stress incontinence
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2022 ◽  
Vol 12 (1) ◽  
pp. 94
Author(s):  
Juan F. Dorado ◽  
Javier C. Angulo

(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.


2021 ◽  
Vol 50 (3) ◽  
pp. 83-89
Author(s):  
В. И. Кулаков ◽  
Л. В. Адамян

In the clinical lecture the main principles of arranging endovideosurgical carein gynecology are substantiated on the basis of the material of 17,5 thousandslaparoscopies and 10 thousands hysteroscopies. The detailed analysis of possibilities of endoscopic methods in operative gynecology is given. The peculiarities of laparoscopys application are depicted in cases of tube-peritoneal infertility, uterine and ovarian tumors, pyoinflammatory diseases of uterine adnexa, ectopic pregnancy, maldevelopment of female genital organs, stress incontinence in women. Perspectives of endovideosurgical technologies in gynecological practice are also shown.


2021 ◽  
Vol 50 (3) ◽  
pp. 61-62
Author(s):  
A. A. Popov ◽  
S. L. Gorsky ◽  
O. S. Slavutskaya

The results of treating urinary stress incontinence in women with the help of some combined methods are demonstrated. Original methods laparoscopic retropubic colpopexy by lateral approach, MESH-vaginopexy, laparoscopic retropubic colpopexy are analyzed considering the type of urinary incontinence to substantiate pathogenetically the prophylaxis of stress incontinence recurrence.


Author(s):  
Janosch Jahn ◽  
Christl Reisenauer ◽  
Birgitt Schoenfisch ◽  
Bastian Amend ◽  
Sara Yvonne Brucker ◽  
...  

Abstract Purpose The purpose is to analyse perioperative complications associated with the retropubic tension-free vaginal tape (TVT) procedure and their management. Methods This retrospective, monocentric cohort study included 960 women after retropubic TVT procedure performed by one surgeon from 2011 to 2016. Complications were identified up to 6 weeks after the procedure, divided into specific and general complications and classified based on the Clavien–Dindo (CD) Classification. A visit 6 weeks after the surgical procedure was attended by all patients. Results 77 complications, of which 74 occurred postoperatively and 3 intraoperatively, affecting 72 (7.5%) out of 960 women. Urinary retention and voiding problems were the most common complication. The mean age of women suffering complications was 3.4 years higher in comparison to the mean age of women without complications (p = 0.036). The Body Mass Index (BMI) of the group of women with perioperative complications had an average BMI which was 0.5 kg/m2 lower than the average BMI of the women without complications. 22 (12.8%) out of 172 women with recurrent stress incontinence had postoperative complications, of which 21 were related to the TVT. Conclusion The retropubic TVT is a surgical procedure associated with a low number of perioperative complications, even in the group of elderly and overweight women, as well as in cases of recurrent stress incontinence.


2021 ◽  
Vol 10 (19) ◽  
pp. 4571
Author(s):  
Maciej Zalewski ◽  
Gabriela Kołodyńska ◽  
Anna Mucha ◽  
Waldemar Andrzejewski

Background: Urinary incontinence (UI) is a significant social problem. The latest figures show that it affects as many as 17–60% of the female population, and it is one of the most common chronic diseases. Incontinence substantially decreases the quality of patients’ lives. The transobturator tape (TOT) procedure is the gold standard in surgical treatment due to its high efficacy and low complication rate. Objective: The aim of this study was to assess the quality of life (QoL) of patients with stress incontinence before and after the TOT procedure. Method: The study included 57 patients diagnosed with stress incontinence on the basis of ultrasonography and history. The QoL before and after surgery was measured using the Incontinence Impact Questionnaire (IIQ-7) and the Incontinence Quality of Life (I-QOL) standardised questionnaires. Results: The IIQ-7 scores for each question were higher (indicating poorer quality of life) before surgery than after surgery. The results for almost all domains were statistically significant. The I-QOL results also showed that, in most cases, the quality of patients’ lives improved after the surgery. Statistically significant changes were observed in all three questionnaire domains of avoidance/limiting behaviour, psychosocial impact, and social embarrassment. Conclusion: Surgical treatment of stress incontinence with TOT results in resolution of bothersome symptoms in the majority of patients, leading to improved comfort in life.


2021 ◽  
pp. 267-320
Author(s):  
Ellie Stewart

This chapter covers problems that can occur with the bladder, and then pelvic organ prolapse. It provides an assessment of urinary incontinence, and associated investigations, followed by an overview and treatment for overactive bladder (OAB). An overview of urinary stress incontinence is covered, along with both specialist and conservative treatments. Uroflowmetry and urodynamics are described. Pelvic organ prolapse and its treatment is covered, along with vaginal pessaries and surgical treatment. Cystitis, continence products, and all aspects of urinary catheters including trouble-shooting are covered.


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