. A total of 88% of the patients reported satisfaction with the AUS. The 5-year actuarial revision-free for AUS total device was 51%. Patients for primary implant for radiation were not more likely to experience revision than non-radiation patients. Preservation of erections was reported in half of the potent patients. Conclusions Transcorporal AUS cuff placement is a useful alternative procedure option for severe male UI treatment, especially in patients with a compromised urethra after prior surgery or radiation. A high continence rate was reported and implantation as first option in radiation patients should be considered.

A transobturator adjustable system for male incontinence: 30-month follow-up of a multicenter study

Purpose To report long-term results of the Argus T adjustable system for treatment of post-prostatectomy urinary incontinence (PPI). Materials and Methods From October 2007 to August 2008, 37 patients with PPI were included in a prospective, single-arm, multicenter trial of treatment with the Argus T adjustable system (Promedon, Argentina). Preoperative evaluation included urine culture, urethrocystoscopy, urodynamic testing, 24-h pad weight test (PWT) and quality of life questionnaires. Patients were stratified according to baseline degree of incontinence (mild–moderate or severe). Postoperative evaluation included immediate PWT, quality of life questionnaires and daily use of pads at 1, 12 and 30 months. Results and Conclusions One patient was lost to follow-up. At the 30-month follow-up, 24/31 patients (77%) were dry, 3/31 (10%) improved and 4/31 (13%) were failures. In particular, in the mild-moderate group, 8/8 (100%) patients were dry. In the severe group, 20/28 patients (71%) were dry, 3/28 (11%) improved and 5/28 (18%) were failures. Median visual analogue scale (VAS) scores dropped from 9 (4-10) to 0.5 (0-10) and International Consultation on Incontinence Questionnaire Short Form scores from (ICIQ-SF) 19 (12–21) to 1 (0–10). Retrograde leak point pressure increased from 18 (5–29) to 35 (22–45) cm H2O after intraoperative adjustment. Complications included immediate postoperative infection in 2/36 patients (6%) and transient inguinal and/or perineal pain in 22/36 patients (61%). Argus T has a long-term high success rate (86% cure + improvement at the 30-month follow-up). Good outcomes were achieved even in severe incontinence cases and maintained for over 30 months. .

Efficacy of Pelvisoft® Biomesh for cystocele repair: assessment of long-term results

Introduction and Hypothesis To our knowledge a study regarding the efficacy of Pelvisoft® Biomesh for cystocele repair has not previously been reported in the literature. The aim of our study was to assess the long-term efficacy, subjective outcomes and complications in the use of a non-synthetic porcine skin mesh graft (Pelvisoft® Biomesh) associated with transvaginal anterior colporrhaphy in the treatment of cystocele prolapse. Materials and Methods A retrospective study was performed at a single centre. Thirty-three women aged 35-77 years underwent cystocele repair using Pelvisoft® graft between December 2005 and June 2009. Twenty-nine women who underwent transvaginal cystocele repair with Pelvisoft® Biomesh for over a 2 years period were assessed. Four patients were lost to follow-up. Cystocele repair was performed via the vaginal route using Pelvisoft®Biomesh implant by inserting it in the anterior vaginal wall. The median follow-up time was 54.0 months. The rate of recurrence was 17.3%. A total of 6.9% of patients presented early mesh exposure treated by conservative treatment. The mean PFDI-20 score was 72.2. Among sexually active women, the mean PISQ 12 was 33.9 but 56.2% had dyspareunia. After surgery, 6 patients had de novo intercourse. Our results show that the use of Pelvisoft® biomaterial associated with anterior colporrhaphy for cystocele repair appears to be safe with acceptable failure and complication rates at long term. Nevertheless, an adverse impact on sexual function was reported by the majority of patients. .

Patients lost to follow-up after midurethral sling surgery: How are they?

Purpose To assess the ratio of patients lost to follow-up (FU) after midurethral sling surgery, to evaluate their success rate and current status, and to identify the reasons for FU loss. Materials and Methods Two-hundred thirty-eight patients who received trans-obturator tape (TOT) surgery were reviewed. For patients lost to FU within 3 months, Stamey’s outcome questionnaire and questions regarding the reasons for FU loss were submitted via phone interview. Results One hundred forty-three (60.1%) patients (FU loss group) were lost to FU within 3 months postoperatively. In the FU loss group, phone interviews were conducted with 117 (81.8%) patients. Aside from the urgency rate (59.3% vs. 72.3%, p=0.049), there were no significant statistical differences in preoperative profiles between two group. The success rate of the FU loss group (80.3%, 94 of 117 patients) was lower than that of the FU group (95.8%, 91 of 95 patients) (p=0.001). The success rates in the FU loss group with mixed urinary incontinence (MUI) were significantly lower than in the FU group with MUI. As for the reason for FU loss, 74 patients (62.7%) were lost due to incontinence improvement, 19 patients (16.1%) cited personal problems, and 5 patients forgot the next follow-up date. Only 10 patients gave up further treatment despite their persisting incontinence. Conclusions In our study, more than half of patients were lost to follow-up after midurethral sling surgery. The FU loss group showed a lower surgical success rate, particularly with MUI. Close FU is recommended for better consultation of patients’ incontinence. .

Long-Term Follow-up of Polypropylene Bone Anchored Slings

Introduction The transvaginal bone anchored polypropylene sling (BAS) has proven to be a successful treatment for patients with SUI. However, there is limited data on long-term outcomes following BAS with polypropylene mesh. We report our series of patients who had at least 3 years of follow-up after placement of BAS. Materials and Methods A retrospective review of prospectively collected data of patients undergoing BAS for stress urinary incontinence (SUI) with minimum 3 year follow-up was performed. Outcomes and complications were determined from annual mailed post-operative questionnaires. Results 142 patients who had undergone BAS and had answered post-operative questionnaires at a minimum of 3 years were identified. Average follow-up was 58 months (range 36-97 months). The overall success rate was 71% with a dry rate of 27%. Complications occurred in 9% of patients, more commonly in patients without a history of anti-incontinence procedure. Conclusions Although less commonly used, BAS with polypropylene mesh is associated with an acceptable success rate at long term follow-up but a low completely dry rate. .

Complicaciones postoperatorias de la cistouretropexia con cinta transobturatriz (TOT) en pacientes con y sin cirugía concomitante atendidas en el Hospital Nacional Arzobispo Loayza durante el periodo 2008 al 2011 / Postoperative complications of the transobturator tape cystourethropexy (TOT) in patients with and without concomitant surgery treated at the National Hospital Arzobispo Loayza during the period 2008 to 2011

OBJETIVO: Determinar las complicaciones postoperatorias de la Cistouretropexia con cinta transobturatriz en pacientes con y sin cirugía concomitante, atendidos en el Hospital Nacional Arzobispo Loayza durante el periodo 2008 - 2011. METODOLOGIA: Estudio observacional, analítico-comparativo, retrospectivo de corte transversal, realizado en 220 pacientes con incontinencia urinaria de esfuerzo programadas para cistouretropexia con cinta transobturatriz con y sin otra cirugía concomitante, en el Hospital Nacional Arzobispo Loayza durante el periodo 2008 - 2011, RESULTADOS: Se encontró en general una edad promedio de 60.3±11.9 años, mientras que para aquellas intervenidas con alguna cirugía concomitante el promedio de edad fue de 56,1±11,2 años y 62.0±11,7 años para aquellas intervenidas sin cirugía concomitante alguna. La mayoría fueron de estado civil casadas (50 por ciento), de grado de instrucción educación primaria (44.5 por ciento) y de ocupación ama de casa (94.5 por ciento). El 64.5 por ciento de ellas tuvieron al menos sobrepeso (IMC>25kg/m2). Tanto el grupo control como el grupo comparativo tuvieron características similares en cuanto a edad (p=0.358), grado de instrucción (p=0.155) e IMC (p=0.759). Respecto a los antecedentes clínicos de importante, la mayoría tuvo como antecedente la multiparidad, tanto en aquellas con cirugías concomitantes (89.2 por ciento) y sin cirugías concomitantes (87.1 por ciento) (p=0.896). Asimismo, la mayoría solo tuvo partos de tipo vaginal, 84.6 por ciento para aquellas intervenidas con cirugía concomitante y 94.8 por ciento para aquellas intervenidas sin cirugía concomitante alguna (p=0.01). Además la mayoría de pacientes manifestó encontrarse en edad post menopaúsica, 78.5 por ciento en aquellas intervenidas con alguna cirugía concomitante manifestaron y 89.7 por ciento en quienes no se realizó cirugía concomitante alguna (p=0.027). En cuanto a los antecedentes quirúrgicos, casi el 90 por ciento mencionó no haber sido...

Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure

PURPOSE: To analyze the influence of urethral mobility and Valsalva leak point pressure on postoperative outcomes of transobturator sling (TOT) for female stress urinary incontinence. MATERIALS AND METHODS: A prospective cohort was conducted including 66 patients submitted to TOT from March 2006 to May 2009. Urethral hypermobility was defined as mobility ≥ 30º on Q-tip test, and Valsalva leak point pressure (VLPP) was classified as greater than 60 cmH2O or 60 and less on preoperative urodynamics. These parameters were compared through well defined postoperative objective and subjective success criteria. Intensity of urinary leakage and quality of life was analysed by ICIQ-SF. Statistical analysis was accomplished and the results rendered significant if p < 0.05. RESULTS: Mean follow up was 10 months (3 to 28). Mean age was 55 years (33 to 80), 70% were white and 30% African descendent, mean body mass index was 27 (21 to 38), average vaginal and abdominal deliveries were 2.8 and 0.5 respectively. A quarter had prior stress incontinence surgery. Patients with urethral hypermobility had higher objective success rates (98% versus 81.25%, p = 0.04). The subjective success rate was also greater in the hypermobility group (84% versus 62.5%), but statistical significance was not reached (p = 0.07). VLPP had no influence on either objective or subjective postoperative success rates (p = 0.17 and 0.34, respectively). In the subgroup analysis, those with low mobility and high VLPP had worse objective success rates in comparison to the group with hypermobility and low VLPP (p = 0.04) and also in relation to the remaining of the studied population. Other possible prognostic factors (previous surgery, mixed incontinence, gestational status) had no influence on success rates. CONCLUSIONS: High urethral mobility, regardless of the sphincteric status indicated by VLPP, is a favorable prognostic factor for tension-free transobturator tape procedure. No relationship was demonstrated between postoperative success rates and VLPP.