Single incision slings:Are they ready for real life?

AIM： To review of the efficacy and safety outcomes of different single incision slings （SIS） systems, also in comparison with traditional slings.METHODS： A literature search was conducted in PubMed/MEDLINE database. The research was re-stricted to randomized and/or prospective trials and retrospective studies, published after 2006, with at least 20 patients with non-neurogenic stress urinary incontinence （SUI）. The studies had to assess effcacy and/or safety of the SIS with a minimum follow-up of 12 mo. All the paper assessing the performance of tension free vaginal tape secur were excluded from this review. The fnal selection included 19 papers fulflling the aforementioned criteria. Two authors independently reviewed the selected papers.RESULTS： Four different SIS systems were analysed： Ajust , Ophira , Altis and MiniArc . The average objective cure rate was 88%. Overall no statistically significant differences were found between SIS and traditional mid-urethral slings （MUS） in terms of objective cure （all P 〉 0.005）. Only one paper showed a statistically lower success rate in MiniArc？ vs Advant-age？ slings （40% vs 90%） and higher rates of failure in the SIS group. Since there was a great variability in terms of tests performed, it was not possible to com-pare subjective cure between studies. The vast part of the studies showed no major complications after SIS surgery. We also observed very low reported pain rates in SIS patients. The RCTs on Ajust？ and MiniArc？, showed better outcomes in terms of post-operative pain compared to MUS. None of the patients reported long- term pain complains. CONCLUSION： SIS showed similar effcacy to that of traditional slings but lower short-term pain, complication and failure rates.

Acupuncture combined with heavy moxibustion at Guanyuan (关元 CV 4) for 31 cases of elderly women with stress urinary incontinence

Objective To investigate the clinical efficacy of acupuncture combined with heavy moxibustion at Guan yuan （关元CV 4） in treating stress urinary incontinence of elderly women. Methods Patients （31 cases） were treated with acupuncture combined with double moxa sticks at CV 4 for 30 minutes, once a day, with 10 days of treatments as a therapeutic course, lasting for 3 courses and 3 days interval between courses. 4-5 courses were treated in severe cases. After treatment, condition of urinary incontinence of the patients was observed and the efficacy was analyzed. Results After treatment, 18 cases were cured, 7 cases were marked effective, 14 cases were effective and 2 cases were failed, and the total effective rate was 93.54%. Conclusion The acupuncture combined with heavy moxibustion at CV 4 has remarkable efficacy on stress urinary incontinence of elderly women.

Clinical observation of deep electroacupuncture at Baliao points for female stress urinary incontinence

Objective:To observe the clinical efficacy of deep electroacupuncture(EA)at Baliao points in treating stress urinary incontinence(SUI).Methods:A total of 60 female patients with SUI were divided into two groups according to the order of consultation,with 30 cases in each group.The control group was treated with pelvic floor muscle training.The treatment group was treated with deep EA at Baliao points[Shangliao(BL 31),Ciliao(BL 32),Zhongliao(BL 33)and Xialiao(BL 34)].Results:The total effective rate was 93.3%in the treatment group,versus 33.3%in the control group,and the total effective rate of the treatment group was significantly higher than that of the control group(P<0.05).After treatment,the scores of international consultation on incontinence questionnaire-short form(ICIQ-SF)and the volume of urinary leakage in both groups were lower than those before treatment(all P<0.05),and the ICIQ-SF score and the volume of urinary leakage in the treatment group were lower than those in the control group(both P<0.05).Conclusion:Deep EA at Baliao points with long needles can improve the clinical symptoms in female patients with SUI,and it has a better curative effect than pelvic floor muscle training.

Simultaneous Perineal Ultrasound and Vaginal Pressure Measurement Proves Electroacupuncture Pudendal Nerve Stimulation

Purpose： To prove that electroacupuncmre pudendal nerve stimulation （EPNS） can exactly excites the pudendal nerve, by simultaneous measurements of pelvic floor muscle （PFM） movements （perineal ultrasound）, vaginal pressure and pelvic floor surface myoelectricity. Methods： Long needles （acupuncture needles） were deeply inserted into four sacral points and electrified to stimulate the pudendal nerves. When EPNS was performed, perineal ultrasound B-mode images of PFM movements （contractions）, M-mode PFM movement curves; vaginal pressure and pelvic floor surface electromyogram were recorded simultaneously by use of an urodynamic instrument with video suite （Medtronic Duet Encompass）. Simultaneous records were also obtained under three conditions in the process of the nerve stimulation： 1） pausing electric stimulation; 2） reducing the intensity of electric stimulation （to about 2/7 of the original）; 3） drawing back the two lower needles to make the tips 1-2 cm away from the original position. Results： Thirty-five female patients with stress incontinence （aged 54.9±9.8） received EPNS and the simultaneous measurements. When EPNS was performed correctly, the patient felt rhythmic and cephalad PFM contractions with the urethra as the center. Simultaneous records showed the following： 1） cranio-caudal PFM movements on the B-mode image; 2） the M-mode curves indicating the PFM contractions （amplitude： about 1 mm, n=31, 14 cases ） 1 mm and 17 cases 〈1 mm）; 3） A sawtooth curve of changes in vaginal pressure [amplitude： 2.61＋1.69 （0.7-5.6） cmH20, n=34]; 4） pelvic floor myoelectric waves [amplitude： 23.9＋25.3 （5-96） gV, n=34]. The amplitude ofa PFM movement curve conformed basically to that of a vaginal pressure curve. If the electric current was stopped or its intensity was reduced to about 2/7 of the original or during the process of the nerve stimulation the two lower needles were gradually drawn back until the tips were 1-2 cm away from the original positions, then B-mode PFM movements, M-mode curves and sawtooth changes in vaginal pressure disappeared. Conclusion： Electroacupuncture pudendal nerve stimulation can exactly excites the pudendal nerve and effectively contract the pelvic floor muscles.

“Four Sacral Needles” Therapy for Female Stress Incontinence

Objective： To make a retrospective control study of the curative effects of ＂Four sacral needles＂ method and conventional acupuncture therapy on female stress incontinence. Methods：A treatment group was treated by ＂Four sacral needles＂ method, in which four sacral points were electroacupunctured with special insertion of needles to excite the pudendal nerve and induce the rhythmic contraction of the pelvic floor muscles, thereby increasing the strength of the pelvic floor muscles and improving ability in urinary continence. A control group was treated by conventional acupuncture therapy, in which corresponding points were acupunctured according to syndrome-based classification. Results： In the 31 cases of the treatment group treated by ＂Four sacral needles＂ method, 100% symptom improvement occurred in 22（71.0% ）after an average of 21 treatments （3-63 treatments）. In the 34 cases of the control group treated by conventional acupuncture therapy, 100% symptom improvement occurred in 0 after 30 treatments. The curative effect was better in the treatment group than in the control group（p〈 0.01）.The curative effect improved with an increase in the number of treatments in the treatment group. Conclusion： ＂Four sacral needles＂ method is more effective than conventional acupuncture therapy in treating female stress incontinence.