Does local vaginal estrogen after tension-free transobturator vaginal tape reduce overactive bladder symptoms in postmenopausal women? A prospective randomized, controlled study

Objective:We aimed to evaluate the efficacy of topical estrogen after transvaginal tension-free vaginal tape-obturator(TVT-O)in the treatment of de novo overactive bladder symptoms that appear after surgery.Methods:This is a prospective randomized controlled study performed in the Urology and Gynecology Departments,Kasr Al Ainy Hospital,Cairo University,Cairo,Egypt.Two hundred and ten postmenopausal females presenting during the period between January 2017 and November 2020 with stress urinary incontinence were included in the study.Patients were divided into two groups,105 patients in Group A(treatment group)and 105 patients in Group B(control group).Patients in Group A underwent transvaginal TVT-O followed by local vaginal estrogen treatment for 6 months,while patients in Group B underwent transvaginal TVT-O only.The study included any postmenopausal female with urodynamic stress urinary incontinence.All patients had to fulfill a 3-day bladder diary,overactive bladder symptoms score,urine analysis,urodynamic study,and post-voiding residual urine measurement by abdominal ultrasound preoperatively and at 3-month and 6-month follow-ups.Results:At 6-month follow-up,daytime frequency was reduced to 8%in Group A(increased to 21%in Group B)with a statistically significant difference between both groups(p=0.009).At 6-month follow-up,nocturia was 8%in Group A(11%in Group B)with no statistically significant difference between both groups(p=0.469).There was a statistically significant difference between both groups as regards to urinary urgency at 6-month follow-up(p=0.024).There was a statistically significant difference in postoperative wound healing events as regards to cure,hyperemia,gapping,and wound infection 1 week after intervention between both groups(p=0.008).No local or systemic side-effects were reported from local estrogen use.Conclusion:Local vaginal estrogen treatment given to postmenopausal patients after midurethral sling procedures can reduce the symptoms of daytime frequency and urinary urgency.Long-term follow-up is needed.

Contemporary diagnostics and treatment options for female stress urinary incontinence

Stress urinary incontinence is not a deadly disease,but for the large population of women suffering from it,it is a very important issue.Especially in the continuously aging population all over the world,there is more and more need for treatment of this serious medical condition.Treatment of female stress urinary incontinence exists already for ages.In the 20th century invasive treatments like Burch colposuspension and pubovaginal slings were the mainstay of surgical treatments.The introduction of the midurethral sling made the procedure less invasive and accessible for more caregivers.Luckily there are many options available and the field is developing quickly.In recent years many new medical devices have been developed,that increase the number of treatment options available and make it possible to find a suitable solution for the individual patient based on subjective and objective results and the chances of complications.This manuscript provides an introduction to the therapeutical options that are available nowadays for female stress urinary incontinence.

Investigation of cholecystokinin receptors in the human lower esophageal sphincter

AIM: To compare the binding of cholecystokinin (CCK)-8 to CCK receptors in sling and clasp fibers of the human lower esophageal sphincter.

Nitric oxide activation of a potassium channel (BK_(Ca)) in feline lower esophageal sphincter

AIM:To assess the effect of nitric oxide (NO) on the large conductance potassium channel (BKCa) in isolated circular (CM) and sling (SM) muscle cells and muscle strips from the cat lower esophageal sphincter (LES) to determine its regulation of resting tone and relaxation.METHODS:Freshly enzymatically-digested and isolated circular smooth muscle cells were prepared from each LES region.To study outward K + currents,the perforated patch clamp technique was employed.To assess LES resting tone and relaxation,muscle strips were mounted in perfused organ baths.RESULTS:(1) Electrophysiological recordings from isolated cells:(a) CM was more depolarized than SM (-39.7 ± 0.8mV vs-48.1 ± 1.6 mV,P < 0.001),and maximal outward current was similar (27.1 ± 1.5 pA/pF vs 25.7 ± 2.0 pA/pF,P > 0.05);(b) The NO donor sodium nitroprusside (SNP) increased outward currents only in CM (25.9 ± 1.9 to 46.7 ± 4.2 pA/pF,P < 0.001) but not SM (23.2 ± 3.1 to 27.0 ± 3.4 pA/pF,P > 0.05);(c) SNP added in the presence of the BK Ca antagonist iberiotoxin (IbTX) produced no increase in the outward current in CM (17.0 ± 2.8 vs 13.7 ± 2.2,P > 0.05);and (d) L-NNA caused a small insignificant inhibition of outward K + currents in both muscles;and (2) Muscle strip studies:(a) Blockade of the nerves with tetrodotoxin (TTX),or BK Ca with IbTX had no significant effect on resting tone of either muscle;and (b) SNP reduced tone in both muscles,and was unaffected by the presence of TTX or IbTX.CONCLUSION:Exogenous NO activates BK Ca only in CM of the cat.However,as opposed to other species,exogenous NO-induced relaxation is predominantly by a non-BK Ca mechanism,and endogenous NO has minimal effect on resting tone.

Long Term Follow up of the Solyx Single Incision Sling in the Treatment of Female Stress Urinary Incontinence (SUI)

Objectives: The Solyx System was developed to be easier and safer to use than other slings. It was the objective of this study to retrospectively assess the long-term safety and efficacy of the SolyxTM SIS Sling System. Methods: After IRB approval and informed consent, chart reviews with follow up phone questionnaires of 69 subjects implanted with the Solyx Sling were collected at 2 sites. All of the patients had SUI and had urethral hypermobility with a q-tip test of >30 degrees. All subjects underwent surgery from 12/2008 to 01/2010 with a mean follow up of 43 months (range 39 -49). Subjects included in this data collection had a mean age of 67 years (range 30 -87). The dominant type of incontinence within the study patients was SUI while 17/69 (25%) of the subjects also had a component of urge incontinence. 38/69 (55%) of study patients had concomitant procedures. Results: Long-term Solyx results showed 64/69 (93%) of patients were subjectively dry by questionnaire and were satisfied with their outcome. 63/69 (91%) would have the procedure again. There were 4 cases of denovo urge incontinence and 2 reports of transient retention. There were no serious adverse events including no bladder, bowel, vessel or nerve perforations and no erosions or extrusions. No pain was reported that was attributed to the implant. Conclusions: Chart review with follow phone questionnaires indicated that the Solyx Sling was a safe, efficacious and less-invasive option for patients requiring SUI surgery and that these results were sustainable for an average of 43 months.

Combination therapy for male erectile dysfunction and urinary incontinence

Urinary incontinence （UI） and erectile dysfunction （ED） are both very prevalent conditions. Insertion of an artificial urinary sphincter （AUS） and penile prosthesis （PP） is an effective and proven method of treatment for both conditions. With advancing age, as well as with increasing populations of patients radically treated for prostate cancer, the occurrence of both conditions found in the same patient is increasing. The purpose of this article was to analyze the available evidence for simultaneous surgical management of male ED and UI using prosthetic devices. The existing literature pertaining to dual implantation of AUS and PP was reviewed. The concomitant insertion of the PP with the male perineal sling was also considered. Concurrent ED and UI are increasingly seen in the post radical prostatectomy population, who are often younger and less willing to suffer with these conditions. Insertion of an AUS and PP, either simultaneously or as a two-stage procedure, appears to be a safe, efficacious and long-lasting method of treatment. The improvements in design of both the AUS and PP as well as the development of the single transverse scrotal incision have made simultaneous insertion of these prostheses possible. Dual implantation of the PP and male sling looks promising in a selected population. In conclusion, the insertion of the AUS and PP for the treatment of concurrent UI and ED is safe and effective. Simultaneous insertion of these prostheses in the same patient offers potential advantages in operative and recovery time and is associated with high patient satisfaction. Combination therapy should therefore be included in the arsenal of treatment of these conditions.

Severe unilateral congenital ptosis with poor levator function:tarsoconjunctival mullerectomy plus levator resection vs frontalis sling procedure

AIM:To compare frontalis sling and tarsoconjunctival mullerectomy plus levator resection(TCMLR)in subjects with severe unilateral congenital ptosis with poor levator function(LF).METHODS:A prospective non-randomized nonblinded single center clinical trial.Fifty patients with severe unilateral congenital ptosis with poor LF were recruited.The frontalis sling and TCMLR were performed and the functional,cosmetic outcomes,complications,and success rate were evaluated at 1,3,and 6mo postoperatively.The t-test,Chi-square,Fishers exact,and nonparametric MannWhitney tests were used by SPSS software.RESULTS:Frontalis sling and TCMLR procedures were performed on 26 and 24 patients respectively.The mean age was 10.97±10.67y.LF was significantly better in the TCMLR group at months 1,3,and 6(P=0.002).Lagophthalmos was more common in the TCMLR group(no significant difference).At month 3,mild punctate epithelial erosions were observed more in the frontalis sling group(P=0.002).Significant complete success rate of 1st and 6th month for the frontalis sling vs TCMLR groups were 50%vs 20.8%(P=0.02),and 38.4%vs 50%(P=0.03)respectively.CONCLUSION:Complete success rate of TCMLR is higher in long-term follow-up in contrast with the frontalis sling in the short-term.Transient complications are more detected in mid-term follow-ups in both groups.

Treatment success of transobturator tape compared with tension free vaginal tape for stress urinary incontinence at 24 months: A randomized controlled trial

Objective: To compare the long term efficacy of transobturator Tape (TOT) with tension free vaginal tape (TVT) at 24 months postoperatively. Patients & Methods: 160 women with stress urinary incontinence (SUI) were randomly allocated to either TVT or TOT procedures and reviewed at 24 months after surgery. The primary outcomes were objective cure (a negative cough stress test, and a negative 1-hour pad test), and subjective cure (defined as “very much better” or “much better” improvement in the Patient Global Impression of Improvement scale). The secondary outcomes included incontinence related quality of life (using Urogenital Distress Inventory Questionnaire, and Incontinence Impact Questionnaire), and complications. Results: No statistical difference was reported in objective and subjective cure rates between both groups. Objective cure rate was 85.6% and 81.6% in the TOT and TVT groups respectively (P = 0.55). Subjective cure rate in the TOT and TVT groups were 87% and 83% respectively (P = 0.68). There were no significant differences in postoperative complications and incontinence related quality of life. However, the operating time was significantly shorter in the TOT group compared with the TVT group (22.6 ± 3.9, 27.1 ± 3;respectively, P < 0.001). Conclusion: TOT and TVT procedures were equally efficient and safe for treatment of SUI, with maintenance of high objective and subjective cure rates for 24 months. Longer follow-up is needed to confirm these results.

Effect of Tuina-SET Sling Exercise Therapy on Analgesic Substances in Serum of Patients with Nonspecific Low Back Pain

[Objectives]This paper aimed to investigate the effect of Tuina combined with sling exercise therapy(SET)and psoas&abdominal training on serum 5-hydroxytryptamine(5-HT)andβ-endorphin(β-EP)levels in patients with nonspecific low back pain(NLBP).[Methods]Total 46 patients with NLBP who visited the Tuina Department of the First Affiliated Hospital of Hainan Medical University from August 2019 to May 2020 were randomly and evenly divided into control group and treatment group.On the basis of Tuina therapy,the patients in the control group and treatment group were treated with psoas&abdominal training and SET,respectively.After the treatment,the serum 5-HT andβ-EP levels of the patients were detected.[Results]The serum 5-HT andβ-EP levels in the treatment group were significantly improved compared with the control group(P<0.05).[Conclusions]The nerve&muscle reconstruction techniques of Tuina combined with SET or psoas&abdominal training can improve serum 5-HT andβ-EP levels in patients with NLBP.

Sling Suspension Therapy Utilization in Musculoskeletal Rehabilitation

The development of an effective and inexpensive device to restore and enhance the human musculoskeletal functions is of particular interest. Sling exercise therapy (SET) is one of the most effective developed tools in rehabilitation of musculoskeletal disorders, which has been successfully used in various applications ranging from diagnosis to treatment. To the best of our knowledge, SET has never been comprehended and reviewed previously. Therefore, it was highly required to further understand the role of SET in various therapeutic applications. Inspired by this herein, this study is dedicated to emphasize the advancement in utilization of the SET in both diagnosis and treatment as well as their related challenges. This would be concluded by future perspectives of the SET.

经sling法治疗女性压力性尿失禁术前术后护理

我院自1996年至今采用sling法治疗压力性尿失禁病人22例,疗效满意.现围手术期的护理体会报告如下.

Clinical value of needleless sling in treatment of female stress urinary incontinence

BACKGROUND Stress urinary incontinence(SUI)is a common disease in women.The emergence of the needle-free sling has led to a new clinical treatment for SUI in women.AIM To explore the clinical value of the needleless sling without acupuncture in the treatment of SUI in women.METHODS From February 2017 to November 2018,according to the order of admission,44 patients(mid-suspension group)were treated by tension-free transobturator urethral suspension,and 44 patients(non-acupuncture group)were treated with a needleless non-acupuncture band.The clinical effects of the two treatments were evaluated.RESULTS There was no significant difference between the two groups in the total clinical effectiveness rate(P=0.374),but intraoperative blood loss and visual analogue scale score at postoperative day 1 were significantly lower in the non-acupuncture suspension group than in the middle urethral suspension group(P=0.396).The incidence of complications in the needle-free sling group was significantly lower than that in the middle urethral suspension group(P=0.025).CONCLUSION The clinical effectiveness of acupuncture-free suspension in treating SUI in female patients is better than that of traditional tension-free transobturator mid-urethral suspension.

The Suburethral Sling Transobturator Approach for Stress Urinary Incontinence Treatment in Women in the Maternity and Neonatology Center of Tunis (WTSC)

The authors, through a descriptive retrospective study have evaluated the results of surgical treatment, by Tension-Free Obturator tape (TOT) technique, of urinary incontinence in the first 68 patients operated in the Department “C” of Obstetrics and Gynecology of the Maternity and Neonatology Centre of Tunis (WTSC). The average age in those patients was 55.14 ± 8.47 years with extremes of 40 and 82 years. The majority of the patients (72%) were under the age of 60 years. In sixty-one patients (89%), no urine leak has been detected and they were healed. In three patients (4%) there was improvement with partial recovery. Three other (4%) did not notice any improvement after the surgery. No case of dysuria or rejection of the strip has been reported. It was concluded that the declared satisfaction rate is 93%.

The Effect of Isometric and Isotonic Exercises of Lower Limbs Extensor Sling on Static and Dynamic Balance in Basketball Players with Patellofemoral Pain

Background: Patellofemoral Pain Syndrome (PFPS) is one of the most common conditions among athletes. Although there are various causes for this condition, reduced balance is the problem most frequently expressed by these patients. The aim of the present study was to examine the effect of Extensor Muscle Sling Isometric and Isotonic (EMSII) exercises of lower limbs on female basketball players suffering from PFPS. Method: A total of 30 participants, all female basketball players suffering from PFPS, with an average age of 20 - 30 years, were divided into two isometric/isotonic and control experimental groups. Eight weeks of isometric and isotonic exercises were recommended to the participants with a focus on EMSII exercises of lower limbs in two four-week phases. The control group received no specific exercise program. Pre-test and post-test included the use of Stork balance test (SBT) and Y Balance tests (YBT) to assess the static and dynamic balance, respectively. Results: After eight weeks of performing separate isometric and isotonic exercises on the mentioned muscles, and according to the results of the pre-test, a significant increase was observed in the results of both static and dynamic balance tests (P Conclusion: EMSII exercises of lower limbs showed a significant effect on the increased balance. Recommended exercises can be suggested according to the type of exercises as a factor for increasing static and dynamic balance.

Surgical treatment of bipolar segmental clavicle fracture:A case report

BACKGROUND Shoulder injuries caused by trauma are common,including clavicle fractures.Even so,bipolar segmental fracture of the clavicle is extremely rare and seldom reported.Therefore,there is still a controversial issue about how to treat these bipolar segmental clavicle fractures.CASE SUMMARY A 56-year-old security guard arrived at our emergency room after falling on his electric bicycle.There was no loss of consciousness or other pain.He had no numbness in his fingers.X-rays and 3D computed tomography revealed that the patient’s right shoulder had a bipolar segmental clavicle fracture.The surgical procedure included both open reduction and internal fixation.At the 1-year follow-up,he had a full range of motion and minimal discomfort in the injured shoulder.CONCLUSION We provide a rare case of bipolar clavicle facture in the right clavicle.We hold the opinion that such patients would get better clinical and radiological outcomes by early and correct operation.

Single incision slings: Past, present, and future

Pubovaginal slings have become the gold standard to treat stress urinary incontinence. Traditionally, the sling referred to a suspensory that was placed under the urethra and brought through the retropubic space and anchored on either side of the midline. Since this original concept, there have been many materials used for the sling, and there have been many different anchoring approaches. Most agree that one of the best materials is polypropylene mesh. However, the means of anchoring the device and where best to have this anchorage placed is debatable. The options for anchoring simply include using darts vs not to hold the sling in place. The location of this anchorage, on the other hand, is much more controversial. The main locations are retropubic, transobturator, and via a single incision. The obturator and retropubic slings have become the standard of care over time. The single incision sling, on the other hand, is starting to be more acceptable which has resulted in it being used more frequently. The single incision relies on mainly anchoring the sling through the obturator internus muscle with possible inclusion of the obturator membrane. The purpose of this review article is to present the data that exists for the use of the single incision sling.

A retrospective comparative series comparing monarc and sparc suburethral slings

A Retrospective Comparative Series Comparing Monarc and Sparc Suburethral Slings. Introduction and Hypothesis: There are a number of suburethral slings used in current practice to treat female urinary incontinence. To date there has been a lack of larger comparative series. This paper aims to evaluate the effectiveness and complications of two types of suburethral sling. Methods: A retrospective comparative series comparing 113 consecutive Sparcsuburethral slings with 112 consecutive Monarc slings. Results: The success rate of SparcvsMonarc was similar at 6 weeks (96.1% vs 94.2%, NS) and at 6 months (96.0% vs 92.6%, NS). The Monarc procedure had less intraoperative bladder fenestrations & less postoperative urgency. Conclusions: Both procedures had a similar success rate, while the Monarc had less complications. Brief Summary: Both procedures had a similar success rate, while the Monarc had less complications of intraoperative bladder fenestration & postoperative urgency.

Cadaveric Assessment of Synthetic Mid-Urethral Sling Placement

Purpose: To determine if 3 types of mid-urethral synthetic slings are visually the same. Materials and Methods: A retropubic, obturator, and single incision sling was individually placed in three cadavers. Tension was set using a spacer (obturator and retropubic). Single incision sling (SIS) tension was set by visual inspection. Thirty physicians were asked to determine placement method, tension, and location of the 3 slings. Results: Physicians were composed of 5 urologists, 7 urogynecologist, and 18 general gynecologists, with an average of 53 slings performed per year. Conclusion: This study showed that after placement of a sling it is hard to tell how the sling was placed and that most physicians felt the SIS was tensioned the best and most likely at the mid-urethra.

Can We Predict De Novo Urge Incontinence by Perineal Ultrasound?

Introduction: Urinary incontinence affects over 200 million people worldwide [1]. Tension free vaginal tape is the standard surgical treatment for stress urinary incontinence. De novo urge urinary incontinence is a long-term complication of this treatment with a significant impact in the quality of life of these patients. Objective: The major aim of this study is to assess the correlation between perineal ultrasonography findings and the incidence of de novo urge urinary incontinence. Material and Methods: A prospective observational study was designed. Patients with stress urinary incontinence diagnosed by clinical and urodynamic findings submitted to a tension-free vaginal tape surgery were included. International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and introital perineal ultrasound were performed before surgical intervention (I-STOP&copy). Clinical and ultrasound re-evaluation were executed six months after surgery. Stress urinary incontinence was defined according to the ICS-IUGA. Data were recorded using a Microsoft Access database and statistical analysis using SAS&copy. Results: Bladder thickness equal to or below 6 mm has a low positive predictive value (PPV, 0.55), but a negative predictive power (NPP) of 0.72. Following surgery, a slight increase in postvoid residue is observed. Considering demographic data, an increase of 5 points in body mass index (BMI) resulted in an odds ratio (OR) of 1.74 of presenting de novo urge urinary in continence. Conclusions: In patients submitted to a tension-free vaginal tape surgery, high BMI seems to be associated with a higher rate of de novo urge urinary incontinence. Preoperative bladder wall thickness below 6 mm seems predict absence of this complication.

The Outpatient Burch-Sling Procedure: A Nerve-Sparing Method for Correcting Female Urinary Incontinence

Conventional methods to treat urinary stress incontinence, including the Sling, Burch, and Pereyra modification methods, are limited by several shortcomings due to disrupted nerve and vaginal wall integrity. The nerve-sparing Burch-Sling method represents a surgical advancement through the use of a nerve-sparing sling to treat genuine stress urinary incontinence. The procedure involves retropubic urethropexy using the FDA-approved Burch-Sling device. In this technique, the vagina is elevated bilaterally at the urethrovesical junction to the mid-urethra toward Cooper’s ligament above the base of the bladder. Then, the anterior vaginal wall and fascia are used as an endogenous suburethral sling without dissection. Two hundred twenty cases were included in this study;two hundred patients underwent the outpatient nerve-sparing sling method, and the other twenty underwent the novel abdominal Burch method. There were no major complications. The follow-up duration ranged from 6 months to eight years. All procedures were performed at the U.S. Women’s Institute at a 400-bed hospital in Fountain Valley, CA.