Transobturator mid-urethral sling in females with stress urinary incontinence and detrusor underactivity: effect on voiding phase

Natale, Franca; Illiano, Ester; Zucchi, Alessandro; Penna, Chiara La

doi:10.1007/s00192-019-03871-7

Cited by 17 publications

(20 citation statements)

References 30 publications

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“…With adjustable or non‐adjustable retropubic suburethral sling or transobturator sling, the success rate of being dry or having improvement can be achieved in up to 80%–90% . However, postoperative voiding dysfunction remains a problem and a baseline Pdet of ≤12 cmH 2 O has been found to predict postoperative voiding dysfunction in women with SUI and DU who underwent transobturator mid‐urethral sling . In our previous long‐term follow‐up of women with SUI and DU who received retropubic suburethral sling, the success rate was 79.3% and no different from patients with pure SUI or mixed DO with SUI …”

Section: Discussionmentioning

confidence: 92%

“…Therefore, the suburethral procedure is not widely applied to treat SUI in patients with DU. Nevertheless, suburethral sling procedure has been tried in this specific patient group to eradicate SUI, and amazingly, a satisfactory outcome has been achieved although some of the patients need clean intermittent catheterization (CIC) after operation . Till now, there was little study to evaluate the predictive factors which may influence the surgical outcome in patients with SUI and DU.…”

Section: Introductionmentioning

confidence: 99%

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Surgical results in women with detrusor underactivity and stress urinary incontinence undergoing suburethral sling procedure—Predictive factors for successful outcome

Chen

Yeoh

Yeh

et al. 2019

LUTS

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Objectives: To elucidate the treatment results and predictors for successful outcome in women with detrusor underactivity (DU) and stress urinary incontinence (SUI) undergoing suburethral sling procedure.Methods: Medical records of women with coexistent SUI and DU treated with a suburethral sling were retrospectively reviewed and we analyzed the association between treatment outcome and baseline demographics including etiology of DU and urodynamic variables. Patients who were dry and could urinate spontaneously were considered successful. Treatment failure was considered in those who were dry but needing clean intermittent catheterization (CIC) and patients who were still wet.Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7)scores were used to assess the impact of surgery on the quality of life.Results: Among 71 patients, a successful outcome was noted in 39 (55%), failed outcome with CIC in 15 (21%), and totally treatment failure in 17 (24%). Treatment outcome did not differ among the etiology subgroups. Overall, UDI-6 and IIQ-7 scores significantly improved after surgery. Multivariable logistic regression analysis revealed that the IIQ-7 and maximum flow rate (Qmax) were two independent predictors for improvement after surgery. An IIQ-7 score ≤6, and Qmax ≥6 mL/s can predict improvement by receiver operating characteristic analysis. Qmax ≤6 mL/s can predict needing CIC after surgery.Conclusions: For women with SUI and coexistent DU who underwent suburethral sling procedure, low IIQ-7 (≤6) scores and higher Qmax (≥6 mL/s) are predictors for improvement of surgical outcome. A Qmax of <6 mL/s was the only predictor for CIC after surgery. K E Y W O R D S detrusor underactivity, incontinence, sling surgery, urodynamics

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Surgical results in women with detrusor underactivity and stress urinary incontinence undergoing suburethral sling procedure—Predictive factors for successful outcome

Chen

Yeoh

Yeh

et al. 2019

LUTS

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“…Our experience has shown that pathophysiological explanations relating to the detrusor pump and container functionality in particular are a valuable part of counselling. As an example, the potential benefits of MUS implantation in women with detrusor under-contractility is still a research field and the only studyavailable on this topic reported that, in a population of 50 women with under-contractility, the cure rate with MUS was not significantly different from that in the normo-contractility group, but voiding dysfunctions were statistically significant higher [29]. As a result, the authors concluded that UDS investigations are useful for counseling purposes in this population.…”

Section: Contentsmentioning

confidence: 95%

The bladder is an unreliable witness: The case for urodynamic investigations in female stress urinary incontinence

Serati

Tarcan

Finazzi‐Agrò

et al. 2020

European Journal of Obstetrics & Gynecology and Reproductiv

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A B S T R A C TFor some years, the role of urodynamics (UDS) in female stress urinary incontinence (SUI) has been a topic of intense debate. The findings of the VaLUE and VUSIS-II randomised clinical trials (RCTs) published in 2012 appeared to suggest that UDS is not useful in women with uncomplicated SUI, with the result that several authoritative guidelines were amended and the routine use of UDS in this setting fell sharply. However, many experts have raised concerns about the design of these two RCTs and their subsequent interpretationincluding the inappropriate generalisation of the findings beyond uncomplicated cases, which represent only a small minority of the overall patient population. In this paper, we consider a range of issues and confounding factors which raise doubts about how influential these RCTs should have been and reflect on the potential value of UDS both for objective diagnosis and patient counselling in female SUI.

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“…The presence of DU may impact upon the management of other lower urinary tract dysfunctions, in particular the management of SUI. Natale and co-workers recently investigated whether DU is a risk factor for voiding dysfunction after transobutrator tape insertion in one of few such studies [33]. A total of 50 patients with normal contractility (PIP 30-75) and 50 patients with reduced contractility were prospectively studied.…”

Section: Other Considerationsmentioning

confidence: 99%

Detrusor Underactivity and Underactive Bladder in Women: What Is New?

Osman

Pang

Martens

et al. 2019

Curr Bladder Dysfunct Rep

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Purpose of Review Detrusor underactivity (DU) and its symptom-based correlation, the underactive bladder (UAB), are common problems encountered in urological practice. Whilst DU has been defined for many years, only recently has UAB received a formal definition and there is now accumulating literature based on this condition. In this article, we reviewed the recent literature on the aetiology, pathogenesis, diagnosis and management of DU/UAB in women. Recent Findings Detrusor underactivity is diagnosed on urodynamic studies but there still remains a lack of widely recognised and accepted diagnostic criteria. Commencing treatment based on the diagnosis of UAB, with or without a PVR measurement, is perhaps feasible due to the lower occurrence of BOO in women and specific clinical features that may distinguish this group. Prospective studies attempting to correlate UAB with the underlying DU are needed before this approach could be considered. Summary Detrusor underactivity/UAB in women requires a separate consideration from men due to the anatomical and functional differences in the lower urinary tracts between both genders and consequent differences in pathologies affecting them. The aetiology of DU remains largely unknown, but is probably multifactorial, including myogenic, neurogenic and vasculogenic factors. There remains a lack of any simple effective drug treatments, whilst apart from sacral neuromodulation for the specific subgroup with non-obstructive urinary retention, no safe and effective surgical treatment is currently available. Often, permanent or intermittent bladder drainage with a catheter is the final solution.

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Transobturator mid-urethral sling in females with stress urinary incontinence and detrusor underactivity: effect on voiding phase

Cited by 17 publications

References 30 publications

Surgical results in women with detrusor underactivity and stress urinary incontinence undergoing suburethral sling procedure—Predictive factors for successful outcome

Surgical results in women with detrusor underactivity and stress urinary incontinence undergoing suburethral sling procedure—Predictive factors for successful outcome

The bladder is an unreliable witness: The case for urodynamic investigations in female stress urinary incontinence

Detrusor Underactivity and Underactive Bladder in Women: What Is New?

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