Retropubic TFS Minisling for Postprostatectomy Male Incontinence: First Report

<b><i>Hypothesis:</i></b> A structurally sound puboprostatic ligament (PPL), like the pubourethral ligament in the female, is the core structure for control of stress urinary incontinence (SUI) in males. <b><i>Methods:</i></b> The hypothesis was tested at several levels. Twelve transperineal ultrasound examinations were performed to confirm reflex directional closure vectors around the PPL, with digital support for the PPL rectally and cadaveric testing with a tissue fixation system (TFS) minisling, and finally, 22 cases of postprostatectomy incontinence were addressed only with retropubic insertion of a 7-mm TFS sling between the bladder neck and perineal membrane to reinforce the PPL. <b><i>Results:</i></b> On ultrasound testing, 3 urethral closure muscles were confirmed to act reflexively around the PPL to close the urethra distally and at the bladder neck. A finger was inserted rectally, pressed against the symphysis only on one side of the urethra at the origin of the PPL that controlled urine loss on coughing. The mean pre-op pad loss was 3.8 pads at 9 months; the mean post-op loss was 0.7 pads; 13/22 (59%) patients were 100% improved; 7/22 (31%) improved &#x3e;50% but &#x3c;100%; 2/22 (9.1%) improved &#x3c;50%. <b><i>Conclusions:</i></b> The 7-mm-wide TFS minisling is the first retropubic minisling for postprostatectomy urinary incontinence. It differs significantly from transobturator male operations surgically and in modus operandi. As in the female, reconstruction of the PPL alone was sufficient to cure/improve SUI, suggesting that preservation of the PPL is of critical importance during retropubic radical prostatectomy.

Correlation of Urine Loss after Catheter Removal and Early Continence in Men Undergoing Radical Prostatectomy

Background: To determine the correlation between urine loss in PAD-test after catheter removal, and early urinary continence (UC) in RP treated patients. Methods: Urine loss was measured by using a standardized, validated PAD-test within 24 h after removal of the transurethral catheter, and was grouped as a loss of <1, 1–10, 11–50, and >50 g of urine, respectively. Early UC (median: 3 months) was defined as the usage of no or one safety-pad. Uni- and multivariable logistic regression models tested the correlation between PAD-test results and early UC. Covariates consisted of age, BMI, nerve-sparing approach, prostate volume, and extraprostatic extension of tumor. Results: From 01/2018 to 03/2021, 100 patients undergoing RP with data available for a PAD-test and early UC were retrospectively identified. Ultimately, 24%, 47%, 15%, and 14% of patients had a loss of urine <1 g, 1–10 g, 11–50 g, and >50 g in PAD-test, respectively. Additionally, 59% of patients reported to be continent. In multivariable logistic regression models, urine loss in PAD-test predicted early UC (OR: 0.21 vs. 0.09 vs. 0.03; for urine loss 1–10 g vs. 11–50 g vs. >50 g, Ref: <1 g; all p < 0.05). Conclusions: Urine loss after catheter removal strongly correlated with early continence as well as a severity in urinary incontinence.

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

Observational Study on the Prevalence of Urinary Incontinence in Female Athletes

Purpose: To study the prevalence of UI in female athletes, the category of sports with the highest number of cases, the most incident risk factors and the bio-psycho-social consequences. Methods: Preparation of a survey, based on two validated questionnaires answered by 63 participants, to carry out an analytical, transversal and observational study. All participants were European, adult, female athletes (mean age 30.78 years, standard deviation 12.16 years). Results: UI has a high prevalence (44.4%) in female athletes (compared to 10% in non-athletes), being more frequent in those who practice long-distance running. As age and years of sport practice increase, the incidence of this pathology increases. Absorbent pads are used by more than half of women with incontinence, while the rest wet their underwear. Menopause, childbirth and surgery in the region are risk factors for UI, while the presence of urinary tract infections or candidiasis is not. The results state that urine loss does not cause anxiety or depression, but it does affect sporting life. Conclusions: The prevalence of UI in this study is very high and more common in female athletes and the incidence increases with age and other risk factors. The salient consequence of this study is that urine loss affects their sporting environment, but does not induce depression or anxiety.

Five-Year Results of a Prospective Multicenter Trial: AdVance XP for Postprostatectomy-Incontinence in Patients with Favorable Prognostic Factors

<b><i>Objective:</i></b> The aim of this study was to assess the security, value, and efficacy of the second-generation AdVance male sling XP (Boston Scientific®), after implementation in 2010 with advantageous modifications in the sling structure and needle shape, in a prospective multicenter long-term follow-up study. <b><i>Methods:</i></b> In total, 115 patients were included. Exclusion criteria were earlier incontinence (UI) surgery, nocturnal UI, former radiotherapy, or night-time incontinence. We also excluded patients with a functional urethra &#x3c;1 cm in a preoperatively performed repositioning test. A consistent 24-h pad test, International Quality of Life (IQOL) score, visual analog pain scale (VAS), International Consultation-Incontinence Questionnaire (ICIQ-UI SF), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), and Patient Global Impression of Improvement (PGI-I) scores were requested postoperatively. <b><i>Results:</i></b> The 24-month follow-up (114 patients) revealed 64.0% cured and 28.8% improved patients. Mean urine loss was reduced significantly to 19.0 g (<i>p</i> &#x3c; 0.001). A mean PGI score of 1.5 and a mean VAS score of 0.2 were obtained. The 60-month follow-up (59 patients) revealed 57.6% cured and 25.4% improved patients. Mean urine loss was reduced significantly to 18.3 g (<i>p</i> &#x3c; 0.001). A mean PGI score of 1.6 and a mean VAS score of 0.2 were obtained. <b><i>Conclusions:</i></b> The AdVance XP displays excellent continence results and secure effectiveness over a 5-year period. Moreover, these data are demonstrating low complication rates and improved quality of life in the long-term use of AdVance XP.

Effects of the Pilates method isolated and associated with manual therapy in women with urinary incontinence

Background: Urinary incontinence (UI) is clinically defined by the International Continence Society as involuntary urine loss. Currently, UI isconsidered a public health issue worldwide, considering that the prevalence in women is quite high, requiring attention from healthprofessionals. Objective: To evaluate the effects of the Pilates method associated with Manual Therapy in women with UI. Methods: It wasperformed a randomized, controlled, longitudinal clinical trial with a quantitative approach of the data. 14 female participants were evaluated,aged 20 to 55 years and who had presented episodes of urinary loss in the last months. The following evaluations were carried out: anamnesis,evaluation of urogynecological history, application of the King’s Health Questionnaire and PERFECT test. After all the evaluations, half of thevolunteers received treatment for urinary incontinence through a physical therapy approach that includes the Pilates method associated withManual Therapies (GPT), and the other half received treatment using only the Pilates method (GP). Results: Both groups showed increasedPFM strength, being GPT (p = 0.04) and GP (p = 0.00); increased resistance, being GPT (p = 0.02) and GP (p = 0.01); and the contraction offibers, being GPT (p = 0.04) and GP (p = 0.02). In the GPT there was a decrease in the severity measures (p = 0.01); disappearance ofnocturia (p = 0.04); decreased symptoms of SUI (p = 0.02); and bladder pain (p = 0.04). In the GP, there was a significant improvement in theperception of health (p = 0.00); decreased UI impact on the participant's life (p = 0.02); the influence of UI on emotions (p = 0.00); symptomsof overactive bladder (p = 0.01); and the SUI (p = 0.00). Conclusion: Both treatment protocols decrease episodes of leakage of urine whenthere is an increase in intra-abdominal pressure, increase the PFM strength, endurance and number of fast contractions, and the quality oflife of women with UI. However, only the group that received only the Pilates protocol showed an increase in repetitions of slow contraction.