Treating stress urinary incontinence in female patients with neuropathic bladder: the value of the autologous fascia rectus sling
ABSTRACT The aim of this study was to evaluate the efficacy of the autologous fascia rectus sling in treating stress urinary incontinence in female patients with neuropathic bladder. Furthermore, correlations between preoperative parameters and outcome were evaluated.
We retrospectively reviewed operative logs from a single surgeon (EM) of 33 female patients with neuropathic bladder treated over a 3-year period for stress urinary incontinence by implantation of an autologous fascia rectus sling. Efficacy was evaluated objectively in terms of the number of pads used per day, while subjective patient satisfaction was also recorded using a global assessment question. Possible correlations between age, obesity, preoperative Valsalva leak point pressure and incontinence severity and outcome were investigated using univariate analysis.
The mean follow-up time was 52 months, while the mean age of the patients was 37 years. Causes of neuropathic bladder were myelomeningocele in 21 (63.63 %) and spinal cord injury in 12 patients (36.36 %). A total of 30 patients were successfully treated and satisfied with the outcome of the operation (90.9 %). Twenty-five patients (75.75 %) were totally dry, while 5 patients (15.15 %) had markedly improved but still required one pad per day. The complication rate was 15.20 %. Univariate analysis failed to show any correlation between the final outcome and the checked parameters.
The free autologous rectus fascia sling is a highly effective technique for the treatment of female stress incontinence in patients with neuropathic bladder, while the morbidity is mild.
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ABSTRACT: Introduction and hypothesis Preliminary reports show promising data on tension-free vaginal tape (TVT) in women with lower motor neuron lesion (LMNL) presenting with stress urinary incontinence (SUI). We compared efficacy and safety of TVT to pubovaginal sling (PVS) in treating SUI in women with LMNL. Methods This was a pilot, nonrandomized clinical trial evaluating women with SUI associated with pathology at or below S2 spinal segment. Failure was defined as leakage of urine during cough test at 250 ml bladder volume. Primary outcome was time to treatment failure based on positive cough stress test. Other outcomes were Urogenital Distress Inventory Short Form-6 (UDI-6), Incontinence Impact Questionnaire Short Form-7 (IIQ-7) and urodynamics. Regression models were used to adjust for confounders. Results The study evaluated 40 women: 20 TVT and 20 PVS, and cure rates were 80 and 85 %, respectively. Time to treatment failure in the TVT group was comparable with the PVS group, with an unadjusted hazard ratio (HR) of 2.90 [95 % confidence interval (CI), 0.61-15.42, P = 0.154]. After adjusting for confounders, adjusted HR for treatment failure was 1.04 (95 % CI, 0.12-8.66, likelihood ratio chi-square P = 0.973). Both groups showed significant reductions in UDI-6 and IIQ-7 scores after surgery. One patient had mesh erosion in the TVT group. Conclusions TVT is feasible, effective and safe for women with LMNL presenting with SUI, with comparable treatment outcomes to PVS. TVT might be of benefit to women who do not use clean intermittent catheterization (CIC) at baseline.International Urogynecology Journal 10/2014; 26(3). DOI:10.1007/s00192-014-2521-8 · 2.16 Impact Factor
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ABSTRACT: PURPOSE: We analyzed the correlation between pad usage as determined by objective pad count and the severity of urinary incontinence as measured by pad weight. MATERIALS AND METHODS: This is a retrospective study of consecutive incontinent patients who wore pads on a daily basis and were instructed to complete a 24-hour pad test. They were told to use their usual pads, change them as they usually do and place each in a separate plastic bag the day before their scheduled appointment. All pads were weighed and total urine loss was calculated by subtracting the dry pad weight from the wet pad weight assuming that 1 gram of weight increase is equivalent to 1 ml of urine loss. The number of pads was correlated to the pad weight using Spearman's rank correlation coefficient due to the non-parametric nature of the data. RESULTS: There were 116 patients comprised of 51 men (age range 39-89, mean 66) and 65 women (age range 27-95, mean 72). The Spearman's rho comparing the number of pads used to grams of urine loss was 0.26 (p=0.005) for the total cohort and 0.40 (p<0.05) and 0.26 (p<0.05) for males and females, respectively. CONCLUSION: There was little correlation between number of pads used and severity of urinary incontinence (r = 0.26). This data suggests that pad counts should not be used as an objective measure of incontinence severity and that instead, pad weight on a 24 hour pad test should be utilized.The Journal of urology 05/2013; 190(5). DOI:10.1016/j.juro.2013.05.055 · 3.75 Impact Factor