Background: This retrospective cohort study assessed the outcomes of combined surgeries for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) in 31 patients with a follow-up of 7 years. Objectives: The study aimed to determine the success and recurrence rates of POP and SUI while comparing the outcomes, analyzing the predictors for recurrence, and reporting on complications. Materials and Methods: Demographic and clinical profiles were analyzed descriptively using frequency and percentages. Objective SUI cure rate was assessed via office cystometry with a cough stress test, while POP was evaluated using the POP-Q system. Subjective cure rates for both conditions were determined using a symptom severity checklist based on the King's Health Questionnaire. Chi-square tests assessed associations between objective outcome parameters and time elapsed since surgery, and other outcome predictors, with significance set at p < 0.05. Results: The results showed a high objective cure rate of 96% for SUI and subjective cure rates of 96% for both SUI and POP. Long-term symptoms included urine frequency and retention, while mesh erosion occurred in one patient. The objective cure rate for POP was 67.7%, with recurrence in the anterior compartment at the midterm and in various compartments at long term. Vault fixation suggests efficacy in reducing apical prolapse recurrence. The preoperative age was identified as a significant risk factor for POP recurrence. Conclusion This study supports the durability and efficacy of combined surgeries for SUI and POP, with high patient satisfaction.
Suburethral Slings

Penile prosthesis implant (PPI) remains an effective and safe treatment option for men with erectile dysfunction (ED). However, PPI surgery can be associated with a higher risk of complications in certain populations. This article provides a critical review of relevant publications pertaining to PPI in men with diabetes, significant corporal fibrosis, spinal cord injury, concurrent continence surgery, and complex salvage cases. The discussion of each category of special populations includes a brief review of the surgical challenges and a practical action-based set of recommendations. While specific patient populations posed considerable challenges in PPI surgery, strict pre- and postoperative management coupled with safe surgical practice is a prerequisite to achieving excellent clinical outcomes and high patient satisfaction rate.
Diabetes Complications ; Diabetes Mellitus ; Erectile Dysfunction/surgery* ; Humans ; Male ; Penile Implantation ; Penile Induration/surgery* ; Penile Prosthesis ; Priapism/surgery* ; Prosthesis-Related Infections/prevention & control* ; Salvage Therapy ; Spinal Cord Injuries/complications* ; Suburethral Slings ; Surgical Wound Infection/prevention & control* ; Urinary Incontinence/surgery* ; Urinary Sphincter, Artificial

Male stress urinary incontinence (SUI) can undoubtedly reduce quality of life and promote personal distress and psychosocial alienation. The frequency of postprostatectomy urinary incontinence (PPI) counts on the characterization of urinary incontinence and the periods of patient follow-up. Operational therapeutics, for instance, urethral male slings and artificial urinary sphincters, are well-chosen as adequate and secure surgeries for male SUI in men with continual PPI when conservative treatment is ineffective. Over the former 2 decades, surgery has progressed regarding both operative approach and sling architecture. However, there are no guidelines about when surgery should be carried out and which is the most appropriate surgical option. In this review, we summarize recent advances in implantable devices for PPI and also discuss traditional surgical care. When we are planning the male PPI surgery, careful preoperative work-up should be performed and surgical method should be chosen according to the severity of the disease. Male sling is preferred in mild and moderate symptomatic patients with normal detrusor pressure and it is recommended to select traditional artificial urinary sphincter device in those with severe symptoms. It is expected that effective devices without adverse events will be developed with technical advances in near future.
Emigrants and Immigrants ; Follow-Up Studies ; Humans ; Male ; Methods ; Prostatectomy ; Quality of Life ; Suburethral Slings ; Urinary Incontinence ; Urinary Incontinence, Stress ; Urinary Sphincter, Artificial

The management of postprostatectomy urinary incontinence (PPI) is still challenging for urologists. In recent decades, various kinds of male sling system have been developed and introduced; however, they have not yet shown as good a result as that of artificial urinary sphincter (AUS). However, a male sling is still in an important position because patients have a high demand for sling implantation, and it can allow the avoidance of the use of mechanical devices like AUS. Recently, the male sling has been widely used in mild-to-moderate PPI patients; however, there are no studies that compare individual devices. Thus, it is hard to directly compare the success rate of operation, and it is impossible to judge which sling system is more excellent. It is expected that many sling options will be available in addition to AUS in the near future with the technological development of various male slings and the accumulation of long-term surgical outcomes. In that in patients with PPI, sling implantation is an option that must be explained rather than an option that need not be explained to them, this review would share the latest outcomes and complications.
Humans ; Male ; Prostatectomy ; Suburethral Slings ; Urinary Incontinence ; Urinary Sphincter, Artificial

OBJECTIVE: Women with pelvic floor disorders and urinary incontinence (UI) are at an increased risk of sexual dysfunction. The purpose of this study was to investigate the effect of surgery for UI on sexual function. METHODS: We retrospectively reviewed the charts of 82 women who underwent mid-urethral transobturator tape (TOT) surgery between March 2010 and December 2014. The Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12) were administered pre- and postoperatively. RESULTS: We observed a significant increase in the total postoperative PISQ-12 scores compared to the preoperative scores (from 27.1±7.3 to 30.5±6.8, P < 0.001). Improved sexual function was confirmed in the physical (13.3±4.5 vs. 15.8±3.5, P < 0.001) and partner-related domains (6.7±2.6 vs. 7.4±2.4, P=0.001). Coital incontinence and preoperative urinary distress inventory score were significant factors influencing postoperative sexual function in women undergoing TOT surgery for UI after adjusting for age, body mass index, menopause, and preoperative PISQ-12 score in multivariate regression analysis. CONCLUSION: TOT surgery for UI correction resulted in significant improvement in sexual function.
Body Mass Index ; Female ; Humans ; Menopause ; Pelvic Floor ; Pelvic Floor Disorders ; Retrospective Studies ; Sexual Dysfunction, Physiological ; Suburethral Slings ; Urinary Incontinence

OBJECTIVE: To evaluate the long-term efficacy of tension-free vaginal tape (TVT)and trans-obturator tape (TOT)for different types of female stress urinary incontinence (FSUI). METHODS: The clinical data of all female patients with stress urinary incontinence (SUI) who underwent mid-urethral slings (MUS) in Peking University People's Hospital from January 2008 to June 2016 were retrospectively analyzed, and all the patients were followed up. Based on the level of abdominal leak point pressure (ALPP), the patients with ALPP lower than or equal to 60 cmH₂O (1 cmH₂O=0.74 mmHg) were regarded as intrinsic sphincter deficiency (ISD) type, and the patients with ALPP higher than 60 cmH₂O were regarded as non-ISD type. According to the degree of remission of leakage of urine by using the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF), the surgical outcomes were divided into three categories: cured, improved or failed. The efficacy of TVT and TOT for different types of FSUI was evaluated by comparing the cure rate of TVT with the cure rate of TOT in ISD type and non-ISD type separately. RESULTS: A total of 170 patients were included in this study. The patients were among 30-78 years, and the follow-up period were among 12-110 months. In the study, 117 patients belonged to non-ISD type. Of whom 30 underwent TVT with a cure rate of 86.7% (26/30), and the other 87 underwent TOT with a cure rate of 69.0% (60/87). The cure rate of TVT was higher than that of TOT in non-ISD type, however, Chi-square test showed that there was no significant difference (χ²=3.589, P>0.05). In addition, 53 patients belonged to ISD type, of whom 16 underwent TVT with a cure rate of 87.5% (14/16), and the other 37 underwent TOT with a cure rate of 51.4% (19/37). The cure rate of TVT was higher than that of TOT in ISD type, and Chi-square test showed that the difference was statistically significant (χ²=6.212, P<0.05). CONCLUSION For the treatment of FSUI, MUS can achieve satisfactory long-term efficacy. For non-ISD type, the cure rates of TVT and TOT are similar, while for ISD type, the cure rate of TVT is higher than that of TOT.
Female ; Follow-Up Studies ; Humans ; Retrospective Studies ; Suburethral Slings ; Treatment Outcome ; Urinary Incontinence, Stress

OBJECTIVES: To examine the clinical outcome of obesity in women who underwent the transobturator tape procedure for stress urinary incontinence and to compare postoperative urinary symptoms after transobturator tape surgery between normal-weight women and overweight and obese women. METHODS: We performed a retrospective cohort study of the risk of postoperative urinary symptoms, including recurrence after transobturator tape surgery, in normal-weight women compared with overweight and obese women at our institution from January 2009 through October 2011. We compared the body mass index (BMI) among the four groups. The primary outcome was the occurrence of postoperative urinary symptoms. RESULTS: Three hundred ten patients who underwent transobturator tape surgery were reviewed. At the 1-year follow-up, 281 women were analyzed: 89 (34%) normal-weight women, 78 (25%) overweight women, 101 (37%) obese 1 women, and 13 (3%) obese 2 women. There was a significant difference in the occurrence of postoperative urinary symptoms. They occurred in 3.4% (n=3) of normal-weight women, 5.1% (n=4) of overweight women, and 12.9% (n=13) of obese 1 women (P=0.038). The most common postoperative urinary symptom was frequent urination (n=14). There was a significant difference in leakage; it occurred in 1.1% (n=1) of normal-weight women, 3.9% (n=3) of overweight women, and 7.9% (n=8) of obese 1 women (P=0.139). Postoperative urinary symptoms were almost four times more likely to occur in obese 1 women than in normal-weight women. CONCLUSION: Transobturator tape surgery seems effective regardless of BMI, but obese women had a higher occurrence of postoperative urinary symptoms than did normal-weight women.
Body Mass Index ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Obesity ; Overweight* ; Recurrence ; Retrospective Studies ; Suburethral Slings* ; Urinary Incontinence ; Urinary Incontinence, Stress ; Urination

PURPOSE: To evaluate the impact of preoperative patient characteristics and flow rate on failure, early postoperative complications, and voiding in patients who underwent transvaginal tension-free vaginal tape-obturator (TVT-O) treatment for uncomplicated stress urinary incontinence (SUI). METHODS: We retrospectively reviewed patients who underwent TVT-O for SUI at 3 Italian centres. The exclusion criteria were predominant voiding and storage symptoms suggestive of detrusor overactivity, the presence of grade >1 urogenital prolapse, previous pelvic radiotherapy or other clinical contraindications for surgical procedures, neurogenic bladder dysfunction, and collagen diseases. Multivariate logistic regression models were constructed to identify predictors of early voiding dysfunction after TVT-O. RESULTS: A total of 219 patients underwent TVT-O between January 2010 and December 2015. All patients received follow-up at 3, 6, and 12 months, and underwent a stress test, uroflowmetry, and bladder ultrasound to evaluate the postvoid residual volume. They also responded to the Urogenital Distress Inventory (UDI-6) questionnaire. The rates of persistent incontinence after TVT-O, postoperative complications, and satisfaction were 16.4% (36 of 219), 24.2% (53 of 219), and 86.3% (189 of 219), respectively. Nineteen patients (9.5%) experienced early voiding dysfunction. Based on an analysis of baseline characteristics, we determined that a cutoff value of 9.0 on the UDI-6 predicted postoperative SUI with 62% specificity, 72% sensitivity, and 66% accuracy. In the multivariate logistic regression analysis, a preoperative UDI-6≥9.0 was an independent predictor of postoperative SUI. The predictors of complications were menopause (P = 0.04) and the preoperative UDI-6 score (P = 0.01). CONCLUSIONS: Menopause and UDI-6 scores could be prognostic factors for persistent SUI after TVT-O. Well-designed prospective studies with a suitable number of patients are needed to corroborate our findings.
Collagen Diseases ; Exercise Test ; Female ; Follow-Up Studies ; Humans ; Logistic Models ; Menopause ; Pelvic Organ Prolapse ; Postoperative Complications ; Prospective Studies ; Radiotherapy ; Residual Volume ; Retrospective Studies ; Sensitivity and Specificity ; Suburethral Slings* ; Ultrasonography ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Incontinence ; Urinary Incontinence, Stress ; Urodynamics

PURPOSE: Many surgeons worry about postoperative voiding problems in patients with stress urinary incontinence (SUI) and detrusor underactivity (DU). This study hypothesized that adjusting the tension after surgery would benefit patients with DU, and therefore researchers evaluated the outcomes and quality of life of women with SUI and DU who underwent the readjustable sling procedure (Remeex). METHODS: The medical records of 27 patients who were treated with the Remeex system for SUI and DU between 2007 and 2013 were retrospectively analyzed. The incontinence visual analogue scale (I-VAS), incontinence quality of life questionnaire (I-QOL) and the Sandvik incontinence severity index (ISI) were used to evaluate the efficacy of the Remeex system both prior to surgery and at the last visit after surgery. The treatment was considered successful if there was no urine leakage based on the Sandvik questionnaire. RESULTS: The mean follow-up period was 38.0 months (range, 1–75 months), and the treatment success rate was 81.5%. Despite no urine leakage, 7 patients wanted the Remeex system to be removed due to persistent postoperative urinary retention within a year of surgery. One patient underwent a long-term adjustment under local anesthesia 6 years after the initial surgery. The I-VAS, ISI and all domains of the I-QOL scores improved significantly postoperatively and the maximum flow rate decreased significantly after the procedure. However, the postvoid residual did not change significantly. CONCLUSIONS: The Remeex system provided a good cure rate and improved the quality of life of women with SUI and DU. Therefore, the Remeex system should be considered as a treatment option for female patients with concomitant SUI and DU.
Anesthesia, Local ; Female* ; Follow-Up Studies ; Humans ; Medical Records ; Quality of Life ; Retrospective Studies ; Suburethral Slings ; Surgeons ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Retention

PURPOSE: To analyze perioperative complications and postoperative explantation rates for selected readjustable male sling systems and the perineal single-cuff artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. METHODS: Two hundred eighty-two male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in the study (n=127 adjustable male sling [n=95 Argus classic, n=32 Argus T], n=155 AUS). Perioperative characteristics and postoperative complications were analyzed. The explantation rates of the respective devices were assessed using the Fisher exact test and the Mann-Whitney U-test. A Kaplan-Meier curve was generated. Potential features associated with device explantation were analyzed using a multiple logistic regression model (P<0.05). RESULTS: We found significantly increased intraoperative complication rates after adjustable male sling implantation (15.9% [adjustable male sling] vs. 4.2% [AUS], P=0.003). The most frequent intraoperative complication was bladder perforation (n=17). Postoperative infection rates did not vary significantly between the respective devices (P=0.378). Device explantation rates were significantly higher after AUS implantation (9.7% [adjustable male sling] vs. 21.5% [AUS], P=0.030). In multivariate analysis, postoperative infection was a strong independent predictor of decreased device survival (odds ratio, 6.556; P=0.001). CONCLUSIONS: Complication profiles vary between adjustable male slings and AUS. Explantation rates are lower after adjustable male sling implantation. Any kind of postoperative infections are independent predictors of decreased device survival. There is no significant effect of the experience of the implanting institution on device survival.
Cohort Studies ; Humans ; Intraoperative Complications ; Logistic Models ; Male* ; Multivariate Analysis ; Postoperative Complications ; Suburethral Slings* ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Sphincter, Artificial*