Search Results (34)

Background: Stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) are common disorders that impair quality of life. While transobturator tension-free vaginal tape (TVT-O) is established for SUI, outcomes in MUI remain uncertain. Methods: We analyzed 111 women who underwent TVT-O at Keelung Chang Gung Memorial Hospital. Baseline data included demographics, Overactive Bladder Symptom Score (OABSS), uroflowmetry [peak flow rate (PFR), residual urine (RU)], and Pelvic Organ Prolapse Quantification (POP-Q) stage. The primary outcome was OABSS improvement (≥1-point reduction); secondary outcomes were longitudinal OABSS, uroflowmetry, pad usage, and POP-Q stage. Results: At 3 months, 31.5% (35/111) met responder criteria. Symptom improvement occurred more often in MUI than in SUI, with about half of women with MUI (48.6%) and one quarter of those with SUI (27.4%) reporting subjective improvement (p = 0.018). OABSS improved in MUI (7.92 → 7.18, p = 0.001) but worsened in SUI (6.84 → 7.52, p < 0.001). In SUI, PFR increased (p = 0.001) and RU decreased (p = 0.029); no significant changes occurred in MUI. MUI independently predicted response (OR, 2.59; 95% CI, 1.10–6.14) and greater ΔOABSS (β = −1.391, p < 0.001); higher baseline OABSS also predicted improvement (β = −0.093, p = 0.049). For pad usage, MUI was associated with persistence (OR, 3.855, p = 0.010). ROC analysis showed modest discrimination for MUI (AUC 0.626, p = 0.034). Conclusions: TVT-O provided symptom relief, with about half of the women with MUI, and one quarter of those with SUI experienced subjective improvement. Women with MUI and higher baseline OABSS were more likely to improve, but these findings should be interpreted with caution, given the modest sample size. Full article

Background/Objectives: De novo stress urinary incontinence (SUI) can develop postoperatively in patients without prior symptoms, and can persist beyond 6 months, posing clinical challenges. This study aimed to identify predictors of persistent de novo SUI after transvaginal mesh (TVM) surgery and to evaluate management strategies. Methods: A retrospective review of 817 women with anterior and apical pelvic organ prolapse (POP) (stage II–IV) who underwent TVM surgery from 2013 to 2021 was conducted. Fifty patients developed de novo SUI postoperatively. Assessments included urodynamic studies, validated symptom questionnaires, and POP quantification (POP-Q) staging. Logistic regression analysis was used to identify predictors of persistent symptoms. Results: Spontaneous resolution occurred in 30% (15/50) of participants within six months, while 70% (35/50) had persistent SUI. Concomitant posterior mesh repair was more frequent in the persistent group compared to the self-limiting group (29% vs. 7%), and was significantly associated with symptom persistence (OR 5.6, 95% CI, 0.65–48.4; p = 0.03, chi-square test). During conservative management with observation alone, 30% (15/50) experienced spontaneous resolution within 6 months, while 70% (35/50) had persistent symptoms. Among those with persistent symptoms, 56% required no further treatment, 10% improved with vaginal laser therapy, and 4% underwent sling surgery. Conclusions: Conservative management remains critical in the early postoperative period, given the high rate of spontaneous symptom resolution. For persistent cases, minimally invasive options such as vaginal laser therapy may be beneficial. Notably, only 4% required anti-incontinence surgery. Full article

Urinary incontinence is characterized by the involuntary leakage of urine. The primary cause of stress urinary incontinence in women is the weakening of the pelvic floor muscles. Stress urinary incontinence (SUI) is a significant global health problem that impacts mainly middle-aged women, with a severe impact on their quality of life. Traditional diagnostic methods and treatments often fail, although technological innovations have improved diagnostic accuracy, such as specific questionnaires or transperineal ultrasound. While medical therapies and surgical procedures are continuously being developed, controversies about the correct choices regarding diagnostic and treatment methods continue to exist. The aim of our review was to identify the innovative diagnostic tools and effective treatment procedures for SUI. A narrative review was conducted due to the heterogeneity of the studies. New methods for diagnosis and treatment have gained ground, and we have covered them in our review; however, the field continues to expand. A personalized approach to diagnosis is also a requirement because of the limitations of conventional urodynamic studies, and we emphasize the importance of such personalization in enhancing clinical decision making. Future medical strategies that combine both preventive and therapeutic care are desirable. Newer technologies were brought to light in this review, including stem cell therapy and laser therapy. Full article

Background and Objectives: This study aims to evaluate the relevance of urethral pressure profile (UPP) measurements in the diagnosis of urodynamic stress incontinence (USI) in women with stress and mixed urinary incontinence (SUI and MUI). Materials and Methods: A cross-sectional chart review was used. All patients who had urodynamic studies (UDSs) in the urogynecology unit of an academic hospital over the last 6 months and complained of SUI or MUI were analyzed. Clinical examination included prolapse grading with the POP-Q system. The presenting symptoms, initial diagnosis before UDS, and results from flow studies—cystometrography (CMG), which included a 1-3-5 cough test at 300–350 mL bladder filling, and urethral pressure profilometry (UPP)—were recorded. p < 0.05 was considered significant in all statistical comparison tests; receiver operator characteristic (ROC) curves were also used to determine the best predictor of SUI diagnosis. Results: In total, 57 women were included in this study, with a mean age of 60.7 (±9.3). Upon UDS, 28 women (49.1%) demonstrated USI (Group 1), while 29 women (50.9%) did not demonstrate USI (Group 2). No differences between the two groups were noted during free uroflowmetry and the filling phase of CMG. However, the women in Group 2 had a significantly lower MUCP, FUL, and post-void residual after pressure flow compared to the women in Group 1 (p = 0.038, 0.003, and 0.04, respectively, upon Student’s t test for independent parameters). The ROC analysis indicated that when using MUCP and FUL for the diagnosis of USI, the AUCs are 0.663 (0.525–0.782) and 0.756 (0.623–0.861), respectively. Conclusions: By exhibiting correlations between low MUCP/FUL and USI, UPP appears to be a valid test for USI. The value of UPP in diagnosing USI in those with SUI and MUI appears to be clinically important. Further studies are needed in non-SUI patients, in addition to SUI subgroups and various incontinence treatment groups. Full article

Stress urinary incontinence (SUI) is a common condition that can significantly impair a woman’s quality of life. While initial management includes conservative treatments, surgical options are recommended in refractory cases. Suburethral slings are currently one of the most widely recommended surgical treatments due to their high long-term efficacy. However, complications such as postoperative urinary retention can occur and may lead to chronic voiding dysfunction when not promptly diagnosed and managed. Background/Objectives: The aim of this study was to evaluate the long-term voiding function in women undergoing delayed sling removal or incision for neglected chronic voiding dysfunction. Methods: This retrospective study examined women with chronic voiding dysfunction occurring at least one year after suburethral sling placement for SUI. Preoperative evaluation included comprehensive history, physical examination, urethral ultrasound, uroflowmetry, and urodynamic studies. Surgical interventions consisted of partial or complete sling removal or sling incision (unilateral or bilateral). Postoperative follow-up was conducted at one month and then at 12 months, including clinical examination, ultrasound, and symptom assessment. Results: Sixteen patients were included in the study, all of whom presented with urodynamic confirmation of voiding dysfunction. Following surgical intervention, a significant improvement was observed in voiding symptoms and overall symptoms (p < 0.01). Notably, only one patient experienced persistent voiding difficulties, although complete symptom remission was achieved following sacral neuromodulation. Conclusions: Sling removal or incision has proven to be an effective approach in resolving the majority of cases of neglected chronic voiding dysfunction. These findings suggest that, when appropriately performed, surgical intervention can substantially alleviate symptoms and improve patient well-being, providing an effective therapeutic option for what is often a debilitating condition. Full article

Background/Objectives: Urethral sphincter muscle deficiency is the leading cause of stress urinary incontinence. Preclinical and clinical studies suggested that cell therapy may improve the situation. However, the overall efficacy of cell therapies did often not satisfy the patient’s needs. We, therefore, investigated in a large animal model of incontinence if the localization of injected regenerative cells in the deficient urethral sphincter muscle correlated with the outcome. Methods: Urethral sphincter insufficiency was induced in three cohorts of pigs and confirmed by urodynamics. Then, either myogenic progenitor cells (MPCs) or adipose tissue-derived stromal cells (ADSCs) were injected into the injured sphincter complex by Williams needle under visual using a cystoscope. Sham-treated animals served as controls. Functional sphincter muscle regeneration was monitored by urodynamics over 5 weeks of follow-up. The localization of the injected cells was investigated by histology of cryosections of the tissue targeted. Results: Injection of MPCs near the sphincter muscle yielded better functional recovery when compared to MPC injections in adjacent sides. By contrast, injection of ADSCs in the submucosal tissue adjacent to the muscle led to better regeneration when compared to ADSC injections into the sphincter muscle. After five weeks of follow-up, MPCs yielded an overall robust but not significant improvement when compared to mock-treated controls, while ADSC injections reached significance. Conclusions: This small proof-of-principle study suggests that the clinical outcome of cell therapy for urinary incontinence depends on the choice of therapeutic cells and the precise localization of the cells in the tissue targeted as well. Full article

Objectives: We aimed to evaluate management strategies for female urinary incontinence, specifically stress urinary incontinence (SUI), and anterior vaginal prolapse (pelvic organ prolapse, POP), emphasizing diagnostic methods, treatment options, and factors influencing surgical outcomes. Methods: We conducted a thorough literature review examining diagnostic tools, including physical examinations, urodynamic testing, and pessary evaluations, alongside treatment options for SUI and POP. Both surgical interventions, such as mid-urethral sling placement and anterior colporrhaphy, and non-surgical methods, including pelvic floor exercises, were analyzed. This review assesses these approaches’ efficacy, complications, and outcomes, incorporating current clinical guidelines and evidence-based practices. Results: Evidence indicates that SUI frequently coexists with POP, with a notable proportion of cases being occult until a prolapse is reduced. Diagnostic methods such as pessary testing and urodynamic evaluations are essential in identifying masked SUI, though their predictive accuracy varies. Surgical techniques such as using mid-urethral slings are highly effective but pose risks, including voiding dysfunction and lower urinary tract injury. Long-term data emphasize the need for personalized treatment strategies, with combined procedures showing superior outcomes for the concurrent management of POP and SUI in select cases. Conclusions: Effective management of SUI and POP requires a personalized approach, factoring in the severity of a prolapse and the likelihood of postoperative incontinence. While conservative treatments are practical initial options, surgical solutions, such as mid-urethral slings and apical suspension procedures, offer robust, lasting results for advanced cases. Preoperative diagnostics, collaborative decision-making, and tailored treatment plans are essential to optimize success and minimize complications. Future research should prioritize enhancing diagnostic precision and refining surgical methods to further advance patient care. Full article

Background/Objectives: The role of urodynamic study (UDS) in women with pelvic organ prolapse (POP) and concurrent lower urinary tract symptoms (LUTS) remains controversial. Although LUTS alone often fail to yield an accurate diagnosis, routine UDS is debated due to its invasiveness, cost, patient discomfort, and risk of urinary tract infections. The aim of this narrative review is to summarise the utility of UDS in the pre- and postoperative management of POP, focusing on its role in diagnosing and predicting outcomes for detrusor overactivity (DO), bladder outlet obstruction (BOO), detrusor underactivity (DU), and SUI. Methods: An extensive search of the available medical literature was conducted using PubMed, Scopus, and Embase to identify relevant studies published up to December 2024. The search combined keywords and MeSH terms related to pelvic organ prolapse (POP), urodynamic studies (UDS), overactive bladder, detrusor overactivity, stress urinary incontinence (SUI), female bladder outlet obstruction (BOO), detrusor underactivity (DU), preoperative assessment, and postoperative outcomes. Results: Occult stress urinary incontinence (SUI) detection with UDS can aid in planning concurrent anti-incontinence procedures, while preoperative assessment of DO or DU helps predict postoperative complications like urinary retention or overactive bladder symptoms. Conclusions: Despite its diagnostic advantages, evidence on UDS parameters and surgical outcomes remains inconsistent. The most important societies’ guidelines promote the use of UDS in selected cases, highlighting the need for individualised assessments to optimise patient counselling and management strategies. Full article

Background: CUOB (co-existent underactive overactive bladder) syndrome is a clinical entity that embraces storage and emptying symptoms, not strictly correlated with urodynamic findings. We assessed the differences between patients diagnosed with CUOB with/without cystocele. Methods: The study group was allocated from 2000 women who underwent urodynamic studies between 2008 and 2016. The demographic and clinical data of 369 patients with complaints consistent with CUOB were retrieved. The study group was subdivided using the Pelvic Organ Prolapse Quantification System. The International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) was used to quantify LUTS severity. Results: A total of 185 women had no or grade I cystocele (group 1), and 185 had grade II or III cystocele (group 2). No difference in mean age was computed. Patients from group 1 had a higher BMI (27 vs. 25, p = 0.02). Risk factors for prolapse, such as parity (1.7 vs. 2.1, p = 0.001) and maximal birthweight (3460 g vs. 3612 g, p = 0.049), were higher in group 2. Pelvic Organ Prolapse symptoms were 4.5 times more frequent in group 2 [n = 36/185 (19.5%) vs. n = 162/184 (88%) p < 0.001]. The rate of stress (70.8% vs. 55.4%, p = 0.002) and urge (64.9% vs. 50%, p = 0.04), urinary incontinence, and ICIQ-UI-SF scores (8 vs. 5, p < 0.001) were higher in group 1. Qmax measured lower in group 2 (17 vs. 15 mL/s, p = 0.008). Detrusor pressure at maximum flow was identical (24 cm H₂O). The Bladder Contractility Index (BCI) was higher in group 1 (108 vs. 96.5, p = 0.017), and weak contraction (BCI < 100) was more common in group 2 (73/185; 39.5% vs. 95/184; 52.7%, p = 0.011). Conclusions: Based on our results, we assume that CUOB could be further subdivided based on its association with cystocele. The effect of prolapse repair in women with CUOB and cystocele remains to be evaluated in order to afford better counseling in the future. Full article

Background: The aim of the study was to assess the effect of high-intensity focused electromagnetic (HIFEM) technology in the treatment of female stress urinary incontinence (SUI). Materials and Methods: 20 women with SUI were delivered a treatment course with HIFEM technology. Patients attended 6 therapies scheduled twice a week. Validated questionnaires were assessed, including the overactive bladder symptoms score (OABSS), urogenital distress inventory-6 (UDI-6), incontinence impact questionnaire-7 (IIQ-7), international consultation on incontinence questionnaire (ICIQ), and valued living questionnaire (VLQ). Some urodynamic parameters, such as maximum flow rate (Qmax), residual urine (RU), and bladder volume at first sensation to void (Vfst). Bladder neck mobility in ultrasound topography was also collected pre- and post-treatment at 1- and 6-month follow-up visits. Results: HIFEM treatment significantly improved SUI symptoms on pad tests from 4.2 ± 5.5 to 0.6 ± 1.3 and patients’ self-assessment in the 6-month follow-up. Additionally, the data from urinary-related questionnaires, including OABSS (5.3 ± 3.9 to 3.9 ± 3.6), UDI-6 (35.7 ± 22.3 to 15.2 ± 10.6), IIQ-7 (33.1 ± 28.7 to 14.3 ± 17.2), and ICIQ (9.4 ± 5.0 to 5.4 ± 3.6), all showed a significant reduction. Then, the analysis of the urodynamic study revealed that only maximum urethral closure pressure (MUCP) (46.4 ± 25.2 to 58.1 ± 21.2) and urethral closure angle (UCA) (705.3 ± 302.3 to 990.0 ± 439.6) significantly increased after the six sessions of HIFEM treatment. The urethral and vaginal topography were performed and found that HIFEM mainly worked on pelvic floor muscles (PFM) and enhanced their function and integrity. Conclusions: The results suggest that HIFEM technology is an efficacious therapy for the treatment of SUI. Full article

Background/Objectives: The most common variant of mixed urinary incontinence is stress-induced urge urinary incontinence with the correlating urodynamic findings of cough-induced detrusor overactivity (CIDO). This prospective study assessed the clinical outcomes and leakage improvement among patients with CIDO following conservative or surgical treatment. Methods: We included patients with CIDO treated at our tertiary referral center from January 2018 to July 2021 in this prospective cohort study. The detection of a detrusor contraction after a cough was diagnosed as CIDO by urodynamic multichannel testing. All the patients in our study received personalized care, with behavioral therapy and anticholinergic/betamimetic treatment as a first step. If leakage persisted, patients were given a choice between pelvic floor muscle exercises (PFMEs), periurethral bulking or a midurethral sling. The primary outcome was the mean difference in urine leakage in the pad test before and six months after treatment. Results: Thirty-five patients met the inclusion criteria for CIDO and all presented a positive pad test at baseline (mean: 27 g). All 35 patients participated in behavioral therapy and anticholinergic/betamimetic treatment. Twenty-two patients (62.9%) underwent PFME, twelve patients (34.2%) received periurethral bulking, and nine patients (25.7%) received a midurethral sling. After all the treatments, our cohort showed a significant improvement in the pad test (mean: 5.7 g, p < 0.001). The result was more favorable after periurethral bulking than the midurethral sling (p < 0.001). Conclusions: This study shows the effectiveness of conservative treatment as a first step. In cases needing further treatment, bulking agents may be superior to PFME and midurethral propylene slings, offering new perspectives in the field of urogynecology and urinary incontinence. Full article

Objectives: Stress urinary incontinence (SUI) negatively affects the quality of life and sexual function in women. This study aimed to evaluate the efficacy of radiofrequency (RF) therapy in reducing SUI symptoms and its impact on sexual function. Methods: Thirty-four women with SUI were enrolled and underwent a single RF treatment session using the Viveve^® System (Viveve Medical Inc., USA) with parameters of 90 J/cm² and 220 pulses per hour. Assessments at baseline and 6 months post treatment included perineal ultrasound and personal interviews to evaluate lower urinary tract symptoms and sexual function. Urodynamic studies, voiding diaries, and questionnaires such as the Female Sexual Function Index (FSFI), Overactive Bladder Symptom Score (OABSS), Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF) measured outcomes. Results: RF therapy significantly improved sexual function, with higher FSFI scores in all domains except pain at 6 months. SUI symptoms were significantly reduced, as indicated by improved scores on OABSS, UDI-6, IIQ-7, and ICIQ-SF, alongside better voiding diary results. Anatomical changes included reduced bladder neck mobility, decreased vaginal width, and a reduced rotation angle of the proximal urethra. Conclusions: RF therapy is effective and safe for treating mild to moderate SUI and enhances sexual function, potentially due to changes in vaginal topography. These results suggest RF therapy as a viable non-surgical option for managing SUI and improving sexual health. Full article

Background: Mixed urinary incontinence (MUI) has always represented a major therapeutic challenge and the management of this type of incontinence is often complicated by uncertain outcomes. Surgical options include interventions targeting both stress urinary incontinence (SUI) and urge urinary incontinence (UUI), although there are no international published guidelines that dictate whether it is better to start with surgical management to address the SUI or UUI component after the failure of conservative treatment. The aim of the present study is to evaluate the effectiveness of the Macroplastique (MPQ) procedure on overactive bladder (OAB) symptoms in women with MUI with a minimum follow-up of 1 year. Methods: A retrospective analysis of prospectively collected data was performed in two tertiary reference centers. We enrolled all women complaining of symptoms of SUI and OAB, dry or wet, with a urodynamically confirmed diagnosis of MUI [urodynamic stress incontinence (USI) with detrusor overactivity (DO)], who took a previous ineffective antimuscarinic treatment and underwent the MPQ procedure. We considered as objectively cured women who did not leak urine during the stress test and with a 1 h pad-test negative, while International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF), ICIQ-OAB, Patient Global Impression of Improvement (PGI-I) scale, and a Visual Analogue Scale (VAS) were used to assess subjective outcomes. Results: A total of forty-six patients who met the inclusion criteria and who underwent the MPQ procedure were considered for the analysis. At the 1-year mark of follow-up, 72% of patients were objectively cured at stress test and 65% were objectively cured at pad-test, while 72% of women declared themselves subjectively cured. OAB symptoms significantly improved after MPQ and a complete resolution of OAB was recorded in 35% of patients. Conclusions: This study demonstrated that MPQ is a safe and effective option for the treatment of female MUI. Furthermore, MPQ significantly improves the symptoms of OAB and is able to completely cure this condition in a relevant percentage of women with MUI when pharmacological treatment fails. Full article

Background/Objectives: The use of tension-free vaginal tape obturator (TVT-O) for the treatment of stress urinary incontinence (SUI) has been widely debated over the last decade due to the lack of evidence on its long-term outcomes. The aim of this prospective study is to assess, for the first time in the available literature, the efficacy and safety of TVT-O implantation in women with pure SUI over a 17-year follow-up period. Methods: We included all women who complained of pure SUI symptoms (confirmed urodynamically) and underwent the TVT-O procedure. An objective cure was defined as the absence of urine leakage during the stress test, while subjective outcomes were assessed by means of the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF), the Patient Global Impression of Improvement (PGI-I) scale, and a Visual Analogue Scale (VAS). Results: A total of 70 patients who met the inclusion criteria underwent the TVT-O procedure. During the study period, no patients were lost to follow-up, and all women completed the last evaluation at the 17-year mark. At the 17-year mark of follow-up, 62 out of 70 patients (81.4%) were subjectively cured, and 56 out of 70 (80%) patients were objectively cured. These data do not reveal any significant variation in the surgical outcomes over the follow-up period. We recorded seven (10%) tape exposure (three occurred after 10 years and four after 17 years). Among these, one woman was symptomatic for dyspareunia and “hispareunia”. All patients with mesh exposure were treated with partial removal and re-suture of the vagina, but only one developed the recurrence of SUI that required a second treatment with a urethral bulking agent (UBA). In all other cases, women reported a complete resolution of symptoms without any worsening of the urinary continence. No significant bladder or urethral erosion was recorded. Conclusions: The 17-year evaluation of the TVT-O procedure has shown that it is a highly effective and safe option for the treatment of female SUI. Although there was an increased risk of tape exposure 17 years after implantation, no serious complications were reported, and no patient required the total removal of the sling. Full article

Background and Objectives: Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic floor and abdominal muscles, hypothesizing that the anatomical and functional integrity of the abdominal wall plays a role in the prevention of pelvic floor disorders. Some studies have shown a significant correlation between diastasis recti abdominis (DRA) and stress urinary incontinence (SUI). Nevertheless, the evidence reported in the literature is controversial and based on low-quality data. The aim of the study is to clarify whether DRA-specific abdominal rehabilitation is needed in women with SUI after childbirth. Materials and Methods: All consecutive women who had at least one delivery and complained of symptoms of pure SUI that were urodynamically proven were considered for the study. The group of symptomatic patients was compared with a series of consecutive women, identified during the same study period, without any symptoms of SUI. In both groups, we measured the inter-rectal distance (IRD) with an ultrasound scanner above and below the navel. Results: A total of 102 women eligible for the study group and 100 women who did not report any symptoms of SUI were enrolled. The inter-rectal distance above the umbilicus showed no significant difference between the two groups (2.12 ± 0.98 vs. 2.1 ± 0.77; p = 0.94). In contrast, the data from the sub-umbilical measurements showed a significant difference. Surprisingly, the asymptomatic group showed significantly greater (0.98 ± 0.9 vs. 1.33 ± 0.87 p-value: 0.009) IRD compared to the symptomatic group. Conclusions: The study shows that DRA is not a risk factor for SUI in women after childbirth. Therefore, specific abdominal wall rehabilitation after childbirth does not seem to be indicated. Full article