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Peripheral Neuropathies of the Lower Urinary Tract Following Pelvic Surgery and Radiation Therapy
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
For patients with continued sphincter insufficiency and urinary incontinence 6–12 months following surgery, operative intervention with urethral sling, or artificial urinary sphincter in men, can be considered.14 For impaired compliance refractory to medications and onabotulinumtoxinA injection, bladder augmentation is an option. Continued urinary retention due to poor detrusor contractility remains the most difficult to treat. Bladder outlet surgery may also be indicated in men with borderline BOO to decrease outlet resistance enough for adequate bladder emptying.35 Some authors advocate for the use of sacral neurostimulation in these patients,14 although its use has not been reported for patients with peripheral neuropathies in particular. There is also at least one current prospective trial of external electrical stimulation for bladder underactivity following radical hysterectomy,14 which may provide an additional treatment option for these patients.
Outcomes of Pessary Use
Published in Teresa Tam, Matthew F. Davies, Vaginal Pessaries, 2019
Incontinence pessaries serve as a nonsurgical management option and are inserted into the vagina to provide support to the urethrovesical junction and anterior vaginal wall. By providing compression to the urethra against the pubic symphysis, urinary incontinence is ameliorated when intra-abdominal pressure is increased.5,6 An incontinence pessary similarly provides support to a mid-urethral sling while avoiding a surgical procedure. Various pessaries of this nature are available, including the anti-incontinence ring with and without support, the anti-incontinence dish, and the Uresta incontinence pessary. A retrospective chart review of 100 patients demonstrated a 59% continued pessary use at 11 months and reported a resolution or improvement in incontinence.7
Gynaecological Considerations and Urogenital Fistulas
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Brooke Gurland, André D’Hoore, Paul Hilton
Urethral sling procedures may be curative for stress incontinence whilst anticholinergic medications can be useful to decrease bladder contractions and sense of urgency for urge incontinence mid-urethral slings are the most common type of surgery to correct stress urinary incontinence. A narrow strap of synthetic mesh is placed under the urethra to support the urethra and bladder neck. This procedure can be done as an outpatient and takes 30 minutes to perform. A number of injectables have been used for the treatment of stress incontinence in women, including collagen, Macroplastique (Uroplasty) and Duglux rather than ADH. A prospective multicentre trial of Macroplastique has reported success rates of 75% at three months,11 although other trials have reported cure and improvement rates of 60%.12 Overall success rates tend to be lower with injectable agents than with other procedures, but they offer an alternative to patients who have recurrent urodynamic stress incontinence following anti-incontinence surgery.
Complications and clinical outcomes of laparoscopic sacrocolpopexy for pelvic organ prolapse
Published in Journal of Obstetrics and Gynaecology, 2021
Hirotaka Sato, Hirokazu Abe, Atsushi Ikeda, Tomoaki Miyagawa, Katsuhiko Sato
The Hokusuikai Kinen Hospital institutional review board approved this study (2019-021). The women who underwent LSC between August 2015 and July 2017 in the Urology Unit of Hokusukai Kinen Hospital in Japan were retrospectively included; The need of informed consent was waived due to the retrospective nature of the study. Consecutive patients aged 18 years and older were included if they had undergone double-mesh LSC surgery for symptomatic POP. The patient demographic data were extracted from the medical records regarding age at the time of surgery, parity, body mass index, medical comorbidities, history of hysterectomy, preoperative and postoperative simplified International Continence Society (ICS) Pelvic Organ Prolapse Quantification (POP-Q) (Bump et al. 1996) results, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) (Gotoh et al. 2009) results, Overactive Bladder Symptom Score (OABSS) (Homma et al. 2006), operative time, estimated blood loss, concomitant surgical procedures, perioperative and postoperative complications, and the anatomical results of interest. The postoperative complications were classified using the Clavien–Dindo scale (Dindo et al. 2004). The patients who had undergone a concomitant mid-urethral sling procedure and those with no postoperative records and POP-Q data were excluded.
Stem cell applications in regenerative medicine for stress urinary incontinence: A review of effectiveness based on clinical trials
Published in Arab Journal of Urology, 2020
Bara Barakat, Knut Franke, Samer Schakaki, Sameh Hijazi, Viktoria Hasselhof, Thomas-Alexander Vögeli
SUI can be attributed to different causes, with differences in both sexes. In general, mechanical and functional reasons can be considered as causes of SUI. Important factors are myogenic, neurogenic, connective tissue and hormonal changes. In addition, muscle cell density decreases as a result of physiological apoptosis due to a decrease in the muscle cells of the rhabdosphincter, with a total volume of 88% immediately after birth decreasing to ~34% in the 90th year of life [5]. Female SUI often has a multifactorial cause with functional defects of the urinary bladder sphincter and morphological nerve damage. This is in contrast to the almost exclusively postoperative prostate resection or radical prostatectomy (RP)-related UI seen in men. In recent years, placement of transvaginal tension-free transobturator tape and retropubic tension-free vaginal tape have become well-established treatment options. The mid-urethral sling has the advantage of a shorter duration of intervention time. The rate of any re-operation, including mesh removal, was 5.5% (95% Cl 5.4–5.7%) at 5 years and 6.9% (95% Cl 6.7–7.1%) at 9 years [6]. However, the USA Food and Drug Administration (FDA) has repeatedly issued warnings on the use of alloplastic material in the treatment of female UI due to >1000 reported severe adverse events [7]. Consequently, alternative treatments are being sought and although stem cell-based therapy has had numerous setbacks, it may well be a concept for treating these disorders. In the last decade, the use of the patient’s own adult stem cells for lower urinary tract dysfunction has been shown to be a promising, causal therapeutic approach [8].
An update on research and outcomes in surgical management of vaginal mesh complications
Published in Expert Review of Medical Devices, 2019
Dominic Lee, Philippe E. Zimmern
We have previously published our technique on mid-urethral sling excision [26]. An urethra-cystoscopy is first performed with a 17.5 Fr female scope to assess the course of the sling which, if too tight presents as a kink of the urethra. We prefer to perform a transverse vaginal incision along the direction of the vaginal ridges to allow access to the lateral extensions of the MUS and to facilitate repair for overt urethral injury during MUS excision by allowing the insertion of a Martius fat pad graft and/or a fascial patch as tissue interposition over the urethral repair. In some instance, hydro-dissection may be useful, although not routinely utilized, if prior procedures have resulted in a very scarred and thin vaginal wall.