scholarly journals Refined Nomogram Incorporating Standing Cough Test Improves Prediction of Adjustable Trans-Obturator Male System (ATOMS) Success to Treat Post-Prostatectomy Male Stress Incontinence

2022 ◽  
Vol 12 (1) ◽  
pp. 94
Author(s):  
Juan F. Dorado ◽  
Javier C. Angulo
Keyword(s):  
Stress Incontinence ◽  
Short Form ◽  
Treatment Success ◽  
Univariate Analysis ◽  
Roc Curves ◽  
Clinical History ◽  
Independent Variables ◽  
Pad Test ◽  
Cough Test ◽  
International Consultation

(1) Background: The adjustable transobturator male system (ATOMS) device serves to treat post-prostatectomy incontinence, as it enhances residual urinary sphincteric function by dorsal compression of the bulbar urethra. We investigated the clinical parameters affecting continence recovery using this device and developed a decision aid to predict success. (2) Methods: We reviewed consecutive men treated with first-time ATOMS for post-prostatectomy incontinence from 2014 to 2021 at our institution. Patient demographics, reported pads per day (PPD), 24-h pad-test and Standing Cough Test (SCT), results’ grades 1–4, according to Male Stress Incontinence Grading Scale (MSIGS), and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire were assessed. Treatment success was defined as no pads or a single PPD with ≤20-mL 24-h pad-test. Logistic regression was performed using a stepwise model (entry 0.15 and stay criterium 0.1) to evaluate independent variables’ determinant of dryness. Receiver-operating characteristic (ROC) curves for predictive variables were evaluated and their area under curve (AUC) was compared. A nomogram was generated and internally validated to predict probability of treatment success. (3) Results: Overall, 149 men (median age 70 years, IQR 7) were evaluated with a median follow-up of 45 months (IQR 26). Twelve patients (8%) had previous devices for incontinence, and 21 (14.1%) had pelvic radiation. Thirty-five men (23.5%) did not achieve continence after ATOMS adjustment (use of no or one security PPD with ≤20-mL 24-h pad-test). In univariate analysis, Charlson comorbidity index (p = 0.0412), previous urethroplasty (p = 0.0187), baseline PPD (p < 0.0001), 24-h pad-test (p < 0.0001), MSIGS (p < 0.0001), and ICIQ-SF questionnaire score (p < 0.0001) predicted ATOMS failure. In a multivariable model, 24-h pad-test (p = 0.0031), MSIGS (p = 0.0244), and radiotherapy (p = 0.0216) were independent variables, with AUC 0.8221. The association of MSIGS and 24-h pad-test was the superior combination (AUC 0.8236). A nomogram to predict the probability of ATOMS failure using the independent variables identified was proposed. (4) Conclusions: Several variables were identified as predictive of success for ATOMS using clinical history, physical examination (MSIGS), and factors that evaluate urine loss severity (PPD, 24-h pad-test, and ICIQ-SF questionnaire). MSIGS adds prognostic value to 24-h pad-test in assessing success of ATOMS device to treat post-prostatectomy incontinence. A nomogram was proposed to calculate the risk of ATOMS failure, which could be of interest to personalize the decision to use this device or not in the individual patient.

scholarly journals Injectable Bulking Agent to Treat Postprostatectomy Urinary Incontinence: A Safety and Effectiveness Pilot Study

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Janneke I. M. van Uhm ◽  
Marloes Vermeer ◽  
Henk W. Elzevier ◽  
Joop W. Noordzij ◽  
Evert L. Koldewijn ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pilot Study ◽  
Radical Prostatectomy ◽  
Treatment Option ◽  
Short Form ◽  
Treatment Success ◽  
Bulking Agent ◽  
International Consultation ◽  
Weight Test ◽  
Urine Loss

Objectives. To evaluate the safety and effectiveness of the injectable bulking agent Opsys® (Promedon, Cordoba, Argentina) for treating minimal postprostatectomy stress urinary incontinence (SUI). Patients and Methods. Single-centre, pilot study on ten male patients with SUI, < 30 g urine loss/ 24 h, more than 1 year after radical prostatectomy. Patients were treated by endoscopic transurethral injections of bulking agent in the presphincteric zone of the urethral submucosa. The results were evaluated using a pad weight test to quantify the differences in urine loss at 1, 3, and 6 months after intervention. Subsequently, the results of treatment were also evaluated by International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory Short Form (UDI-6-SF), and the Patient Global Impression of Improvement (PGI-I) at 1, 3, and 6 months after intervention. Results. The primary outcome was the absolute result of the 24-hour pad weight test after treatment. Treatment success was defined as <3 g urine loss/24 h, improvement as ≥50% decrease in urine loss/ 24h, failure as <50% decrease in urine loss/24 h, or worsening of urine loss. Success was demonstrated in one, improvement in one, and failure in eight patients one month after treatment. One patient improved and 9 failed 3 and 6 months after treatment. The median 24-hour pad weight test was higher at all three moments of follow-up (1, 3, and 6 months after treatment). The median 24-hour pad weight test was before treatment 17.3g (6.4-20.9) and 1, 3, and 6 months after treatment, respectively, 40.3g (5.9-130.6) p= 0.038, 38.3g (18.3-202.1) p= 0.014, 55.0g (16.5-314.6) p= 0.028. The ICIQ-SF was significantly higher at 3 and 6 months, respectively 15.0 (12.0-18.5) p= 0.007 and 16.0 (12.5-17.5) p=0.012 versus 10.0 (9.0-12.0) before injection. No significant differences were found between IIQ-7, UDI-6-SF, and PGI-I before and after injection. Complications occurred in four patients: two patients reported spontaneously resolved haematuria and two patients reported urinary frequency. All complications were classified as Clavien–Dindo 1. Conclusion. Injection therapy with Opsys® bulking agent is not an effective treatment option for male SUI after radical prostatectomy. It is not a safe treatment option, due to worsening urine loss after treatment.

scholarly journals The effects of stress incontinence surgery on sexual function and life quality of women

2016 ◽  
Vol 88 (2) ◽  
pp. 106 ◽  
Author(s):  
Murat Tuncer ◽  
Fatih Tarhan ◽  
Alper Kafkasli ◽  
Kadir Demir ◽  
Ugur Yucetas ◽  
...  
Keyword(s):  
Sexual Function ◽  
Stress Incontinence ◽  
Short Form ◽  
Stress Test ◽  
Life Quality ◽  
Transobturator Tape ◽  
Stress Tests ◽  
International Consultation ◽  
Stress Incontinence Surgery

Objective: To evaluate Transobturator tape (TOT) and Burch colposuspension procedure’s effects on sexual functions and life quality. Materials and Methods: A total of 81 patients who underwent TOT (n = 49) or Burch (n = 32) with stress incontinence were included in this prospective study. Preoperatively and at postoperative 6 month follow up pad and stress tests, physical examinations, Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7) questionnaires were performed. Patient Global Impression of Improvement (PGI-I) questionnare was added postoperatively. Results: According to stress test, success rate was found to be 69% and 45%, in the TOT and Burch groups respectively. Pad test decreased in both groups (p &lt; 0.05). PGI-I scores was higher in the TOT group when compared to Burch group (p = 0.031). ICIQ-SF scores were improved in both TOT (p &lt; 0.0001) and Burch groups (p &lt; 0.012). IUDI-6 and IIQ-7 scores improved only in TOT group. Total FSFI scores did not change in both groups but only in TOT group sexual desire improved. Total FSFI scores did not change in patients that were successful and unsuccessful according to the stress test in both TOT and Burch groups (p &lt; 0.05). Conclusions: TOT and Burch procedures have no effect on the sexual functions. However TOT improved life quality of patients.

scholarly journals A model identifying characteristics predictive of successful pelvic floor muscle training outcomes among women with stress urinary incontinence

2020 ◽  
Author(s):  
Kaylee C. L. Brooks ◽  
Kevin Varette ◽  
Marie-Andrée Harvey ◽  
Magali Robert ◽  
Robert J. Brison ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Pelvic Floor ◽  
Pelvic Floor Muscle Training ◽  
Short Form ◽  
Pelvic Floor Muscle ◽  
Standing Position ◽  
Muscle Training ◽  
Pad Test ◽  
International Consultation

Abstract Introduction and hypothesis The aim of this study was to prospectively identify aspects of baseline demographic, clinical, and pelvic morphology of women with stress urinary incontinence (SUI) that are predictive of cure with physiotherapist-supervised pelvic floor muscle training (PFMT). Methods Women ≥18 years old with SUI were recruited from urogynecology and pelvic health physiotherapy clinics. Participants completed a 3-day bladder diary, the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF), a standardized pad test, manual assessment of pelvic floor muscle (PFM) strength and tone, and transperineal ultrasound (TPUS) assessment of their urogenital structures at rest while in a supine position and standing, and during contraction, straining, and coughing. Participants attended six physiotherapy sessions over 12 weeks and performed a home PFMT program. The assessment was repeated after the intervention; cure was defined as a dry (≤2 g) pad test. Results Seventy-seven women aged 50 (±10) years completed the protocol; 38 (49%) were deemed cured. Based on univariate testing, four predictors were entered into a binary logistic regression model: ICIQ-UI-SF, PFM tone, bladder neck (BN) height in a quiet standing position, and BN height during a cough in a standing position. The model was significant (p < 0.001), accurately classifying outcome in 74% of participants. The model, validated through bootstrapping, performed moderately, with the area under the receiver operating characteristic curve = 0.80 (95% CI: 0.69–0.90; p = 0.00), and with 70% sensitivity and 75% specificity. Conclusions Women with better bladder support in a standing position and less severe symptoms were most likely to be cured with PFMT. Clinical trial registration #NCT01602107.

scholarly journals Comparison of urethral sling surgery and non-ablative vaginal Erbium:YAG laser treatment in 327 patients with stress urinary incontinence: a case-matching analysis

2021 ◽  
Author(s):  
Nobuo Okui ◽  
Hironari Miyazaki ◽  
Wataru Takahashi ◽  
Toshihide Miyauchi ◽  
Chikako Ito ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Laser Treatment ◽  
Short Form ◽  
Control Group ◽  
Abdominal Pressure ◽  
Erbium:Yag Laser ◽  
Pad Test ◽  
International Consultation ◽  
Sling Surgery

AbstractStress urinary incontinence (SUI) occurs when abdominal pressure, such as from coughing or sneezing, causes urine leakage. We retrospectively compared tension-free vaginal tape (TVT) and non-ablative vaginal Erbium:YAG laser treatment (VEL) by propensity score (PS) analysis in women with SUI. No PS analysis studies have investigated urethral sling surgery using polypropylene TVT and VEL for SUI. Data from patients aged 35–50 years who were treated for SUI and registered at several institutions were selected. Patients with medical records covering 1 year for the 1-h pad test, who completed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the Overactive Bladder Symptom Score (OABSS), were included. We analyzed 102, 113, and 112 patients in the TVT, VEL, and control groups, respectively. Compared with the control group, the TVT and VEL groups exhibited significant improvement in the 1-h pad test and ICIQ-SF. In the PS analysis, the TVT and VEL groups similarly improved in the 1-h pad test and ICIQ-SF. As for the OABSS, the VEL group showed significantly greater improvement than the TVT group. In the odds ratio analysis for the 1-h pad test, no differences in any of the parameters were observed between TVT and VEL. VEL may be considered an alternative to TVT for SUI treatment.

scholarly journals Prevalence and severity levels of post-radical prostatectomy incontinence: different assessment instruments

2021 ◽  
Vol 74 (2) ◽  
Author(s):  
Luciana Regina Ferreira da Mata ◽  
Cissa Azevedo ◽  
Lívia Cristina de Resende Izidoro ◽  
Darkiane Fernandes Ferreira ◽  
Fabrícia Eduarda Baia Estevam ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Short Form ◽  
Objective Assessment ◽  
Self Report ◽  
Kappa Index ◽  
Cross Sectional ◽  
Significance Level ◽  
Pad Test ◽  
International Consultation ◽  
Severity Levels

ABSTRACT Objectives: to analyze urinary incontinence prevalence and severity in prostatectomized men assessed by three different instruments. Methods: a cross-sectional study was conducted with 152 men. The pad test, pad used, and International Consultation on Incontinence Questionnaire - Short Form (self-report) were considered. Data were analyzed using Spearman’s correlation, Kappa index, considering a significance level of 0.05. Results: urinary incontinence prevalence was 41.4%, 46.7% and 80.3% according to pad used, pad test and self-report. Positive correlations and moderate to poor agreement were found between the instruments. As for severity, most participants had mild incontinence. The largest number of cases of mild and severe incontinence was identified by self-report. Conclusions: the self-report showed higher values for prevalence of mild and severe severity levels. Through the identified differences, we propose that the objective assessment (pad used and pad test) be associated with individuals’ perception (self-report) to better estimate prevalence and severity.

A Novel Artificial Urinary Sphincter (VICTO®) for the Management of Postprostatectomy Urinary Incontinence: Description of the Surgical Technique and Preliminary Results from a Multicenter Series

2021 ◽  
pp. 1-7
Author(s):  
Alessandro Giammò ◽  
Marco Falcone ◽  
Gideon Blecher ◽  
Enrico Ammirati ◽  
Paolo Geretto ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Short Form ◽  
Nonparametric Tests ◽  
Artificial Urinary Sphincter ◽  
Pad Test ◽  
International Consultation ◽  
Urinary Sphincter ◽  
Male Patients ◽  
Continence Rate

Aims: The objective of the study was to analyze short-term outcomes and safety profile of the newly designed artificial urinary sphincters (AUSs) VICTO® and VICTOplus®. Methods: Data from the implant of VICTO® or VICTOplus® AUSs on a series of consecutive male patients with stress urinary incontinence (SUI) following radical prostatectomy (RP) were retrospectively collected in 3 tertiary referral centers between May 2017 and December 2019. Patients were affected by moderate-severe genuine SUI (200–400 or >400 g urine leakage in 24-h pad test) refractory to conservative treatment. Outcomes were evaluated through the 24-h pad test and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF). Follow-up was scheduled after 3, 6, and 12 months and then when clinically needed. Nonparametric tests were applied in subgroup analyses. Results: Seventeen patients were enrolled: 8 were implanted with the VICTO® device and 9 with VICTOplus®. The median age at surgery was 69 (interquartile range (IQR) 60–75) years. The median follow-up was 15 (IQR 12–18) months. At 12 months, the dry rate was 76.4% and the social continence rate was 94%. The postoperative complication rate was 17.6%. All complications were classified as Clavien-Dindo I. No difference in terms of outcomes was observed between the VICTO® and the VICTOplus® subgroups. Conclusions: Preliminary outcomes of the VICTO® and VICTOplus® implantation are satisfactory. These devices may represent a safe and realistic solution for patients with moderate-severe SUI following RP.

INCONTINÊNCIA URINÁRIA EM MULHERES COM CÂNCER DE MAMA EM TRATAMENTO QUIMIOTERÁPICO

2019 ◽  
Vol 1 (3) ◽  
pp. 169-175
Author(s):  
Keli Lovison ◽  
Marcelo Taglieti ◽  
Aniele Tomadon ◽  
Karoline Calichio Medeiro ◽  
Bethina Bernardon Busatta ◽  
...  
Keyword(s):  
Short Form ◽  
Cáncer De Mama ◽  
International Consultation

Objetivo: O presente estudo objetiva avaliar a presença de incontinência urinária em mulheres com câncer de mama no início do tratamento quimioterápico. Métodos: Estudo descritivo exploratório e de corte longitudinal, realizado no Hospital União Oeste Paranaense de Estudos e Combate ao Câncer. Para avaliação da Incontinência Urinária foi utilizado o International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Para análise de correlação foi utilizado o Coeficiente de Correlação de Pearson. Resultados: Participaram do estudo 20 mulheres, com idade média de 53,8±7,1 anos. Quando abordado as respostas do ICIQ-SF, a média encontrada foi de 1,6±0,9 pontos, o que significa baixo impacto da incontinência urinária na vida das participantes. Conclusão: Apesar do baixo impacto de incontinência urinária em mulheres com câncer de mama no inicio do tratamento quimioterápico adjuvante, é de extrema importância avaliar a presença da incontinência urinária.

scholarly journals Predictors of Central Compartment Involvement in Patients with Positive Lateral Cervical Lymph Nodes according to Clinical and/or Ultrasound Evaluation

2021 ◽  
Vol 10 (15) ◽  
pp. 3407
Author(s):  
Giuseppa Graceffa ◽  
Giuseppina Orlando ◽  
Gianfranco Cocorullo ◽  
Sergio Mazzola ◽  
Irene Vitale ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Univariate Analysis ◽  
Roc Curves ◽  
Central Compartment ◽  
Central Neck Dissection ◽  
Level Of Evidence ◽  
Cervical Lymph Nodes ◽  
Kaplan Meier ◽  
Ultrasound Evaluation ◽  
Central Lymph

Lymph node neck metastases are frequent in papillary thyroid carcinoma (PTC). Current guidelines state, on a weak level of evidence, that level VI dissection is mandatory in the presence of latero-cervical metastases. The aim of our study is to evaluate predictive factors for the absence of level VI involvement despite the presence of metastases to the lateral cervical stations in PTC. Eighty-eight patients operated for PTC with level II–V metastases were retrospectively enrolled in the study. Demographics, thyroid function, autoimmunity, nodule size and site, cancer variant, multifocality, Bethesda and EU-TIRADS, number of central and lateral lymph nodes removed, number of positive lymph nodes and outcome were recorded. At univariate analysis, PTC location and number of positive lateral lymph nodes were risk criteria for failure to cure. ROC curves demonstrated the association of the number of positive lateral lymph nodes and failure to cure. On multivariate analysis, the protective factors were PTC located in lobe center and number of positive lateral lymph nodes < 4. Kaplan–Meier curves confirmed the absence of central lymph nodes as a positive prognostic factor. In the selected cases, Central Neck Dissection (CND) could be avoided even in the presence of positive Lateralcervical Lymph Nodes (LLN+).

Endoscopic Internal Drainage and Low Negative Pressure Endoscopic Vacuum Therapy for anastomotic leaks after oncologic upper gastrointestinal surgery

Endoscopy ◽  
2021 ◽  
Author(s):  
Carlo Jung ◽  
Rachel Hallit ◽  
Annegret Müller-Dornieden ◽  
Melanie Calmels ◽  
Diane Goere ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Treatment Duration ◽  
Treatment Success ◽  
Univariate Analysis ◽  
Gastrointestinal Surgery ◽  
Vacuum Therapy ◽  
Internal Drainage ◽  
Upper Gi ◽  
Endoscopic Internal Drainage ◽  
Endoscopic Vacuum Therapy

Background: Endoscopic internal drainage (EID) with double pigtail stents and low negative pressure endoscopic vacuum therapy (EVT) are treatment options for leakages after upper GI oncologic surgery. We aimed to compare the effectiveness of these techniques. Patients and methods: Between 2016 and 2019, patients treated with EID in five centers in France and with EVT in Göttingen, Germany were included and retrospectively analyzed using univariate analysis. Pigtails were changed every 4 weeks, EVT was repeated every 3-4 days until leak closure. Results: 35 EID and 27 EVT patients were included, with a median leak size of 0.75 cm (0.5-1.5). Overall treatment success was 100% [CI 90; 100] in EID vs. 85.2% [CI 66.3; 95.8] in EVT, p=0.03. The median number of endoscopic procedures was 2 (2; 3) vs. 3 (2; 6.5), p<0.01 and the median treatment duration was 42 (28; 60) vs. 17 days (7.5; 28), p<0.01, for EID vs. EVT, respectively. Conclusion: EID and EVT provide high closure rates for upper GI anastomotic leakages. EVT provides a shorter treatment duration at the cost of a higher number of procedures.

scholarly journals Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040819
Author(s):  
Pontus Rygh ◽  
Ina Asklund ◽  
Eva Samuelsson
Keyword(s):  
Urinary Incontinence ◽  
Cohort Study ◽  
Real World ◽  
Short Form ◽  
Pelvic Floor Muscle ◽  
Controlled Trial ◽  
Healthcare Services ◽  
International Consultation ◽  
The Mean

ObjectivesThe efficacy of app-based treatment for stress urinary incontinence (SUI) has been demonstrated in a randomised controlled trial (RCT). In this study, we investigate the user characteristics and the effectiveness of the same app when freely available, and compare these results with the RCT.DesignProspective cohort study.ParticipantsDuring a 17-month period, 24 602 non-pregnant, non-postpartum women older than 18 years downloaded the app and responded anonymously to a questionnaire. Of these, 2672 (11%) responded to the 3-month follow-up.InterventionThree months’ use of the app Tät, containing information, a pelvic floor muscle training programme and lifestyle advice.Main outcome measuresChange in symptom severity (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF)) and subjective improvement (Patient Global Impression of Improvement (PGI-I)).ResultsOf the respondents, 88% lived in Sweden and 75% (18 384/24 602) were incontinent with a mean age of 45.5 (SD 14.1) years. The UI types, based on symptoms, were SUI (53%), urgency UI (12%), mixed UI (31%) and undefined (4%). The mean ICIQ-UI SF score was 8.2 (SD 4.0) at baseline. The mean ICIQ-UI SF score reduction at follow-up was 1.31 (95% CI: 1.19 to 1.44) with a larger reduction in those with more severe incontinence at baseline (severe/very severe 3.23 (95% CI: 2.85 to 3.61), moderate 1.41 (95% CI: 1.24 to 1.59) and slight 0.24 (95% CI 0.06 to 0.42). When the results were weighted to match the distribution of severity in the RCT, the ICIQ-UI SF score reduction was 2.2 compared with 3.9 in the RCT. Regarding PGI-I, 65% experienced improvement compared with 92% in the RCT.ConclusionsThe app Tät was effective for self-management of UI even in the real world. Although the reduction in incontinence symptoms was less than in the RCT, two-thirds of the users improved. App-based treatment reaches many women without requiring resources from ordinary healthcare services.

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