Surgical interventions for stress urinary incontinence

BMJ ◽  
2019 ◽  
pp. l2350
Author(s):  
Emily Carter ◽  
Rufus Cartwright
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Surgical Interventions

scholarly journals A comparative Histologic and Immunohistochemistry Evaluation Between Normal Aponeurotic Tissue, Fibrotic Aponeurotic Scars and Polypropylene Embedded Aponeurotic Scars

2017 ◽  
Vol 54 (3) ◽  
pp. 510-512
Author(s):  
Radu Chicea ◽  
Dan Bratu ◽  
Anca Lucia Chicea ◽  
Alin Mihetiu ◽  
Vlad Preluca ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Prognostic Marker ◽  
Genital Prolapse ◽  
Tissue Response ◽  
Surgical Interventions ◽  
Inflammatory Tissue

Synthetic polypropylene materials are increasingly being used in surgery to repair parietal defects in perineal floor curing surgery, in genital prolapse and stress urinary incontinence. The tissue response to contact with these materials varies, and the inflammatory tissue response may be a prognostic marker of success in surgical interventions that involve contact between tissues and polypropylene materials.

scholarly journals Surgical interventions for women with stress urinary incontinence: systematic review and network meta-analysis of randomised controlled trials

BMJ ◽  
2019 ◽  
pp. l1842 ◽  
Author(s):  
Mari Imamura ◽  
Jemma Hudson ◽  
Sheila A Wallace ◽  
Graeme MacLennan ◽  
Michal Shimonovich ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Adverse Events ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Surgical Interventions ◽  
Randomised Controlled ◽  
Meta Analyses

Abstract Objectives To compare the effectiveness and safety of surgical interventions for women with stress urinary incontinence. Design Systematic review and network meta-analysis. Eligibility criteria for selecting studies Randomised controlled trials evaluating surgical interventions for the treatment of stress urinary incontinence in women. Methods Identification of relevant randomised controlled trials from Cochrane reviews and the Cochrane Incontinence Specialised Register (searched May 2017), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Medline In-Process, Medline Epub Ahead of Print, CINAHL, ClinicalTrials.gov, and WHO ICTRP. The reference lists of relevant articles were also searched. Primary outcomes were “cure” and “improvement” at 12 months, analysed by means of network meta-analyses, with results presented as the surface under the cumulative ranking curve (SUCRA). Adverse events were analysed using pairwise meta-analyses. Risk of bias was assessed using the Cochrane risk of bias tool. The quality of evidence for network meta-analysis was assessed using the GRADE approach. Results 175 randomised controlled trials assessing a total of 21 598 women were included. Most studies had high or unclear risk across all risk of bias domains. Network meta-analyses were based on data from 105 trials that reported cure and 120 trials that reported improvement of incontinence symptoms. Results showed that the interventions with highest cure rates were traditional sling, retropubic midurethral sling (MUS), open colposuspension, and transobturator MUS, with rankings of 89.4%, 89.1%, 76.7%, and 64.1%, respectively. Compared with retropubic MUS, the odds ratio of cure for traditional sling was 1.06 (95% credible interval 0.62 to 1.85), for open colposuspension was 0.85 (0.54 to 1.33), and for transobtrurator MUS was 0.74 (0.59 to 0.92). Women were also more likely to experience an improvement in their incontinence symptoms after receiving retropubic MUS or transobturator MUS compared with other surgical procedures. In particular, compared with retropubic MUS, the odds ratio of improvement for transobturator MUS was 0.76 (95% credible interval 0.59 to 0.98), for traditional sling was 0.69 (0.39 to 1.26), and for open colposuspension was 0.65 (0.41 to 1.02). Quality of evidence was moderate for retropubic MUS versus transobturator MUS and low or very low for retropubic MUS versus the other two interventions. Data on adverse events were available mainly for mesh procedures, indicating a higher rate of repeat surgery and groin pain but a lower rate of suprapubic pain, vascular complications, bladder or urethral perforation, and voiding difficulties after transobturator MUS compared with retropubic MUS. Data on adverse events for non-MUS procedures were sparse and showed wide confidence intervals. Long term data were limited. Conclusions Retropubic MUS, transobturator MUS, traditional sling, and open colposuspension are more effective than other procedures for stress urinary incontinence in the short to medium term. Data on long term effectiveness and adverse events are, however, limited, especially around the comparative adverse events profiles of MUS and non-MUS procedures. A better understanding of complications after surgery for stress urinary incontinence is imperative. Systematic review registration PROSPERO CRD42016049339.

scholarly journals Economic evaluation of surgical treatments for women with stress urinary incontinence: a cost-utility and value of information analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035555
Author(s):  
Mehdi Javanbakht ◽  
Eoin Moloney ◽  
Miriam Brazzelli ◽  
Sheila Wallace ◽  
Laura Ternent ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Value Of Information ◽  
Time Horizon ◽  
Cost Effective ◽  
Incidence Rates ◽  
Information Analysis ◽  
Surgical Interventions ◽  
Value Of Information Analysis ◽  
Surgical Treatments

ObjectivesStress urinary incontinence (SUI) and stress-predominant mixed urinary incontinence (MUI) are common conditions that can have a negative impact on the quality of life of patients and serious cost implications for healthcare providers. The objective of this study was to assess the cost-effectiveness of nine different surgical interventions for treatment of SUI and stress-predominant MUI from a National Health Service and personal social services perspective in the UK.MethodsA Markov microsimulation model was developed to compare the costs and effectiveness of nine surgical interventions. The model was informed by undertaking a systematic review of clinical effectiveness and network meta-analysis. The main clinical parameters in the model were the cure and incidence rates of complications after different interventions. The outcomes from the model were expressed in terms of cost per quality-adjusted life-years (QALYs) gained. In addition, expected value of perfect information (EVPI) analyses were conducted to quantify the main uncertainties facing decision-makers.ResultsThe base-case results suggest that retropubic mid-urethral sling (retro-MUS) is the most cost-effective surgical intervention over a 10-year and lifetime time horizon. The probabilistic results show that retro-MUS and traditional sling are the interventions with the highest probability of being cost-effective across all willingness-to-pay thresholds over a lifetime time horizon. The value of information analysis results suggest that the largest value appears to be in removing uncertainty around the incidence rates of complications, the relative treatment effectiveness and health utility values.ConclusionsAlthough retro-MUS appears, at this stage, to be a cost-effective intervention, research is needed on possible long-term complications of all surgical treatments to provide reassurance of safety, or earlier warning of unanticipated adverse effects. The value of information analysis supports the need, as a first step, for further research to improve our knowledge of the actual incidence of complications.

Cross-sectional imaging following surgical interventions for stress urinary incontinence in females

2016 ◽  
Vol 41 (6) ◽  
pp. 1178-1186 ◽  
Author(s):  
Brian C. Jung ◽  
Ngoc-Anh Tran ◽  
Sadhna Verma ◽  
Rahul Dutta ◽  
Paul Tung ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Cross Sectional ◽  
Surgical Interventions ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

scholarly journals Heterogeneity in reporting on urinary outcome and cure after surgical interventions for stress urinary incontinence in adult neuro-urological patients: A systematic review

2017 ◽  
Vol 37 (2) ◽  
pp. 554-565 ◽  
Author(s):  
Sarah H.M. Reuvers ◽  
Jan Groen ◽  
Jeroen R. Scheepe ◽  
Lisette A. ‘t Hoen ◽  
David Castro-Diaz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Surgical Interventions

scholarly journals Long-term re-procedure rate after mid-urethral slings for stress urinary incontinence

2020 ◽  
Vol 31 (4) ◽  
pp. 727-735 ◽  
Author(s):  
Sari Tulokas ◽  
Päivi Rahkola-Soisalo ◽  
Mika Gissler ◽  
Tomi S. Mikkola ◽  
Maarit J. Mentula
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Secondary Outcome ◽  
Cumulative Number ◽  
Patient Records ◽  
Hospital Patient ◽  
National Hospital ◽  
Surgical Interventions

Abstract Introduction and hypothesis Long-term safety concerns have risen over the mid-urethral sling operation (MUS) for stress urinary incontinence (SUI), which in some countries has led to litigations and even suspending MUS insertions. We examined the long-term re-procedure rate after MUS operations. The main outcome was re-procedures for SUI. The secondary outcome was surgical interventions due to complications. Methods We analysed a retrospective population cohort of 3531 women with MUS operations in 2000–2006 and followed them up until 31 December 2016. Data were collected from a national hospital register and from hospital patient records. Results The median follow-up time was 13 years (IQR 11.6–14.8) for the 3280 women with a retropubic MUS (RP-MUS) and 11 years (IQR 10.3–11.9) for the 245 women with a transobturator MUS (TO-MUS). The cumulative number of re-procedures for SUI was 16 (0.5%) at 1 year, 66 (1.9%) at 5 years, 97 (2.8%) at 10 years and 112 (3.2%) at 17 years. This risk was higher after TO-MUS than after RP-MUS operations (OR 3.6, 95% CI 2.5–5.2, p < 0.001). The cumulative number of any long-term re-procedure was 43 (1.2%) at year 1, 105 (3.0%) at year 5, 144 (4.1%) at year 10 and 163 (4.6%) at year 17. Conclusions Re-procedures occur up to 17 years after primary MUS insertion, but their incidence is low after the first few postoperative years. Re-procedures for recurrent SUI are more common after TO-MUS than RP-MUS.

scholarly journals Correction of urinary incontinence after radical prostatectomy. Surgical technique step by step.

2020 ◽  
Vol 13 (5) ◽  
pp. 22-29
Author(s):  
S.V. Kotov ◽  
◽  
I.S. Pavlov ◽  
◽  
Keyword(s):  
Urinary Incontinence ◽  
Surgical Treatment ◽  
Stress Urinary Incontinence ◽  
Radical Prostatectomy ◽  
Surgical Technique ◽  
Artificial Urinary Sphincter ◽  
High Tech ◽  
Boston Scientific ◽  
Surgical Interventions ◽  
Urinary Sphincter

Introduction. The main cause of stress urinary incontinence in men is prostate surgery - radical prostatectomy, transurethral resection of the prostate (TURP), enucleation, etc. The gold standard for the surgical treatment of urinary incontinence after prostate surgery is the implantation of an artificial urinary sphincter. For the treatment of mild/moderate urinary incontinence, implantation of synthetic urethral male slings is recommended. For the treatment of severe urinary incontinence, implantation of artificial urinary sphincter recommended. According to the Decree of the Moscow Government dated 12.24.2019 N 1822-PP, surgical interventions on the organs of the genitourinary system with the implantation of synthetic complex and mesh prostheses are included in the standards for the provision of high-tech medical care. Materials and methods. The paper presents a surgical technique for implantation of an artificial urinary sphincter model AMS 800 (Boston Scientific, Boston, MA, USA) and a male urethral sling AdVance XP (Boston Scientific, Boston, MA, USA). The indications for surgical treatment of stress urinary incontinence in men are listed, the criteria for selecting patients for the implantation of an artificial bladder sphincter and the installation of a urethral sling are described, and described in detail. Conclusion. The materials presented in the lecture will help urologists in mastering the technique of implantation of an artificial bladder sphincter and urethral sling in men.

A new device for the treatment of female stress urinary incontinence

2003 ◽  
Vol 217 (4) ◽  
pp. 317-321 ◽  
Author(s):  
L van Veggel ◽  
M Morrell ◽  
C Harris ◽  
M Dormans-Linssen
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Female Stress Urinary Incontinence ◽  
Bulking Agents ◽  
Surgical Interventions ◽  
New Device ◽  
Sling Surgery ◽  
Urethral Bulking ◽  
Polydimethylsiloxane Elastomer ◽  
Invasive Techniques

Treatment for stress urinary incontinence (SUI) comprises a broad range of possible interventions. Non-surgical options include absorbent pads, vaginal weights and cones, biofeedback and minimally invasive techniques such as urethral bulking agents (UBAs). Surgical interventions range in complexity from sling surgery and suspension techniques to more major surgeries such as burch colposuspension. Each option has its challenges and limitations. This paper will focus on UBAs, which are implantable materials whose purpose is to augment urethral tissue function and restore continence. The characteristics required of such materials, and the challenges to be overcome when incorporating them in a successful product design, will be described and discussed. Particular attention will be given to the latest developments in the administration of polydimethylsiloxane elastomer UBA.

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