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This multicenter, randomized clinical trial compared two surgical procedures — the Burch colposuspension and the autologous fascial pubovaginal sling — in women with urinary stress incontinence. Success rates (in terms of overall urinary-incontinence measures and stress-incontinence measures specifically) were higher at 2 years for the sling group, but this group also had greater morbidity. These findings inform decision making with respect to surgical treatment of stress incontinence and underscore the importance of surgical randomized trials. This trial compared two surgical procedures — the Burch colposuspension and the fascial sling — in women with urinary stress incontinence. Success rates were higher at 2 years for the sling group, but this group also had greater morbidity. Urinary incontinence affects an estimated 15 to 50% of women, 1 , 2 resulting in a significant medical, social, and economic burden. 1 In 1995 dollars, the annual direct costs of incontinence in the United States were estimated to be more than $16 billion. 3 Among women with incontinence, 50 to 80% are identified as having stress incontinence, 4 or involuntary leakage of urine resulting from physical exertion or sneezing and coughing. 5 Although the initial treatment of stress incontinence is often nonsurgical (behavioral therapy, pelvic-floor exercises, or incontinence devices), surgical treatment is considered for patients who are bothered by persistent symptoms. An estimated 4 to . . .

Introduction and hypothesis Prior studies demonstrate mixed results on the impact of obesity on the success of midurethral slings (MUS), with little known about how postoperative weight change affects outcomes. We aimed to examine the effect of postoperative weight change on outcomes 12 months after MUS for stress urinary incontinence (SUI). Methods This secondary analysis utilized data from two multicenter randomized trials of women undergoing MUS placement. Subjects were categorized into cohorts based on change in body weight at 12 months postoperatively: weight gain (≥5% increase); weight loss (≥5% decrease), and weight stable (<5% change). The primary outcome was SUI cure (no SUI episodes in a 3-day bladder diary). Patients with mixed urinary incontinence (MUI) were analyzed for changes in daily average urge incontinence (UUI) episodes in a 3-day diary. Penalized logistic regression assessed the impact of demographic and perioperative variables on the primary outcome. Results Of the 918 women included, 635 (70%) were weight stable, 144 (15%) had weight gain, and 139 (15%) had weight loss. Patients in the weight loss cohort had a higher smoking rate and a higher baseline body mass index (SD 0.29, 2.7 respectively). All cohorts experienced high SUI cure rates ranging from 77 to 81%, with no significant difference in SUI cure between cohorts ( p  = 0.607). Of 372 subjects with MUI, the weight loss cohort had significantly greater improvement in UUI episodes. Conclusions Weight change at 12 months postoperatively did not significantly alter efficacy of MUS for treatment of SUI. Patients with MUI who lost ≥5% body weight had significantly greater improvement in UUI episodes.

Background Urgency is a complaint of sudden, compelling desire to pass urine, which is difficult to defer, caused by involuntary contraction of the detrusor muscle during the bladder-filling stage. To enable detrusor inhibition, electrotherapy resources such as transcutaneous tibial nerve stimulation (TTNS) and parasacral transcutaneous electrical stimulation (PTES) have been used. The objective this study is to publish the study protocol that aims to investigate whether urgency decreases after treatment with both of the techniques. Methods This randomized controlled clinical trial will include 99 women, aged more than 18 years old, with urgency (score ≥ 8 in the Overactive Bladder-Validated 8-Question Awareness Tool [OAB-V8]). Women will be randomly allocated into three groups: TTNS, PTES, and placebo. The following questionnaires will be applied: the Anamnesis Record, the Incontinence Questionnaire Overactive Bladder, the King’s Health Questionnaire, the 24-Hour Voiding Diary, and the OAB-V8, at four different time points: at baseline prior to the first session, at the 6th session, the 12th session and at follow-up. The current used for the transcutaneous electrical stimulation will be a symmetrical balanced biphasic pulsed current, for 12 sessions, twice a week, for 20 minutes. Qualitative variables will be displayed as frequency and percentage, quantitative variables as mean and standard deviation. Comparison of urgency severity among groups will be performed with a repeated measures ANOVA, considering the effect of the three groups and the four evaluations, and interactions among them. Discussion The present study aims to contribute evidence for a more in-depth discussion on electrode positioning for electrostimulation used in urgency treatment. It should be emphasized that, based on the possibility of confirming the hypothesis that urgency will decrease in a similar way after both treatments (TTNS and PTES), the PTES will be used as an option for positioning the electrodes alternatively to the tibial nerve region in special populations, such as amputees or people with severe lower limb sensory impairment. Trial registration Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-9rf33n , date of registration: 17 May 2018.

Introduction and hypothesis The objective was to compare the efficacy and safety of an innovative single-incision sling (SIS) with the inside-out transobturator sling (TOT) in the treatment of female stress urinary incontinence (SUI). Methods A prospective randomized trial was performed in a tertiary referral urogynecology center from January 2012 to December 2013. The study included women with pure urodynamic SUI. Patients were randomized to either the SIS or the TOT anti-incontinence procedure. Surgery duration, blood loss, and groin pain scores were recorded for each patient. The 1-year follow-up visit included objective and subjective cure parameters, postoperative de novo urgency, complications, and the impact on the patient’s life quality. Results Of 285 patients assessed for eligibility, a total of 93 patients (32.6 %) were randomized into TOT ( n  = 48) and SIS groups ( n  = 45). There were no significant differences in either operating time or blood loss. A statistically significant difference between the two groups was found in pain scores three (5.6 ± 1.8 vs 3.1 ± 2.1, p  < 0.001) and 12 h postoperatively (3.8 ± 1.7 vs 2.1 ± 1.7, p  < 0.001). After 1 year, there were no significant differences between the TOT and SIS groups in objective cure rates (87.0 % vs 90.9 %; p  = 0.399) or patient-reported success rates (91.3 % vs 93.2 %; p  = 0.999). Incidence of postoperative de novo urgency did not differ between TOT and SIS patients. Both groups registered a significant improvement in quality of life. Conclusions The Ophira SIS procedure has 1-year success rates comparable to standard TOT with significantly less groin pain in the early postoperative period. Both methods were safe and effective in terms of postoperative urgency and life quality improvement.

Introduction and hypothesis The aim of this study was to determine whether preoperative voiding detrusor pressures were associated with postoperative outcomes after stress incontinence surgery. Methods Opening detrusor pressure, detrusor pressure at maximum flow ( p det Q max ), and closing detrusor pressure were assessed from 280 valid preoperative urodynamic studies in subjects without advanced prolapse from a multicenter randomized trial comparing Burch and autologous fascia sling procedures. These pressures were compared between subjects with and without overall success, stress-specific success, postoperative detrusor overactivity, and postoperative urge incontinence using independent sample t tests. Results There were no clinically or statistically significant differences in mean preoperative voiding detrusor pressures in any comparison of postoperative outcomes. Conclusions We found no evidence that preoperative voiding detrusor pressures predict outcomes in women with stress predominant urinary incontinence undergoing Burch or autologous fascial sling procedures.

Introduction and hypothesis This study deals with assessment of safety, efficacy, and potential complications of Prolift+M system to correct uterovaginal prolapse. Methods We analyzed a prospective cohort treated with the Gynecare PROLIFT+M mesh system between October 2008 and March 2010. A composite score that included subjective/objective cure and lack of complications was used to assess treatment success. Results One hundred sixty-seven women (age 65.1 ± 11.2 years, BMI 29.2 ± 5.8 kg/m 2 ) were treated for pelvic organ prolapse using the PROLIFT+M system. Seven anterior Prolift+M, 42 posterior Prolift+M, and 118 total Prolift+M mesh surgeries were performed in patients with stage II or greater degrees of prolapse. Mean operative time was 122.7 ± 43.9 min. Mean intraoperative blood loss was 119.4 ± 125.3 ml. Our composite success score was 72.5% (treatment failures per POP-Q stage 1.4%, perception of bulge 4.4%, erosions 3.6%, pain/dyspareunia 3.7%, incontinence 0.7%, de novo urge urinary incontinence 8.7%, voiding dysfunction 0.6%, recurrent urinary tract infection 2.2%, and anal incontinence 2.2%). Conclusions Prolift+M surgery is safe and effective with minimal postoperative morbidities.

Introduction Ginger-salt-indirect moxibustion is widely applied to treat urge urinary incontinence after stroke, which is a common complication in stroke survivors. Moxa cone moxibustion and moxa box moxibustion are the main techniques of ginger-salt-indirect moxibustion. Our previous study had shown that ginger-salt-indirect moxibustion using moxa cones was feasible and effective for urination disorders post-stroke. This pilot study aims to assess the feasibility of conducting research to evaluate the efficacy and safety of ginger-salt-indirect moxibustion for patients with post-stroke urge urinary incontinence. Methods and analysis This is a multicentre, prospective, single-blinded, pilot randomised controlled trial. 120 eligible patients will be randomly allocated to three groups. Treatment group A (n=40) will receive moxa cone moxibustion and routine care; treatment group B (n=40) will receive moxa box moxibustion and routine care; control group (n=40) will only receive routine care for stroke recovery. The entire moxibustion treatment will consist of a total of 28 sessions during the course of 4 weeks. The primary outcome measure will be the increase in mean volume per void assessed at week 4 from the first moxibustion session (baseline). Secondary outcome measures will include mean frequency of urination per day and quality of life assessments measured by completion of the Incontinence Quality of Life Questionnaire and Barthel Index. All outcome measures will be assessed at baseline and at 4 and 16 weeks from baseline. Adverse events in the three groups will be recorded to assess the safety of moxibustion. Ethics and dissemination Research ethics was approved by the Research Ethical Committee of Beijing Hospital of Traditional Chinese Medicine Affiliated to the Capital Medical University (ref: 2013BL-094). Written informed consent will be obtained from all participants. Study results will be published in peer reviewed journals. Trial registration number ISRCTN 44706974.

Introduction and hypothesis Urinary incontinence (UI) is very common and heterogeneous among women with limited knowledge of progression or prognosis. Evidence based on clinical epidemiology can help to better understand the natural history of UI. Methods We examine the challenges of UI definition and its subtypes, its impact on quality of life and health-seeking behavior. We review the proposed pathophysiology of UI subtypes and known risk factors as they relate to our current knowledge of the disease state. Finally, we emphasize the role of epidemiology in the process of acquiring new insight, improving knowledge, and translating this information into clinical practice. Results Stress UI is most common overall, but mixed UI is most prevalent in older women. The three UI subtypes have some common risk factors, and others that are unique, but there remains a significant gap in our understanding of how they develop. Although the pathophysiology of stress UI is somewhat understood, urgency UI remains mostly idiopathic, whereas mixed UI is the least studied and most complex subtype. Moreover, there exists limited information on the progression of symptoms over time, and disproportionate UI health-seeking behavior. We identify areas of exploration (e.g., epigenetics, urinary microbiome), and offer new insights into a better understanding of the relationship among the UI subtypes and to develop an integrated construct of UI natural history. Conclusion Future epidemiological strategies using longitudinal study designs could play a pivotal role in better elucidating the controversies in UI natural history and the pathophysiology of its subtypes leading to improved clinical care.

Parity increases the risk of urinary incontinence, but this risk differs by mode of delivery. This study evaluated the association between mode of delivery and prevalence of urge, stress, and mixed urinary incontinence in middle age. The association between mode of delivery and urinary incontinence subtypes was examined using data from the SWAN cohort. Women who experienced vaginal, cesarean, or combination deliveries were compared against nulliparous women. Women who delivered vaginally had a significantly higher prevalence of all subtypes of incontinence compared to women who were nulliparous or delivered via other modes. No significant differences in urinary incontinence were observed when comparing women who birthed vaginally, via cesarean, or combination to nulliparous women. However, in comparison to those who delivered via cesarean, women who delivered vaginally have significantly increased odds of experiencing stress urinary incontinence, and those who delivered via combination have significantly increased odds of experiencing mixed urinary incontinence. Urge urinary incontinence appears to be driven by aging, not childbearing. Compared to cesarean, vaginal deliveries increase the odds of stress and mixed urinary incontinence during middle age. Delivering via a combination of vaginal and cesarean sections increases the odds of mixed urinary incontinence during middle age.

Urinary incontinence (UI), encompassing stress urinary incontinence (SUI) and urge urinary incontinence (UUI), is a prevalent and debilitating condition in patients with multiple sclerosis (MS), profoundly impacting their quality of life. This systematic review and meta-analysis aimed to elucidate the worldwide prevalence rates of SUI and UUI among MS patients. This study was conducted by examining observational studies published between 2000 and 2023. An exhaustive literature search was conducted across databases such as PubMed, MEDLINE, Web of Science, Scopus, ProQuest, and Google Scholar. The Meta-prop method facilitated pooled prevalence estimation of UUI and SUI, while Egger tests assessed publication bias. In total, 27 studies with 15,052 participants were included in the meta-analysis. The findings revealed a high random effect pooled prevalence of UUI at 41.02% (95% Confidence Interval [CI]: 30.57–51.89; I2 = 99%, p < 0.001) and SUI at 25.67% (95% CI: 19.30–32.58%; I2 = 94.9%, P < 0.001). Additionally, the pooled prevalence of mixed urinary incontinence (MUI) was reported at 18.81% (95% CI: 7.55–33.48; I2:95.44%, p < 0.001). The high heterogeneity observed suggests variable prevalence across populations and highlights the intricate nature of UI in MS. These findings underscore the critical need for dedicated supportive, therapeutic, and rehabilitative interventions to manage this common complaint in MS patients effectively.