The female urethral closure mechanism during physical stress.

The closure of the urethra under the condition of stress is the result of a reflex contraction of the urethral rhabdosphincter and pelvic floor muscles. This is likely induced by activity of the abdominal muscles due to a sudden increase in abdominal pressure. This reflex contraction with an increase of urethral pressure occurs a few milliseconds before an increase in intraabdominal pressure. The urethral pressure increase during stress is only possible with fixation of the urethra by the pubourethral ligaments (PUL), facilitating urethral kinking. The highest and most important increase in pressure and resistance occurs in the distal urethra due to this kinking of the urethra.

Effect of easy cupping combined with pelvic floor electrical stimulation and Kegel exercise and pelvic floor muscle surface electromyography on symptoms improvement in women with stress urinary incontinence.

This study aimed to evaluate the effectiveness of easy cupping combined with pelvic floor electrical stimulation and Kegel exercises in treating female patients with stress urinary incontinence (SUI). Ninety SUI patients were randomly assigned to two groups: the control group (pelvic floor electrical stimulation + Kegel exercises) and the experimental group (easy cupping + pelvic floor electrical stimulation + Kegel exercises). Outcomes assessed included pelvic floor muscle strength, urinary incontinence, urinary leakage, pelvic floor muscle surface electromyography, adverse effects, and patient satisfaction before and after treatment. Results showed significant improvements in pelvic floor muscle strength, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICI-Q-SF) scores, and urinary leakage in both groups, with the experimental group showing greater improvements (P < 0.05). The experimental group also had higher pelvic floor muscle potential values and a greater total effective rate (P < 0.05). No significant differences in adverse effects were noted between groups, and patient satisfaction was higher in the experimental group (P < 0.05). In conclusion, the combination of easy cupping with pelvic floor electrical stimulation and Kegel exercises effectively enhances pelvic floor muscle strength, reduces urinary leakage, and improves patient satisfaction in women with stress urinary incontinence.

Cette étude visait à évaluer l'efficacité des ventouses faciles combinées à la stimulation électrique du plancher pelvien et aux exercices de Kegel dans le traitement des patientes souffrant d'incontinence urinaire d'effort (IUE). Quatre-vingt-dix patients SUI ont été répartis au hasard en deux groupes : le groupe témoin (stimulation électrique du plancher pelvien + exercices de Kegel) et le groupe expérimental (ventouses faciles + stimulation électrique du plancher pelvien + exercices de Kegel). Les résultats évalués comprenaient la force musculaire du plancher pelvien, l'incontinence urinaire, les fuites urinaires, l'électromyographie de la surface des muscles du plancher pelvien, les effets indésirables et la satisfaction des patients avant et après le traitement. Les résultats ont montré des améliorations significatives de la force musculaire du plancher pelvien, des scores de la Consultation internationale sur l'incontinence (ICI-Q-SF) et des fuites urinaires dans les deux groupes, le groupe expérimental montrant de plus grandes améliorations (P < 0,05). Le groupe expérimental présentait également des valeurs de potentiel musculaire du plancher pelvien plus élevées et un taux effectif total plus élevé (P < 0,05). Aucune différence significative dans les effets indésirables n'a été notée entre les groupes et la satisfaction des patients était plus élevée dans le groupe expérimental (P < 0,05). En conclusion, la combinaison de ventouses faciles avec la stimulation électrique du plancher pelvien et les exercices de Kegel améliore efficacement la force musculaire du plancher pelvien, réduit les fuites urinaires et améliore la satisfaction des patientes souffrant d'incontinence urinaire d'effort.

Urethral support in female urinary continence part 1: dynamic measurements of urethral shape and motion.

INTRODUCTION AND HYPOTHESIS: Urethral closure mechanism dysfunction in female stress urinary incontinence (SUI) is poorly understood. We aimed to quantify these mechanisms through changes in urethral shape and position during squeeze (voluntary closure) and Valsalva (passive closure) via endovaginal ultrasound in women with varying SUI severity. METHODS: In this prospective cohort study, 76 women who presented to our tertiary center for urodynamic testing as preoperative assessment were recruited. Urodynamics were performed according to International Continence Society criteria. Urethral pressures were obtained during serial Valsalva maneuvers. Urethral lengths, thicknesses, and angles were measured in the midsagittal plane via dynamic anterior compartment ultrasound. Statistical shape modeling was carried out by a principal component analysis on aligned urethra shapes. RESULTS: Age, parity, and BMI did not vary by SUI group. Ultrasound detected a larger retropubic angle, urethral knee-pubic bone angle (a novel measure developed for this study), and infrapubic urethral length measurements at Valsalva in women with severe SUI (p = 0.016, 0.015, and 0.010). Shape analysis defined increased "c" shape concavity and distal wall pinching during squeeze and increased "s" shape concavity and distal wall thickening during Valsalva (p < 0.001). It also described significant urethral shape differences across SUI severity groups (p < 0.001). CONCLUSIONS: Dynamic endovaginal ultrasound can visualize and allow for quantification of voluntary and passive urethral closure and variations with SUI severity. In women with severe SUI, excessive bladder neck and distal urethra swinging during Valsalva longitudinally compressed the urethra, resulting in a proportionally thicker wall at the mid-urethra and urethral knee.

Urethral support in female urinary continence part 2: a computational, biomechanical analysis of Valsalva.

INTRODUCTION AND HYPOTHESIS: In Part 1, we observed urethral mechanics during Valsalva that oppose current continence theories. In this study, we utilize a finite element model to elucidate the role of supportive tissues on the urethra during Valsalva. By determining the sensitivity of urethral motion and deformations to variations in tissue stiffnesses, we formulate new hypotheses regarding mechanisms of urethral passive closure. METHODS: Anatomy was segmented from a nulliparous, continent woman at rest. The model was tuned such that urethral motion during Valsalva matched that observed in that patient. Urethra and surrounding tissue material properties were varied using Latin hypercube sampling to perform a sensitivity analysis. As in Part 1, urethral length, proximal and distal swinging, and shape parameters were measured at peak Valsalva for 50 simulations, and partial rank correlation coefficients were calculated between all model inputs and outputs. Cumulative influence factors determined which tissue properties were meaningfully influential (≥ 0.5). RESULTS: The material properties of the urethra, perineal membrane, bladder, and paraurethral connective tissues meaningfully influenced urethral motion, deformation, and shape. Reduction of the urethral stiffness and/or the perineal membrane soft constraint resulted in simulated urethral motions and shapes associated with stress urinary incontinence in Part 1. CONCLUSIONS: The data from Parts 1 and 2 suggest that connective tissues guide the controlled swinging motion and deformation of the urethra needed for passive closure during Valsalva. The swinging and kinking quantified in Part 1 and simulated in Part 2 are inconsistent with current continence theories.

Narrow Vagina as a Predictor of Obstructive Voiding Dysfunction after Transobturator Sling Surgery.

BACKGROUND: Voiding dysfunction (VD) is a potential complication after female midurethral sling operations. OBJECTIVES: Our goal was to assess the rate of obstructive VD after -transobturator tension-free tape (TOT) procedures and to find perioperative risk factors (RFs) predicting postoperative voiding problems. METHODS: We have retrospectively evaluated the perioperative data of 397 women who underwent TOT operations. Significant post-void residual (PVR) (>50 mL) was considered as the primary (objective) end point of the study, the voiding difficulty as the secondary (subjective) 1. First univariate analysis and then multivariate logistic regression were performed, with a 5% significance level. RESULTS: Significant PVR was present in 51 (12.8%) women; catheterization was needed in 21 (5.3%) and reoperation in 3 (0.8%) cases. Seventy women (17.6%) experienced postoperative voiding difficulty. Narrow vagina (<2 cm), older age >70 years, and preoperative voiding difficulty were independent RFs for significant PVR (odds ratio: 5.07, 2.14, 5.38, respectively, p < 0.05). Preoperative overactive bladder syndrome and previous pelvic organ prolapse surgery were considered independent RFs for postoperative voiding difficulty. CONCLUSIONS: Older age, narrow vagina, or preoperative voiding difficulty increases the chance for significant postoperative PVR. These patients should be chosen and counseled appropriately.

Contasure-needleless single incision slings versus transobturator slings (TOT/TVT-O) for female patients with stress urinary incontinence: a systematic review and meta-analysis.

BACKGROUND: To assess the current evidence on the effectiveness and safety of Contasure-Needleless (C-NDL) versus transobturator slings (TOT/TVT-O) in the management of female stress urinary incontinence (SUI). METHODS: A comprehensive literature review of articles that investigated the efficacy and safety of C-NDL and TOT/TVT-O was performed based on studies published before June 2019 and retrieved from PubMed, Embase, CNKI and the Cochrane Library. Two reviewers searched the literature, independently extracted the data and evaluated the quality of the data according to the inclusion and exclusion criteria. A meta-analysis was performed by using Review Manager 5.3 software. RESULTS: Seven studies with 1188 SUI female patients without intrinsic sphincter deficiency (ISD) or mixed urinary incontinence were included. Our meta-analysis showed that the clinical efficacy of C-NDL is statistically non-inferior to that of TOT / TVT-O in terms of subjective cure rate [OR = 0.77, 95% confidence interval (CI) (0.53 to 1.10), p = 0.15] and objective cure rate [OR = 0.78, 95% CI (0.53 to 1.13), p = 0.19]. In addition, operating times were statistically shorter with C-NDL compared to TOT / TVT-O [mean difference (MD) = - 7.38, 95% CI (- 10.73 to - 4.04), p < 0.0001]. In terms of the postoperative visual analogue scale (VAS) and the incidence of postoperative pain, C-NDL has a greater advantage [MD = - 1.71, 95% CI (- 2.91 to - 0.50), p = 0.005]; [OR = 0.21, 95% CI (0.05 to 0.96), p = 0.04]. Complication rates were statistically similar between the groups, except for groin pain which was higher in TOT / TVT-O. CONCLUSION: Our data suggest that C-NDL slings have similar short-term efficacy as TOT/TVT-O in curing SUI patients. Compared with TOT/TVT-O, C-NDL is associated with a shorter operative time, and the incidence of postoperative pain is decreased. Nevertheless, these findings should be further confirmed through large-volume, well-designed prospective randomized controlled trials (RCTs) with long-term follow-up.

Current treatments for female primary stress urinary incontinence.

Stress urinary incontinence (SUI) affects millions of women worldwide. Pelvic floor muscle training is the first-line treatment for SUI, and if this fails, midurethral sling surgery has become the gold-standard treatment. More recently, complications from midurethral mesh slings, particularly chronic pain and dyspareunia, have become a major concern. Although traditional SUI treatments, such as colposuspension and fascia slings, are used, the future of SUI treatment likely will rely on less invasive alternatives. Modern bulking agents could have the potential to become a first-line treatment for SUI, but further long-term studies are needed. Patients should be involved in decision-making prior to any surgery to ensure that they are aware of the risks and also any reasonable treatment alternatives. Furthermore, the effectiveness of a procedure should be balanced with its invasiveness and possible risks to provide women individually with the best possible treatment option.

Para-Urethral Injections with Urolastic® for Treatment of Female Stress Urinary Incontinence: Subjective Improvement and Safety.

INTRODUCTION: Female stress urinary incontinence (SUI) is often treated surgically. Urethral bulking agents are a minimally invasive alternative, especially in patients suffering from intrinsic sphincter deficiency, but often with limited long-term efficacy. Urolastic® is a non-deformable, non-resorbable silicone elastomer that is used as an injectable. Its properties might result in a more durable response after injection. If this durability factor can be combined with a low complication rate, this can become a useful treatment option. We therefore assessed the subjective improvement and safety after treatment with Urolastic®. MATERIALS AND METHODS: In 2 Dutch hospitals, 65 patients were treated with Urolastic®. The subjective improvement was assessed and the medical charts were reviewed for complications that appeared during the follow-up period. The complications were classified using the Clavien-Dindo classification. RESULTS: We found that 76-88% of the patients showed subjective improvement at 12-25 months follow-up. The rate of improvement experienced was 50-70%. The rate of complications classified as Clavien-Dindo >II was 24-33%. The 12 patients with 75-100% subjective improvement after 2 months, showed 85% improvement after a median of 25 months. CONCLUSIONS: With careful patient selection, Urolastic® seems to be a safe, durable and effective treatment option for female SUI.

Transobturator tape versus retropubic tension-free vaginal tape for stress urinary incontinence: 5-year safety and effectiveness outcomes following a randomised trial.

INTRODUCTION AND HYPOTHESIS: In a randomised trial comparing transobturator tape (TOT) to retropubic tension-free vaginal tape (TVT) for women with stress urinary incontinence (SUI), vaginal examination at 12 months showed that tapes were palpable for 80.0 % of the TOT group versus 26.7 % of the TVT group. We hypothesized that this difference would lead to more women in the TOT group experiencing vaginal mesh erosion or other serious adverse events compared to women in the TVT group 5 years after surgery. METHODS: All participants were invited to join the follow-up study after being randomised to receive TOT or TVT for SUI. Consenting women had a vaginal examination, a pad test for urinary incontinence (UI) and completed Health-related Quality of Life Questionnaires (HRQOL). Women unable to attend the clinic completed questionnaires only. The primary composite outcome incorporated mesh exposure, urinary retention, repeat incontinence surgery and moderate to severe pelvic pain. Assuming 80 % follow-up, our study would have 67 % power to detect a difference in primary outcome (two-sided 5 % level of significance). Comparisons between groups used chi-square tests and t tests. RESULTS: One hundred and seventy-six (88.4 %) women participated in the 5-year follow-up (83 TOT, 93 TVT). The primary composite outcome occurred in 21.8 % of the TOT and 27.6 % of the TVT groups [difference =-5.8 %, 95 % confidence interval (CI) -18.9 % to 7.3 %, p value 0.39)] Vaginal examination found more women with palpable tapes in the TOT versus the TVT group (48.5 % versus 22.4 %, p value 0.001). There were no other significant differences between groups. CONCLUSIONS: Serious adverse events and tape effectiveness did not differ between groups at 5 years. Palpable tape remains a concern for women who receive TOT for treating SUI.

Surgeon-tailored polypropylene mesh as a tension-free vaginal tape-obturator versus original TVT-O for the treatment of female stress urinary incontinence: a long-term comparative study.

INTRODUCTION AND HYPOTHESIS: The objective of the study was to compare the safety and efficacy of surgeon-tailored polypropylene mesh (STM) through tension-free vaginal tape-obturator (TVT-O) versus original TVT-O in the treatment of stress urinary incontinence (SUI) aiming to decrease the cost of treatment. This is important in developing countries due to limited health care resources. METHODS: A retrospective cohort study was done at the Urology and Gynecology Departments (dual-center), Cairo University from May 2007 to June 2010. Women evaluated by cough stress test, Stress and Urge Incontinence and Quality of Life Questionnaire (SUIQQ), maximum flow rate (Qmax), and abdominal leak point pressure (ALPP) with follow-up for at least 48 months were included. Patients with post-void residual urine > 100 ml, bladder capacity < 300 ml, or impaired compliance were excluded. The effect of different factors on outcome was compared between both groups pre- and postoperatively using the paired t, Wilcoxon signed rank, McNemar, chi-square, Fisher's exact, independent t, or Mann-Whitney tests. RESULTS: STM and TVT-O were inserted in 79 and 66 women, respectively. Intrinsic sphincter deficiency, ALPP, previous surgeries, associated urgency, urgency urinary incontinence (UUI), and prolapse were comparable in both groups. Operative duration was longer in STM by 10 min. No significant difference was found between both groups in complications (p = 0.462), cure (p = 0.654), and different indices of SUIQQ. In STM, 74 (93 %) were cured and 3 (4 %) improved, while SUI persisted in 2 (2 %) patients. In TVT-O, 59 (89 %) were cured and 4 (6 %) improved, while failure was detected in 3 (4 %) patients. CONCLUSIONS: The 5-year outcome is comparable between STM and TVT-O. Furthermore, STM is more economical due to our resterilizable modified helical passers and the cheap polypropylene mesh.

AUA Guideline Committee Members Determine Quality of Artificial Intelligence‒Generated Responses for Female Stress Urinary Incontinence.

INTRODUCTION: Stress urinary incontinence (SUI) affects countless women worldwide. Given ChatGPT's rising ubiquity, patients may turn to the platform for SUI advice. Our objective was to evaluate the quality of clinical information about SUI from the ChatGPT platform. METHODS: The most-asked patient questions regarding SUI were derived from patient materials from societal websites and forums, and queried using ChatGPT 3.5. The responses from ChatGPT were compiled into a survey and disseminated to 3 AUA guideline committee members who developed the Surgical Management of Female SUI guidelines. They were asked to grade responses on reliability, understandability, quality, and actionability using DISCERN and Patient Education Materials Assessment Tool standardized questionnaires. Accuracy was assessed with a 4-point Likert scale and readability using Flesch Reading Ease score. RESULTS: The overall material was rated as moderate to moderately high quality (DISCERN = 3.73/5) with potentially important but no serious shortcomings. Reliability and quality were reported to be 63% and 75%. Understandability was 89%, actionability 18%, and accuracy 88%. All question domains were rated at moderate or better. Actionability was poor in all domains. Every response was "hard to read" translating to a college graduate reading level. CONCLUSIONS: The urologic community should critically evaluate this platform's output if patients are to use it for adjunctive medical guidance. AUA committee members, who are experts in the field, rate ChatGPT-produced responses on SUI as moderate to moderately high quality, moderate reliability, excellent understandability, and poor actionability utilizing standardized questionnaires. The reading level of the material was advanced, which is an area of potential improvement to make generated responses more comprehensible.

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

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

Small Extracellular Vesicles Secreted by Peri-urethral Tissues Regulate Fibroblast Function and Contribute to the Pathogenesis of Female Stress Urinary Incontinence.

OBJECTIVE: This study aimed to explore the existence of small extracellular vesicles (sEVs) in peri-urethral tissues and the role of abnormal expression of sEVs in the pathogenesis of female stress urinary incontinence (SUI). METHODS: sEVs were extracted from peri-urethral vaginal wall tissues using differential centrifugation and were observed by transmission electron microscopy (TEM). The number of sEVs and their protein contents were compared between SUI and control groups using nanoparticle tracking analysis (NTA) and bicinchoninic acid (BCA) protein assay. Fibroblasts were cultured separately with SUI (SsEVs group) and normal tissue sEVs (NsEVs group). Proliferation and migration of fibroblasts were compared between groups using CCK-8 and wound healing assays, respectively. Expression levels of collagen I and III were compared among blank control (BC), NsEVs, and SsEVs groups using real-time PCR. Protein mass spectrometry was used to test the differentially expressed proteins contained in sEVs between groups. RESULTS: sEVs were extracted and found under the electron microscope. There were significantly more sEVs extracted from the SUI group compared to the normal group. Fibroblasts showed increased proliferative and decreased migratory abilities, and expressed more collagen in the SsEVs group compared to the NsEVs and BC groups. Protein spectrum analysis demonstrated several differentially expressed targets, including components of microfibrils, elastin polymer, and anti-inflammatory factors. CONCLUSION: sEVs were detected in the peri-urethral tissues. SUI tissues expressed more sEVs than control. The abnormal expression of sEVs and their protein contents may contribute to the pathogenesis and progression of SUI.

Therapeutic effect of autologous fascia urethral suspension on female stress urinary incontinence and analysis of risk factors affecting the efficacy.

OBJECTIVE: To observe the therapeutic effect of autologous fascial urethral suspension on female stress urinary incontinence and analyze the risk factors affecting the therapeutic effect. METHOD: The clinical data of 89 female patients with stress urinary incontinence treated in our hospital from February 2018 to February 2020 were retrospectively analyzed (training group). Another cohort of 45 patients treated in Xi'an Gaoxin Hospital from March 2020 to March 2021 were retrospectively enrolled as the validation group. Surgery-related parameters (including operation time, intraoperative blood loss, indwelling time of catheter, and hospital stay) were recorded. The scores of the urinary incontinence questionnaire short form (IC-IQ-SF), urinary incontinence quality of life questionnaire (I-QOL), and pelvic organ prolapse/urinary incontinence sexual function questionnaire (PISQ-12) were compared before and after the operation. The clinical efficacy of the treatment was counted. The risk factors affecting the treatment efficacy were analyzed. The efficacy prediction model was established by logistics regression equation and verified by the data from the validation group. RESULTS: After the treatment, the urine leakage score, urine leakage score quality of life score, and the total score were evidently reduced compared with those before the treatment (P < 0.05). Patients' I-QOL score and PISQ-12 score increased significantly after the treatment (P < 0.05). Multivariate logistics regression analysis revealed that age, BMI, history of pelvic surgery, and length of hospital stay were risk factors affecting the outcome of patients (P < 0.05). The ROC curve analysis revealed that the area under the curve of the efficacy score in predicting the treatment efficacy was 0.828, and that in the validation group was 0.895. CONCLUSION: The treatment effect of autologous fascia urethral suspension in female patients with stress urinary incontinence was significant. It improved the quality of life of patients. The risk factor analysis showed that age, BMI, history of pelvic surgery, and length of hospital stay were risk factors affecting the treatment outcome of patients.

Can urethral re-bulking improve the outcomes of a prior urethral bulking?

AIMS: To analyze the outcomes of urethral re-bulking in the treatment of female stress urinary incontinence. MATERIALS AND METHODS: We performed a multicenter observational retrospective study, which included all consecutive patients treated with urethral re-bulking for the treatment of persistent stress or mixed urinary incontinence after a previous urethral bulking. Objective outcomes were evaluated with the 24 h pad-test, while PGI-I questionnaires were administered to evaluate subjective outcomes. Clinical outcomes were assessed before re-bulking procedure and at last follow-up. Mann-Whitney's U test was used for subgroup analysis. Shapiro-Wilk's tests were used as normality tests. RESULTS: In total, 62 patients who underwent urethral re-bulking between 2013 and 2020 in a multicenter setting were included. Most patients did not reach complete continence after the first procedure (n = 56) while the remainder reported recurrence of urinary incontinence after initial benefit. Median age at surgery was 66 (IQR: 55-73). Median overall follow-up was 30 months (IQR: 24-41). Median time occurred between the first procedure and reintervention was 12 months (IQR: 7-27). Bulking agents for the re-bulking procedures were bulkamid(n = 56), macroplastique(n = 4), and Prolastic(n = 2). A statistically significant reduction of median 24 h pad test from 100 g(IQR: 40-200) to 35 g(IQR: 0-120) was observed (p = 0.003). Dry rate after rebulking was 36.6%, while 85.4% patients declared themselves 'very much improved' or 'much improved' (PGI-I 1-2). Very few low-grade complications were observed (n = 4). A single case of major complication occurred. CONCLUSIONS: Urethral re-bulking can be an effective technique for the treatment of stress urinary incontinence refractory to a previous urethral bulking and can determine a cumulative benefit after the first procedure.

Urethral Bulking in the Treatment of Stress and Mixed Female Urinary Incontinence: Results from a Multicenter Cohort and Predictors of Clinical Outcomes.

The aim of the present study is to analyze the outcomes of urethral bulking in the treatment of non-neurogenic female stress and mixed urinary incontinence and to assess predictors of clinical outcomes. We retrospectively included all consecutive patients affected by stress or mixed urinary incontinence and treated with urethral bulking. Outcomes were evaluated via the PGI-I questionnaire and the 24-h pad test. Between January 2010 and January 2020, we treated 216 patients (Bulkamid n = 206; Macro-plastique n = 10). The median age at surgery was 66 years (IQR 55−73.75). The median follow-up was 12 months (IQR 12−24). In total, 23.8% of patients were subjected to prior incontinence surgery, 63.8% of patients were affected by genuine stress urinary incontinence, 36.2% reported mixed urinary incontinence, whereas detrusor overactivity was confirmed in only 24.9%. The dry rate was 32.9%; nevertheless, 69.9% of patients declared themselves "very improved" or "improved" (PGI-I1-2). Low complications were observed, mostly classified as Clavien I. After univariate and multivariate analyses, the only statistically significant independent predictor of "dry" outcome was the 24 h pad test, p < 0.001. Urethral bulking could be proposed with more expectations of success in patients with mild urinary incontinence. Patients affected by moderate−severe incontinence are less likely to obtain clinical success; therefore, they should be carefully counselled about clinical expectations before the procedure.

Preoperative abdominal straining in uncomplicated stress urinary incontinence: is there a correlation with voiding dysfunction and de novo overactive bladder after mid-urethral sling procedures?

OBJECTIVES: To evaluate the role of preoperative abdominal straining in predicting de novo overactive bladder (OAB) and voiding dysfunction in female patients undergoing suburethral taping by trans-obturator approach (TVT-O) for uncomplicated stress urinary incontinence (SUI). METHODS: Data from patients who underwent TVT-O surgery for SUI were retrospectively analyzed. Inclusion criteria included: history of pure SUI. Exclusion criteria included previous surgery for urinary incontinence, pelvic radiation, pelvic surgery within the last 3 months, and anterior or apical pelvic organ prolapse (POP) ⩾ +1 cm. Voiding dysfunction has been defined through symptoms and or urodynamics (UDS) signs. Accordingly, patients were divided into group A and group B according to the presence of abdominal straining during UDS. Patients were observed clinically and with UDS at a 3-year follow-up. RESULTS: A total of 192 patients underwent TVT-O surgery for uncomplicated SUI. Preoperative abdominal straining was identified in 60/192 patients (Group A: 31.2% vs Group B: 68.8%). Qmax was not different in the two groups (Group A: 19.5 vs Group B: 20.5 mL/s, p = 0.76). Demographics was similar for the two groups regarding age, parity. At 3-year follow-up, voiding dysfunction was reported in Group A: 9 and Group B: 8 patients (p = 0.056), de novo OAB was significantly reported in Group A: 23 and Group B: 26 patients (p = 0.007). CONCLUSION: Preoperative abdominal straining was found to be related to a significant incidence of de novo OAB. A significant correlation was not assessed for postoperative voiding dysfunction. Further studies may better define the impact of preoperative abdominal straining.

Progress in studies on pathological changes and future treatment strategies of obesity-associated female stress urinary incontinence: a narrative review.

With the increasing prevalence of obesity worldwide, obesity-related female stress urinary incontinence (FSUI) has become a key health problem. Recent studies indicated that FSUI is primarily caused by obesity-related pathological changes, such as fat droplet deposition, and results in pelvic floor nerve, vascular, and urethral striated muscle injury. Meanwhile, treatments for obesity-associated FSUI (OA-FSUI) have garnered much attention. Although existing OA-FSUI management strategies, including weight loss, pelvic floor muscle exercise, and urethral sling operation, could play a role in symptomatic relief; they cannot reverse the pathological changes in OA-FSUI. The continued exploration of safe and reliable treatments has led to regenerative therapy becoming a particularly promising area of researches. Specifically, micro-energy, such as low-intensity pulsed ultrasound (LIPUS), low-intensity extracorporeal shock wave therapy (Li-ESWT), and pulsed electromagnetic field (PEMF), have been shown to restore the underlying pathological changes of OA-FSUI, which might be related by regulation endogenous stem cells (ESCs) to restore urine control function ultimately in animal experiments. Therefore, ESCs may be a target for repairing pathological changes of OA-FSUI. The aim of this review was to summarize the OA-FSUI-related pathogenesis, current treatments, and to discuss potential therapeutic options. In particular, this review is focused on the effects and related mechanisms of micro-energy therapy for OA-FSUI to provide a reference for future basically and clinical researches.

Clinical value of needleless sling in treatment of female stress urinary incontinence.

BACKGROUND: Stress urinary incontinence (SUI) is a common disease in women. The emergence of the needle-free sling has led to a new clinical treatment for SUI in women. AIM: To explore the clinical value of the needleless sling without acupuncture in the treatment of SUI in women. METHODS: From February 2017 to November 2018, according to the order of admission, 44 patients (mid-suspension group) were treated by tension-free transobturator urethral suspension, and 44 patients (non-acupuncture group) were treated with a needleless non-acupuncture band. The clinical effects of the two treatments were evaluated. RESULTS: There was no significant difference between the two groups in the total clinical effectiveness rate (P = 0.374), but intraoperative blood loss and visual analogue scale score at postoperative day 1 were significantly lower in the non-acupuncture suspension group than in the middle urethral suspension group (P = 0.396). The incidence of complications in the needle-free sling group was significantly lower than that in the middle urethral suspension group (P = 0.025). CONCLUSION: The clinical effectiveness of acupuncture-free suspension in treating SUI in female patients is better than that of traditional tension-free transobturator mid-urethral suspension.