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Purpose: The suburethral sling procedure has been widely used as the first-line treatment for female stress urinary incontinence (SUI). This study retrospectively compared the long-term surgical outcomes and complications between retropubic and transobturator suburethral sling procedures. Methods: From 2010 to 2022, a total of 533 women with SUI underwent retropubic pubovaginal sling (PVS) or transobturator tape (TOT) procedures using a synthetic polypropylene mesh with or without concomitant anterior colporrhaphy. All patients underwent preoperative videourodynamic studies, Valsalva leak point pressure (VLPP), and voiding efficiency (VE). The success rate, postoperative complications, overactive bladder symptoms, transvaginal urethrolysis, and repeat procedures were compared among different surgical procedures. Results: Among the patients, PVS was performed in 251 (47.1%) patients and with colporrhaphy in 58 (10.9%), TOT in 174 (32.6%) and with colporrhaphy in 50 (9.4%). The success rate was 87.4% in the PVS group and 75.4% in the TOT group, with or without colporrhaphy (p = 0.001). Urethrolysis was performed in 4.7% of the patients, and repeat suburethral sling procedures were performed in 8.3%. The overall success rate was significantly lower in TOT group, either with high or low VLPP, or with high or low VE. The rate of persistent OAB was significantly higher in TOT group regardless of VLPP or VE, whereas patients with VE < 90% at baseline had a significantly higher rate of postoperative dysuria. Conclusion: TOT procedures had an inferior long-term success rate than PVS procedures for female SUI. Additionally, no differences in the success rate were observed between patients with different bladder functions, high or low VLPP, and high or low VE. [ABSTRACT FROM AUTHOR]

Introduction: There is no guideline or clinical consensus concerning the mid‐urethral sling (MUS) operation for stress urinary incontinence (SUI) and future pregnancies. The aim of this systematic review and metanalysis is to evaluate the impact of pregnancy and of delivery on SUI in women who previously sustained a MUS surgery. Methods: We performed a systematic review and meta‐analysis, according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 guidelines, and selected seven publications for inclusion in the analysis. Results: Recurrence of SUI after childbirth in women previously submitted to MUS was 22% (95% confidence interval [CI]: 18.0%−26.0%; I2 = 0%) while the reintervention rate for SUI the 5% (95% CI: 2.0%−8.0%; I2 = 47.34%) in the included studies. There was not statistically significant difference between women who delivered (both vaginally and by caesarian section) or not after MUS in SUI recurrence (RR 1.01, 95% CI 0.73−1.40; p = 0.96 and I2—test of 41% p = 0.18) and in SUI reintervention (RR 1.45, 95% CI 0.91−2.30; p = 0.12 and I2—test of 0% p = 0.38) with homogeneity among studies. There was no difference between women who delivered vaginally or by caesarian section both for recurrence of SUI (RR 1.24, 95%CI 0.77‐2.01; p = 0.37 and I2—test of 0% p = 0.60) and reintervention (RR 1.61, 95% CI 0.76−3.42; p = 0.22 and I2—test of 0% p = 0.47). BMI ≥ 30 kg/m2, urinary incontinence (UI) before and during pregnancy emerged as risk factors for postpartum UI relapse. Conclusion: Childbirth do not affect SUI relapse or reintervention in women previously submitted to MUS. In the same population of patients, no difference was highlighted concerning the mode of delivery for the outcome SUI relapse or reintervention. Previous MUS surgery may not be an appropriate indication for cesarean birth in subsequent pregnancy. [ABSTRACT FROM AUTHOR]

Aims: To assess and compare 30‐day perioperative adverse events following suburethral sling surgery using synthetic mesh, autologous rectus fascia, and autologous fascia lata in women. Methods: This was a retrospective cohort study of patients who underwent fascial or synthetic sling placement for stress urinary incontinence between 2008 and 2021 using the American College of Surgeons' National Surgical Quality Improvement Program database. Current Procedural Terminology codes were used to identify patients undergoing each type of sling procedure. Multivariable regression analysis with stepwise regression was used to assess the odds of composite adverse events (e.g., urinary tract infection, surgical site infection, pulmonary embolism, and other reportable events) between cohorts. Results: Of the 41 533 female patients who underwent isolated suburethral sling placement without concurrent procedures, 41 292 (99.4%) received a synthetic mesh sling, and 241 (0.6%) received an autologous facial sling. In the fascial sling cohort, 160 (66.4%) underwent rectus fascia harvest and 81 (33.6%) underwent fascia lata harvest. Sling surgeries involving autologous fascia were associated with increased odds of adverse events compared to those involving synthetic mesh, even after adjusting for confounders (adjusted odds ratio [aOR]: 3.63, 95% confidence interval [CI]: 2.56–5.15). Compared to fascial slings from rectus fascia, slings from fascia lata were associated with increased odds of composite adverse events (aOR: 2.11, 95% CI: 1.03–4.04). However, with the exclusion of urinary tract infections, the adverse event rate was similar between slings using the two fascial harvest techniques (aOR: 1.93, 95% CI: 0.81–4.63). Conclusions: In this retrospective database study, suburethral sling surgeries using autologous fascia were independently associated with a 3.6‐fold increase in odds of 30‐day perioperative adverse events compared to sling surgeries using synthetic mesh. [ABSTRACT FROM AUTHOR]

Introduction: The synthetic mid‐urethral slings are currently considered to be the most widely used technique for the surgical treatment of stress urinary incontinence (SUI). The most challenging aspect of the existing approaches is to achieve the optimal tension of the sling which treatment results are directly dependent on. To solve this problem, sling systems enabling an adjustment of the tension in the early postoperative period were created. A comparative study of the effectiveness and safety of such a system and a nonadjustable sling seems to be a relevant task. Materials and Methods: A double‐blind, randomized, multicenter trial enrolled 320 patients with a mean age of 55.2 ± 11.2 years and confirmed SUI. Patients were randomized into two groups: the first group underwent a standard synthetic suburethral sling (transobturator tape [TOT]) procedure and the second group underwent a tunable tension tape sling (TTT) procedure. All patients underwent stress test, uroflowmetry and ultrasound scan to determine the postvoid residual volume. Urinary Distress Inventory Short Form 6, International Consultation on Incontinence Questionnaire—Short Form, Pelvic Organ Prolapse Incontinence Sexual Questionnaire 12 questionnaires were used to assess subjective efficacy. Results: Enhancement of prosthesis tension in the second group was required in 44 (28%) patients. Due to the possibility of tightening of the sling in the early postoperative period, the operation was effective in 143 (89%) patients in the adjustable sling group and in 109 (68%) patients in Group 1, p < 0.001. Loosening of the sling tension was performed in 25 (16%) patients in Group 2. The signs of obstructive voiding symptoms at the follow‐up time of 36 months remained in Group 1 in 13 (8%) patients. Subjective satisfaction with treatment on the PGI‐I scale was higher in Group 2: 100 (62%) versus 132 (82%), p < 0.001. Conclusion: A synthetic mid‐urethral TTT is superior to a standard nonadjustable sling in long‐term effectiveness and safety. [ABSTRACT FROM AUTHOR]

Purpose: Few studies exist comparing the effect of different lower urinary tract dysfunctions (LUTDs) on anti-incontinence surgery. This study investigates the long-term therapeutic outcome of a suburethral sling procedure among women with stress urinary incontinence (SUI) and different LUTDs. Methods: This study retrospectively reviewed 401 women treated with a suburethral sling for SUI. Following baseline videourodynamic findings, the patients were divided into pure SUI or SUI with concomitant LUTD (mixed detrusor overactivity and SUI, low detrusor contractility and SUI, and presence of bladder outlet obstruction and SUI) groups. The primary endpoint was the SUI-free-specific survival rate. A successful outcome was defined as the absence of any SUI event. The secondary endpoints included postoperative complications, surgical revision rate, and changes in videourodynamic parameters. Results: At a mean follow-up of 5.1 (standard deviation: 5.4, range 0.1–24.1) years, the median cumulative duration of SUI-free survival was 15.4 years and 15.9 years in the pure SUI and SUI and concomitant LUTD subgroup, respectively, without significant difference between the groups. No between-group difference in postoperative complications was also noted. The cumulative incidences of the overall reoperation rate were 15.3%, 11.6%, 30.9%, and 7.3% in the pure SUI, detrusor overactivity, low detrusor contractility, and bladder outlet obstruction subgroups, respectively, with a significant difference between the groups (p = 0.006). Conclusions: Women who underwent suburethral sling surgery for SUI treatment had comparable long-term success rates regardless of baseline LUTD. However, those with low detrusor contractility may experience less favorable results in terms of higher reoperation rates. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to report the rate of stress urinary incontinence (SUI) recurrence after sling revision, and to determine predictive factors of SUI recurrence. Methods: We conducted a retrospective cohort study in a single academic center between 2005 and 2022, of patients who underwent sling revision. Four surgical techniques were used for sling revision (loosening, section, partial, and total excision). The primary endpoint was recurrence of SUI at 3 months postoperatively, and the other outcome of interest was the rate of subsequent anti‐incontinence surgical procedure. Results: Sixty‐nine patients were included for analysis. SUI recurred in 46.4% of patients. Fifteen patients underwent a subsequent anti‐incontinence procedure (21.8%). The time to revision was significantly longer in the group with recurrent SUI (median: 84.5 vs. 44.8 months; p = 0.004). The recurrence rate differed significantly depending on the revision technique: 7.7% after sling loosening, 22.2% after sling section, 60% after partial excision, and 66.7% after complete sling removal (p = 0.001). The risk of SUI recurrence was lower for those whose indication of reoperation was voiding dysfunction (27.3% vs. 66.7%; p = 0.002), and was higher for those who underwent a trans‐obturator tap rather than a tension‐free vaginal tape revision (68.4% vs. 35.7%; p = 0.02). In multivariate analysis, only the revision technique remained significantly associated with the risk of recurrence of SUI (complete excision vs. section: odds ratio = 4.66; p = 0.04). Conclusion: The risk of SUI recurrence may differ widely according to the techniques used, and it seems that the less extensive the surgical procedure is, the lower the risk is. [ABSTRACT FROM AUTHOR]

Copyright of Lithuanian Surgery / Lietuvos Chirurgija is the property of Vilnius University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and hypothesis: The objective was to characterize the impact of the COVID-19 pandemic on the surgical treatment of female stress urinary incontinence (FSUI) in Brazil. Methods: This study was conducted with population-based data from the Brazilian public health system database. We obtained data on the number of surgical procedures for FSUI in 2019 (before the coronavirus disease [COVID-19] pandemic), 2020, and 2021 (during the pandemic) in each of the 27 Brazilian states. We included official Brazilian Institute of Geography and Statistics (IBGE) data on the population, Human Development Index (HDI), and annual per capita income of each state. Results: A total of 6,718 surgical procedures for FSUI were performed in the Brazilian public health system in 2019. The number of procedures was reduced by 56.2% in 2020, and an additional reduction of 7.2% was seen in 2021. The distribution of procedures by state showed important differences, ranging from 4.4 procedures/1,000,000 inhabitants in Paraíba and Sergipe to 67.6 procedures/1,000,000 inhabitants in Paraná (p<0.01) in 2019. The number of surgical procedures was higher in states with a higher HDI (p=0.0001) and per capita income (p=0.042). The decrease in the number of surgical procedures affected the whole country and its rate did not correlate with HDI (p=0.289) or per capita income (p=0.598). Conclusion: The impact of the COVID-19 pandemic on the surgical treatment of FSUI in Brazil was significant in 2020 and persisted in 2021. Access to surgical treatment of FSUI varied according to geographic region, HDI, and per capita income, even before COVID-19. [ABSTRACT FROM AUTHOR]

Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and hypothesis: The objective was to describe the different laparoscopic and vaginal steps of sub-urethral infected mesh explantation as well as an unexpected and unusual complication: a sub-mucosal calcification on the sub-urethral segment of the sling that was not infiltrating the urethra. Methods: This was carried out at our University Teaching Hospital of Strasbourg. Results: We show the complete removal of an infected retropubic sling in a patient who had already undergone three previous surgeries without resolution of symptoms. This is a difficult case requiring a laparoscopic approach of the space of Retzius, which has been less familiar to surgeons since the advent of the midurethral sling. We show how to approach this space in an inflammatory environment by specifying its anatomical limits. Moreover, a great deal can be learned from the occurrence of an infectious complication after the surgery and the presence of a large calcification on the prosthesis. In this context, we advise a systematic antibiotic treatment to avoid this kind of complication. Conclusions: Knowing the guidelines and the different surgical steps will help urogynecological surgeons to perform similar procedures in patients requiring removal of retropubic slings for complications such as infection and pain, where conservative management has not been successful. These cases must be discussed in a multidisciplinary meeting, as recommended by the French National Authority for Health, and managed in an expert establishment. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of our study was to evaluate the efficiency and safety of synthetic mid-urethral slings (sMUS) for the treatment of stress urinary incontinence (SUI) in women with neurogenic lower urinary tract dysfunction (NLUTD). Methods: A systematic review was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MEDLINE, Embase and Cochrane controlled trials databases were systematically searched from January 1995 to April 2021. Studies including adult women with NLUTD who had a sMUS for SUI were considered for inclusion. Primary outcome was success of the surgery according to study criteria. Secondary outcomes were complications, especially de novo urgency, urinary retention, tape exposure and revision for complications. Results: A total of 752 abstracts were screened and 9 studies were included, representing 298 patients. The mean age was 52 years and median follow-up was 41.3 months. sMUS insertion was successful in 237 patients (79.5%). The median rate of de novo urgency was 15.7% (range 8.3–30%). In patients with spontaneous voiding, the median rate of retention was 19.3% (range 0–46.7%) and 21 out of 26 patients required intermittent self-catheterisation. Four cases of tape exposure were reported, and 8 patients underwent a revision for complications. Conclusions: This review suggests that sMUS might offer interesting success rates and acceptable morbidity and could be considered for the treatment of SUI in women with NLUTD. Further studies are required to define which patients would be more likely to benefit from this intervention, as well as its place among the other surgical treatments for SUI. [ABSTRACT FROM AUTHOR]

Aims: To describe the changes in urodynamic parameters after Remeex® placement in women with recurrent stress urinary incontinence (rSUI) or intrinsic sphincteric deficiency (ISD) and to analyze a potential relationship between postoperative bladder outlet obstruction and a successful surgical outcome. Methods: Retrospective analysis of those women who had undergone Remeex® placement due to rSUI or ISD in our department between 2000 and 2017. All patients underwent urodynamic evaluation before and after the surgery. If tension readjustment was required, postoperative urodynamics was performed after the last regulation, once the final continence status had been achieved. The female Bladder Outlet Obstruction Index (BOOIf) was calculated for all patients postoperatively. Obstruction was considered present if BOOIf was >18. Pre‐ and postoperative urodynamic variables were compared. Postoperative urodynamic changes were also compared between cured and noncured patients. Results: A total of 205 women were included. After a follow‐up of 89 ± 36 months, 165 women (80.5%) were continent. A significant impairment in the majority of the urodynamic parameters was observed. Mean postoperative BOOIf was −11.8 ± 21.5 in cured patients and −15.3 ± 23.1 in noncured patients (p = 0.365); 15 (9.1%) patients in the cured group had a postoperative BOOIf >18, whereas all (100%) patients in the noncured group had a postoperative BOOIf <18. Conclusions: Most urodynamic parameters may worsen after the Remeex® system placement. Postoperative urodynamic parameters may not differ substantially between cured and noncured patients, although a certain grade of bladder outlet obstruction could be related to postoperative continence status in some patients. [ABSTRACT FROM AUTHOR]

The aim of this paper is to describe our surgical technique and results of proper 6-branch autologous sling tensioning during RALP employing intraoperatively the Retrograde Perfusion Sphincterometry (RPS). Between May 2016 and February 2020, 374 patients underwent RALP with the 6-branch suburethral autologous sling tensioned under intraoperative guidance of RPS. Surgical procedure: Retrograde Leak Point pressure (RLPP) was evaluated by means of RPS after pneumoperitoneum induction (RLPPp), after urethrovescical anastomosis (RLPPa) and during proper sling tensioning (RLPPs). The goal of the sling tensioning was to obtain at the end of the procedure similar pressures as after pneumoperitoneum induction (RLPPs ≅ RLPPp). Intraoperative variables, postoperative complications, and continence recovery outcomes were assessed. A descriptive statistical analysis was performed. Sling positioning and tensioning was feasible in all patients. Mean operative time was 215 min. Proper sling tensioning allowed for the possibility to restore sphincteric efficacy to preoperative value (RLPPs vs. RLPPp (42.5 vs. 42.6) cmH2O). Urinary continence was achieved, respectively, in 58%, 67%, 74%, 88% and 92% of patients after 24 h, 10 days, 1 month, 6 months and 1 year after catheter removal. In conclusion, RPS revealed a valid option for proper autologous 6-branch sling tensioning during RALP, offering the possibility to restore sphincteric apparatus efficiency to its preoperative status to improve EUC. [ABSTRACT FROM AUTHOR]

Currently, the midurethral sling (MUS) is widely used as a standard treatment in patients with stress urinary incontinence (SUI). Several studies have reported the failure rate of MUS to be approximately 5%-20%. In general, sling failure can be defined as persistent SUI after surgery or a temporary improvement in incontinence followed by recurrence. Failure is also often considered to include cases requiring secondary surgery due to mesh exposure, postoperative voiding difficulty, de novo urgency/urge incontinence, and severe postoperative pain. Because of the lack of large-scale, high-quality research on this topic, no clear guidelines exist for second-line management. To date, transurethral bulking agent injections, tape shortening, repeat MUS, pubovaginal sling (PVS) using autologous fascia, and Burch colposuspension are available options for second-line surgery. Repeat MUS is the most widely used second-line surgical method at present. Bulking agent injections have lower durability and efficacy than other treatments. Tape shortening demonstrates a relatively low success rate, but comparable outcomes if the period from first treatment to relapse is short. In patients with intrinsic sphincter deficiency, PVS and retropubic (RP) MUS can be considered first as second-line management because of their higher success rate than other treatments. When revision or reoperation is required due to prior mesh-related complications, PVS or colposuspension, which is performed without a synthetic mesh, is appropriate for second-line surgery. For patients with detrusor underactivity, a readjustable sling can be a better option because of the high risk of postoperative voiding dysfunction in PVS or RP slings. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate postoperative pain and complications following AdVance™/AdVance™ XP male sling implantation. Materials and Methods: A multi‐center retrospective medical notes review of patients implanted for bothersome post‐prostatectomy incontinence was conducted. All patients were telephoned to provide further information on pain or further complications related to their surgery. Statistical evaluation utilized logistical regression analysis. Additionally, a literature review was conducted reviewing pain outcomes following AdVance™/AdVance™ XP implantation. Results: One‐hundred and twenty‐seven men were reviewed over an 8‐year period. The mean age was 70 years, with mean follow up 52 months. Of those with mild stress urinary incontinence, 45 (79%) had a successful outcome compared to 42 (72%) in the moderate group. Twenty‐nine (23%) men reported postoperative pain, with a mean maximal pain score of 6 (range: 0–10). The majority of pain resolved within 4 weeks (19/29 men). A further seven patients resolved by 3 months. Only three men (2.3%) had chronic pain greater than 3 months, which all resolved by 1 year. Men less than 65 years were more likely to suffer pain (p = 0.009). Acute urinary retention occurred in 23 (18%) men and correlated significantly with postoperative pain (p = 0.04). Overactive bladder symptoms, severity of incontinence or radiotherapy were not correlated with postoperative pain. In our cohort, there were no extrusions, divisions, or explantations. Conclusion: Approximately a quarter of men experience pain in the early postoperative period. However, the severity and rates of chronic pain (>3 months) are low (2.3%) but all settle within a year. [ABSTRACT FROM AUTHOR]

Aims: To compare the effectiveness and safety of polypropylene (PP) and polyvinylidene fluoride (PVDF) transobturator tapes (TOT) for the treatment of female stress urinary incontinence (SUI). Methods: This is a multicentre randomized trial. Women with SUI or stress‐predominant mixed urinary incontinence and scheduled for a TOT procedure were randomized to PP or PVDF slings. The primary outcome was 1‐year cure or improvement rate using composite criteria. Complications were also compared. Relationships with outcomes were analyzed using multivariable logistic regressions models. Results: From April 2016 to January 2018 285 participants were randomized. PP and PVDF slings showed similar high cure or improvement rate (91.0% vs. 95.6%, p =.138). Improvement in validated questionnaires was also similar. PVDF slings were associated with a lower rate of de novo urgency incontinence (adjusted odds ratio = 0.35; 95% confidence interval = 0.15–0.80). We found no statistical differences in complications rates, although a higher incidence of long‐term pain events were observed in the PP group. The study is underpowered to find differences in specific complications owing to the low number of events. Conclusion: PP and PVDF TOTs are equally effective, although PVDF is associated with fewer cases of de novo urgency incontinence. Further studies are needed to give robust conclusions on safety profiles. [ABSTRACT FROM AUTHOR]

Copyright of Selcuk University Medical Journal is the property of Selcuk University Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The management of postprostatectomy urinary incontinence (PPI) is still challenging for urologists. In recent decades, various kinds of male sling system have been developed and introduced; however, they have not yet shown as good a result as that of artificial urinary sphincter (AUS). However, a male sling is still in an important position because patients have a high demand for sling implantation, and it can allow the avoidance of the use of mechanical devices like AUS. Recently, the male sling has been widely used in mild-to-moderate PPI patients; however, there are no studies that compare individual devices. Thus, it is hard to directly compare the success rate of operation, and it is impossible to judge which sling system is more excellent. It is expected that many sling options will be available in addition to AUS in the near future with the technological development of various male slings and the accumulation of long-term surgical outcomes. In that in patients with PPI, sling implantation is an option that must be explained rather than an option that need not be explained to them, this review would share the latest outcomes and complications. [ABSTRACT FROM AUTHOR]

The introduction of suburethral sling was a breakthrough in the treatment of stress urinary incontinence in women. The method is highly effective. However, the mechanism of action of a sling and the reasons for surgical failures are not fully understood. Aim: The aim of the study was to assess the impact of sling-pubic symphysis distance on eliminating the symptoms of stress urinary incontinence and urethral funneling. Materials and methods: The analysis included 106 patients who reported 3 to 6 months after sling placement for a follow-up visit encompassing clinical examination and standard ultrasonography. We evaluated the position of sling in relation to the pubic symphysis, urethral length, as well as urethral funneling length and width. Results: Cure criteria were met by 91 patients. Elimination of urethral funneling was achieved in 76.9% (n = 70) of cured patients. Urethral funneling was still present, yet shorter by a mean of 10.2 mm (p = 0.02) than before surgery in the remaining cured patients. There was a 32.5% reduction in the mean relative length of urethral funneling (p = 0.002). No significant differences were found in the pre- and postoperative funneling width. The tapepubic symphysis distance was lower in cured women: 23.2 mm vs. 26.1 mm in failed women (p = 0.04). Similar observations were made for cured patients with persistent urethral funneling vs. failed patients (22.47 mm vs. 26.0 mm, p = 0.027). There were no differences between cured patients without urethral funneling and cured patients with persistent postoperative funneling (23.5 mm; 22.5 mm; p = 0.417). Conclusions: Tape position in relation to the pubic symphysis is important for the elimination of stress urinary incontinence. Sling location closer to the pubic symphysis reduces the length of urethral funneling, but has no effects on its width in cured patients with persistent postoperative funneling. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The suburethral sling procedure has been widely used as the first-line treatment for stress urinary incontinence (SUI) in women. Although the success rate is high, difficult urination and urine retention can occur in a small portion of patients. A transvaginal sling incision can solve this problem but recurrent SUI may occur. This study investigated the long-term outcomes of women who underwent the pubovaginal sling (PVS) procedure and subsequent transvaginal sling incision for urethral obstruction. Methods: We retrospectively reviewed the voiding conditions of women who underwent transvaginal sling incision owing to bladder outlet obstruction after the PVS procedure over the past two decades. Urodynamic study was performed before and after each operation. The patients' Global Impression of Improvement (PGI-I) and quality of life index (QoL-I) due to urinary symptoms were used for outcome evaluation. Results: Among 405 women who underwent PVS procedure, 14 (3.5%) underwent subsequent transvaginal sling incision. The main symptoms were severe dysuria, followed by urinary retention or severe wound discomfort. The average interval between the two operations was 147.6 ± 353.6 days (range 3~1,344). The mean follow-up time after sling incision was 91.1 ± 50.7 months. At follow-up, 12 patients (85.7%) could maintain urinary continence whereas 2 had urgency incontinence. Ten patients (71.4%) were satisfied with their quality of life postoperatively. Conclusions: Transvaginal sling incision is effective for urethral obstruction after PVS procedure. Voiding dysfunction after PVS could be resolved via sling incision. Most patients could maintain urinary continence and reported good satisfaction. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To identify patient characteristics and surgical factors predictive of complications requiring mid-urethral sling (MUS) revision/removal.Design: Case-control study.Setting: Tertiary academic centre in Canada.Population: One hundred and seven women undergoing MUS revision/removal between 2005 and 2016 were matched with 214 controls by date of index MUS procedure (2:1 ratio).Methods: Data on patient and surgical factors were obtained via manual electronic and paper chart review. Three sets of pre-specified simple and multivariable logistic regression models were fitted to: (1) examine previously reported risk factors for MUS revision after primary surgical treatment; (2) identify preoperative predictors of MUS complications requiring revision/removal; and (3) identify surgical factors associated with this outcome after adjusting for potential confounding factors.Main Outcome Measures: Crude and adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) for patient and surgical factors.Results: The median time to MUS revision was 153 days (interquartile range, IQR 49-432 days). Active smoking status (OR 2.29, 95% CI 1.13-4.63, P = 0.03), having had a previous hysterectomy (OR 3.88, 95% CI 2.02-7.46, P < 0.01), and undergoing concomitant pelvic organ prolapse surgery at the time of the index MUS procedure (OR 2.63, 95% CI 1.32-5.52, P < 0.01) were independently associated with the need for MUS revision/removal. Sling type (obturator versus retropubic), method of tensioning (to cough versus over instrument), anaesthetic type, and estimated blood loss were not associated with this outcome in the analysis presented here.Conclusions: Active smoking status, having had a previous hysterectomy, and undergoing concomitant surgery for pelvic organ prolapse are risk factors for requiring subsequent MUS revision/removal.Tweetable Abstract: Risk factors for sling revision include smoking, previous hysterectomy, and concomitant prolapse surgery. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence following radical prostatectomy can have a significant impact on a man's quality of life. Male slings offer a perceived minimally invasive treatment option and do not require the manual dexterity necessary to operate an artificial urinary sphincter. In this review, we outline the history of male slings and discuss the various fixed and adjustable slings that are available on the market. It is important for the general urologist to understand the technical differences, outcomes, and common complications of suburethral slings. [ABSTRACT FROM AUTHOR]

Aims: The objective of this study was to evaluate the efficacy of surgical removal of prosthetic material, possibly combined with nerve release, on chronic postoperative pain following placement of prosthetic material. Material and methods: Single‐tertiary‐centre study on 107 patients managed between November 2004 and April 2016 for removal of prosthetic material responsible for postoperative chronic pain: retropubic suburethral sling (n = 32), transobturator suburethral sling (n = 50), prolapse mesh (n = 16), and hernia mesh (n = 9). The primary endpoint was at least 50% reduction of pain evaluated by a pain numerical rating scale (NRS). Results: The mean interval between the initial operation involving placement of prosthetic material and reoperation for removal of prosthetic material was 41.2 ± 35.4 months. In all cases pain apperaed immediately following prosthetic material placement surgery. Pain presented neuropathic features in almost 30% of cases and was poorly systematized in more than one‐half The mean follow‐up of the study population was 8.4 ± 10.3 months. The mean pain NRS score for the overall population was seven preoperatively and three at last follow‐up. At least 50% reduction of the pain NRS score was observed 67% of cases at last follow‐up. During follow‐up, 45% of patients experienced relapse of the disorder for which the prosthetic material was initially placed with, in particular, a 62% recurrence rate of urinary incontinence after removal of transobturator suburethral tape. Conclusion: Surgical removal of prosthetic material to treat chronic postoperative pain, achieved global improvement of pain in about two‐thirds of cases, but with a risk of recurrence of the initial disorders. [ABSTRACT FROM AUTHOR]

Aims: To fabricate a novel nanoyarn biomaterial via a dynamic liquid electrospinning system, and to simultaneously evaluate whether nanoyarn is capable of being applied as a urinary sling for future clinical transfer. Methods: Nanoyarn was cultured with adipose‐derived stem cells (ADSCs). Cell morphology and function were observed on nanoyarn. Female rats that underwent vagina dilatation (VD) and bilateral ovarian resection (BOR) were used as the urinary incontinence model. After 2 weeks, the cells‐sling was fixed to the suburethra. A commercial sling that tension‐free vaginal tape‐obturator (TVT‐O) was used as a control. The urodynamic test for leak point pressure (LPP) and histological tests were used to evaluate the sling's performance in vivo. Results: The nanoyarn possessed beneficial properties and the actin filament from ADSCs, which is very similar to muscle. Rats that underwent VD and BOR maintained a low LPP, whereas the LPP in rats with VD alone recovered to normal levels within 2 weeks. LPP in the nanoyarn group gradually decreased on the three urodynamic tests post‐suburethral surgery, however, the cell‐laden nanoyarn maintained LPP at normal levels for 8 weeks; the TVT‐O group showed a significant increase in LPP at 8 weeks. Cell‐laden nanoyarn was infiltrated with more cells, collagen, and vessels than the controls. Conclusions: The nanoyarn showed sufficient efficacy to maintain LPP in urinary incontinence rat model. In addition, it improved cell infiltration, collagen and muscle development compared to TVT‐O. Thus, the combination of ADSCs and a nanoyarn scaffold could be a promising tissue‐engineered sling for the treatment of urinary incontinence. [ABSTRACT FROM AUTHOR]

Aims Translabial ultrasound (TUS) is a useful tool for identifying and assessing synthetic slings. This study evaluates the ability of urology trainees to learn basic pelvic anatomy and sling assessment on TUS. Methods Eight urology trainees (six residents and two medical students) received a lecture reviewing basic anatomy and sling assessment on TUS followed by review of two training cases. Next, they underwent a 126-question examination assessing their ability to identify anatomic planes and structures in those planes, identify the presence of slings, and assess the location and intactness of a sling. The correct response rate was compared to that of an attending radiologist experienced in reading TUS. Non-parametric tests (Fisher's exact, chi-squared tests, and Yates correction) were used for statistical analysis, with P < 0.05 considered significant. Results 847/1008 (84.0%) of questions were answered correctly by eight trainees compared to 119/126 (94.4%) by the radiologist ( P = 0.001). The trainees' correct response rates and Fisher's exact test P values associated with the difference in correct answers between radiologist and trainee were as follows: identification of anatomic plane (94.4%; P = 0.599), identification of structure in sagittal view (80.6%; P = 0.201), identification of structure in transverse view (88.2%; P = 0.696), presence of synthetic sling (95.8%; P = 1.000), location of sling along the urethra in (71.5%; P = 0.403), intactness of sling (82.6%; P = 0.311), and laterality of sling disruption (75.0%; P = 0.076). Conclusions Urology trainees can quickly learn to identify anatomic landmarks and assess slings on TUS with reasonable proficiency compared to an experienced attending radiologist. [ABSTRACT FROM AUTHOR]

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Purpose: Stress urinary incontinence (SUI) in men is a complication secondary to prostatectomy or resulting from neurological lesions. This study presents our experiences with male suburethral slings over the past decade. Methods: In this study, we considered patients who presented with SUI and were diagnosed with an intrinsic sphincteric deficiency due to postprostatectomy incontinence (PPI) or other causes (non-PPI). Patients who underwent the suburethral sling procedure using a polypropylene mesh and a cardiovascular patch were retrospectively included. An urodynamic study was performed before and after the operation. Global response assessment (GRA) and SUI grading were used for surgical outcome. The revision rate and the infection rate were also evaluated. Results: A total 31 patients were enrolled in this study; the mean patient age was 59.5±18.9 years, and the mean follow-up period was 36.9±29.4 months. Fourteen patients comprised the non-PPI group and 17 were in the PPI group. The preoperative SUI of all patients were categorized as a moderate to severe problem according to the SUI grade, with a mean score of 2.32±0.48 before the operation and 0.48±0.57 after the operation. With a mean score of 2.35±0.71, GRA showed that the patients were satisfied with the treatment. After the sling procedure, 4 patients (13%) reported a mild improvement, 12 (38.7%) a moderate improvement, while 15 (48.4%) reported an excellent improvement. Six patients (19.4%), including 5 from the non-PPI group (35.7%) and 1 (5.9%) from the PPI group (P=0.037), underwent sling removal because of infection. Conclusions: The male suburethral sling procedure using a polypropylene mesh and a cardiovascular patch is a safe, efficacious, and inexpensive surgical procedure for PPI. In cases of neurological incontinence, however, the higher infection rate in non-PPI patients means that they should be carefully managed. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: There is no consensus on the most appropriate type of anesthesia for placement of a midurethral sling. Our objective was to compare intra- and perioperative outcomes for this procedure performed under general anesthesia versus monitored anesthesia care. Methods: Retrospective cohort analysis of women undergoing outpatient placement of synthetic retropubic midurethral sling under general anesthesia ( n = 141) or monitored anesthesia care ( n = 84). Patients undergoing concomitant procedures were excluded. Primary outcome was operating room time. Secondary outcomes included surgical and recovery times, cost, discharge home with a catheter, and postoperative pain and/or nausea. Results: In the general anesthesia group, both operating room time (mean ± SD, 67.6 ± 13.3 min vs 56.9 ± 11.8 min, p < 0.001) and recovery room time (240.0 ± 69.8 min vs 190.1 ± 78.3 min, p < 0.001) were longer, whereas there was no difference in surgical time (30.0 ± 8.9 min vs 29.0 ± 9.7 min, p = 0.43). Cost was significantly higher in the general anesthesia group ($4,095 ± 715 vs $3,877 ± 777, p = 0.03). There was no difference in rates of bladder perforation (6.4 % vs 11.9 %, p = 0.33). Patients who underwent general anesthesia had higher rates of discharge with a catheter (27.0 % vs 15.8 %, p = 0.04). Conclusion: Monitored anesthesia care may offer significant benefits over general anesthesia in women undergoing retropubic midurethral sling, including shorter operating room and recovery times, lower costs, and less voiding dysfunction in the immediate postoperative period. [ABSTRACT FROM AUTHOR]

Objective To assess tolerance and mid-term clinical outcomes of treatment, with a new four-arm mesh sling, of post-prostatectomy incontinence (PPI) in men. Material and Methods This was a French multicentre prospective study that included 93 patients who underwent radical prostatectomy at least 1 year before Surgimesh M-SLING® implantation for the treatment of PPI. Data were collected preoperatively, and patients were followed at 3, 12 and 24 months postoperatively. Objective outcome measures included number of pads per day, 24-h pad-test, maximum urinary flow rate (Qmax) and urinary retention. We also analysed Urinary Symptom Profile (USP®) score, degree of erectile dysfunction, patients’ satisfaction level, postoperative pain and procedure complications. Length of catheterization and hospitalization periods were also recorded. Patients were considered cured if no protection was used and/or daily pad weight was <2 g. Patients whose condition was considered to have improved reduced their daily urinary losses by >50%. Those not included in any of the aforementioned groups were assessed as unchanged or to have deteriorated, and were considered as treatment failures. Results The mean hospitalization period was 1.57 ± 0.70 days. All patients remained catheterized for 1.17 ± 0.48 days. Intention-to-treat analysis at 24 months showed that 34.4% of patients were cured, 27.1% had improved, and 19.4% were considered failures. Two patients experienced transient urinary retention. USP questionnaire scores showed a significant decrease in incontinence and prevalence of hyperactive bladder. There was a nonsignificant tendency for reduced severe erectile dysfunction (ED), and a shift towards moderate ED was observed. No severe complications occurred. Conclusion The Surgimesh M-SLING transobturator and prepubic four-arm urethral sling represents an easy-to-deploy, safe and durable therapeutic alternative for mild to moderate PPI. Its implantation did not have a negative influence on sexual performance outcomes. [ABSTRACT FROM AUTHOR]

Aims Evaluate the effectiveness and safety of polyvinylidene fluoride (PVDF) transobturator suburethral slings/tapes (TOTs) in the treatment of stress urinary incontinence, and compare them to polypropylene (PP) slings. Material and Methods A retrospective cohort study was performed on women treated with a TOT procedure at Vall d'Hebron Hospital between February 2010 and May 2013. A PVDF sling was used in surgeries on 23 women. A comparison group was randomly selected among all women treated with a PP sling in a 1:4 ratio ( n = 92). Failure incidence was analyzed by Kaplan-Meier survival functions and a multivariate Cox regression model. Results Both groups were similar in their initial characteristics. The median follow-up was 24.6 months in the PP group and 21.3 months in the PVDF group. The survival functions showed a higher incidence of failures in the PP group, primarily because of obstructive symptoms. However, the differences were not statistically significant (hazard ratio of failure of PP vs PVDF 4.31; 95% confidence interval 0.56-33.05). Complication rates did not differ between the two groups. More cases of voiding dysfunction were observed in the PP group. Conclusions Polyvinylidene fluoride suburethral tapes have been found to have an effectiveness and safety comparable to PP tapes. [ABSTRACT FROM AUTHOR]

Introduction: Concomitant anti-incontinence surgery at the time of prolapse repair has been a long-debated topic. Still today, there remains no clear answer to this question, although in recent years the literature has become more robust with the addition of more randomized controlled trials. The lifetime risk for women of undergoing surgical correction of pelvic organ prolapse is significant, and concomitant anti-incontinence surgery is an important question during surgical planning. Materials and methods: This review delves further into the current literature to discuss a possible algorithm for managing the risk of stress incontinence after pelvic organ prolapse repair and examines the support in the literature for the following treatment methods: (1) anti-incontinence surgery for all women undergoing pelvic organ prolapse repair, (2) anti-incontinence surgery for no women undergoing pelvic organ prolapse repair, and (3) anti-incontinence surgery in select women undergoing pelvic organ prolapse repair. Conclusions: While there are data both for and against each of these approaches, after a review of the literature, we recommend anti-incontinence surgery for select women undergoing pelvic organ prolapse repair, including women with a history of symptomatic and occult stress incontinence diagnosed preoperatively. [ABSTRACT FROM AUTHOR]

Objectives To assess the efficacy and complications associated with the use of the tension-free vaginal tape ( TVT)- Secur system device for the treatment of female stress urinary incontinence ( SUI) based on a 3-year follow-up. Methods Women with SUI were randomly allocated to either the U- or H-type groups depending on the TVT-Secur approach used. Patients were questioned about continence and satisfaction 1, 2, and 3 years after surgery. Patients were assessed postoperatively by questionnaires including Sandvik, Incontinence Quality of Life (I- QoL), Bristol Female Lower Urinary Tract Symptoms- Scored Form ( BF-LUTS), incontinence visual analogue scale ( I-VAS), and benefit, satisfaction, and willingness to continue questionnaire. Cure was regarded as no leakage on the Sandvik questionnaire. Results A total of 115 patients with SUI were included in this study ( U-type: 53, H-type: 62). A total of 102 patients were followed-up for 3 years ( U-type: 47, H-type: 55). The overall cure rate at the 1-, 2-, and 3-year follow-ups was 87.8, 83.0, and 79.4%, respectively, and there was no difference in the cure rate between the U-and H-type approaches. Approximately 83.4 and 83.3% of patients were satisfied with the surgical outcome at the 1- and 3-year follow-ups. I-QoL, BFLUTS-SF, and I-VAS were improved from baseline regardless of the approach used at the 1- and 2-year follow-ups. Complications included intraoperative vaginal wall perforation (three cases), voiding difficulties such as immediate postoperative retention, and urgency episodes. Conclusions Both U- and H-type approaches of TVT-Secur for the treatment of female SUI remains efficacious, safe, and satisfactory for up to 3 years after surgery. [ABSTRACT FROM AUTHOR]

Female urinary incontinence represents a medical and social problem with huge impact regarding both patient's quality of life and social costs. The diagnosis is important for therapeutic choice and should consider some factors: the degree of urethral mobility, urodynamics parameters, patient's will and expectations, information about surgical complications and risks. Nowadays suburethral sling evolution and bulking therapy for selected cases consent to perform miniinvasive surgery; the most relevant problem concerns the management of postoperative complications: in this sense autologous slings are used after urethrolisis. In most difficult cases, it is possible to consider artificial sphincter as the best option. [ABSTRACT FROM AUTHOR]

Aim Recently a miniature version of the Monarc suburethral sling has been introduced. This paper aims to evaluate the postoperative recovery, effectiveness and complications of these two types of suburethral sling. Methods This was a prospective randomized series of 50 female patients with stress incontinence who underwent either a Monarc or Miniarc suburethral sling. Results The only significant intraoperative difference was a shorter operation time for the Miniarc (18.8 vs 22.4 min). The success rates were similar at 6 weeks and 6 months. Conclusion There were no significant differences between the Miniarc and Monarc, except for a significantly shorter Miniarc sling operating time. [ABSTRACT FROM AUTHOR]

Introduction: There is still no consensus on which surgical technique is the most effective for female recurrent stress urinary incontinence after the initial surgery. Aim: To compare the long-term treatment outcomes of Burch colposuspension operation, transobturator tape implantation (TOT) and tension-free vaginal tape (TVT) procedures performed for female recurrent stress urinary incontinence after the initial surgery. Material and methods: A retrospective study was performed on 45 women operated on for recurrent stress urinary incontinence after the initial surgery. Depending on the surgical approach, the patients were divided into three groups: group I (n = 19) -- Burch colposuspension operation, group II (n = 16) -- TOT, and group III (n = 10) -- TVT operation was performed. The treatment results were assessed using the UDI-6 (Urogenital Distress Inventory) and IIQ-7 (Incontinence Impact Questionnaire) short form questionnaires. We included one additional question: Is the patient satisfied with the treatment outcome? We classified the urinary continence results after surgery as good when patients were cured or improved, and as bad when the treatment failed. Results: Good urinary continence results were observed in 84.2% of patients in group I, 93.8% of patients in group II, and 90% of patients in group III. 68.4% of patients in group I, 81.3% of patients in group II, and 90% of patients in group III were satisfied with the treatment outcomes. Conclusions: Burch colposuspension operation, TOT and TVT procedures performed for the female recurrent stress urinary incontinence treatment are effective and show similar good urinary continence results and similar number of patients satisfied with the treatment outcomes. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to evaluate cure rate and mid-term results of tension-free vaginal tape for recurrent stress urinary incontinence after failed transobturator tape surgery. Material and Methods Between January 2006 and December 2011, 42 women were enrolled in this study. Patient characteristics and operating parameters were recorded, and any complications were noted. All patients were followed up for at least 24 months after the second surgery. The Incontinence Impact Questionnaire and the Urinary Distress Inventory were used to identify satisfaction level. Results The mean age of the patients was 49.07 ± 8.6 years, and median period between transobturator surgery and the tension-free vaginal tape procedure was 12.8 (range 9.2-17.8) months. The cure rate was 83.3% and 76.2% at the first- and second-year follow-up visits, respectively. Intraoperative complications were transient and slight. Bladder injury in five patients and subcutaneous hematoma above the pubis in two patients were the most serious complications, but they were managed conservatively. We found the scores of the Incontinence Impact Questionnaire and Urinary Distress Inventory to be significantly lower at follow-up, compared to the preoperative assessment. De novo urgency was the most common complaint at follow-up and occurred in 11.9% of the women. Conclusions We suggest that tension-free vaginal tape is a feasible surgical option for recurrent stress urinary incontinence. Further studies with larger patient numbers and longer follow-up periods are needed to support this finding. [ABSTRACT FROM AUTHOR]

Purpose: We investigated whether the Valsalva leak point pressure (VLPP) is valuable for predicting postoperative outcome measurement after transobturator suburethral tape (TVT-O) implantation for treating stress urinary incontinence (SUI) in women. Materials and Methods: A total of 204 female patients who underwent TVT-O placement for treatment of SUI from March 2008 to February 2012 were enrolled in this retrospective study. All patients completed the incontinence quality of Life questionnaire (I-QoL), a self-reported quality of life measure specific to urinary incontinence, and the cure rate of incontinence was measured before and 6 months after surgery. Cure was defined as no leakage of urine postoperatively both subjectively and objectively. We compared pre- and postoperative I-QoL scores according to preoperative VLPP and Stamey grade. Results: The numbers of patients with Stamey grades I, II, and III were 99 (48.5%), 84 (41.2%), and 21 (10.3%), respectively. A total of 30 (14.7%), 87 (42.6%), and 87 patients (42.6%) showed VLPP≤60, 6090 cm H2O, respectively. Preoperative VLPP was not significantly different according to preoperative I-QoL or change in I-QoL after surgery. However, I-QoL after surgery improved in patients with a high preoperative Stamey grade (p=0.001). Conclusions: VLPP was not a factor related to surgical outcome from the midurethral sling procedure. Stamey grade rather than VLPP was important for predicting subjective quality of life and improved incontinence-related quality of life after surgery. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of this study was to evaluate the functional outcome of a single-incision sling procedure for the treatment of female stress urinary incontinence (SUI) and to correlate the cure rate with a pelvic floor ultrasound examination Methods: Fifty-seven patients treated with a single-incision sling procedure between January 2009 and September 2010 were included in the study. Functional outcome was evaluated as objective cure rate assessed with stress test and subjective cure rate determined by the International Consultation on Incontinence-Short Form and Patient Global Impression of Improvement scores. Women underwent perineal ultrasound examination by a combined 2D translabial and 3D transvaginal approach to assess bladder neck and tape mobility, tape position along the urethral axis, and tape anchorage. According to the position of self-fixating tips, we divided patients into group A (both tips crossed the obturator membrane), group B (only one tip crossed the obturator membrane) and group C (none of the tips crossed the obturator membrane). Objective cure rate and type of anchorage were compared with all ultrasound parameters. Results: At an average follow-up of 13 months objective cure rate was 87.7 % with a significant subjective improvement. A significant difference in tape mobility was noted between group A and group C. Bladder neck mobility significantly increased in failures. Sling was significantly closer to mid-urethra in cured than in failures. Conclusions: In 77 % of patients MA didn't reach the obturator membrane on both sides. This feature conditioned significantly bladder neck mobility but not the efficacy of the procedure. Tape position seems to be the most important factor for success. [ABSTRACT FROM AUTHOR]

Objectives: Inside-out tension-free vaginal tape obturators for the cure of female stress incontinence can cause postoperative thigh pain. The aim of the present study was to analyze and compare the mid-term outcomes of two tension-free vaginal tape obturator procedures. Methods: Patients diagnosed with urinary stress incontinence were enrolled to undergo a tension-free vaginal tape obturator sub-mid urethral tape operation either by de-Leval's method or by Flam's modification. Peri- and postoperative data were collected by uninvolved researchers and analyzed. Follow up was 36 months. Results: Overall, 161 patients were included in the study. Cure and complication rates were similar between the two treatment groups. Postoperative thigh pain was significantly more frequent and lasted longer in the de-Leval group compared with the Flam group (31.9% vs 10.0%, respectively). Urinary urgency was more frequent in the de-Leval patients (20.3% vs 2.8%). Conclusion: Our findings suggest that both tension-free vaginal tape obturator procedures are effective with few adverse effects. The Flam method provides shorter and decreased levels of postoperative thigh pain, as well as reduced long-term postoperative urinary urgency. [ABSTRACT FROM AUTHOR]

Suburethral transobturator slings are accepted as a first-line procedure for treatment of stress urinary incontinence (SI). However, persistent or recurrent SI and de novo or worsened urge incontinence (UI) remain a problem in a minority of cases. The objective of this study was to determine clinical predictors for success and failure after Monarc™ suburethral sling placement. We conducted a retrospective clinical audit of 98 patients who had undergone Monarc™ suburethral slings. The preoperative work-up included a standardised interview, a clinical examination, multichannel urodynamic testing, and 4D pelvic floor ultrasound. Potential predictors were tested against subjective failure for SI, UI and overall satisfaction. With subjective cure defined as success, 19/98 (19.4%) patients had procedures classified as failed with regard to SI and 45/98 (45.9%) for UI. The only consistent finding was that a lower maximal urethral closure pressure was associated with both SI and UI postoperatively (p=0.015 and 0.017 respectively). The Monarc™ suburethral sling is associated with high subjective cure and satisfaction rates. We confirmed maximal urethral closure pressure as a predictor for success. Interestingly, this applied to both SI and UI. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: This study aims to identify independent risk factors for treatment failure of tension-free vaginal tape TVT-Secur (TVT-S) compared to that of the well-established transobturator tape. Materials and methods: Of a total of 175 consecutive patients with urodynamically confirmed stress urinary incontinence (SUI) identified between July 2007 and March 2010, 89 patients underwent TVT-S, and 86 underwent TOT. Cure was defined using the Urogenital Distress Inventory as no urinary leakage during physical activity, coughing, or sneezing as reported by patients during a telephone survey. To identify predictors of treatment failure, multivariable logistic regression models were used, and odds ratios (ORs) were calculated using variables identified during univariate analysis. Results: There were more patients with cystocele ≥ grade 2 in the TVT-S group ( p = 0.031); otherwise the groups were well matched. After a median follow-up of 32 months (range, 12-44 months), the overall cure rate was 80.6%; it was 70.8% for those treated with TVT-S and 90.7% for those treated with TOT ( p = 0.001). In a multivariate model, previous incontinence surgery (OR 27.1, p = 0.005) and a cystocele ≥ grade 2 (OR 3.0, p = 0.020) were independent risk factors influencing the outcome of TVT-S procedures. For the TOT procedures, detrusor overactivity was an independent risk factor in a multivariate model (OR 8.6, p = 0.033). Conclusions: TVT-S could be performed for selected patients, but conventional TOT procedures are still superior to the novel TVT-S device. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: It is unclear whether preoperative urodynamic study (UDS) values are predictive of outcomes after midurethral sling. Materials and methods: We systematically reviewed multiple databases from January 1989 to October 2011 for English-language studies correlating UDS data with postoperative outcomes after midurethral slings. We performed random effects model meta-analyses, as indicated. Relative risk (RR) ratios for the outcome of stress urinary incontinence (SUI) cure were calculated using high maximum urethral closure pressure (MUCP) and Valsalva leak point pressure (VLPP) values as the reference group. Results: High preoperative MUCP was associated with cure after retropubic [RR 0.67; 95% confidence interval (CI) 0.47-0.97)] and transobturator slings (RR 0.65; 95% CI 0.49-0.90). High preoperative VLPP was also associated with cure after retropubic sling (RR 0.89; 95% CI 0.82-0.96), but this relationship did not achieve statistical significance for cure after transobturator sling (RR 0.86; 95% CI 0.74-1.00). Conclusions: Preoperative MUCP and VLPP values may add insight into postoperative outcomes after surgical treatment for SUI. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objective of this study was the assessment of the efficiency of the MiniArc for curing stress urinary incontinence. Methods: Seventy-seven patients, operated on from March 2008 to November 2009, were evaluated in this study. One-year post-operative data are presented. All patients suffered from predominant stress urinary incontinence. After 1 year, response was 74%. Evaluation was performed using a questionnaire consisting of the EuroQol-5 Dimensions, the Patient Global Impression of Improvement, the Incontinence Impact Questionnaire, the Urinary Distress Inventory, the Prolapse/Urinary Incontinence Sexual Questionnaire, short form, and the Defecation Distress Inventory. Results: One year after surgery, 68% of the patients stated an improvement in their incontinence status, while only 44% stated to be completely dry. Conclusion: The 1-year follow-up suggests that the MiniArc is less effective in the treatment of stress urinary incontinence than the TVT. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Suburethral sling procedures are a mainstay for the surgical treatment of stress urinary incontinence (SUI). The interaction between the sling and the host is fundamental for the success of the procedure. Patients affected by autoimmune disease present with an overactive immune system; this should theoretically increase rejection risk. Methods: The data from 19 autoimmune patients affected by SUI were retrospectively collected. Primary outcome consisted of evaluating whether tape-related complications may occur more frequently. Secondary outcome measures were assessment of objective and subjective cure of SUI. Changes from baseline were analyzed using the Mann-Whitney and Fisher tests. Results: Success rate, evaluated at 12-month follow-up, was 89.5%. No tape erosion or urinary retention was observed; chronic pelvic pain and dyspareunia rates were 5.26% and 15.4%, respectively. One patient developed de novo urgency. Conclusions: According to our experience, the suburethral sling is a safe procedure with low complication rates comparable to those reported in the literature. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: This study was conducted to evaluate the effectiveness and safety of retropubic suburethral slings (TVT) to treat recurrent stress urinary incontinence (SUI) after transobturator tape (TOT) failure. Methods: A descriptive study was performed among women with recurrent SUI treated at the Vall d'Hebron University Hospital between January 2006 and December 2009. All women were preoperatively evaluated to rule out complications of the first sling. Urodynamic testing was performed before and after the TOT procedure in all cases. Postoperative follow-up was performed at 1, 6, and 12 months and yearly thereafter. Outcomes were classified as cured, improved, or failed. Results: Twenty-three women were operated on over the study period. The median time to reoperation was 12 months (range 6 to 34 months) and the median follow-up time was 36.1 months (range 7.8 to 60.2 months). Overall cure and improvement rates were 86.4% at 12 and 24 months and 75% at 36 months. Failure was found not to be related to time between both sling surgeries. Two cases of bladder perforation were recorded (8.7%). Postoperative complications were slight and self-limited. De novo urgency occurred in five cases (21.7%). Conclusions: TVT has been found to be effective to treat recurrent SUI after TOT failure in the present series with slight side effects. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of the study was to investigate the variability of bony pelvis architecture from the viewpoint of transobturator sling placement. Methods: The pelvimetry was performed on 122 women who underwent pelvic computed tomography. Measurements included: the distance between the interobturator foramina line and inferior pubic symphysis (IF-PS distance) as well as pubic arch angle, pubic ramus width, and pubic symphysis length. Results: The length of the IF-PS distance varied between 7.4 and 26.9 mm (mean 15.2 ± 4.3 mm, median 14.2 mm). The distribution of measurements was asymmetrical with a tilt of the values towards shorter distances. In 11.5% of women, the IF-PS distance was longer than 20 mm. The IF-PS distance correlated with the pubic ramus width ( r = 0.37, p < 0.0001) and pubic arch angle ( r = −0.22, p = 0.017). Conclusion: The IF-PS distance varies considerably in the general population of women. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: We compared outcomes after midurethral sling (MUS) with and without concomitant repair for prolapse. Methods: Women who underwent MUS with or without concomitant repair for prolapse completed a follow-up survey. Outcomes were assessed with validated questionnaires and medical record review. Kaplan-Meier, Cox proportional hazards regression, and logistic regression models were used for analysis. Results: Of 317 women, 281 (89%) responded to the survey. During a median follow-up of 2.7 years, survival free of 'any' incontinence (Incontinence Severity Index score, >0) was similar in both groups (adjusted hazard ratio, 1.07; P = 0.77). Women with concomitant repair for advanced prolapse tended to be more bothered by frequent urination (adjusted odds ratio, 1.78; P = 0.08) and more likely to require urethrolysis (odds ratio, 6.11; P = 0.04) than those without concomitant pelvic floor repair. Conclusions: Prolapse repairs concomitant with MUS did not affect incontinence recurrence. However, repairs may cause increased lower urinary tract symptoms. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of this study was to determine associations between the ultrasonic appearance of Monarc suburethral slings and postoperative bladder symptoms at an average follow-up time of 11 months. Methods: A prospective clinical audit was conducted on 98 patients after Monarc suburethral sling. The assessment included pelvic floor ultrasound to determine the gap between the sling and symphysis pubis, the angle formed by cranial and caudal ends of the sling at rest and on Valsalva, and the location of the sling relative to the urethra. Results: Patients who reported postoperative stress incontinence (SI) or urge incontinence (UI) had a significantly wider gap between the symphysis pubis and sling ( P = 0.032 and P = 0.006, respectively). Conclusions: A narrower gap between the tape and symphysis pubis is associated with both SI and UI cure. Tighter transobturator sling placement seems to be advantageous for the cure of both SI and UI. [ABSTRACT FROM AUTHOR]