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Objective: To assess the efficacy of transobturator tapes in the management of women with urodynamic mixed urinary incontinence (UI)., Study Design: A secondary analysis of a prospective randomized study; 83 women with mixed UI on urodynamics and predominant stress UI symptoms were recruited and randomly assigned to undergo "outside-in" or inside-out transobturator tapes. Preoperative assessment included urodynamic assessment and completion of validated symptom severity and quality of life (QoL) questionnaires. The primary outcome was patient-reported success rates at 1-year as assessed by the Patient Global Impression of Improvement (very much/much improved). Secondary outcomes included changes in preoperative urgency/urgency incontinence, changes in QoL scores and comparison between the 2 types of transobturator tapes., Results: Seventy-seven women completed 1-year follow-up (outside-in [n=42] vs inside-out [n=35]). The patient-reported success rate and objective cure rate were 75% and 90%, respectively. At 1-year follow-up; 40 women (52%) and 31 women (57.4%) reported cure in their preoperative urgency and urgency incontinence, respectively. A total of 74% reported≥10 point improvement in QoL scores., Conclusion: In women with urodynamic mixed incontinence and predominant stress UI, transobturator tapes were associated with good patient-reported success rate at 1 year. Urgency/ urgency incontinence are cured in over 50% of women., (Copyright © 2011 Mosby, Inc. All rights reserved.)

The objective of this retrospective longitudinal study was to investigate the incidence and severity of urinary and faecal incontinence in women after either total abdominal hysterectomy or comparable abdominal surgery. Age-matched and postoperative time-matched control groups were drawn from women attending for operation at a Scottish District General Hospital, during the early 1990s (59 women in the hysterectomy group and 33 women in the control group, with a mean preoperative age 40.4 years and 38.1 years, respectively). Within-group and between-group analyses were conducted using t and Fisher's exact tests. Within each group, changes in all urinary and faecal variables during the 10-year period were extremely significant (p < 0003). With the exception of urinary urgency (p = 0.028), there was no statistical difference between the groups.

Aim: The objective of this study is to determine whether a simple visual analogue scale; "incontinence bothersome scale (IBS)" can reliably assess the quality of life in women with urinary incontinence., Design: A prospective cohort study in a UK district general hospital., Methods: Two hundreds women with urinary incontinence participated in the study over 1-year period. They completed Kings health questionnaire version 7 (KHQ) and the incontinence bothersome scale (IBS). The results of the IBS were then compared to the total KHQ score and to each domain separately, using the Pearson correlation test. Women in the study were then classified into two main groups according to their urodynamics diagnosis (urodynamic stress incontinence group/detrusor overactivity group) and the total KHQ scores were compared with the IBS scores in each group., Results: The IBS scores had poor correlation with the total KHQ scores (r=0.656) and the difference between both arms was not statistically significant (p=0.084). Further analysis of KHQ domains showed that except for the impact of incontinence domain (r=0.728) all other domains correlated poorly to the IBS. This poor correlation pertained in sub-analysis of women with DO and USI (r=0.65 and 0.48, respectively)., Conclusion: This study has shown that a simple visual scale is not a reliable tool in assessing the QoL in women with urinary incontinence. A formal, validated and reliable QoL questionnaire is still the method of choice for QoL assessment, even if it takes longer to complete.

Seventy-four patients presenting with a mixed pattern of urinary symptoms were randomly allocated to undergo either inpatient or outpatient continence programs as initial treatment, without prior urodynamic investigation. Both programs consisted of physiotherapy, bladder retraining, fluid normalization, dietary advice and general support and advice. Nine out of 39 in the outpatient group and 8 out of the 35 of the inpatient group failed to complete the study. There was a significant decrease in frequency, nocturia, number of incontinent episodes and visual analog scores for both groups. In addition the outpatients had a significant reduction in loss on pad testing, and a significantly greater improvement in their visual analog score. In each group 63% were cured or improved to the extent that they did not require further treatment. Staff costs per outpatient were half those for an inpatient. We conclude that outpatient conservative treatment as detailed above is a successful first-line treatment of urinary incontinence in women. It is as successful and possibly better than inpatient treatment, and is significantly cheaper.

A total of 36 subtrigonal phenol injections were performed on 29 patients with detrusor instability. Long-term follow-up (mean 13.7 months) showed a subjective response rate of only 14%, and objectively there was no significant change in any urodynamic parameter in the group as a whole. There was, however, a significant improvement in cystometric capacity and volume at first contraction, in those under 55 years of age. One patient developed a vesicovaginal fistula following repeat injections. This suggests that subtrigonal phenol injections have little place in the treatment of detrusor instability, especially in the over 55s, and repeat injections should be abandoned because of the risk of major complications.

Objectives To identify the rate of, and risk factors for, lower urinary tract (LUT) injuries associated with the transobturator tension-free vaginal tape (TOT) procedure. Design Retrospective cohort study. Setting Tertiary referral urogynaecology centre. Population 390 women who underwent transobturator suburethral tapes for management of urodynamic stress incontinence between July 2002 and January 2006. Methods Early cases were identified from theatre records and a case note review performed. From May 2005 ( n= 94), data from an ongoing prospective audit were reviewed. Data for LUT injuries with TOT procedures were examined and routes of insertion were compared using Fischer’s exact test. Main outcome measures Rate of LUT injuries associated with the TOT procedures. Assessment of factors increasing risk of LUT injury, and comparison of the ‘outside-in’ and ‘inside–out’ techniques. Results 241 women underwent TOT outside–in technique and 148 of them underwent inside–out technique. Four LUT injuries occurred (1%): two urethral injuries (0.5%) and two bladder injuries (0.5%). All LUT injuries occurred in the outside–in group, although this difference did not reach significance ( P= 0.146). Bladder injuries occurred in women who underwent concomitant vaginal surgery, while urethral injuries occurred in women undergoing secondary procedures. Conclusion LUT injury is an uncommon complication of the TOT procedures, and in our hands only occurred with the outside–in technique. Intraoperative cystoscopy should be considered only in selected cases. [ABSTRACT FROM AUTHOR]