A novel Levator Ani Midurethral Support Via Single Vaginal Incision to Treat Stress Urinary Incontinence: Case Report

IntroductionA novel native tissue midurethral support procedure, Levator Ani Midurethral Support via single vaginal incision, to treat patients with stress urinary incontinence is introduced in this case report. After mesh controversy, there is a need for a minimal invasive native tissue surgical procedure to treat stress urinary incontinence with minimal complication.Case PresentationA 51-year-old female with stress urinary incontinence had three mesh midurethral slings and one autologous fascia sling with severe infection that failed. She developed recurrent stress urinary incontinence and coital incontinence. After she was referred to our care, she was initially treated with urethral bulking injections which also failed. There were few alternatives left after failure of three mesh midurethral slings, one autologous fascia sling with severe infection and urethral bulking injections. The patient was successful treated with our novel native tissue midurethral support procedure, Levator Ani Midurethral Support via single vaginal incision. She remains continent 23 months after the Levator Ani Midurethral Support via single vaginal incision and her coital incontinence has also resolved. She reported she has no pelvic pain or dyspareunia. ConclusionsAfter further study, this novel native tissue midurethral support procedure, Levator Ani Midurethral Support via single vaginal incision may meet the need for a minimal invasive native tissue surgical procedure for the treatment of stress urinary incontinence with minimal complication.

A cross-sectional case-control study of sexual dysfunction and associated depression in postmenopausal incontinent women.

Background: Female sexual dysfunction (FSD) has higher prevalence in postmenopausal women especially with urinary incontinence (UI) and coital incontinence (CI). This study was attempted as there is dearth of literature to quantify FSD, CI and depression in UI women and their correlation with each other especially in Indian scenario. Aim: Aim of this study was to determine the prevalence of FSD, CI and depression in postmenopausal UI women. Material and Methods: Cross-sectional case control study of 100 menopausal women with previously diagnosed UI with matching controls over period of 3 months were analyzed for the prevalence of FSD, CI and depression using validated questionnaires like Female Sexual Function Index (FSFI) and Primary Health Questionnaire 9 (PHQ 9). Statistical Analysis was performed using SPSS version 19.0. Results: UI is independently associated with FSD, CI and depression (p < 0.001) with prevalence of 100%, 83%, and 100% respectively for cases versus 5%, 6%, and 4% respectively for controls. FSD and CI are also independently associated with depression (p < 0.001). Combined FSD with UI and CI with UI are also significantly associated with depression. Conclusion: UI is independently associated with FSD, CI and depression. FSD and CI are also independently associated with depression. UI is the major determinant of depression in those with both FSD and UI or CI and UI. Keywords: Female sexual dysfunction (FSD), urinary incontinence (UI), coital incontinence (CI), depression, sexual health

Investigation of the Incidence of Coital Incontinence in Incontinent Women

<p><strong>Objective:</strong> Coital incontinence is the involuntary leakage of urine during sexual intercourse and is rarely reported in women with urinary incontinence. The aim of this study is to investigate the frequency of coital incontinence and its association with incontinence types.</p><p><strong>Study Design:</strong> All sexually active women with urinary incontinence (diagnosed as self-reported) attending the out-patient gynecology clinic of a regional state hospital were interviewed consecutively between September 2017 and September 2018 about their experience with regards to coital incontinence. The clinical evaluation consisted of medical history, physical examination, and urine analysis. The SPSS 20 program designed for Windows was used for statistical analysis. </p><p><strong>Results:</strong> Twenty-two of the 64 women who participated in the study were diagnosed with coital incontinence and the remaining 42 women were to be compared. 42 women were included in the control group, and 22 women were defined as the study group. The women with coital incontinence had significantly higher stress test positivity than the control group (p = 0.00). No significant differences in the frequency of coital incontinence between incontinence types were found. The chi-square test was applied, and the p-value was &gt;0.05 (p=0.110). So there was no statistically significant relationship between the type of incontinence and the frequency of coital incontinence.</p><p><strong>Conclusion:</strong> Coital incontinence is much more prevalent than expected and therefore patients with symptomatic urinary incontinence should be investigated for the presence of coital incontinence, as this may affect patient approach and treatment.</p>