Laparoscopic retropubic colpopexy in the treatment of stress incontinence

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.

Bladder and urogenital prolapse

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.

Sexual Disorders in Women with Overactive Bladder and Urinary Stress Incontinence Compared to Controls: A Prospective Study

Introduction and Hypothesis Female urinary incontinence (UI) has a negative impact on sexual function and sexual quality of life (QoL) in women. But there is still no consensus on the type of UI or the prevalence of sexual dysfunction (SD). The aim of the study was to evaluate sexual disorders in women with overactive bladder (OAB) compared to patients with urinary stress incontinence (SUI) and healthy controls. Materials and Methods 106 women presenting to a urogynecological outpatient clinic (referral clinic) were investigated using standardized questionnaires and the Female Sexual Function Index (FSFI-d). All 65 incontinent women underwent a full urodynamic examination; the controls (31) were non-incontinent women in the same age range who came for routine check-ups or minor disorders not involving micturition or pelvic floor function. Women with mixed urinary incontinence, a history of previous medical or surgical treatment for UI, recurrent urinary tract infections, previous radiation therapy or pelvic organ prolapse of more than stage 2 on the Pelvic Organ Prolapse Quantification (POP-Q) system were excluded. Results 100 questionnaires could be evaluated (94.3%). Thirty-four women had urinary stress incontinence, 35 had OAB, 31 were controls. Mean age was 56 years, with no significant differences between groups. The scores of the questionnaire ranged from 2 to 35.1 points. The median score of OAB patients was significantly lower (17.6) than the median score of the controls (26.5; p = 0,004). The stress-incontinent women had a score of 21.95, which was lower than that of the controls but statistically non-significant (p = 0.051). In all subdomains, the OAB patients had lower scores than the stress-incontinent women and significantly lower values than the control group. Most striking was the impairment of “sexual interest in the last 4 weeks”. The figure for “none or almost no sexual activity” was 80% for the OAB group, 64.7% for the group of stress-incontinent women and 48% for the control group. Incontinence during intercourse was reported by one OAB patient and 4 stress-incontinent women but did not occur in the control group. Conclusions There is a high prevalence of SD in women with urinary incontinence. Patients with OAB reported a greater negative impact on sexual function and had significantly lower scores for the FSFI questionnaire than patients with stress incontinence or controls.

Conservative Management of Urinary Stress Incontinence in Selected Post Menopause Patients with Fractional CO2 Laser

Objective: This PUBA study aims to evaluate the effectiveness of the Fractional CO2 Laser in the conservative treatment of Urinary Stress Incontinence in pre-selected Post-Menopausal Patients, with urine loss to Valsalva maneuvers. Methods: Symptoms of Urinary Stress Incontinence were evaluated before, and 1 month after the last session (3 sessions with a 30-day interval between them) in 50 post-menopausal women (Middle Age - Menopause, Interquartile Range Parity - BMI). Subjective measures (ICIQ SF, VAS) and objective measures such as PAD TEST were used (a dry diaper was previously weighed, and she was instructed to take 500 cc for 15 minutes at rest, and then for 45 minutes to perform Valsalva maneuvers, go up and down stairs, sit, stand up, etc. and then reweigh the diaper) during the study period in order to evaluate the results of the fractional CO2 laser treatment compared to the baseline. Results: Of the 50 patients enrolled, 12 patients in total who presented minimal Urinary symptoms of incontinence (USI) according to the ICIQ questionnaire, all were cured, defining this, as the no loss of urine. Of the 18 patients who presented moderate USI, 10 were cured (55%), that is, they did not present urine loss, and the other 8 patients (45%) had partial recovery, but continued losing urine. Of the 20 patients who presented severe USI, none were cured, 9 (45%) of them remained in severity, and 11 (55%) patients had partial recovery, migrating to the degree of moderate USI. An objective assessment was also performed using the PAD TEST, of the 12 patients with minimal USI, all were cured, of the 18 patients who presented moderate USI, what was found in the ICIQ was confirmed, with 10 patients cured, and 8 with partial recovery. Likewise, of the 20 patients with severe USI, none were cured. VAS (Visual Analogue Scale) was also performed at the end of the treatment and after a year by telephone call, to assess the degree of satisfaction, in regards to the minimal USI at the end of the treatment, this was 100%, and after a year it was reduced to 95%. The patients who presented moderate USI at the end of the treatment presented an average degree of satisfaction of 88.8%, and after 1 year it was 72.2%, and in respect of severe USI it was 6.5% at the end of the laser treatment, and after one year it was 0% Conclusions: In the present study, the data suggest that Fractional CO2 Laser is an effective alternative for the treatment of Minimal-Moderate Urinary Stress Incontinence in well-selected post-menopausal patients, with positive results that persist over time. Keywords (MESH): Fractional CO2 Laser; Menopause; Urinary Incontinence

Association Between Urinary Stress Incontinence and Levator Avulsion Detected by 3D Transperineal Ultrasound

Purpose To determine the association between levator avulsion and urinary stress incontinence (USI) by 3/4D transperineal ultrasound. Materials and Methods 842 patients who were admitted to our hospital from 2016 to 2019 were recruited for our study. 3D/4D transperineal ultrasound was performed. After standard interview and clinical evaluation, general conditions and levator hiatus data were collected and measured to compare with each group. The odds ratio (OR) of USI symptoms or ultrasound features with levator avulsion were calculated. Results A total of 593 women were studied: 204 suffered from levator avulsion (96 cases of left-side avulsion, 80 cases of right-side avulsion and 28 cases of bilateral avulsion) and 389 women had no avulsion. The gravidity and episiotomy conditions of the avulsion groups were significantly different from the no-avulsion group. Significant differences were found in the transverse diameters and anteroposterior diameters between the levator avulsion group and the no-avulsion group, but there was no difference among the avulsion groups, regardless of whether the patient was at rest or performing the Valsalva maneuver. Interestingly, a significant difference was found in the presence of USI symptoms between the uni-avulsion group and the no-avulsion group. The odds ratio (OR) of USI symptoms in the uni-avulsion group is 2.786 (95 %CI, 1.663–4.669), but 0.939 (95 %CI, 0.276–3.199) for the bilateral avulsion and no-avulsion groups. Conclusion Unilateral levator avulsion may be a risk factor for urinary stress incontinence.