Continence Reports最新文献

Objective:

To describe the outcomes and subsequent postoperative management of autologous fascial pubovaginal slings when used for stress urinary incontinence in women who have failed a prior midurethral sling.

Methods:

A retrospective review was performed from 2012 to 2017 at a single center of patients who underwent an autologous fascial pubovaginal sling to correct recurrent stress urinary incontinence after a midurethral sling. Postoperative data was abstracted for three years post-procedure. The outcomes examined were patient-reported symptoms consistent with postoperative stress urinary incontinence, overactive bladder, and/or urinary obstruction. Secondary interventions to manage these postoperative urinary symptoms, and the associated success rates, were also reported.

Results:

Fifty-five females underwent an autologous fascial pubovaginal sling placement. Postoperatively, 20% of patients reported persistent or recurrent stress urinary incontinence symptoms, which were managed with secondary interventions such as sling tightening and urethral bulking successfully. 49% of all patients reported postoperative overactive bladder symptoms, with some noting improvement after overactive bladder medication therapy and others requiring bladder botulinum toxin injection. 16% of patients presented with postoperative urinary obstruction, for which 67% underwent sling incision with resolution of urinary retention in all cases.

Conclusions:

Autologous fascial pubovaginal slings when used as a non-primary surgical treatment for stress urinary incontinence can be effective in many cases. However, the management of these women is complex and often requires additional postoperative interventions to address persistent, recurrent, or de novo lower urinary tract symptoms.

In the modern era, neurosyphilis is rare and its effects on the lower urinary tract are poorly understood. Two cases of neurosyphilis with resultant bladder dysfunction are presented, and the relevant literature on neurosyphilis is reviewed. For our patients, urodynamic studies revealed low-capacity bladders associated with detrusor overactivity in both cases, one with a clinical diagnosis of urge incontinence and the other with urinary retention. These cases highlight the importance of early assessment of urinary function in patients with neurosyphilis and the role of urodynamics in guiding appropriate management.

This is the first report of a combined laparoscopic Pectopexy and vesicovaginal fistula repair. A 77 year-old woman developed persistent leakage of urine after surgical removal of an impacted pessary, and a vesicovaginal fistula was diagnosed. The fistula was inaccessible through the vagina due to stenosis of the upper vagina resulting from the impacted pessary, so a laparoscopic repair was performed together with a Pectopexy to eliminate the patient’s residual prolapse symptoms. Careful consideration was given to the decision to perform a fistula repair together with a mesh suspension procedure, which included a review of the relevant medical literature as well as our own practice data. The combined operation resulted in relief of both fistula and prolapse symptoms.

Background:

A fistula is an unusual connection between two organs, vessels, or structures. Urological fistulas in developed countries are consequences of iatrogenic injury, and the more common cause of fistula development in these countries is related to labor sequence.

Case presentation:

More than 156 cases were treated in our hospitals during the last 10 years, and in this case report, we present only unusual fistula from two different urology departments. Different cases with a variety of fistula including huge stone formation following vesicouterine fistula, vesicosacral fistula and expelling urine from bedsore region of sacrum, fistula in the junction of the orthotopic neobladder, and fistula in a patient with duplicated collecting system are presented in the current study.

Conclusion:

Vesicouterine fistula after cesarean section (C/S) led to the formation of a huge intrauterine stone. Vesicouterine fistula is the least common form of fistula, and C/S is the most common cause of this type of fistula. However, this type of fistula is not always associated with urinary incontinence due to the cervix’s sphincter-like mechanism. Vesicocutaneous fistula is another uncommon type. Iatrogenic injury, extensive trauma, irradiation of malignancies, and various other etiologies, can lead to Vesicocutaneous fistula. For these cases, both conservative, and surgery can be considered. However, surgery is the only definitive repair method. Moreover, fistula in the junction of orthotopic neobladder to the vagina, and left ureter to vagina fistula in a patient with duplicated collecting system are among the strangest urogynecological fistulas.

The introduction of the artificial urinary sphincter (AUS) in 1972 was heralded as a revolution for the treatment of stress incontinence (Scott et al., 1973). The evolution of the AUS has affected the current surgical options for urinary incontinence. With its unique features, the AUS has been an attractive option for the treatment of urinary incontinence regardless of gender. The device has evolved in the last decades and has now been in routine clinical use for nearly 50 years (Burkhard et al., 2019). Furthermore, the indications and surgical principles involved in its use along with short- and long-term outcomes are more clearly defined. The main indications for AUS insertion are post-prostatectomy incontinence (PPI), sphincter weakness incontinence due to neurogenic bladder dysfunction, intrinsic sphincter deficiency (ISD) and rare congenital causes of incontinence. In the following we summarize the conclusions worked out during the expert workshop on artificial urinary sphincter during ICS 2022 in Vienna, Austria; and present some strategies for difficult cases.

Introduction:

Leaking for no obvious reason and leaking all the time are unusual urinary incontinence patterns. They are often associated to most severe incontinence cases. However, its real impact in severity and impact on quality of life has not been extensively studied

Objective:

To determine the influence on severity and impact on quality of life of these two types of urinary leakage in patients with stress, urgency or mixed UI based on ICIQ-UI questionnaire.

Study design:

We performed a retrospective analysis of the ICIQ-UI questionnaire in 560 non-neurogenic patients complaining of UI. Patients were classified according to their UI pattern into stress, urgency or mixed UI. Frequency (Q1: 0-5), amount (Q2: 0-6), impact in quality of life (Q3: 0-10) as well as total ICIQ-UI scores were compared between patients who claimed to also have leakage for no obvious reason (LforNOR) or all the time (LAT) and those who did not. UI patterns were stratified according to its severity.

Results:

203 males and 357 females were studied. Scores for frequency, amount, impact on quality of life and total ICIQ-UI scores were significantly higher for women who LAT (4.7 vs 3.3, 5.4 vs 3.4, 9.3 vs 6.8 and 19.4 vs 13.4 respectively, all with p<0.001) or LforNOR (4.1 vs 3.4, 4.5 vs 3.5, 8.6 vs 6.7 and 17.1 vs 13.6, all with p<0.001). In men, mean Q1, Q2, Q3 and total ICIQ-UI scores were also higher in those with LAT (4.6 vs 2.9, 5 vs 2.8, 9.1 vs 5.3 and 18.7 vs 11 respectively, all with p<0.001) and LforNOR (3.9 vs 2.8, 4.2 vs 2.7, 7.6 vs 5.2 and 15.6 vs 10.7 all with p<0.001). ICIQ-UI scores were also significantly higher when controlling for UI pattern with or without LforNOR or LAT. Stratification of incontinence severity by UI patterns with or without these two types of leakage had clinical consistency as most patients with LforNOR and LAT had higher ICIQ-UI scores.

Conclusion:

Leaking for no obvious reason and leaking all the time are clinical markers of incontinence severity.

Since 2017, polytetrafluoroethylene (PTFE) mesh ORIHIME® has been available in Japan for pelvic organ prolapse surgery. PTFE mesh is a potential material for the reconstruction of pelvic floor, however, there have not been any report on the LSC using PTFE mesh. The aim of the study is to confirm the feasibility of LSC with PTFE mesh by investigating the mid-term outcomes of LSC with this mesh. The materials were ORIHIME® and 30 patients with POP who underwent LSC using ORIHIME® in 2018. All cases underwent double mesh LSC, and subtotal hysterectomy was carried out concomitantly. Mean operation time was 145 min. We experienced no intraoperative complication. The patients were to be followed up to 3 years after operation. But only 19 patients were able to be followed up to 3 years. We experienced no mesh related complication. Stress urinary incontinence was seen in 8 patients (27%). As for recurrence of POP, we saw 3 cases (10%). Considering the results, LSC with PTFE mesh may have potential in reconstructing the female pelvic floor of POP patients.

Overactive bladder (OAB) affects around 12% of the adult population and is the subject of thousands of studies. Qualitative studies of OAB are less common and the patient voice is rarely heard. This protocol outlines the theoretical framework underpinning the study and defines the methodology that will be used to investigate the lived experience of OAB and choices regarding treatment options. This study will reference the patient experience of receiving acupuncture for OAB symptoms, a novel treatment with a growing evidence base. This is the first study to address patient experience related to acupuncture for OAB and may produce information of use to people with OAB, clinicians and those developing new pathways of care.

Aims:

To estimate costs, number of encounters, and adherence and persistence, among overactive bladder (OAB) patients initiating mirabegron (MIRA) and antimuscarinic (AM) combination therapy.

Methods:

In this retrospective cohort study using US claims data, incident combination therapy users (identification period: April 2018–March 2019) were followed for one year from first observed combination therapy fill (index) and stratified into four treatment pathways based on subsequent treatments used: continued combination therapy, switched to monotherapy, discontinued combination therapy or transitioned to OAB procedures (e.g., onabotulinumtoxinA injection). Outcomes were all-cause and OAB-related healthcare per-patient-per-month (PPPM) costs, number of encounters, treatment persistence and adherence. The cohort was weighted to align with the age distribution of the population of interest.

Results:

Patients (n=761) were 69% female; mean age was 67.8 years. Median (interquartile range [IQR]) all-cause PPPM costs ranged from $1,432 ($785, $2,914) for the combination therapy group to $2,335 ($1,482, $5,152) for the procedures group. OAB-related costs were lowest for the discontinuers ($362 [$222, $522]) and highest for those receiving procedures ($810; [$512, $1,433]). The median (IQR) PPPM number of OAB-related outpatient services encounters was 0.2 (0.1, 0.3; similar across treatment pathway groups). Treatment persistence was 167 (83, 300) days; adherence through day 365 was 26%.

Conclusions:

Monthly all-cause healthcare costs were similar among all patients except for those that transitioned to receive an OAB procedure, which was associated with higher costs. Persistence on combination therapy was similar to published persistence estimates for MIRA monotherapy and was potentially higher than published reports of AM persistence, though adherence may be lower.

Uncomplicated urinary tract infection (UTI) is common, resulting in a wide range of expenses and disturbing quality of life, especially in women.

Clinicians should take patients’ complete history and physical examination to determine the cause of recurrent UTI, and should consider further investigation in patients who are suspected of having complicated UTI. A urine culture is mandatory for recurrent UTI in every episode of symptomatic infection, before starting treatment. The antibiotic can be nitrofurantoin, TMP-SFX, or fosfomycin, for no longer than 7 days, to treat episodic uncomplicated infection patients. Post-coital prophylaxis show efficacy for recurrent UTI associated with sexual activity in premenopausal women. Non-antibiotic prophylaxis and low dose antibiotic prophylaxis can be used for patients who have frequent recurrent UTIs. Vaginal estrogen has efficacy to treat recurrent UTIs for post-menopausal women. Good hygiene is generally advised, despite limited data to support it. The vaccine for recurrent cystitis has opened a new door for the treatment of women with recurrent cystitis, however, long tern data are needed to confirm the efficacy.