Retropubic TFS Minisling for Postprostatectomy Male Incontinence: First Report

2022 ◽  
pp. 1-7
Author(s):  
Sidi Muctar ◽  
David Ende ◽  
Peter Petros
Keyword(s):  
Urinary Incontinence ◽  
Bladder Neck ◽  
Male Incontinence ◽  
The Core ◽  
Pubourethral Ligament ◽  
Urethral Closure ◽  
Retropubic Radical Prostatectomy ◽  
The Mean ◽  
Urine Loss ◽  
Ultrasound Testing

<b><i>Hypothesis:</i></b> A structurally sound puboprostatic ligament (PPL), like the pubourethral ligament in the female, is the core structure for control of stress urinary incontinence (SUI) in males. <b><i>Methods:</i></b> The hypothesis was tested at several levels. Twelve transperineal ultrasound examinations were performed to confirm reflex directional closure vectors around the PPL, with digital support for the PPL rectally and cadaveric testing with a tissue fixation system (TFS) minisling, and finally, 22 cases of postprostatectomy incontinence were addressed only with retropubic insertion of a 7-mm TFS sling between the bladder neck and perineal membrane to reinforce the PPL. <b><i>Results:</i></b> On ultrasound testing, 3 urethral closure muscles were confirmed to act reflexively around the PPL to close the urethra distally and at the bladder neck. A finger was inserted rectally, pressed against the symphysis only on one side of the urethra at the origin of the PPL that controlled urine loss on coughing. The mean pre-op pad loss was 3.8 pads at 9 months; the mean post-op loss was 0.7 pads; 13/22 (59%) patients were 100% improved; 7/22 (31%) improved &#x3e;50% but &#x3c;100%; 2/22 (9.1%) improved &#x3c;50%. <b><i>Conclusions:</i></b> The 7-mm-wide TFS minisling is the first retropubic minisling for postprostatectomy urinary incontinence. It differs significantly from transobturator male operations surgically and in modus operandi. As in the female, reconstruction of the PPL alone was sufficient to cure/improve SUI, suggesting that preservation of the PPL is of critical importance during retropubic radical prostatectomy.

scholarly journals PD22-12 BLADDER NECK/URETHRAL CLOSURE IN WOMEN USING A CONTINENT CUTANEOUS DIVERSION AND SUFFERING REFRACTORY URETHRAL URINARY INCONTINENCE

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Nuno Grilo* ◽  
Christine Reus ◽  
Véronique Phé ◽  
Cyrille Guillot-Tantay ◽  
Louise Alechinsky ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Bladder Neck ◽  
Continent Cutaneous Diversion ◽  
Urethral Closure

scholarly journals Bladder neck placement of a synthetic polypropylene sling for the treatment of stress urinary incontinence

2018 ◽  
Vol 12 (11) ◽  
Author(s):  
Louise C. McLoughlin ◽  
Mari Gleeson ◽  
Sami Francis ◽  
Colin O’Rourke ◽  
Hugh D. Flood
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Bladder Neck ◽  
Postoperative Recovery ◽  
Subjective Response ◽  
Improvement Rate ◽  
Initial Report ◽  
Maximum Score ◽  
Significant Difference ◽  
The Mean

Introduction: Pubo-vaginal sling placed at the bladder neck is the gold standard treatment for stress urinary incontinence (SUI). The synthetic mid-urethral sling (MUS) is now widely used, as morbidity rates with this technique are substantially reduced. This is an initial report on long-term outcomes of a polypropylene sling (PPS) placed in the traditional bladder neck location.Methods: A retrospective analysis of all patients who underwent PPS insertion at our institution between 2006 and 2014 was conducted. Patient and urodynamic demographics were recorded. Subjective and objective measures of success were determined by postoperative pad usage and validated incontinence questionnaires. Results: A total of 170 patients were followed for a median of four years (range 1–8). The mean age was 51 years (±10). Subjective response was assessed in 57% of patients; the overall subjective cure rate was 85.3% (n=145), subjective improvement rate was 4.1% (n=7), and the subjective failure rate was 10.6% (n=18). The mean Urogenital Distress Inventory (UDI)-6 score was 6.5 (±5.6) out of a maximum score of 24 and the Incontinence Impact Questionnaire (IIQ)-7 score was 5.5 (±6.3) out of a maximum score of 28. There was no significant difference in objective outcome measures in those with an abdominal leak-point pressure (ALPP) < or >60 cmH2O.Conclusions: Bladder neck placement of a PPS resulted in cure rates of 85% in this series. SUI secondary to intrinsic sphincter deficiency (ISD) and urethral hypermobility were treated with equal success. Bladder neck PPS placement has a role in the treatment of SUI. Our data may well reassure rectus fascia sling (RFS) surgeons who wish to take advantage of faster postoperative recovery using the less invasive PPS placed at the bladder neck.

Surgical treatment of urinary incontinence

1997 ◽  
Vol 7 (3) ◽  
pp. 229-234
Author(s):  
M Saxby ◽  
D Farrar
Keyword(s):  
Urinary Incontinence ◽  
Surgical Treatment ◽  
Nursing Homes ◽  
Pelvic Floor ◽  
Bladder Neck ◽  
The Elderly ◽  
Common Finding ◽  
Urethral Sphincter ◽  
Male Incontinence ◽  
Homes For The Elderly

Incontinence is a common problem and the incidence increases with age. Approximately 85% of all cases of incontinence occur in women, essentially because bladder neck competence and pelvic floor/urethral sphincter activity is more readily compromised than in the male. Incontinence is an important cause of admission to and a common finding in nursing homes for the elderly but is not an inevitable sequela of aging.

Retropubic Radical Prostatectomy and Immediate Continence

1998 ◽  
Vol 65 (1_suppl) ◽  
pp. 7-10
Author(s):  
A. Simonato ◽  
S. Galli ◽  
A. Romagnoli ◽  
P. Traverso ◽  
R. Pizzorno ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Radical Prostatectomy ◽  
Bladder Neck ◽  
Saline Solution ◽  
Prostatic Adenocarcinoma ◽  
Prostatic Urethra ◽  
New Technique ◽  
Retropubic Radical Prostatectomy ◽  
A New Technique

Aim Temporary urinary incontinence after removing the catheter in patients who have undergone radical prostatectomy is commonly accepted and considered inevitable. Detailed information can be found in literature regarding continence at 3, 6 and 12 months after operation, but few reports mention the immediate results upon removing the catheter. We have collected together data from our patients regarding continence upon removal of the catheter, in order to assess this important aspect. Materials and methods Between November ‘94 and August ‘98, 156 patients underwent retropubic radical prostatectomy for histologically diagnosed prostatic adenocarcinoma (average age 65 years, range 49–74). Out of 156 patients, the bladder neck was removed in 72 (46%) (RCV), in 43 (28%) the bladder neck circular fibres (CCV) were preserved and in 41 (26%) a new technique was used to anatomically dissect the bladder-prostate junction, preserving the mucous of the prostatic urethra (CUP). Continence immediately after removal of the catheter was assessed in all patients in orthostatism and under stress by filling the bladder with 150 cc of saline solution. Results Upon removal of the catheter, 59/130 patients (45.5%) were perfectly continent. Of these 26/72 (36%) had undergone ample removal of the bladder neck, the bladder neck circular fibres were spared in 18/43 (43%), whilst the proximal tract of the prostatic urethra had been preserved in 26/41 (63%). There was infiltration of the bladder neck in 11/156 patients (7%), none of whom had the bladder neck circular fibres or the end section of the prostatic urethra spared. Conclusions Our experience shows that in correctly selected patients, if the bladder neck circular fibres and the proximal tract of the prostatic urethra are preserved, the possibility of immediate continence is high without increasing the oncological risk.

scholarly journals The urethral hanging theory and how it relates to Enhörning’s theory and the integral theory

2019 ◽  
Vol 31 (6) ◽  
pp. 1175-1180 ◽  
Author(s):  
Bo S. Bergström
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Bladder Neck ◽  
Abdominal Cavity ◽  
Integral Theory ◽  
Abdominal Pressure ◽  
The Core ◽  
Pressure Transmission

Abstract Introduction and hypothesis The article discusses three theories of stress urinary incontinence, the urethral hanging theory, Enhörning’s theory, and the integral theory. Methods The abdominal pressure transmission theory proposed by Enhörning is often misunderstood. It is regularly interpreted to mean that, in cases of stress urinary incontinence, the bladder neck descends outside the abdominal cavity, and treatment must involve elevating or repositioning the bladder neck. Results However, this actually contradicts the information provided in Enhörning’s original paper. The urethral hanging theory accepts the core of Enhörning’s theory and the integral theory rejects it. The three theories have different views on closure and opening of the bladder neck and on the pathophysiology of urethral funneling. Conclusion These differences are described and discussed.

Evaluation of Road Utilisation as Space For Holding Social Ceremonies in Indigenous Residential Area of Ogbomoso, Nigeria

2018 ◽  
Vol 1 (March 2018) ◽  
Author(s):  
S.A Okanlawon ◽  
O.O Odunjo ◽  
S.A Olaniyan
Keyword(s):  
Transport Infrastructure ◽  
Noisy Environment ◽  
Policy Makers ◽  
The Core ◽  
Local Roads ◽  
Strict Enforcement ◽  
The Mean ◽  
The One ◽  
The City ◽  
The Town

This study examined Residents’ evaluation of turning transport infrastructure (road) to spaces for holding social ceremonies in the indigenous residential zone of Ogbomoso, Oyo State, Nigeria. Upon stratifying the city into the three identifiable zones, the core, otherwise known as the indigenous residential zone was isolated for study. Of the twenty (20) political wards in the two local government areas of the town, fifteen (15) wards that were located in the indigenous zone constituted the study area. Respondents were selected along one out of every three (33.3%) of the Trunk — C (local) roads being the one mostly used for the purpose in the study area. The respondents were the residents, commercial motorists, commercial motorcyclists, and celebrants. Six hundred and forty-two (642) copies of questionnaire were administered and harvested on the spot. The Mean Analysis generated from the respondents’ rating of twelve perceived hazards listed in the questionnaire were then used to determine respondents’ most highly rated perceived consequences of the practice. These were noisy environment, Blockage of drainage by waste, and Endangering the life of the sick on the way to hospital; the most highly rated reasons why the practice came into being; and level of acceptability of the practice which was found to be very unacceptable in the study area. Policy makers should therefore focus their attention on strict enforcement of the law prohibiting the practice in order to ensure more cordial relationship among the citizenry, seeing citizens’ unacceptability of the practice in the study area.

scholarly journals Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040819
Author(s):  
Pontus Rygh ◽  
Ina Asklund ◽  
Eva Samuelsson
Keyword(s):  
Urinary Incontinence ◽  
Cohort Study ◽  
Real World ◽  
Short Form ◽  
Pelvic Floor Muscle ◽  
Controlled Trial ◽  
Healthcare Services ◽  
International Consultation ◽  
The Mean

ObjectivesThe efficacy of app-based treatment for stress urinary incontinence (SUI) has been demonstrated in a randomised controlled trial (RCT). In this study, we investigate the user characteristics and the effectiveness of the same app when freely available, and compare these results with the RCT.DesignProspective cohort study.ParticipantsDuring a 17-month period, 24 602 non-pregnant, non-postpartum women older than 18 years downloaded the app and responded anonymously to a questionnaire. Of these, 2672 (11%) responded to the 3-month follow-up.InterventionThree months’ use of the app Tät, containing information, a pelvic floor muscle training programme and lifestyle advice.Main outcome measuresChange in symptom severity (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF)) and subjective improvement (Patient Global Impression of Improvement (PGI-I)).ResultsOf the respondents, 88% lived in Sweden and 75% (18 384/24 602) were incontinent with a mean age of 45.5 (SD 14.1) years. The UI types, based on symptoms, were SUI (53%), urgency UI (12%), mixed UI (31%) and undefined (4%). The mean ICIQ-UI SF score was 8.2 (SD 4.0) at baseline. The mean ICIQ-UI SF score reduction at follow-up was 1.31 (95% CI: 1.19 to 1.44) with a larger reduction in those with more severe incontinence at baseline (severe/very severe 3.23 (95% CI: 2.85 to 3.61), moderate 1.41 (95% CI: 1.24 to 1.59) and slight 0.24 (95% CI 0.06 to 0.42). When the results were weighted to match the distribution of severity in the RCT, the ICIQ-UI SF score reduction was 2.2 compared with 3.9 in the RCT. Regarding PGI-I, 65% experienced improvement compared with 92% in the RCT.ConclusionsThe app Tät was effective for self-management of UI even in the real world. Although the reduction in incontinence symptoms was less than in the RCT, two-thirds of the users improved. App-based treatment reaches many women without requiring resources from ordinary healthcare services.

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