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Objective: To determine outcomes after removal of two synthetic mid‐urethral slings (MUS) at a tertiary care center. Methods: Following IRB approval, a retrospective chart review of non‐neurogenic, symptomatic women requiring re‐operation after ≥2 MUS was performed. Data reviewed by a third party included: demographics, prior anti‐incontinence surgery, complications, pelvic/urinary symptoms, subsequent investigations, surgical repair and outcomes (including UDI‐6/IIQ‐7 questionnaires) at a minimum 6 months follow‐up. Cure was defined as being continent, no dyspareunia, and no additional surgical therapy. Results: Between 2007 and 2014, 21 women met the inclusion criteria. Mean age was 57 years (range: 40–82) and mean follow‐up was 30.2 months (range: 6–78). The majority of patients presented with one or more symptoms of voiding dysfunction (95%), urinary incontinence (86%), irritative voiding symptoms (62%), dyspareunia (57%), recurrent urinary tract infections (UTIs) (29%), vaginal extrusion (20%) and erosion involving the urinary tract (5%). Patients had a mean of 2 prior anti‐incontinence procedures (range 2–3). Over two‐thirds had a combination of retropubic and transobturator MUS. Mean number of pre‐operative investigations was 3.5 (1–6) including voiding cystourethrogram, cystoscopy and urodynamics. Two patients had complete remission, 14 partial remission, and five failed. Mean postoperative total UDI‐6 and IIQ‐7 scores at last clinic visit were 10 (range: 0–16/SD 4.1) and 11 (range: 0–28/SD 10.3), respectively. Conclusion: The management of women with suboptimal outcomes following two synthetic MUS from transvaginal excision results in modest symptomatic improvement but low permanent complete remission and frequent need for additional therapies. [ABSTRACT FROM AUTHOR]

Aims To evaluate quality of life in patients with neurogenic bladder (NGB) conditions who have elected to undergo suprapubic catheterization (SPC), as well as assess adverse events (AEs) related to the procedure. Methods This is a retrospective review from a database of NGB patients from 1/1/2003 to 6/30/2013. Patients who underwent SPC placement were invited to complete a validated, single item Patient Global Impression of Improvement (PGI-I) questionnaire. Success or positive response was defined as 1 or 2 on a scale of 1-7. All patients were included in the assessment of AEs. Results Of the 128 patients who underwent SPC, 89 patients (54 female, 35 male) met inclusion criteria. Response rate to the PGI-I questionnaire was 65.2% (58/89). Mean age at the time of SPC placement was 54.4 years (± 14.4). The mean time from SPC placement to PGI-I questionnaire was 48.3 months (Range 4.4-128.4). Overall, success was seen in 49/58 patients (84.5%). Only 5.2% (3/58) patients reported a negative PGI-I (score 5/7). There was an 18.8% rate of short term complications, with the majority of these being classified as Clavien I. There was one Clavien IIIb complication (0.8%), which consisted of a small bowel perforation. Conclusions SPC is an effective bladder management in carefully selected NGB patients who have failed other options. Over 80% considered the SPC to have improved their urological quality of life with a mean time to questionnaire of 4 years. Severe AEs are rare, though can be particularly serious in this group of neurologically impaired patients. Neurourol. Urodynam. 35:831-835, 2016. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence and pelvic organ prolapse are two of the commonest conditions affecting women today. It is associated with significant compromise to quality of life. Through the years, there has been an evolution of technique and graft material to augment repairs for durability. Transvaginal placements of synthetic mid-urethral slings and vaginal meshes have largely superseded traditional tissue repairs in the current era because of presumed efficacy and ease of implant with device 'kits'. The use of synthetic material has generated novel complications, including mesh extrusion, pelvic and vaginal pain and mesh contraction. In this review, our aim is to discuss the management and outcomes associated with mesh removal. In addition, we will briefly review the safety communications issued by the US FDA on transvaginal mesh placement and a new classification system for complications arising from the use of synthetic graft endorsed by both the International Continence Society and International Urogynecological Association. [ABSTRACT FROM AUTHOR]

Introduction To report our long-term pubovaginal slings (PVS) outcomes between primary (PVS1) and secondary (PVS2) autologous fascia PVS, with the hypothesis that outcomes in PVS1 will be better than in PVS2. Materials and Methods IRB approved retrospective study of women undergoing PVS between 1996 and 2011 with minimum 6 months follow-up. Data reviewed included demographics, questionnaires that is, UDI-6, IIQ-7, QOL, prior anti-incontinence procedure, associated repairs, urodynamic findings and repeat procedures. Primary outcome and surgical success defined by: (1) QOL ≤ 3, (2) UDI question 3 on SUI ≤ 1, and (3) no SUI re-treatment/operation. Secondary outcomes included all other patient reported outcome measures (PROM). Results Of 110 patients, 84 had follow-up. Mean age was 61 years (38-88) and median follow-up was 89 months (7-189). Demographic findings and type of fascia used were similar between the two groups. Mean postoperative scores were not statistically significant for total UDI-6 score ( P = 0.62), IIQ-7 ( P = 0.30) and QOL ( P = 0.35) between groups, but was statistically significant compared to baseline ( P = 0.001) as expected. Twelve patients, 3 in PVS1 and 9 in PVS2 underwent subsequent procedures. Surgical success rate was 76% in PVS1 and 52% in PVS2 for those with completed questionnaires. Overall, 78% (28) in PVS1 and 69% (33) in PVS 2 required no further surgical intervention at last follow-up. Conclusion At long-term follow-up of average 7.4 years, primary and secondary PVS patients had comparable favourable functional outcomes with low morbidity. However, secondary PVS patients had lower success rates as per our definition with higher rate of additional procedures. Neurourol. Urodynam. 34:18-23, 2015. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

The article describes a potential decision algorithm for pelvic organ prolapse (POP) repair. POP can affect quality of life by impairing urinary, bowel and sexual function. Conservative options include pelvic floor muscle training (PFMT) and pessaries. The most common type of anterior repair is anterior colporrhaphy, which involves plicating the pubocervival fascia in the midline with a series of absorbable sutures.

Introduction: To describe urodynamic study (UDS) findings in middle-aged and older women with various lower urinary tract symptoms (LUTS) who were found to have a normal study interpretation., Materials and Methods: Following institutional review board approval, UDS tracings of non-neurogenic women who were tested for various LUTS and whose study was interpreted as normal were reviewed. Demographic data, indications for UDS, and UDS parameter findings were extracted. UDS was conducted according to an established protocol using a 6F dual-lumen catheter (ICS guidelines) with a Laborie system and interpreted with a pre-existing template to standardize each reading. The fill-void study was frequently repeated during the same UDS session to confirm normal findings. Study interpretation was done by a neutral reviewer with UDS expertise., Results: From 2000-2012, 42 middle-aged women, who had been coded as having a normal study, were retrospectively reviewed from a database of over 2200 studies. The majority were Caucasian, with mean age 63 (range 42-85), mean body mass index 24.5 (20-37), mean parity 2 (0-4), and 67% were post-menopausal. Of the 42 patients, 28 underwent a second fill-void study. UDS findings were reported based on clinical indication for UDS: 1) incontinence, 2) pelvic organ prolapse, or 3) other LUTS symptoms. UDS findings were consistent between first and second studies., Conclusions: UDS parameters from a cohort of middle-aged and older women with normal findings could serve as reference values when interpreting urodynamic studies or for designing an age-comparable nomogram.